Cardiopulmonary System
Shannon Ash, RN, BSN
Goal of The Cardiovascular System
• To ensure delivery of oxygenated blood and
nutrients to all the organs and tissues of the
body.
• To carry cellular waste products from the
area where they are produced to the kidneys
and liver where they are processed for
excretion by the body.
Blood Vessels
• Three types of
blood vessels in
body:
~ Arteries: The large
blood vessels that lead
away from the heart.
Their walls are elastic,
and smaller branches
of the arteries are
called arterioles.
Blood Vessels
• Veins: They take deoxygenated blood
back to the heart
and lungs to be reoxygenated. They
have thinner walls
than arteries, and
have valves within
their inner walls, to
keep blood moving
in one direction.
Blood Vessels
• Capillaries:
Are delicate,
microscopic
vessels that are
very thin.
Oxygen and
nutrients can
pass through
them!
Blood Circulation
• Three types:
• Pulmonary
• Cardiac
• Systemic
Cardiac Circulation
• Inferior/Superior Vena
Cava
• Right Atrium
• Right Ventricle
• Pulmonary Artery (to
lungs)
Pulmonary Vein
• Left Atrium
• Left Ventricle
• Aorta (to rest of body)
Circulation
• De-oxygenated blood flows through the venae
cavae (plural) Superior vena cava and Inferior
vena cava into the right side of the heart, through
to pulmonary artery which divides the blood to
each lung, and the branches keep getting smaller
and smaller until it reaches the lung capillaries.
While the blood is flowing through the lung
capillaries, it picks up fresh oxygen, and heads
back to the heart via the pulmonary veins. This
fresh, oxygen-rich blood goes back to the left side
of the heart where it is pumped out to the rest of
the body through the aorta.
Circulation
• When blood flows out the aorta, it flows through
arteries to smaller vessels called arterioles and
to smaller vessels called capillaries. At the
capillary level, the fresh oxygen is exchanged
for carbon dioxide along with other cellular
waste products, and the blood begins to return to
the heart via the veins.
Cardiac Anatomy
• The heart is a muscular pump,
made up of four chambers:
two atria (right and left) and
two ventricles (right and left)
• In between the atria (on top)
and the ventricles (on the
bottom) are valves.
• On the right side of the heart
the valve is called the
tricuspid valve.
• On the left side of the heart
the valve is called the mitral
valve.
Cardiac Anatomy Points
• Left ventricle is largest and most muscular of heart
chambers.
• The atria and ventricles are separated by a wall of tissue
called the septum.
• The heart has three layers that make it up: the endocardium
(inside the heart); the myocardium (middle, muscular
layer); and the pericardium, a sac that surrounds the heart.
• The pericardium has two layers; the visceral pericardium
which adheres to the heart, and the parietal pericardium
which lines the outer fibrous coat.
• The pericardial cavity (lies between the visceral and the
parietal pericardium) contains 10 - 15cc of fluid, which
lubricates the membrane of the heart as it beats.
Physiology of the Heart
• Each heartbeat has two
phases: systole (contraction)
and diastole (relaxation).
• Diastole occurs when the
walls of the ventricle relax,
and blood flows into the heart
from the venae cavae and the
pulmonary veins.
• Systole occurs after that, as
the walls of the right and left
ventricles contract to pump
blood into the pulmonary
artery and the aorta.
Principles related to Cardiac Conduction
• Heart muscle has properties that no other
muscle in body has: principle of
automaticity, meaning that heart muscle
actually initiates the impulse for the heart to
beat.
• Specialized areas in the heart are
responsible for this beat initiation.
Cardiac Conduction System
• Primary responsibility for
initiating impulses comes
from the sinoatrial node.
• Also called the SA node, and
the pacemaker of the heart.
• The electricity produced in the
SA Node travels through the
atria down through the AV
Node, and down through the
Bundle of His, and the right &
left bundle branches, which
depolarizes the ventricles and
produces the contraction.
Heart & Blood Vessel Abnormal
Conditions
• Arrhythmias: Abnormal
heart rhythms.
• Heart Block: Failure of
proper conduction of
impulses through the AV
node to the Bundle of His.
May require a cardiac
pacemaker.
• Atrial Flutter: Rapid, regular
contractions of atria or
ventricles. Heart rates can
reach up to 300 beats per
minute .
• Atrial Fibrillation: Rapid,
random, irregular contractions
of the heart. May require a
blood thinner to be taken.
May require an AICD or
cardiac ablation. Can have
heart rates of greater than 350
“beats” or quivers per minute.
Congential Heart Diseases
• Coarctation of the aorta:
Narrowing of the aorta,
requiring surgical correction.
• Patent ductus arteriosus: A
small duct between the aorta
and the pulmonary artery,
remains open. This must be
closed surgically.
• Septal defects: Small holes in
the septa between the atria or
the ventricles. May
spontaneously close or may
require surgery.
• Tetralogy of Fallot: A
malformation of the heart
involving four distinct
defects:
~ Pulmonary artery stenosis
~ Ventricular septal defect
~ Shift of the aorta to the right
~ Hypertrophy of the right
ventricle
• Baby will be blue or cyanotic
at birth. Surgery is required
to repair.
