Cardiovascular Anatomy
and Physiology
Daymar College
Lisa H. Young, RN, BSN, MA Ed.
Dextrocardia
Skeleton of the heart
Walls of the Heart
Heart Valves
Structures of the AV Valves
Heart Valves
http://www.youtube.com/watch?v=
39n4XWv7flQ
Left Ventricle Wall Surfaces
Heart Chambers

Left and Right Atrium
Receives un-oxygenated blood from the
body and the lungs. Expands to
accommodate large volumes of blood
from the body.

Left and Right Ventricles
Thick muscular walls to forcefully expel
blood to the body. Does not expand well.
Heart Chambers

Auricles (Left & Right)

Arch of Aorta

Subclavian Artery (Left & Right)
http://www.innerbody.com/image_card02
/musc31-new.html
Other Heart Structures
Aortic Arch & Arteries

Blood flows from higher-pressure to lower
pressure

Pressure order: highest to lowest
◦
◦
◦
◦
Left ventricle
Left atrium
Right ventricle
Right atrium
Pressure Differences of the Heart
Pressure differences in the left
and right heart

Right & Left heart pressures:

Pulmonary Vascular Resistance

Systemic Vascular Resistance
◦
◦
◦
◦
◦
◦
◦
Right atria
Right ventricle
Pulmonary arteries
Pulmonary veins
Left atria
Left ventricle
Aorta
2-6 mmHg
25/0 mmHg
25/8 mmHg
8 mmHg
6 mmHg
120/0 mmHg
120/80 mmHg
◦ Less 2.5 mmHg/L/min or 200 Dynes
◦ less than 20 mmHg/L/ min or 1600 Dynes
Normal Values
https://www.youtube.com/watch?v=Rj_qD
0SEGGk
https://www.youtube.com/watch?v=tBQa8I
BzP6I
Animation of Blood Flow
Blood Flow
Fetal Blood Flow

Autonomic Nervous System (ANS)

Sympathetic Nervous System
Adrenergic response
Norepinephrine released
Increased heart rate and blood pressure
Decreases digestion
Heart Rate

Parasympathetic Nervous System
Cholinergic response
Acetycholine released
Decreases heart rate, blood pressure
Increases digestion
Heart Rate

Electrical Cells
Automaticity
Excitability
Conductivity

Mechanical Cells
Contractility
Extensibility
Cardiac Cells
Chemical Basis for Impulse
Formation
http://www.youtube.com/watch?v
=7EyhsOewnH4
Cardiac Action Potential Phases
Electrical Conduction Pathway
Cardiac Cycle

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Hypokalemia (low potassium levels)
http://www.youtube.com/watch?v=oXaff1vbF
nA
Hyperkalemia (high potassium levels)
http://www.youtube.com/watch?v=xluHUcQb
WXo
Hypocalcemia (low calcium levels)
http://www.youtube.com/watch?v=6_Khrzr0
x_A
Hypercalcemia (high calcium levels)
http://www.youtube.com/watch?v=LIdAVjW
wIFo
Cardiac Electrolytes
Hypomagnesemia (low magnesium)
 http://www.youtube.com/watch?v=e0APN
C968MY
 Hypermagnesemia (high magnesium)
 http://www.youtube.com/watch?v=4Gv3J
R4s_Gc

Cardiac Electrolytes
Phases of Systole
Ventricular Systole/Diastole
Heart Action during Systole
A
B
Atrial Kick

Compliance

Preload: L Ventricular Wall Stress at End
Diastolic Volume

Afterload: L Ventricular Wall Stress During
Systole (Ejection out L Ventricle)

Contractility
Physiologic Control Mechanisms of
Blood Pressure
https://www.youtube.com/watch?v=owZqtkAxtiE
Pressure Volume Loop

http://www.youtube.com/watch?v=7w6a
wkDREQM

http://www.youtube.com/watch?v=PUArU
V4VdaY
Cardiac Cycle (Pressure/Volume)






Heart rate X Stroke Volume = CO
5 liters / min. (at rest)
4- 8 liters / min when pumping
Frank –Starling Law
Decreased cardiac output signs and
symptoms
Epinephrine, thyroxine, sympathetic
nervous system, fever, fear, exercise, low
BP increase CO
Cardiac Output







