Paper

English in Nursing

Cardiovascular System

By :

Latansa Hayyil Islam 131411131001

Yuni Natilia 131411131019
Neri Andriani 131411131040
Eva Diana 131411131055
Widya Fathul Jannah 131411131073
Pratama Soldy Izzulhaq 131411131091
Nuzulia Azizi Islamia 131411133005
Ayu Tria Kartika Putri 131411133023

Fasilitator : Ira Suarilah, S.Kp., M.Sc

NURSES EDUCATION STUDY PROGRAM

FACULTY OF NURSING

AIRLANGGA UNIVERSITY

SURABAYA

2015
 PREFACE

Praise be to God Almighty who has given his grace so I managed to finish
a paper entitled "Cardiovascular System". The purpose of this paper is to fulfill
the task of small group discussions English courses in Nursing.

Writing scientific papers is not separated from the cooperation and support
of the other people. Therefore, in this occasion the author would like to thank Ira
Suarilah, S.Kp., M.Sc as supervisor English courses in Nursing. And friends who
have helped we in completing this paper.

The author hopes the paper can be useful for writers and readers. The
authors recognize that in making this paper is far from perfect, to the authors
accept constructive criticism and suggestions for improvement towards perfection.

Surabaya, April 28th 2015

Authors

ii
 CONTENTS

COVER PAGE........................................................................................... i
PREFACE................................................................................................... ii
CONTENTS................................................................................................ iii
CHAPTER I INTRODUCTION 1
1.1 Background 1
1.2 Purpose 1
1.3 Benefit .. 1
CHAPTER II THEORITICAL REVIEW 2
2.1 Cardiovascular system 2
2.2 The heart 2
2.3 The blood vessels 7
2.4 The circulatory system 8
2.5 Atrial Septal Defect 9
CHAPTER III CLOSING 14
3.1 Conclusion 14
3.2 Advice 14
BIBLIOGRAPHY 15

iii
 CHAPTER I

INTRODUCTION

1.1 Background
Cardiovascular system consists of the heart, blood vessels (arteries, veins,
capillaries) and the circulatory system. The function of the cardiovascular
system is to ensure an adequate circulation of blood to the tissue of the body at
all times and thus to transport substance to and from the individual cells as
required. The main role of the cardiovascular system being a general transport
and can be subdivided into the following:
1. Delivery of substance to a body tissues to maintain nutrition and metabolic
function. There are oxygen, nutrient, and other substance manufactured in
the body such as hormones, amino acids, and defend cells.
2. Removal of carbon dioxides and metabolic end product from tissues and
delivery to the appropriate organ for break down and elimination, such as
to the lungs, liver, or kidneys.
3. The dissipation of heart away from active tissue and its redistribution
around the body to maintain body normal temperature.
1.2 The Purpose
1.2.1 General Purpose
To understand about the anatomy and physiology of the cardiovascular
system
1.2.2 Special Purpose
To understand the cardiovascular disorder atrial septal defect
1.3 Benefits
To understand how the cardiovascular system in human body and disorder
atrial septal defect.

CHAPTER II

THEORITICAL REVIEW

2.1 Cardiovascular System

1
 Cardiovascular system consists of the heart, blood vessels (arteries, veins,
capillaries) and the circulatory. The function of the cardiovascular system is to
ensure an adequate circulation of blood to the tissue of the body at all times and
thus to transport substance to and from the individual cells as required (Hammer,
2014).1

2.2 Heart

Heart is a cone shaped muscle with four chambers, a double pump about
the size of a clenched fist (12 cm long and 9 cm wide). Weights 250-390 g (8.8-
13.8 oz) in adult males and 100-275 g (7.0-9.7 oz) in adult females. The location
of the heart is situated between the two lungs in the thoracic cavity, with about
two-thirds lying to the left of the bodys midline.

