CARDIOVASCULAR PART 1 SV

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CARDIOVASCULARStructure & Function :

N671 Tammy Valenta FNP,MSN, APRN Assistant Professor CARDIOVASCULARStructure & Function PART 1

Objectives :

Objectives 1. Describe the anatomic location and function of the following cardiac structures: pericardial layers, atria, ventricles, semilunar valves, and atrioventricular valves. 2. Describe coronary circulation and the areas of heart muscle supplied by the major coronary arteries. 2

Objectives :

Objectives 4. Describe the appropriate techniques used in the physical assessment of the cardiovascular system. 5. Differentiate normal from common abnormal findings of a physical assessment of the cardiovascular system. 6. Describe the age-related changes of the cardiovascular system and differences in assessment findings. 3

Key Terms :

Key Terms afterload arterial blood pressure cardiac index cardiac output cardiac reserve diastole diastolic blood pressure ejection fraction mean arterial pressure point of maximal impulse preload pulse pressure Systole systolic blood pressure 4 Students are responsible for the definitions even if not discussed in lecture.

PUMPING ABILITY :

PUMPING ABILITY Stroke Volume: volume of blood in each systole Cardiac output: CO = SV X R (Bpm) Preload: the stretch of the ventricle before contraction (Frank Starling’s Law) Afterload: the resistance that the ventricle has to pump against (RV against lungs, LV against body (aorta). The heart can alter its cardiac output to adapt to the metabolic needs of the body. 5

CIRCULATION :

CIRCULATION 6 CIRCULATORY SONG () HOW DOES THE HEART WORK?

CONDUCTION SYSTEM :

CONDUCTION SYSTEM Sinoatrial (SA) node: Creates and transports the electrical impulse (action potential) “Pacemaker” Intrinsic rhythm : heart can contract without stimulation from other parts of the body 7

Atrial Fibrillation the most common aRrythmia :

Atrial Fibrillation the most common aRrythmia http://youtu.be/LYKj6SFIP3w THIS IS A GREAT VIDEO PRESENTED BY THE OSHER CENTER FOR INTEGRATIVE MEDICINE AT UCSF. IT’S 1 HOUR AND 27 MINUTES LONG: IT’S OPTIONAL BUT EXCELLENT

STRUCTURELOCATION & ROTATION :

STRUCTURELOCATION & ROTATION 9 CXR INTERPRETATION:

STRUCTUREANGLE OF LOUIS :

STRUCTUREANGLE OF LOUIS 10 Continuation of the 2nd Rib; marks the site of the tracheal bifurcation and upper border of the atria of the heart, and the T4 vertebra on the back

STRUCTUREMEDIASTINUM :

STRUCTUREMEDIASTINUM Middle of the thoracic cavity Esophagus Trachea Heart Great vessels Superior and Inferior vena cava, pulmonary artery, pulmonary veins and aorta. 11

STRUCTUREHEART WALL & CHAMBERS :

STRUCTUREHEART WALL & CHAMBERS Heart Wall Endocardium: inner layer Myocardium: muscular wall/ 2-3 X thicker in LV) Epicardium: outer layer Pericardium sac surrounding heart (2 layers: 10-30 ml fluid between layers) 12

STRUCTURECARDIAC VALVES :

STRUCTURECARDIAC VALVES Atrioventricular (close during systole) Tricuspid Mitral (bicuspid) Semilunar (open during systole) Pulmonic Aortic 13

Apical Impulse (PMI) :

Apical Impulse (PMI) During contraction, the apex beats against the chest wall Points down & left Palpate 4-5 ICS; medial to MCL Diameter 1X2 cm (1 ICS) Short duration ( 1rst ½ of systole) Gentle tap 14

Pregnant Female: Normal Variation :

Pregnant Female: Normal Variation Blood Volume increases 30-40% Increased SV and CO Increased HR of 10-15 bpm BP decreases d/t peripheral vasodilation through the second trimester, then rises BP varies with person’s position 15

Developmental Considerations :

Developmental Considerations Foramen Ovale: closes within 1 hr of birth Ductus Arteriosus: closes with 14-15 hours of birth When a baby has reached 1 year of age, the left ventricle's mass increases to reach the adult ratio of 2:1, left ventricle to right ventricle 16