Heart & Blood Vessel Abnormal
Conditions
• Congestive Heart Failure:
The heart is unable to pump
the required amount of blood
to the body. Can be right
heart failure or left heart
failure. Symptoms are
related to the side of the
failure.
• Coronary Artery Disease:
Disease of the arteries
surrounding the heart. Plaque
in the coronary arteries and
can block them completely,
causing a heart attack.
• Endocarditis: Inflammation
of the inner lining of the heart
caused by bacteria.
• Hypertensive heart disease:
High blood pressure that
affects the heart.
• Mitral Valve Prolapse:
Improper closure of the mitral
valve when the heart is
pumping blood.
• Murmur: An extra heart
sound heard between normal
beats.
Heart & Blood Vessel Abnormal
Conditions
• Pericarditis: Inflammation
of the membrane that
surrounds the heart.
• Rheumatic heart disease:
Heart disease that is caused
by rheumatic fever.
• Aneurysm: An area of an
artery that balloons out, and
causes a weakness in the
vessel.
• Peripheral Vascular
Disease: Blockage of arteries
in the lower extremities due
to atherosclerosis.
• Raynaud Phenomenon:
Short episodes of pallor &
numbness in the fingers and
toes due to temporary
constriction of arterioles in the
skin.
• Varicose veins: Abnormally
swollen and twisted veins that
occur in the legs.
• Angina Pectoris: Chest pain
that is temporary.
Cardiac Related Terms
• Bruit: An abnormal heart sound heard with auscultation.
• Claudication: Pain, tension, and weakness in a leg after walking, but when
at rest there is no pain.
• Emboli: Collections of material (clots or other material) that can travel
through the blood system and suddenly block a blood vessel.
• Infarction: Area of dead tissue.
• Occlusion: Closure of a blood vessel.
• Palpitations: Uncomfortable sensations in the chest caused by irregular
heartbeats.
• Patent: Open
• Petechiae: Small, pinpoint hemorrhages.
• Thrill: A vibration felt when an area is palpated.
• Vegetations: Collections of debris that attach to the endocardium and heart
valves.
Cardiac Drugs
• Angiotensin-converting enzyme inhibitors (ACE): These
drugs reduce blood vessel constriction. They are used to treat
high blood pressure.
• Beta-Blockers: Drugs used to treat angina, hypertension, and
arrhythmias. They help the heart beat more slowly and with less
force.
• Calcium Channel Blockers: Drugs used to treat angina and
hypertension. They dilate blood vessels by blocking the influx
of calcium.
• Digoxin: A drug used to correct arrhythmias and improve the
strength of the heartbeat.
• Nitrates: Drugs used to treat angina. They dilate blood vessels
and give the heart more oxygen. i.e. nitroglycerin
Tests & Procedures
• Lipid Tests: A blood test for
cholesterol and triglycerides.
• Lipoprotein electrophoresis:
Separates out different types
of fats in the bloodstream.
• Serum enzyme tests: Blood
tests to measure levels of
injured cardiac muscle in MI
patients.
• Angiography: Dye is injected
into a vessel and xrays are
taken.
• Doppler Ultrasound: An
instrument focuses sound waves
on a blood vessel to measure
blood flow.
• Echocardiography:
Ultrasound waves are used to
see pictures of the heart and it’s
structures. Can be across the
chest or down the throat.
Tests & Procedures
• Positive Emission
Tomography: (PET)
Scan: IV contrast is
given, then IV glucose is
given. These show up in
the heart muscle, showing
blood flow and heart
structures and functions.
• Cardiac MRI: magnetic
waves beamed at heart
showing structures and
disease.
• Thallium 201
Scintigraphy: Thallium
201 is given and then
measured by a scanner to
show damaged areas of
the heart.
• Technetium 99m or
MUGA scan:
Radioactive test shows
ventricular function.
Tests & Procedures
• Cardiac catheterization: A
small flexible tube is passed into
the coronary arteries of the heart
and a dye is used to show
blockages.
• Cardioversion: Electrical
energy is applied to heart at a
specific time to change heart
rhythm.
• Coronary Artery Bypass
Surgery: Blood vessels from
other areas (legs or donor) are
used to bypass blocked areas of
coronary arteries. Page 401.
• Defibrillation: Electrical energy is
applied to heart to re-start heart
rhythm.
• Electrocardiography: A process of
recording electrical processes in the
heart.
• Endarterectomy: The surgical
removal of the innermost lining of
an artery when it is occluded with
plaque or clots.
• Heart transplantation: A donor
heart from a brain dead person is
placed into a living person and
restarted.
Tests & Procedures
• Holter Monitoring: A very • Stress Test: Places person on
small ECG machine
treadmill or similarly elevates
measures electrical activity,
heart function, and takes ECG,
usually for 24 hours. Can be
blood pressure, and other
done at home.
readings while heart is stressed.
• Percutaneous transluminal • Thrombolytic Therapy: Clotcoronary angioplasty: A
busting drugs are given to break
balloon is inserted (on a
up clots that could be causing a
wire) into a coronary artery
heart attack, stroke, or reduced
to smoosh or squish the
blood flow to an area.
plaque that’s blocking the
artery.
PTCA
Angioplasty
Cardiac Bypass
Cardiac System
• The cardiac system is a complex and unique
system. Nearly all changes that occur in the
body affect the cardiac system in some way.
• It is a constantly adapting system!