Cardiovascular System

Question 1

What is the main function of the cardiovascular system?

Answer 1

Supply oxygenated blood to all the cells in the body.

Question 2

What are the components of the cardiovascular system?

Answer 2

• Heart: hollow, muscular (myocardium tissue), organ approximately the size of the patient’s clenched fist that pumps blood
• Vessels: arteries carry blood away from heart and veins carry blood back to the heart
• Blood: medium pumped, fluid that carries nutrients essential to cell function

Question 3

1. Where is the exactly is the heart located?
2. How big is the heart?
3. How many chambers does the heart consist of?
4. What sections are they divided into by what?
5. What are the upper chambers called?
6. How about the lower chambers?
7. What tissue is the heart surrounded by?
8. What system prevents backflow into the heart?
9. Which side of the heart is more muscular? Why?

Answer 3

• Located in the thoracic cavity
  
  • Specifically 2nd intercostal space at the right sternal border
  • 5th intercostal space at the left of the midclavicular line
  • Right in the mediastinum (space between lungs)
• The heart is the sized of your clenched fist
• The heart has four chambers
• The heart becomes “two-sided” divided by the septum structure
• The two upper chambers are called the atria
• The two lower chambers are called the ventricles
• The heart is surrounded by a muscular sac called the pericardium
• A system of one way valves prevent backflow into the heart
• The left side of the heart is a muscular high-pressure pump because it has to pump blood to the rest to the body; systemic

Question 4

What function does systemic circulation perform? Write down the flow of blood through the systemic system.

Answer 4

• Systemic circulation carries oxygen rich blood from the left ventricle to the rest of the body and back to the right atrium, the blood passes through tissues and organs giving up oxygen and nutrients while absorbing celluar wastes and carbon dioxide (the wastes are eliminated through the liver and kidneys).
• pulmonary capillaries -> pulmonary veins -> left atrium -> mitral valve –> left ventricle -> aorta –> arteries -> arterioles -> capillaries -> venules -> veins -> vena cava (superior and inferior) -> right atrium

Question 5

What is the function of pulmonary circulation? Trace the blood flow.

Answer 5

• Pulmonary circulation carries oxygen poor blood from right ventricle through the lungs and back to left atrium, basically blood passes through the lungs to give up carbon dioxide and become refreshed with oxygen.
• Right atrium -> right ventricle -> tricuspid valve -> right ventricle -> pulmonary valve -> pulmonary artery (trunk) -> pulmonary capillaries -> pulmonary veins -> left atrium

Question 6

With a partner, trace blood flow through the heart using the figures presented to you in page 164,166.

Answer 6

-Check with partner! :)

Question 7

The heart has an electrical system as you already know. What the two electrical processes that stimulate the contraction of the heart? What is unique about the heart’s electrical system? Where is the electrical signal usually initiated?

Answer 7

The two electrical processes are…

• Depolarization (electrical charges on the surface of the heart muscle cell change from positive to negative; ready to contract)
• Repolarization (electrical charges on the surface of the heart muscle change from negative to positive; resting state)

The heart’s electrical system is unique in which is functions independently of other systems.

Electrical signals are normal initiated in the right atrium (SN node), if it is intiated from any other area, that is abnormal.

Question 8

Step-by-Step explain where electrical conduction of the heart begins and ends.

Answer 8

• Sinoatrial node
• Atrioventricular node
• Bundle of His
• L & R Bundle branches
• Purkinje Fibers

Finally it ends up at the ventricles.

Question 9

List the types of vessels there are.

Answer 9

• Arteries (carries blood away from heart)
• Arterioles (still carries blood away from heart, adjustable)
• Capilaries (tiny vessels, diffusion occurs here)
• Venule (small vessels that carry deoxygenated blood from capillary)
• Veins (large vessels that carry deoxygenated blood from venules)

Question 10

What are the two actions the vessels can do affect blood pressure?

Answer 10

• Vasoconstriction: make blood vessels get smaller; higher blood pressure
• Vasodialation: make blood vessels get bigger; lower blood pressure

Question 11

List the major arteries & list the major veins you must know.

Answer 11

Major Arteries

• Aorta: principal artery leaving back left side of heart.
• Pulmonary artery (trunk): carries deoxygenated blood to lungs (great vessel)
• Carotid artery: lateral to larynx, carries oxygenated blood to head
• Femoral artery: inferior to the pubic area
• Brachial artery: carries blood to arm, medial to the bicep
• Radial artery

Major Veins

• Superior vena cava: transports deoxygenated blood from head, neck, shoulders, and upper extremities. (great vessel)
• Inferior vena cava: transports deoxygenated blood from abdomen, pelvis, and lower extremities. (great vessel)
• Pulmonary veins: delivers fresh, oxygenated blood from lungs to left ventricle. (great vessel)

Question 12

What does blood compose of? What is the function of each of the constiuents? Where are all almost blood cells made in? What is the average amount of blood in an adult, how about for children, how about for infants?