Right heart oxygen saturation – 75%
Left heart oxygen saturation – 95%
Mean arterial pressure – 93 mmHg
Systemic blood pressure – 120/80 mmHg
Aortic pulse pressure – 40 mmHg
Cardiac output – 5L/min
Stroke volume – 60 – 130 mL/beat
Normal Values
 Baroreceptors
◦ Specialized nerve tissue (sensors)
◦ Detect changes in blood pressure
◦ Increase / decrease sympathetic tone
◦ Dilation of blood vessels
Carotid Arteries and Aortic Arch
 Chemoreceptors
specialized nerve tissue (sensors)
detect changes in concentration of pH,
02, C02
sympathetic or parasympathetic
response
Carotid Artery and Aortic Arch
Coronary Arteries & Veins
Coronary Veins
Anterior View of the Heart
Systemic Vasculature Layers
Vascular Layers & Arterioles
Vascular Circulation

Coarctation of the Aorta (CoA)
http://www.youtube.com/watch?v=cgR_XmRJcIg

Patent ductus arteriosus (PDA)

Septal defects
http://www.youtube.com/watch?v=e46jtin-H50

Tetralogy of Fallot
http://www.youtube.com/watch?v=yePivAlbR4A

Transposition of the great arteries (TGA)
http://www.youtube.com/watch?v=O83cYwKOKtI
Congenital Heart Disease
 Health
History
A. Chief complain
B. Family History
C. Coping and emotional history
D. Medications
E. Surgeries
F. Activities of daily living
http://www.youtube.com/watch?v=JLLUkiZZfBo
Cardiovascular Assessment





General appearance
Inspection
Palpation
Percussion
Ausculatation
http://www.youtube.co
m/watch?v=MIfmjFG6B
TQ
Assessing the Heart

Cardiac output X peripheral vascular
resistance

Systolic measurement

Diastolic measurement

Korotkoff sound
http://www.youtube.com/watch?v=ALqdHnD7c18
Blood Pressure

Location

Pressure points

Heave and Thrill

Pulse Pressure

Aortic Pulse Pressure

Mean Arterial Pressure
Pulses
http://www.youtube.com/watch?
v=74v4mEWhOao
Measuring Blood Pressure






Process
http://www.youtube.co
7 important aspects
m/watch?v=diG519dFV
Ns
Distal arteries
What affects measurement
Changes related to cuff size
Classifications
BP
Norm
classificat al
ion
Prehypertensi
ve
Stage 1
Stage
2
SBP
(mmHg)
< 120
120 to 139
140 to
159
160
DBP
(mmHg)
< 80
80 to 99
90 to 99
> 100






“Silent Killer”
Essential Hypertension
Malignant Hypertension
Secondary Hypertension
Pseudohypertension
Risk Factors
Hypertension
Cause
 Signs and symptoms
 Diagnostic Tests
 Treatment

Hypertension
Myocardial Infarction
Atherosclerosis
http://www.youtube.com/
watch?v=qRK7-DCDKEA
P
Provokes (Relieves)
Q
Quality
R
Region / Radiation
S
Severity
T
Time
•Other associated complaints / Pertinent
Assessing Chest Pain
http://www.youtube.com/wa
tch?v=4h80Isb72Xg
http://www.youtube.com/wa
tch?v=H_VsHmoRQKk
Chest Pain
Tightness
Squeezing
Aching
Pressure
Shoulder pain
Jaw pain
Dyspnea
Syncope
Palpitations
Angina





Caused by exertion.
Result of progressive CAD.
Symptoms: typical chest pain.
ST segment depression OR T wave
inversion
ST segment resolves, no elevated
enzymes
http://www.youtube.com/watch?v=SR8sBJgD7UE
STEMI vs NonSTEMI
Test
Initial
elevation
Peak
Return to
Normal
CK :Creatine
kinase
2–6
hours
18-36 hours
3 – 6 days
CKMB :
Creatine kinase
MB
2-3 hours
24 hours
2 – 3 days
LDH :
Lactic
dehydrogenase
12-24
hours
24-48 hours
5 -6 days
Myoglobin
1-2 hours
4-6 hours
24 hours
Troponin
4-8 hours
14-18 hours
< 10 days
Cardiac Enzyme Duration
Cardiac Diagnostic Procedures
•
•
•
•
•
•
•
Percutaneous coronary intervention
Intracoronary Stenting
Directional Atherectomy
Rotational Atherectomy
Extraction techniques
Laser
Cutting balloons
Cardiac Revascularization

http://www.youtube.com/watch?v=GnpL
m9fzYxU&NR=1&feature=endscreen

http://www.youtube.com/watch?v=JHz_Ji
vtNLc
Heart Failure





Pulmonary edema
Shortness of breath, fatigue, and exercise
intolerance
HTN, CAD, MI, ischemic heart disease,
valvular heart disease and
cardiomyopathy
Complications
Adaptation
Congestive Heart Failure










