Cardiovascular System
Chapter 17
Cardiovascular System
 Cardiovascular System – circulates blood continuously
thought the body to deliver oxygen and nutrients to the body’s
organs and tissue and to dispose of waste.
 Heart (pump) and vasculature (plumbing)
 The heart is composed of:
 Cardiac muscle
 Atria
 Ventricles
 Valves
 Cardiac arteries and veins
 Electrical conduction system
 Cardiac Nerves
 Problems or failure of any of these system can lead to serious
health concerns.
 Review Anatomy
Figure 17.3
Structural components of the heart.
Heart
 Heart – pump composed of synchronized structures
 Cardiac Vessels
 Coronary Arteries – extensive network of arteries supplying the heart
 Coronary Veins – network for venous blood drainage
 Conduction system – heart has it own conduction system which
can initiate and transmit an electrical impulse via cardiac muscle
fibers
 This electrical charge stimulates muscular contraction of the heart
 SA node, AV node, Bundle of His, Right and Left Bundle Branch Block,
and Purkinje fibers
 Nerves
 Sympathetic – stimulate the heart, increases heart rate, force of
contraction, and dilation of coronary arteries.
 Parasympathetic – opposite effect
 CNS – influences the activation and interaction of nerves through
information supplies by the cardiac plexus.
Cardiac Musculature
 Heart Muscle
 Base
 Apex – point of maximum impulse so heart beat is more
easily palpated over the apex – 5th intercostal space
 Three Layers:
 Epicardium – outer layer
 Myocardium – thick muscular layer
 Endocardium - smooth inner lining of chambers
Chambers
 Chambers in the Heart – 4 chambers
 Left and right atria – receiving chambers for blood and
pump blood into the ventricles
 Left and right ventricles – eject blood into vessels
Valves
 Valves - Permit the Flow of Blood Between
Chambers and into Blood Vessels
 Atrioventricular (AV)
 Tricuspid
 Mitral
 Semilunar
 Pulmonary
 Aortic
Heart Sounds
 Heart Sounds – Closure of valves which are associated
with the contraction and relaxation phases of the heart.
 Systole – refers to ventricular contraction and begins with
closure of the AV valves (S1) and ends with the closure of
the aortic and pulmonic valve (S2)
 Diastole – refers to ventricular relaxation and begins with
closure of the aortic and pulmonic valve (S2) and ends with
closure of AV valves (S1).
 S1 (lub)
 S2 (dub)
Figure 17.5
Heart sounds in systole and diastole.
Table 17.3
Distinguishing Heart Murmurs
Table 17.3 (continued)
Distinguishing Heart Murmurs
Table 17.4 (continued)
Classifications of Heart Murmurs
Circulation of Heart
 Pulmonary Circulation – carries deoxygenated
blood to the lungs, where carbon dioxide is
exchanged for oxygen.
 Systemic Circulation – supplies freshly
oxygenated blood to the body’s periphery
carrying oxygen and nutrients to cells.
Electrocardiogram
 Electrocardiogram (EKG) - Paper Recording of
Deflections That Represent the Cardiac Cycle –
Signifies electrical conduction
 Electrical deflections
 P wave
 PR interval
 QRS interval
 T wave
Figure 17.11
Electrocardiogram wave.
Cardiac Function
 Stroke volume - Amount of blood that is ejected with
each heartbeat
 Cardiac output - Amount of blood ejected from the left
ventricle over one minute
 Cardiac index - Measurement accounting for an
individual’s weight when evaluating the pumping
action of the heart
Landmarks for Cardiac Assessment
 Landmarks for Cardiac Assessment
 Sternum
 Clavicles
 Ribs
 Second through fifth intercostal spaces
 Correlating assessment findings over body landmarks
provides vital information related to underlying
pathologic mechanisms.
Figure 17.18
Landmarks in precordial assessments.
Inteview
 General Questions
 Specific Questions
 Illness
 Symptoms
 Behaviors
 Infants and children
 Pregnant female
 Older adult
 Environment
Equipment
 Examination gown
 Examination drape
 Stethoscope
 Metric rulers
 Doppler
Techniques
 Physical Assessment of the Cardiovascular System
 Techniques
 Inspection
 Palpation
 Percussion
 Auscultation
Specific Areas
 Specific Areas of the Cardiovascular Assessment
 Inspection of the face, lips, ears, and scalp
 Skin color
 Movement
 Earlobe creases
 Inspection of the jugular veins
 Pulsations
 Distention
 Inspection of the carotid arteries
 Pulse characteristics
 Inspection of the hands and fingers
 Color
 Shape of fingers
Figure 17.17
Splinter hemorrhage.
Specific Areas
 Inspection of the chest, abdomen, legs, and
skeletal structure
 Landmarks
 Right sternal border, 2nd intercostal space
 Left sternal border, 2nd intercostal space
 Left sternal border, 3rd – 5th intercostal space
 Heaves and lifts
Palpation
 Palpation of the chest, including the following
 Precordium at the right and left second intercostal
spaces
 Left third intercostal space
 Left fourth intercostal space
 Left fifth intercostal space at the midclavicular line
 Position patient at a 30 degree angle or less
 No thrills, heaves or lifts should be palpated in
any of the five locations
Figure 17.19
Landmarks for palpation of the chest.