2.2.1 Anatomy

1. The heart wall

1) Endocardium: inner layer of heart, a smooth, thin layer of endothelium

and connective tissue. Smooth inner lining of the heart

1
Hammer, Gary D. 2014. Pathophysiology of Disease. St.Louis, Missouri: Elsevier (Page
201).

2
2) Myocardium: middle and thickest layer of the heart, heart muscle.
Responsible for cardiac contraction.
3) Epicardium: the layer of serous pericardium on hearts surface.
Contains main coronary blood vessels.
4) Pericardium: sac that surrounds the heart and roots of the great vessels.
Composed of two layers, fibrous pericardium (outer layer of fibrous
connective tissue) and serous pericardium. Serous pericardium also has
two layers, outer or parietal layer that lines the fibrous layer and
visceral or inner layer that lines the heart and is also called the
epicardium. Serous pericardium contains pericardial fluid (10-20 mL
of serous fluid). Pericardial fluid moistens the pericardial sac between
the two layers and prevents friction during systole and diastole.

2. The chambers

The interior of the heart is divided into four hollow chambers

which receive the circulation blood.

1) Right atrium: upper chamber of right heart. Receives unoxygenated

blood from superior and inferior vena cava.

2) Left atrium: upper chamber of left heart. Receives oxygenated

blood from lungs through pulmonary veins.

3) Left ventricle: lower chamber of left heart. Receives blood from

left atrium and pumps oxygenated blood through systemic
circulation.

3. The valves

1) Tricuspid valve: right AV valve with three cusps (tricuspid).

Attached by chordae tendineae to papillary muscles, which are
attached to inner heart muscle. Valve between right atrium and
right ventricle.

3
 2) Mitral valve: AV valve with two cusps (bicuspid) attached by
chordae tendineae to papillary muscles, which are attached to inner
heart muscle. Valve between left atrium and left ventricle.
3) Pulmonary semilunar valve: composed of three cusps. Valve
between right ventricle and main pulmonary artery.
4) Aortic valve: composed of three cusps. Valve between left ventricle
and aorta.
4. The Vessels
1) Pulmonary semilunar valve: composed of three cusps. Valve
between right ventricle and main pulmonary artery.
2) Pulmonary veins: veins leading from lungs to left atrium. Carry
oxygenated blood to left atrium.
3) Aortic valve: composed of three cusps. Valve between left ventricle
and aorta.2

2.2.2 Heart Physiology

1. Electrical Activity
Electrical potentials across cell membranes are present in
essentially all cells of the body. Some cells, such as nerve and muscle
cells, are specialized for conduction of electrical impulses along their
membranes. This electrical potential (transmembrane potential), refers
relative electrical difference between the interior of a cell and that of the
fluid surrounding the cell. Ionic channels are pores in cell membranes that
allow for passage of specific signals. Transmembrane potentials and ionic
channels are extremely important in myocardial cells because they form
the basis for electrical impulse conduction and muscular contraction. In a
myocardium cell, when a sudden increase in permeability of the membrane
to Na+ occurs, a rapid sequence of events follows that lasts a fraction of a
second. This sequence of events is termed depolarization.
2. Cardiac Cycle
The cardiac cycle comprises all the physiological events needed for the
heart to beat. The valves, the hemodynamic events within the heart and the
conduction system work together in the cardiac cycle. The cardiac cycle
comprises systolic and diastolic phases. The systolic phase is the
2
Hammer, Gary D. 2014. Pathophysiology of Disease. St.Louis, Missouri: Elsevier (Page
204).

4
 contraction or emptying phase, and the diastolic phase is the resting or
filling phase. The atria and ventricles alternate through the systolic and
diastolic phases, while the atria are contracting, the ventricles are relaxing,
and vice versa.

3. Conduction System of Heart

1) SA Node
This node is the beginning of heart contraction, after that impulses
run to AV Node. This node influenced by sympathetic and
parasympathetic nerves that accelerate or slow down the rhythm.
2) AV Node
AV Node delay impulses until filling of atrial finished and before
contraction of ventricular.
3) AV Bundle
The impulses run from AV Node to front, edge and under of pars
membransea. After that impulses run to cordis stale and split become
two pars septalis dekstra and pars septalis sinistra.
4) Purkinje Fibers
In this place, conductivity speed become 5 times. Fast conductivity
make left and right atrial contraction together, and followed by
ventricular contraction.
4. Cardiac Output

The cardiac output is the amount of blood ejected per minute. Cardiac
output equals stroke volume multiplied by heart rate. The magnitude of
cardiac output is influenced by the circumstances:

a. Preload

Preload is a state in which left ventricular cardiac muscle fibers

elongated or stretched until the end of diastole.

b. Afterload

Afterload are prisoners caused by left ventricular pump, to open the

aortic valve during systole and when the blood pumping.

c. Contractility

5
 The strength of contraction of the heart muscle influence on cardiac
output, heart muscle contraction stronger the more the volume of blood
ejected.

