Unit 6 : Cardiovascular, Circulatory, & Hematologic

Function
Three layers of the heart:
- Epicardium : outer layer
- Myocardium : middle layer;
muscle
fibers;
pumping
action
- Endocardium : inner layer;
endothelial tissues
Pericardium : cases the heart;
fibrous sac
Pericardial space : 20mL; lubricates
the surface of the heart; reduces
friction

Dysrhythmias : disorders of the

formation or conduction of the
electrical impulse within the heart.
Depolarization
:
electrical
stimulation; systole
Repolarization : electrical relaxation;
diastole

P wave : from sinus node to atria;

atrial depolarization
QRS
complex
:
ventricular
depolarization
T wave : ventricular repolarization
U wave : repolarization of the
purkinjie fibers
Cardiac output : amount of blood
pumped by each ventricle; 5mL/min
Stroke volume : amount of blood
ejected per heartbeat; 70mL; HR 60
80 bpm
Baroreceptors: aortic arch, both
internal carotid arteries; sensitive to
changes in BP
Preload : ventricular stretch at the
end of diastole
Afterload : resistance to ejection of
blood from ventricle

Contractility
myocardium

force

of

the

ECGs
Normal Sinus Rhythm
Rate : 60 100
Rhythm : Regular
Sinus Bradycardia
Rate : < 60
Rhythm : Regular
Sinus Tachycardia
Rate : > 100 but usually < 120
Rhythm : Regular
Sinus Arrhythmia
Rate : 60 100
Rhythm : Irregular
Premature Atrial Complex
Rate : depends on underlying
rhythm
Rhythm : Irregular
* Early Pwaves or different
Pwaves
Atrial Flutter
Rate : atrial 250 400;
ventricular 75 150
Rhythm : Regular
*Pwaves are saw-toothed shape
(Fwaves)

Atrial Fibrillation
Rate : atrial 300 600;
ventricular 120 200
Rhythm : Highly Irregular
*Pwaves
are
undiscernible,
irregular undulating waves
Premature Junctional Complex
Rate : depends on underlying
rhythm
Rhythm : Irregular
*Pwaves may be absent
Junctional Rhythm
Rate : 40 60
Rhythm : Regular
*Pwave may be absent
Atrioventricular
Nodal
Reentry
Tachycardia
Rate : atrial 150 250;
ventricular 120 200
Rhythm : Regular
*sudden onset and termination
of
tachycardia;
Pwaves
are
difficult to discern
Premature Ventricular Complex
Rate : depends on underlying
rhythm
Rhythm : Irregular
*Early QRS, shape is bizarre
and abnormal

Ventricular Tachycardia
Rate : 100 200
Rhythm : Regular
*Pwave may be very difficult to
detect;
QRS
is
bizarre
and
abnormal in shape
Ventricular Fibrillation
Rate : > 300 per minute
Rhythm : Extremely irregular
*QRS is bizarre and abnormal
Idioventricular Rhythm
Rate : 20 40
Rhythm : Regular
*QRS is bizarre and abnormal
Ventricular Asystole
*FLATLINE
1 Atrioventricular Block
Rate : depends on underlying
rhythm

Rhythm
:
depends
on
underlying rhythm
*Atrial impulses are slower than
normal
2 Atrioventricular Block, Type I
(Wenckebach)
Rate : depends on underlying
rhythm
Rhythm : *Repeating pattern of a series
of atrial impulses
2 AV Block, Type II
Rate : depends on underlying
rhythm
Rhythm : *Only some of the atrial
impulses are conducted through the
AV node into the ventricles

3
AV Block
Rate : depends on the escape
rhythm and underlying rhythm
Rhythm : Regular
*No
atrial
impulses
is
conducted through the AV node into
the ventricles
Disorders/Diseases
CORONARY ATHEROSCLEROSIS
*Abnormal
accumulation
of
lipid/fats and fibrous tissue in
the lining of arterial blood
vessel walls.
S/Sx : angina, shortness of
breath, arrhythmias,
Risk Factors : family history,
age, gender male, race,
hyperlipidemia,
smoker,
HPN, DM, Metabolic Syndrome,
Obesity, Physical inactivity.
Prevention
:
Controlling
Cholesterol Abnormalities
Promoting Cessation of
Tobacco use
Managing Hypertension
Controlling DM
ANGINA PECTORIS
*Episodes or paroxysms of pain
or pressure in the anterior
chest.
Cause : insufficient coronary
blood flow, resulting in >
oxygen supply when there is
<myocardial
demand

