Cardiovascular System Circulation and Blood Pressure

Cardiovascular Review

Stethoscope A medical instrument to listen to sounds produced in the body, especially those that emanate from the heart and lungs.

Stethoscope Used to auscultate heart sounds (ie: normal heart sounds, heart murmurs, irregular heart rhythms, or abnormal heart sounds). Used to auscultate the sound of air moving through the lungs in order to detect abnormalities in the air tubes and sacs found in the lung or abnormalities outside the lung. Used to auscultate and detect abnormalities in vessel walls. Used to auscultate BP (blood pressure). Used to auscultate gastrointestinal sounds.

Stethoscope Ear tips or Earpieces Binaural or Ear Tubes Acoustic Tubing Chest Piece Diaphragm (for high pitched sounds) Bell (for low pitched sounds)

Cardiac Cycle Is a sequence of events that occur when the heart beats. There are two phases of the cardiac cycle. Diastole - the ventricles are relaxed and the heart fills with blood. Systole - the ventricles contract and pump blood to the arteries.

Diastole During the diastole phase, the atria and ventricles are relaxed and the atrioventricular valves are opened. Blood flows into the relaxed ventricles while the atrioventricular valves are opened. De-oxygenated blood from the superior and inferior vena cava flows into the right atrium. When the pressure in the ventricles gets lower than the pressure in the atria the AV valves open, allowing blood to flow into the relaxed ventricles. The open AV valves allow blood to flow into the ventricles.

Systole During the systolic phase, the ventricles receive impulses from the Purkinje fibers and contract. The AV valves close due to ventricular contraction and the semilunar valves open. The blood is pumped into the Pulmonary artery and Aorta.

Cardiac Cycle One cardiac cycle is when the heart fills with blood and the blood is then pumped from the heart. The audible sounds that can be heard from the heart are made by the closing of the heart valves. These sounds are referred to as the "lub-dub" or "lub-dupp". The "lub" (S1) sound the are by the closing of the AV valves. The "dub" (S2) sound is made by the semilunar valves closing.

Cardiac Cycle

Ejection Fraction (EF) The amount of blood pumped (ejected) by your heart with each beat Measured with an echocardiogram Normal EF is 50% or greater, which means at least one-half of the blood in the heart is ejected with each beat

Types of Circulation Coronary - the circulation of blood within the heart (coronary arteries branch off the aorta to supply blood to the heart muscle) Pulmonary - the flow of blood between the heart and the lungs Systemic - the flow of blood between the heart and the cells of the body (arteries, arterioles, capillaries, venules, veins)

CAD Coronary Artery Disease Also known as, ASHD- Artherosclerotic Heart Disease A result of the accumulation of plaques on the walls of the coronary arteries (fat, cholesterol, calcium, etc) Blocks or reduces the flow of blood to the heart muscle (myocardium) Can cause a heart attack (myocardial infarction)

Myocardial Infarction Occurs when blood flow is blocked to the heart muscle causing ischemia (lack of O2) and cell death or damage Symptoms can include: Pressure Pain (Angina) Diaphoresis Nausea

PAD/PVD Peripheral Artery Disease/ Peripheral Vascular Disease A condition of the blood vessels that leads to narrowing and hardening of the arteries that supplies the legs and feet. The narrowing of the blood vessels leads to decrease blood flow, which can injure nerves and other tissues.

Internal Jugular Veins Left Subclavian Artery Left Subclavian Vein Aortic Arch Ascending Aorta Descending Aorta Pulmonary (Trunk) Artery Left Atrium Left Axillary Vein Right External Iliac Artery Arterial & Venous Branches of the abdominal area Common Iliac Arteries Femoral Veins Femoral Arteries LeftVentricle Right Internal Iliac Artery Inferior Vena Cava Hepatic Veins Right Ventricle Right Atrium Right Axillary Vein Superior Vena Cava Right Subclavian Vein Right Subclavian Artery Brachiocephalic Artery Common Carotid Arteries

Blood Pressure The amount of pressure exerted on the arterial walls as blood pulsates through them.

Blood Pressure Blood pressure is typically recorded as two numbers. Read as "117 over 76 millimeters of mercury“ (mmHg) Systolic- the top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart muscle (ventricles) ______________ Diastolic - the bottom number, which is the lower of the two numbers, measures the pressure in the arteries when the heart muscle is ____________ between beats and refilling with blood contracts resting

Healthy Blood Pressure AHA recommendation Systolic is < 120 Diastolic is < 80 Prehypertensive - systolic is or diastolic is 80-89

Blood Pressures Prehypertension Systolic Pressure mmHg Diastolic Pressure mmHg HTN Stage 1 Systolic Pressure mmHg Diastolic Pressure mmHg HTN Stage 2 Systolic Pressure > 160 Diastolic Pressure > 100

Hypotension Low blood pressure Systolic pressure is < 100 mmHg and Diastolic is < mmHg

Orthostatic Hypotension Postural Hypotension – occurs when there is a sudden drop in both systolic and diastolic pressure This occurs when the individual moves form a lying to a sitting or standing position Caused by an inability of the blood vessels to compensate quickly to the change in position

Sphygmomanometer A sphygmomanometer ( or blood pressure meter ) is a device used to measure blood pressure, composed of an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Sphygmós means pulse, mano means pressure, and meter means measuring device.

Sphygmomanometer A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically.

Sphygmomanometer

The usual unit of measurement of blood pressure is millimeters of mercury (mmHg) as measured directly by a manual sphygmomanometer. Manual sphygmomanometers require a stethoscope for auscultation. They are used by trained practitioners, and cannot be used in environments too noisy to permit hearing the characteristic sounds. It is possible to obtain a systolic reading through palpation.

Mercury Sphygmomanometer Aneroid Sphygmomanometer

Recording Blood Pressure Recorded as a fraction Systolic is the top number Diastolic is the bottom number 120/80

Procedure Cuff appropriate size for patient Arm free of restrictive clothing Deflated cuff should be placed on the arm with the center of the bladder directly over the brachial artery Lower edge of cuff should be 1-1½ inches above the bend of the elbow Place stethoscope (bell or diaphragm directly over the brachial artery at the antecubital area (bend in the elbow)

Procedure (continued) Hold securely with slight pressure (DO NOT use your thumb) Chart BP correctly on graphic sheet

Do Not Use Arm with an IV Arm with paralysis Surgical Arm – surgery has been done on the arm, hand, etc.