Cardiopulmonary System

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Cardiopulmonary System

• Shannon Ash, RN, BSN

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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.

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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.

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Blood Vessels

• Veins They take de-oxygenated blood back to the
  heart and lungs to be re-oxygenated. They have
  thinner walls than arteries, and have valves
  within their inner walls, to keep blood moving in
  one direction.

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Blood Vessels

• Capillaries Are delicate, microscopic vessels
  that are very thin. Oxygen and nutrients can
  pass through them!

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Blood Circulation

• Three types
• Pulmonary
• Cardiac
• Systemic

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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)

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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Tests Procedures

• 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 its structures.
  Can be across the chest or down the throat.

• 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.

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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.

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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.

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Tests Procedures

• Holter Monitoring A very small ECG machine
  measures electrical activity, usually for 24
  hours. Can be done at home.
• Percutaneous transluminal coronary angioplasty A
  balloon is inserted (on a wire) into a coronary
  artery to smoosh or squish the plaque thats
  blocking the artery.

• Stress Test Places person on treadmill or
  similarly elevates heart function, and takes ECG,
  blood pressure, and other readings while heart is
  stressed.
• Thrombolytic Therapy Clot-busting drugs are
  given to break up clots that could be causing a
  heart attack, stroke, or reduced blood flow to an
  area.

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PTCA
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Angioplasty
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Cardiac Bypass
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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!