Pregnancy and childbirth
Increased environmental temperature or
humidity
Severe physical or mental stress
Thyrotoxicosis
Acute blood loss
Pulmonary embolism
Severe infection
Chronic obstructive pulmonary disease
(COPD)
Hypervolemia
Sepsis
Non-heart Related Causes of CHF

Acute Decompensated Heart Failure:
sudden development of symptoms

Sudden Death

Chronic: symptoms over long period of
time with development of compensatory
mechanisms
Classifications of CHF

Left-side Heart Failure: ineffective left
ventricular contraction
Left ventricular dysfunction
Neurohormonal responses: SNS
RAAS
Left-ventricular Remodeling
Classification of CHF

Right-side Heart Failure: ineffective
right ventricular contraction

Systolic Dysfunction or Heart Failure:
during systole, left ventricle can’t pump
blood out
Classifications of CHF
Heart Structure Changes with CHF

Diastolic Dysfunction or Heart
Failure: during diastole, left ventricle
can’t relax to fill with blood
Systolic
dysfunction
2/3 of pts
with heart
failure
Decreased left
ventricular
contractility and
ejection fraction.
Diastolic
dysfunction
1/3 of pts
with heart
failure
Impaired left
Usually
ventricular relaxation related to
and abnormal filling
chronic
hypertension
or ischemic
heart disease.
Classifications of CHF
Most common
cause is CHD
resulting in
MI or Chronic
ischemia.
Left-side Heart Failure








Dyspnea, initially on
exertion
Paroxysmal nocturnal
dyspnea
Cheyne-Stokes
respirations
Cough
Orthopena
“Cardiac Asthma”
Tachycardia
Fatigue
Right-side Heart Failure




Edema, initially
dependent
Jugular vein distention
Hepatomegaly
Ascites
Clinical Signs & Symptoms

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Blood tests
ECG changes
Chest X-ray
Cardiac catheterization
Echocardiography
Transesophageal echocardiography (TEE)
Cardiopulmonary exercise test
Tests for Diagnosis of CHF

Medications
Medication Class
Expected Action
ACE inhibitors / ARBs
Interrupt response of RAAS
Reduce mortality and morbidity
Beta-blockers
Interrupt response of SNS
Reduce hospitalizations
Not used in acute decompensated state
Diuretics
Loop diuretics with the
addition of a thiazide diuretic
if needed
Decrease ECF load
Maintain ECF volume status and sodium
balance
No impact on mortality
Digoxin
Dosage is usually 0.25 mg
Improves symptoms
Symptomatic and on more than 3 meds.
Aldosterone antagonists
Reserved for moderate to severe heart
failure
Treatment for CHF

Lifestyle Changes

Cardiac Resynchronization Therapy

Surgical / devices interventions
Treatment for CHF

Dyslipidemia

LDL (low-density lipoprotein)

HDL (high-density lipoprotein)

Triglycerides
Lipoprotein Disorders of CAD

Dietary changes

Medications

Exercise

Monitor cholesterol levels
Management of Lipoprotein
Disorders

What is Diabetes?
Diabetes and CAD/CVD

CAD: Coronary Artery Disease

CVD: Cerebral Vascular Disease

Greater risk for heart disease

What causes heart disease in diabetics?
Diabetes and CAD/CVD
Metabolic syndrome
Risk Factors
 excessive fat tissue in and around abdomen
 Blood fat disorders
 Insulin resistance
 High fibrinogen inhibitor
 Raised blood pressure
 Elevated high-sensitivity C-reactive protein

Diabetes and CAD/CVD
Other types of heart disease that occur in
people with diabetes:
 TIAs
 Heart Failure
 Cardiomyopathy
 Peripheral Arterial Disease (PAD)
Diabetes and CAD/CVD
Cardiac Revascularization
Heart Transplant (LVAD)
 http://www.youtube.com/watch?v=KsAftMmpyg&list=PL6F28DDE8FDC248C3
 Percutaneous Coronary Intervention (PCI)

Clinical Procedures - Treatments
Cardioversion (defibrillation)
 Thrombolytic Therapy

Clinical Procedures: Treatment

Cardiac Catheterization
Diagnostic Procedure