Answer 12

• Liquid portion
  
  • Plasma: salt solution that helps transports the solid portion of blood
• Solid portion
  
  • Red blood cells (erythrocytes): carry O₂and CO₂ through binding the substances via hemoglobin (a protein)
  • White blood cells (leukocytes): serve as a defense system to fight infection and provide immunity
  • Platelets: tiny disk-shaped elements that are essential for the formation of blood clots, they perform coagulation. (a.k.a. thrombocytes; platelets)
• Almost blood cells (red or white) are made in the bone marrow
• The average amount of blood in an adult is 4-6 liters
• The average amount of blood in a child 2-3 liters
• The average amount of blood in an infant is 300 mL

Question 13

How does the heart supply blood to itself? How does it work? What would happen if the pressure at the beginning of the aorta was not regulated?

Answer 13

• The heart supplies blood to itself through usage of the coronary arteries.
• The coronary arteries have openings immediately above the aortic valve at the beginning of the aorta where the pressures are the highest to receive the blood.
• There would be an ischemic attack; heart attack; myocardio infarction

Question 14

1. What is the difference between systemic and pulmonary circulation?
2. Where does the pulmonary artery carry blood (note whether blood is deoxygenated or not) to?
3. Where does the pulmonary vein (note if blood is deoxygenated or not) carry blood to?
4. What are the coronary arteries for?
5. What is the pericardium (note location too)?
6. What is myocardium?

Have a look of all these in the book too to gain a picture of it.

Answer 14

• Systemic carries oxygenated blood to the body and back to the heart while pulmonary circulation carries deoxygenated blood to the lungs and back to the heart after oxygenation.
• Pulmonary artery carries deoxygenated blood to the lungs.
• Pulmonary vein carries oxygenated blood from lungs to left atrium.
• Coronary arteries have an opening in the aorta through which they receive blood to supply the heart with blood.
• Pericardium is a fibrous tissue, fluid filled sac that surrounds the heart that reduces friction and keeps heart from over expanding.
• Myocardium: middle thickest layer of the heart consisting of muscle fibers that serve contractile purposes for the heart.

Question 15

What do you get if the cardiovascular system is working as it should (think of flow)? What is the state of inadequate circulation that involves the entire body?

Answer 15

• You get perfusion!
  
  • the adequate flow (circulation) of blood through body tissue or organs to meet the needs of the cell?
• The state of inadequate circulation involving the entire body is called shock or hypoperfusion!

Question 16

What is angina pectoris? What is ischemia, how about ischemic heart disease? How does the pain feel (and distributed) and how long does it last? Does it leave permanent damage to the heart muscle? Is it easy to tell this condition from a heart attack?

Answer 16

• Angina pectoris: transient (short-lived) chest discomfort caused by partial or temporary blockage resulting in decreased blood flow to heart muscle; ischemia.
• Ischemia is a condition of decreased blood flow.
  
  • Ischemic heart disease is a disease involving decrease in blood flow in one or more portions of the heart muscle.
• The pain is described as crushing, squeezing “like someone standing on my chest” mild to moderate pain
• The pain may radiate from mid-portion to the chest (usually where it is) to jaw, arms (usually left), mid portion of back, or epigastrium.
• Usually the pain lasts 3-8 minutes (rarely longer than 15 minutes)
• It goes away with no permant damage to the heart muscle
• Nope, it is difficult to differentiate from a heart attack, treat all your patients as if they were experience acute myocardial infarction.

Note, it can go away with some NTG!

Question 17

What is acute myocardial infarction (AMI)? How does it differ from angina pectoris in terms of onset? How severe is the pain? How does the length of time differ from that of angina pectoris? How does angina pectoris differ from AMI in terms of treatment? What is essential in this case?

Answer 17

• Acute myocardial infarction (AMI): a heart attack; death of heart muscle tissue (myocardium) due to decreased flow of blood (e.g. pressure or obstructive problems) to the coronary artery.
• It differs in which it may not be provoked (e.g. exertion) in which it could happen while someone is sitting or sleeping.
• Moderate to severe pain.
• It differs in which it lasts longers, beween 30 minutes to several hours.
• May not be resolved with rest, oxygen, or nitroglycerin
• Immediate transport!

Question 18

What are the signs and symptoms of AMI? What are the pain exceptions to this?

Answer 18

• Signs and symptoms
  
  • Sudden onset of weakness, nausea, and diaphoresis (sweating profusely)
  • Chest pain or discomfort
  • Dyspnea (shortness of breath)
  • Irregular pulse
  • Pain in lower jaw, arms (esp. left), or back
  • Sudden fainting
  • Pulmonary edema (swelling caused by fluid in tissues): fluid accumulation in lungs
  • Sudden death
  • Feeling of impending doom
• Exceptions to pain
  
  • Referred pain: pain felt in body other than at source
  • Atypical pain: in this case, pain not really felt at the sternum
  • No pain: sometimes the patient does not feel pain at all even though they appear with all the signs.