Palpation
 Carotid pulses (sequentially)
 Client may be supine or sitting upright
 Asses:
 Presence – diminished or absent may indicate carotid disease
or dissecting aortic aneurysm
 Strength – should be strong but not bounding
 Rhythm – regular pattern
 Equality – consistent bilaterally
 Palpate each artery separately – may obstruct
blood flow to the brain, resulting in severe
bradycardia or asystole
Figure 17.20
Palpating the carotid artery.
Percussion
 Percussion of the chest for cardiac border
 5th intercostal space at the left anterior axillary line
 Normal findings would be resonance because you will be
over lung tissue
 Next, percuss the mid clavicular line and the left
sternal border
 Should change to dull as you percuss over the heart
 Advance to the 3rd and 2nd intercostal space on the left
side.
 Should change from resonnance to dullness as you
percuss over the heart
Figure 17.21
Percussing the chest.
Auscultation
 Auscultation of the chest using the diaphragm and bell in
various positions to include the following locations
 Aortic area at the right second intercostal space—S2 is louder than S1
 Pulmonic area at the left second intercostal space—S2 is louder than S1
 Erb’s point at the left third intercostal space—S1 and S2 are heard
equally
 Tricuspid area at the left fourth intercostal space—S1 is louder than S2
 Apex at the left fifth intercostal space at the midclavicular line—S1 is
louder than S2
Figure 17.22
Auscultating the chest over five key landmarks.
Figure 17.24A
Positions for auscultation of the heart. A. Supine.
Figure 17.24B
Positions for auscultation of the heart. B. Lateral
Figure 17.24C
Positions for auscultation of the heart. C. Sitting.
Auscultation of Apical Pulse
 Specific Areas of the Cardiovascular
Assessment
 Auscultation of the carotid arteries using the
diaphragm and bell
 Comparison of the apical pulse to a carotid pulse
Figure 17.23
Comparing the carotid and apical pulses.
Abnormal Findings
 Abnormal Findings in the Cardiovascular System
 Myocardial and pump disorders
 Valvular disease
 Septal defects
 Congenital heart disease
 Electrical rhythm disturbances
Muscular and Pump Disorders
 Myocardial and Pump Disorders
 Myocardial ischemia
 Myocardial infarction
 Congestive heart disease
 Ventricular hypertrophy
Valvular Disorders
 Valvular Diseases
 Mitral, aortic, tricuspid, and pulmonic stenosis
 Mitral and aortic regurgitation
 Mitral valve prolapse
Figure 17.25
Mitral stenosis.
Figure 17.26
Aortic stenosis.
Figure 17.27
Mitral regurgitation.
Figure 17.28
Pulmonic stenosis.
Figure 17.29
Tricuspid stenosis.
Figure 17.30
Mitral valve prolapse.
Figure 17.31
Aortic regurgitation.
Setal Defects
 Septal Defects
 Openings between the right and left atria or right and left
ventricles
Figure 17.32
Ventricular septal defect.
Figure 17.33
Atrial septal defect.
Congenital Heart Diseases
 Congenital Heart Diseases
 Coarctation of the aorta
 Patent ductus arteriosus
 Tetralogy of Fallot
Figure 17.34
Coarctation of the aorta.
Figure 17.35
Patent ductus arteriosus.
Figure 17.36
Tetralogy of Fallot.
Figure 17.36 (continued)
Tetralogy of Fallot.
Rhythm Disturbances
 Electrical Rhythm Disturbances
 Ventricular tachycardia
 Ventricular fibrillation
Figure 17.37
Ventricle tachycardia.
Figure 17.38
Ventricular fibrillation.
Figure 17.39
Heart block.
Figure 17.40
Atrial flutter.
Figure 17.41
Atrial fibrillation.
Developmental Considerations
 Pediatric
 Fetus receives oxygen and nutrients from the mother
 Changes occur in the newborn’s cardiovascular system
 Infant’s heart rate
Developmental Considerations
 Pregnant Female
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Heart is displaced to the left and upward
Blood volume increases 30 to 50 percent
Cardiac output and stroke volume increase
Resting pulse may increase
Murmurs may be auscultated
Developmental Considerations
 Geriatric
 Loss of ventricular compliance and vascular rigidity
 Conduction system loses automaticity
Psychosocial Considerations
 Stress and workload of the heart
Considerations
 Race
 Ethnicity
 Diet
 Substance abuse
Healthy People 2010
 Focus Areas Outlined in the Healthy People 2010
 Coronary heart disease
 High blood cholesterol
Healthy People 2010
 Key Objectives for Coronary Heart Disease
 Reduce deaths
 Increase awareness of symptoms of heart attack and
the need for rapid emergency care
 Increase the numbers of adults who can administer
cardiopulmonary resuscitation
 Reduce the number of obese individuals
 Increase physical activity
 Increase the number of adults who are aware of risk
factors and take action to reduce risks
Healthy People 2010
 Key Objectives for High Blood Cholesterol
 Reduce the number of adults with elevated cholesterol
levels
 Increase the number of adults who have cholesterol
levels measured