The Cardiovascular System & Cardiovascular Emergencies

Supplies oxygenated blood to all cells in the body!!

Components Heart – pumps blood Vessels – Arteries carry blood away from the heart and veins carry blood back to the heart Blood – fluid that carries nutrients essential to cell function

The Heart Located in the thoracic cavity 2nd intercostal space at right sternal border 5th intercostal space at left midclavicular line about size of your clenched fist In mediastinum

The Heart 4 chambers “2 sided” - divided by septum 2 upper called atria 2 lower called ventricles surrounded by pericardium system of one way valves

Path of blood flow (Systemic circulation) left ventricle aorta arteries, arterioles, capillaries, etc... Vena cava (superior and inferior) Right atrium

Path of blood flow (Pulmonary circulation) right ventricle pulmonary artery lung ( pulmonary capillaries) Pulmonary veins Left atrium

The Circulatory System

Blood Flow Through the Heart

The Heart Electrical System independent stimulates contractions of heart normally initiated in right atrium if initiated from other areas = abnormal

Electrical Conduction Sinoatrial (SA) node Atrioventricular node Bundle of His (AV bundle) Bundle branches Purkinje fibers

Vessels Arteries Arterioles Capillaries Veinioles Veins

Vessels Vasoconstriction Effect on Blood Pressure? Vasodilation Effect on Blood Pressure?

Major Arteries and Veins Aorta Pulmonary Carotid Femoral Brachial Radial Superior vena cava Inferior vena cava Pulmonary Look Up in TEXT!

coronary arteries – Supply blood to heart muscle itself The two main coronary arteries have openings immediately above the aortic valve at the beginning of the aorta where the pressures are highest

Blood Liquid Portion - Plasma Solid Portion Red blood cells White blood cells Platelets

Blood Plasma - transports solids It is basically a salt solution

Blood Red Blood cells - carry oxygen AKA - Erythrocytes Hemoglobin is the substance that combines with oxygen in a red blood cell

Blood White Blood cells - fight infection AKA Leukocytes almost all blood cells (red or white) are made in the bone marrow.

Blood Platelets – are essential for formation of blood clots. They perform coagulation. AKA - thrombocytes

average amount of blood in an adult is 4-6 liters.

note Systemic Vs pulmonary circulation Pulmonary artery Pulmonary vein Coronary arteries Pericardium Myocardium

If the cardiovascular system is working as it should...

You get…Perfusion Definition – Adequate flow of blood through body tissue or organs to meet the needs of the cell.

Cardiovascular Emergencies

Abnormal Heart Conditions Angina Pectoris Myocardial Infarction Congestive Heart Failure

Angina Pectoris Decreased blood flow to heart muscle results in ischemia- lack of oxygen Causes mild to moderate pain Pain may radiate Usually lasts 3-8 minutes (rarely longer than 15 mins) IT GOES AWAY with no permanent damage to heart muscle Can be difficult to differentiate from heart attack

Acute Myocardial Infarction decreased flow of blood to the myocardium leading to death of tissue may not be provoked moderate to severe pain Can last between 30 minutes and several hours May not go away with rest, O2 or nitroglycerin Immediate transport is essential

AMI Signs and Symptoms Sudden onset of weakness, nausea, and diaphoresis Chest pain or discomfort dyspnea irregular pulse Pain in lower jaw, arms, or back Sudden fainting Pulmonary edema Sudden death Feeling of impending doom

there are always exceptions... Referred pain Atypical pain No pain

Congestive Heart Failure Causes diseased heart valves and damaged ventricles Chronic hypertension obstructive pulmonary disease (emphysema, chronic bronchitis) often a complication of an MI

CHF Heart tries to compensate. Increased heart rate Enlarged left ventricle The heart can not efficiently pump the amount of fluid in the body and CHF develops Fluid backs up into lungs or body as heart fails to pump

Signs & Symptoms of CHF Pedal edema JVD Ascites

Critical CHF & Pulmonary Edema dyspnea rales & audible rales pink frothy sputum tachycardia cyanosis anxiety, restlessness

Vascular emergencies Atherosclerosis & arteriosclerosis Thrombus Embolus Aneurysm

Athero/arterio -sclerosis build up of fatty deposits & calcium causes narrowing of the lumen can create rough inner surface that can lead to clot

Athero/arterio -sclerosis Results in: restricted blood flow high blood pressure AMI

Thrombus formation of clot and debris in vessels from plaque can become large enough to occlude vessel partial blockage = distal reduction of O2 complete blockage = distal tissue death

Embolus a thrombus that breaks off from vessel wall. flows through blood vessels may partially or completely occlude smaller artery occlusion will result in decreased oxygen to tissue or tissue death

Aneurysm is a ballooning out of a weakened section of an artery Possibility of rupture

Ruptured aneurysm Is a bursting of an aneurysm can result in rapid, life threatening internal bleeding

Abdominal Aortic Aneurysm (AAA) Signs & Symptoms “Tearing” abdominal or back pain Pulsating mass in midline of abdomen Unequal femoral pulses Syncope

AAA Treatment Rapid transport High flow O2 Treat for shock

Other Considerations other causes of chest pain pacemakers defibrillator implants CABG – coronary artery bypass graft

RX for all High flow oxygen (ventilate patient if needed!) Position of comfort Rapid transport

medications Lasix Digoxin Lanoxin Inderal NTG = nitroglycerin

Cerebral Vascular Accidents AKA “Stroke” “Brain Attack”

CVA - Cerebral Vascular Accidents sudden change in neurological status caused by interference with blood supply to brain obstructive hemorragic

CVA signs & symptoms hypertension altered mental status hemiparesis & hemiparalysis headache, blurred vision one sided facial droop aphasia incontinence

Transient Iscemic Attack TIA’s AKA “mini-stroke” can have symptoms of CVA temporary

The end Questions?