for oxygen in response to physical

exertion
or
emotional
stress.
S / Sx : chest pains; pain may
spread to shoulders, neck, or
arms; may be at upper
abdomen, back, or jaw;
shortness
of
breath;
lightheadedness; fainting;
anxiety
or
nervousness;
sweating or cold, sweaty
skin;
nausea; tachycardia; pallor; feeling
of
impending doom.
Dx Tests : ECG, CPR and cardiac
biomarker values to rule out
an
ACS,
exercise
or
pharmacologic stress test
Medical Mgt : > the oxygen
demand of the myocardium
< oxygen supply
PTCA and CABG
Pharmacologic
Therapy
:
Nitroglycerin, Beta Blockers,
Calcium
Channel
Blocking
Agents, Antiplatelet and
Anticoagulant
Medications,
Oxygen Administration,
Nrsg Mgt : Treat Angina
Reducing Anxiety
Preventing Pain
ACUTE CORONARY SYNDROME &
MYOCARDIAL INFARCTION
*ACS : emergent situation
characterized by an acute onset
of myocardial ischemia that
results in myocardial
death
S / Sx : sudden onset of chest
pain, shortness of breath,
indigestion, nausea, anxiety,
pallor, moist skin,
tachycardia, tachypnea
Dx Tests : ECG, Serial Cardiac
Biomarkers, Echocardiogram,
CK-MB
Medical
Mgt
:
minimize
myocardial damage
Preserve myocardial
fxn
Prevent
complications
Pharma : Analgesics, ACE-Is,
Thrombolytics,
MITRAL VALVE PROLAPSE

*A portion of one or both mitral

valve leaflets balloons back
into
the atrium during systole
S / Sx : fatigue, shortness of
breath, lightheadedness,
dizziness,
syncope,
palpitations, chest pain, anxiety
Dx : Echocardiogram,
MITRAL REGURGITATION
*Blood flows back from the left
ventricle into the right atrium
during systole
S / Sx : Dyspnea, fatigue,
weakness, palpitations, shortness
of breath on exertion, cough
Dx
:
Transesophageal
Echocardiography
MITRAL STENOSIS
*Obstruction of blood flowing
from the left atrium into the left
ventricle
S / Sx : dyspnea on exertion,
fatigue, dry cough or wheezing,
hemoptysis,
palpitations,
orthopnea, paroxysmal
nocturnal dyspnea, repeated
respiratory infections
Dx : Echocardiography, ECG,
Cardiac catheterization with
angiography.
AORTIC REGURGITATION
*Flow of blood back into the left
ventricle from the aorta
during diastole
S / Sx : forceful heartbeat
(head/neck), arterial pulsations,
orthopnea, PND
AORTIC STENOSIS
*Narrowing of the orifice bt. the
left ventricle and the
aorta.
S / Sx : exertional dyspnea,
orthopnea, PND. Pulmonary
edema, dizziness, syncope,
angina, > BP, HR
RHEUMATIC ENDOCARDITIS
*Acute
rheumatic
fever,
develops after an episode of GABHS
pharyngitis
S / Sx : heart mumur,
cardiomegaly, pericarditis, HF, fever,
chills, sore throat (sudden
onset), abdominal pain,
acute
sinusitis, acute otitis media

INFECTIVE ENDOCARDITIS
*Microbial infection of the
endothelial surface of the heart
Risk Factors : Prosthetic cardiac
valves / prosthetic
materials used for cardiac valve
repair
Hx
of
bacterial
endocarditis
Congenital Heart Disease
Unrepaired
cyanotic
congenital heart disease
S / Sx : fever, heart mumur,
malaise, anorexia, wt. loss,
cough, back and joint pain
MYOCARDITIS
*Inflammation
of
the
myocardium
S / Sx : fatigue, dyspnea,
palpitations, discomfort,
tachycardia, chest pain,
PERICARDITIS
*Inflammation
of
the
pericardium
Cause : idiopathic / nonspecific
causes
Infection
Disorders of connective
tissues
Hypersensitivity state
Neoplastic disease
Renal failure and uremia
Tuberculosis
S / Sx : chest pain, mild fever,
<WBC, anemia,
HEART FAILURE
*Inability of the heart to pump
sufficient blood to meet the
needs
of the tissue for oxygen and
nutrients.

CHRONIC HEART FAILURE

ACUTE HEART FAILURE (PULMONARY

EDEMA)
*Abnormal
accumulation
of
fluid in the interstitial space of the
lungs

CARDIOGENIC SHOCK
*> CO leads to inadequate
tissue perfusion and initiation of the
shock syndrome
THROMBOEMBOLISM
*> mobility of the patient with
cardiac disease and the
impaired
circulation
that
accompany these disorders
contribute to the development
of intracardiac and
intravascular thrombosis.
PERICARDIAC EFFUSION & CARDIAC
TAMPONADE
*Accumulation of fluid in the
pericardial sac
CARDIAC ARREST

*Heart ceases to produce an

effective pulse and circulate blood.
S / Sx : (-) consciousness,
pulse, BP

Ineffective

respiratory

gasping
Dilation of the pupils
Mgt : CPR