5. Mechanisms of Heart Sounds

1) Heart Sound (HS) 1: location at ICS 4 and 5 (on left side). Closing of
the mitral and tricuspid valve.
2) Heart Sound (HS) 2: location at ICS 2 and 3. Closing of the aortic and
pulmonary valve.
3) Heart Sound (HS) 3: extra sounds in diastole after HS1.
4) Heart Sound (HS) 4: extra sounds in diastole before HS2.
5) Murmur: turbulency stream (systolic and diastolic murmur).
6. Frequency heart

The heart beats in one minute around 60-100 times or an average of 75

times per minute. If the heart beats more than 100 times called tachycardia
and if less than 60 times is called bradycardia. Heart rate is influenced by
the state of activity, age, gender, endocrine, temperature, blood pressure,
anxiety, stress, and pain.

7. The Stroke Volume

Stroke volume is less variable and responds to change in preload,

afterload, and contractility of the heart. Preload refers to the volume of
blood in the ventricles at the end of diastole. The greater the preload, the
greater the stretch or contractility of the ventricles, and the greater the
stroke volume. An increase in venous return to the heart will, in turn,
increase preload.3

2.3 Blood Vessels

2.3.1 Anatomy

1. Arteries: blood vessels with three coats, tunica intima, tunica media, and
tunica adventitia. Carry oxygenated blood away from left heart and
unoxygenated blood to lungs via pulmonary arteries.

3
Hammer, Gary D. 2014. Pathophysiology of Disease. St.Louis, Missouri: Elsevier (Page
206)

6
 2. Tunica intima: inner layer of endothelial cells containing basement
membrane of fine, collagenous fibers and external elastic layer called
internal elastic lamina.
3. Tunica media: middle, thickest layer containing collagenous fibers,
connective tissue, smooth muscle cells, and elastic fibers.
4. Tunica adventitia: outer layer containing collagen and elastic fibers,
nerves, lymphatic vessels.
5. Arterioles: smallest arteries, contain large amount of smooth muscle cells
that can dilate and constrict. Carry blood to capillaries and control blood
flow to capillaries through dilation/constriction.
6. Capillaries: single layer of microscopic endothelial cells. Connect arterial
and venous system for exchange of gases, fluids, nutrients, and wastes.
7. Veins: contain same three layers as arteries, but are thinner with less elastic
and collagenous tissue and smooth muscle. BP in venous system is low,
veins have valves to prevent backflow. Carry unoxygenated blood from
lungs to the left heart.
8. Venules: smallest veins, consisting of endothelium and thin tunica
adventitia. Blood from capillaries drains into venules.4

2.4 The Circulatory System

The circulatory system has two main networks, the pulmonary circulation
and systemic circulation. The coronary circulation is part of the systemic
circulation and supplies the heart itself.

1) Systemic Circulation
The systemic circulation is responsible for supplying oxygen to
every cell in the body through the arterial system and then returning
unoxygenated blood to the heart through the venous system. Oxygenated
blood flows into the left atrium from the pulmonary circulation. The left
atrium then pumps the oxygenated blood into the left ventricle
Heart to tissues of the body back to heart

2) Pulmonary Circulation

4
White Louis. 2013. Medical-Surgical Nursing. Delmar: International Edition (Page 345)

7
 The coronary circulation is responsible for supplying the heart with
the oxygen needed to perform this task effectively. The coronary
circulation consists of the right and left coronary arteries and the coronary
sinus and cardiac veins. The coronary arteries are the first branches off the
aorta. The cardiac veins drain into the coronary sinus, which in turn drains
directly into the right atrium.5
Heart lungs back to heart

