16. PULMONARY AND SYSTEMIC CIRCULATION. THE LEFT SIDE OF THE HEART PUMPS OXYGENATED BLOOD
(INDICATED IN RED) INTO THE ARTERIES OF THE SYSTEMIC CIRCULATION, WHICH PROVIDES OXYGEN AND
NUTRIENTS TO THE CELLS. DEOXYGENATED BLOOD (INDICATED IN BLUE) RETURNS VIA THE VENOUS
SYSTEM INTO THE RIGHT SIDE OF THE HEART, WHERE IT IS TRANSPORTED TO THE PULMONARY ARTERIAL
SYSTEM TO BE REOXYGENATED.
17. CIRCULATION OF THE HEART
• Coronary arteries
• Left main
• Right coronary
• Left anterior descending
• Circumflex
20. CONDUCTION SYSTEM OF THE HEART
• Sinoatrial (SA) node
• Intra-atrial pathways
• AV node
• Bundle of His
• Right and left bundle branches
• Purkinje fibers
25. ELECTROCARDIOGRAM (ECG)
• Paper Recording of Deflections That Represent the
Cardiac Cycle
• Electrical deflections
• P wave
• PR interval
• QRS interval
• T wave
27. CARDIAC FUNCTION
• Stroke volume
• Amount of blood that is ejected with each heartbeat
• Cardiac output
• Amount of blood ejected from the left ventricle over 1 minute
• Cardiac index
• Measurement accounting for an individual’s weight when
evaluating the pumping action of the heart
28. PUMPING ACTION OF THE HEART
• Preload volume overload
• Afterload pressure overload
•Cardiac output: stroke volume x heart rate
•Blood pressure: cardiac output x systemic
vascular resistance
29. A. PRELOAD IS RELATED TO THE AMOUNT OF BLOOD AND STRETCHING OF THE VENTRICULAR
MYOCARDIAL FIBERS.
A
30. (CONTINUED) B. AFTERLOAD IS THE PRESSURE THAT THE VENTRICLES MUST OVERCOME IN ORDER TO
OPEN THE AORTIC AND PULMONIC VALVULAR CUSPS.
B
37. PHYSICAL ASSESSMENT OF THE
CARDIOVASCULAR SYSTEM
• Techniques
• Inspection
• Palpation
• Percussion
• Auscultation
38. SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• Inspection of the face, lips, ears, and scalp
• Inspection of the jugular veins
• Inspection of the carotid arteries
• Inspection of the hands and fingers
• Inspection of the chest, abdomen, legs, and skeletal
structure
39. JUGULAR VENOUS PRESSURE (JVP)
AND PULSATIONS
• Recall that jugular veins reflect right atrial pressure
• Steps for examination
• Raise the head of the bed or examining table to 30°
• Turn the patient’s head gently to the left
• Identify the topmost point of the flickering venous pulsations
• Place a centimeter ruler upright on the sternal angle
• Place a card or tongue blade horizontally from the top of the JVP
to the ruler, making a right angle
• Measure the distance above the sternal angle in centimeters: a 3-
to 4-centimeter elevation is normal
41. • Top line – level of the higest visible point of distention
• Bottom line – level of the sternal angle
• Measure: the vertical distance between the sternal angle
and the highest level of jugular distention
44. SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• 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
48. ASSESSING THE CAROTID PULSE
• Keep the patient’s head elevated to 30°
• Place your index and middle fingers on the right then the left carotid
arteries, and palpate the carotid upstroke
• Never palpate right and left carotid arteries simultaneously
• The upstroke may be:
• Brisk – normal
• Delayed – suggests aortic stenosis
• Bounding – suggests aortic insufficiency
• Listen with the stethoscope for any bruits
50. SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• 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
51. SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• Auscultation of the chest using the diaphragm and bell in
various positions to include the following locations
• 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
52. • Listen in all 5 listening areas for S1 and S2 using
the diaphragm of the stethoscope
• Then listen at the apex with the bell
• The diaphragm and the bell ...