Question 19

What is Congestive Heart Failure (CHF)? What are the causes of CHF? Explain the process of CHF.

Answer 19

• Congestive Heart Failure (CHF): a disorder in which the heart muscle becomes so damaged (losing ability to pump blood) that it cannot keep up with the return flow blood from the atria; back of fluid into lungs.

Causes include…

• Diseased Heart Valves
• Damaged ventricles
• Chronic (long-standing) hypertension
• Obstructive pulmonary disease (e.g. emphysema, chronic bronchitis) (taxes the heart by not allowing for proper perfusion of oxygen)
• Often a complication resulting from a myocardial infarction

Process of CHF…

• Heart tries to compensate through two changes
  
  • Increase heart rate
  • Enlarge left ventricle (to increase amt of blood pump each min)
• Once the heart cannot efficiently pump the amount of fluid in the body anymore, CHF develops
• Fluid begins to back up in the lungs or body as heart fails to pump

Question 20

What are the signs and symptoms of CHF?

Answer 20

• Pedal edema: very round legs swelled with fluid in the interstitial spaces.
• Jugular vein distension (JVD)
• Ascites: fluid build up in the abdominal cavity (specifically in the peritoneal membrane surrounding the abdominal cavity)

Question 21

What are the symptoms of critical CHF & w/ pulmonary edema?

Answer 21

• Dyspnea (shortness of breath)
• Rales & audible rales (fluid in lungs; gargling when they talk; bubbly exchange)
• Pink forthy sputum coughed up
• Tachycardia (fast heart rate)
• Cyanosis (poor perfusion)
• Anxiety, restlessness

Question 22

What is Athero/Arterio - sclerosis? What does it result in?

Answer 22

FYI

Athero: glue-like, soft, pasty materials

Arterio: of, relating to the arteries

sclerosis: abnormal hardening of tissue
* a disorder in which cholesterol (fatty deposits) and calcium build up inside the walls of the blood vessels, forming plaque. This causes the lumen to become narrow, create a rough inner surface that can lead to clot,

This results in

• Restrictive blood flow
• High blood pressure
• AMI (Acute myocardial infarction)

Question 23

What is a thrombus? What happens to a thrombus as time passes? What are the results of a thrombus?

Answer 23

• A thrombus is a formation of a bloot clot and debris in the vessels from plaque remaining attached in its place.
• A thrombus can become large enough to occlude the vessel
• The results of a thrombus are…
  
  • Parital blockage = distal reduction of oxygen
  • Complete blockage = distal tissue death

Question 24

What is an embolus? What can happen as a result of this?

Answer 24

• An abnormal particle (bullet fragment, broken off thrombus, air bubble, etc) circulating/flowing in the blood, through the blood vessels.
• It may partially or completely occlude a smaller artery which will result in decreased oxygen to tissue or tissue death.

Question 25

What is aneurysm? What is the the main issue of this disease? What occurs when this issue happens?

Answer 25

• Adnormal dilation; balloning out of a weakened section of an artery as a result of a vascular defect.
• The main issue is that it is always susciptible to the possibility of rupture
• The vessel bursts, resulting in life-threatening internal bleeding

Question 26

What is Abdominal Aortic Aneurysm (AAA)? What are the signs & symptoms of AAA? How do you treat AAA?

Answer 26

• Aneurysm of the lower section of the aorta at the abdomen.

Signs and symptoms include…

• “Tearing” abdominal or back pain
• Pulsating mass in midline of abdomen
• Unequal femoral artery pulses
• Syncope (fainting)

Treatment

• Rapid transport
• High flow oxygen
• treat for shock

Question 27

What are some other causes of chest pain (relating to implanted heart assistants)?

Answer 27

• Pacemakers
• Defibrillator implants
• CABG: coronary artery bypass graft

Question 28

What is the treatment (RX) for all these cardiovascular issues we have worked with? What are some common medications for cardiovascular issues?

Answer 28

Treatment (RX)

• High flow oxygen (ventilate patient if needed)
• Position of comfort
• Rapid transport

Common medications

• Lasix
• Digoxin
• Lanoxin
• Inderal
• NTG = nitroglycerin

Question 29

What are Cerebral Vascular Accidents (note other names it is called too)? What are some possible reasons it happens? What are the signs and symptoms of CVA? What is a Transient Ischemic Attack (TIA)?

Answer 29

• Cerebral Vascular Accidents (a.k.a. stroke, brain attack) are a sudden change in neurological status caused by an interference with blood supply to brain.
  
  • Possible reason: obstructuve (clots, etc..)
  • Possible reason: hemorragic (head trauma, bursted blood vessels, etc..)
• Signs and symptoms of CVA are…
  
  • Hypertension
  • Altered mental status
  • Hemiparesis & hemiparalysis
  • Headache, blurred vision
  • Aphasia
  • Incontinence (no controls over bowels and bladder)
• A transient ischemic attack (TIA; mini-stroke) is temporary (over a 24 period off and on) restricted blood flow to the brain with similar symptoms to CVA.