2.5 Atrial Septal Defect (ASD)

5
Nursalam. 2010. English In Nursing-Midwifery Science and Technologies. Jakarta:
Salemba Medika (Page 96).

8
 Atrial Septal Defect (ASD) is one of the more commonly recognized
congenital cardiac anomalies presenting in adulthood. Atrial septal defect is
characterized by a defect in the interatrial septum allowing pulmonary venous
return from the left atrium to pass directly to the right atrium. Depending on the
size of the defect, size of the shunt, and associated anomalies, this can result in a
spectrum of disease from no significant cardiac sequelae to right-sided volume
overload, pulmonary arterial hypertension, and even atrial arrhythmias.

2.5.1 Types and Classification

1) Ostium secundum defect, the most common type, occurs in the area of
the fossa ovalis and sometimes extends close to the inferior vena cava.
2) Defective venous sinus, occurred in the superior-posterior porsio atrial
septum, sometimes extends into the vena cava and almost always
associated with abnormal pulmonary venous drainage into the right
atrium.
3) Ostium primum defect, occurs in the septum primum porsio and
usually associated with abnormalities of atrioventricular valve (mitral
valve cleft) and conduction defects.

2.5.2 Etiology

Atrial septal defect (ASD) is a congenital cardiac disorder caused by the

spontaneous malformation of the interatrial septum. The cause is not yet known
with certainty, but there are some factors suspected to have an influence on
increasing the incidence of ASD.

These factors include:

1) Prenatal Factors

a) Mother Rubella infections

b) Mother alcoholism

c) Maternal age over 40 years

9
 d) Mother suffered IDDM

e) Mothers taking sedative drugs or herbal

2) Genetic factors

a) Children born before suffering from CHD

b) Father or mother suffering from CHD

c) Down syndrome is a chromosomal abnormality such

d) Born with other congenital abnormalities

2.5.2 Pathophysiology

Shunting of blood from the right atrium to the left atrium due to left
atrial pressure is normally slightly higher than right atrial pressure. This
pressure difference forces blood in large numbers into the defect. These shunts
cause right heart volume overload, which affects the right atrium, right
ventricle, and the pulmonary artery. In the end, enlarged right atrium and right
ventricle dilates to accommodate the increased blood volume. In case of
pulmonary arterial hypertension, pulmonary vascular resistance will increase
followed by right ventricular hypertrophy. Irreversible pulmonary arterial
hypertension causes backflow shunt in some adults, which resulted in no
oxygenated blood enters the systemic circulation and eventually cyanosis.6

2.5.3 Symptoms

1) Fatigue
2) Child tired easily when playing
3) Sweating
4) Shortness of breath and difficulty breathing

6
Kluwer, Wolters. 2008. Kapita Selekta Penyakit: dengan Implikasi
Keperawatan, Ed.2. Jakarta: Kedokteran ECG (Page 124).

10
 5) Rapid breathing
6) The gathering of blood and fluid in the lungs
7) Poor growth

2.5.4 Clinical Manifestations

1) Noisy systolic ejection type in the area between the ribs of two / three left
sternal edge.

2) Dyspnea

3) Arrhythmias

4) Frequent respiratory infections

5) The weight that is difficult to grow

6) Pounding heartbeat (palpitation)

7) Do not have a good appetite

8) Quick tired and reduced level of activity

9) Fever of unexplained causes

10) Cyanosis of the skin around the mouth or lips and tongue

2.5.5 Supporting Investigation

1) Chest x-ray: a diagnostic test which uses invisible electromagnetic energy

beams to produce images of internal tissues, bones, and organs onto film.
With an ASD, the heart may be enlarged because the right atrium and
ventricle have to handle larger amounts of blood flow than normal. Also,
there may be changes that take place in the lungs due to extra blood flow
that can be seen on an x-ray.
2) Electrocardiogram (ECG or EKG): a test that records the electrical
activity of the heart, shows abnormal rhythms (arrhythmias or
dysrhythmias), and detects heart muscle stress.