• The diaphragm is best for detecting high-pitched
sounds like S1, S2, and also S4 and most
murmurs
• The bell is best for detecting low-pitched sounds
like S3 and the rumble of mitral stenosis
58. 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
82. KEY OBJECTIVES FOR CORONARY
HEART DISEASE
• Screening for risk factors
• Individual, community, culturally linguistically appropriate
education and counseling
• Education about symptoms and emergency care
• Weight reduction programs
• Programs to increase physical activity
83. KEY OBJECTIVES FOR HIGH TOTAL
BLOOD CHOLESTEROL
• Education about risks
• Education about diet and exercise
• Education about screening
84. GLOSSARY
• Atrioventricular Valves Valves that separate the atria from the ventricles.
• Bruit A loud blowing sound, an abnormal finding, most often associated
with a narrowing or stricture of the carotid artery usually associated with
atherosclerotic plaque.
• Bundle Branches Expressways of conducting fibers that spread the
electrical current through the ventricular myocardial tissue.
• Bundle of His Atrioventricular Node Nodes that are intricately connected
and function to receive the current that has finished spreading throughout
the atria.
• Cardiac Conduction System The heart's conduction system which can
initiate an electrical charge and transmit that charge via cardiac muscle
fibers throughout the myocardial tissue.
• Cardiac Cycle The events of one complete heartbeat, the contraction and
relaxation of the atria and ventricles.
• Cardiac output The amount of blood ejected from the left ventricle over 1
minute.
• Diastole The phase of ventricular relaxation in which the ventricles relax
and are filled as the atria contract.
85. GLOSSARY
• Electrocardiogram (EKG) Electrical representations of the cardiac cycle
are documented by deflections on recording paper.
• Endocardium The innermost layer of the heart, a smooth layer that
provides an inner lining for the chambers of the heart.
• Heart An intricately designed pump composed of a meticulous network of
synchronized structures.
• Infective Endocarditis A condition caused by bacterial infiltration of the
lining of the heart’s chambers.
• Left Atrium Forms the posterior aspect of the heart.
• Left Ventricle Egg shaped, most muscular chamber of the heart, located
behind the right ventricle and forms the left border of the heart.
• Marfan's Syndrome A degenerative disease of the connective tissue,
which over time may cause the ascending aorta to either dilate or dissect,
leading to abrupt death.
• Mediastinal space The area where the heart sits obliquely within the
thoracic cavity between the lungs and above the diaphragm.
86. GLOSSARY
• Myocardium The second, thick, muscular layer of the heart, made up of
bundles of cardiac muscle fibers reinforced by a branching network of
connective tissue fibers called the fibrous skeleton of the heart.
• Pericardium A thin sac composed of a fibroserous material that surrounds
the heart.
• Purkinje Fibers Fibers that fan out and penetrate into the myocardial
tissue to spread the current into the tissues themselves.
• Right Atrium A thin-walled chamber located above and slightly to the right
of the right ventricle that forms the right border of the heart.
• Right Ventricle Part of heart formed triangularly and comprises much of
the anterior or sternocostal surface of the heart.
• S1 The first heart sound (lub), is heard when the AV valves close. Closure
of these valves occurs when ldrslt the ventricles have been filled.
• S2 The second heart sound (dub), occurs when the aortic and pulmonic
valves close, they close when the ventricles have emptied their blood into
the aorta and pulmonary arteries.
• Semilunar Valves Valves that separate the ventricles from the vascular
system.
87. GLOSSARY
• Sinoatrial Node The node located at the junction of the superior
vena cava and right attrium that initiates the electrical impulse.
• Sternum The flat, narrow center bone of the upper anterior chest.
• Stroke Volume The amount of blood that is ejected with every
heartbeat.
• Systole The phase of ventricular contraction in which the ventricles
have been filled, then contract to expel blood into the aorta and
pulmonary arteries.
• Visceral Layer The inner layer, which lines the surface of the
heart.
• Xanthelasma Yellowish cholesterol deposits seen on the eyelids
and are indicative of premature atherosclerosis.