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 3) Echocardiogram (echo): a procedure that evaluates the structure and
function of the heart by using sound waves recorded on an electronic
sensor that produce a moving picture of the heart and heart valves. An
echo can show the pattern of blood flow through the septal opening, and
determine how large the opening is, as well as how much blood is passing
through it.
4) Cardiac catheterization: a cardiac catheterization is an invasive procedure
that gives very detailed information about the structures inside the heart.
Under sedation, a small, thin, flexible tube (catheter) is inserted into a
blood vessel in the groin, and guided to the inside of the heart. Blood
pressure and oxygen measurements are taken in the four chambers of the
heart, as well as the pulmonary artery and aorta. Contrast dye is also
injected to more clearly visualize the structures inside the heart. If the
echocardiogram has provided enough information, this procedure is often
not needed to evaluate ASD.
2.5.6 Treatment for Atrial Septal Defect
1) Medical management
Some children may need to take medications to help the heart work
better, since the right side is under strain from the extra blood passing
through the ASD. Medication that may be prescribed include the
following:
a) Sigoxin: a medication that helps strengthen the heart muscle,
enabling it to pump more efficiently.
b) Diuretics: the body's water balance can be affected when the heart
is not working as well as it could. These medications help the
kidneys remove excess fluid from the body.
2) Infection control
Children with certain heart defects are at risk for developing an
infection of the inner surfaces of the heart known as bacterial
endocarditis. A common procedure that puts your child at risk for this
infection is a routine dental check-up and teeth cleaning. Other
procedures may also increase the risk of the heart infection occurring. It

12
 is important that you inform all medical personnel that your child has an
ASD so they may determine if the antibiotics are necessary before a
procedure.
3) Surgical repair
The child's ASD may be repaired surgically in the operating room,
or by a cardiac catheterization procedure. The surgical repair is
performed under general anesthesia. The defect may be closed with
stitches or a special patch. The cardiac catheterization procedure may
also be an option for treatment. During the procedure, the child is sedated
and a small, thin, flexible tube (catheter) is inserted into a blood vessel in
the groin and guided to the inside of the heart. Once the catheter is in the
heart, the cardiologist will pass a special device, called a septal occluder,
into the open ASD preventing blood from flowing through it. 7

CHAPTER III

CLOSURE

3.1 Conclusion
Cardiovascular system consists of the heart, blood vessels (arteries,
veins, capillaries) and the circulatory. The function of the cardiovascular
system is to ensure an adequate circulation of blood to the tissue of the
body at all times and thus to transport substance to and from the individual
cells as required. The heart is a complex organ whose primary function is
to pump blood through the pulmonary and systemic circulations.
Atrial Septal Defect (ASD) is one of the more commonly
recognized congenital cardiac anomalies presenting in adulthood. The type

7
Hammer, Gary D. 2014. Pathophysiology of Disease. St.Louis, Missouri: Elsevier (page
545)

13
 of Atrial Septal Defect are: Ostium secundum ASD, Ostium primum ASD,
Sinus venosus ASD, Coronary sinus ASD. The symptoms are: Fatigue,
Child tired easily when playing, sweating, shortness of breath and
difficulty breathing, rapid breathing, the gathering of blood and fluid in the
lungs, poor growth. Causes: Prenatal factors, genetic factors, and the ostium
primum defect usually experienced by patients with Down syndrome.
3.2 Advice
Through this paper the authors are expected to add insight and
knowledge of the cardiovascular system and disorder in atrial septal
defect. The authors hope this paper can be useful for writers and the
readers. In providing nurse care, nurses should attention the theory and
skills that have been acquired. Because between theory and practice there
is attachment. So the patients will receive optimal treatment.

BIBLIOGRAPHY

Hammer, Gary D. (2014). Pathophysiology of Disease. St.Louis, Missouri:

Elsevier.

Kluwer, Wolters. (2008). Kapita Selekta Penyakit: dengan Implikasi

Keperawatan, Ed.2. Jakarta: Kedokteran ECG.

Nursalam. (2010). English In Nursing-Midwifery Science and Technologies.

Jakarta: Salemba Medika.

Udjianti, Wayan Juni. 2010. Keperawatan Kardiovaskuler. Jakarta: Salemba

Medika

White Louis. (2013). Medical-Surgical Nursing. Delmar: International Edition.

14
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