Timby/Smith: Introductory

Medical-Surgical Nursing, 10/e

Chapter 22: Introduction to the
Cardiovascular System
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Cardiovascular System
Comprises heart, major blood vessels, and a vast
network of smaller peripheral blood vessels
Five qualities unique to cardiac tissues
Heart Chambers
Four-chambered muscular pump
Upper chambers: Right, left atria
Lower chambers: Right, left ventricles
Thick septum separates the right heart from left
heart
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Cardiac Tissue Layers
Heart wall: Three distinct layers of tissue
epicardium; myocardium; endocardium
Pericardium: Sac-like structure; Surrounds and
supports the heart; Two membranous layers
Heart Valves
Membranous structures: Ensures one-way flow
of blood; Forward direction
Two atrioventricular valves: Separate the atria
from the ventricles
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement true or false?
The cardiac wall has three distinct layers of tissue.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True.
The cardiac wall has three distinct layers of tissue: the
epicardium, the myocardium, and the endocardium.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Heart Valves (Contd)
Cusped Valves: Tricuspid; bicuspid
Chordaea Tendineae: Papillary muscles contract
to prevent eversion of valves, regurgitation of
blood
Semilunar Valves: Prevents blood from flowing
back into the ventricles after the heart contracts
Pulmonary Valve; Aortic valve

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Arteries and Veins
Arteries: Carry oxygenated blood from heart
Veins: Return deoxygenated blood to heart
Arterioles: Smallest arteries; Branch into
capillaries
Capillaries: Connecting network between
arterioles and venules; Deliver O2, metabolic
substances to blood, cells
Venules: Smallest veins
Consist of three layers
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement true or false?
The arteries carry oxygenated blood to the heart.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False.
The arteries carry oxygenated blood from the heart;
the veins return deoxygenated blood to the heart.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Cardiopulmonary Circulation
Inferior, superior venae cavae: Bring venous
blood from all areas of body into right atrium
Pulmonary artery: Branches to deliver venous
blood to right, left lungs
Pulmonary veins: Bring oxygenated blood into
left atrium; Leave left atrium through bicuspid,
mitral valves
Left ventricle pumps blood through the aorta to
all body cells, tissues
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Blood Supply to the Heart
Left, right coronary arteries: Supply oxygenated
blood to cardiac muscle
Myocardium: First tissue supplied with
oxygenated blood
Left coronary artery, branches: Maintain
pumping function of heart
Right coronary artery, branches: Maintain heart
rhythm
Coronary veins: Empty into the coronary sinus in
right atrium
Blood from inferior, superior venae cavae:
Recirculated to lungs
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement true or false?
The left coronary artery and its branches supply blood
to support the pumping function of the entire heart.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True.
The left coronary artery and its branches supply blood
to support the pumping function of the entire heart.
The right coronary artery and its branches supply
blood to support the maintenance of cardiac rhythm.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Cardiac Cycle
Contraction, relaxation of both atria and
ventricles
Contraction of left ventricle: Wave-like impulse
in peripheral arteries
Auscultated lub-dub sounds: Valves
alternately snap shut
Starlings law

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Conduction System
Sustains the electrical activity of the heart
Sinoatrial (SA) node: Pacemaker of the heart
Atrioventricular (AV) node: Impulse delayed a
few hundredths of a second
Normal sequence of events of the cardiac
impulse
Bundle of His; Bundle branches; Purkinje fibers

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Conduction System (Contd)
Polarization;
Depolarization
Repolarization;
Refractory period
Normal ranges of
potassium and calcium
ions
ECG: Record of electrical
changes caused by
depolarization or
repolarization
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Regulation of Heart Rate
Fluctuates per: Stimulation from Autonomic
nervous system; Baroreceptors; Chemoreceptors
Autonomic nervous system: Sympathetic,
parasympathetic nervous system innervation;
Increased heart rate
Parasympathetic innervation: Vagus nerve;
Decreased heart rate
Responses to baroreceptors
Chemoreceptors
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology

Cardiac Output
Amount of blood pumped out of the left ventricle
each minute
Cardiac output = heart rate x stroke volume
Heart adjusts cardiac output to bodys changing
needs
Two ways of increasing cardiac output
Stroke volume: Amount of blood pumped per
cardiac contraction
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment
History
Physical Examination
General appearance;
Pain; Vital signs
Cardiac rhythm;
Heart sounds
Peripheral pulses
Peripheral edema
Weight; Jugular veins
Lung sounds;
Sputum
Mental status
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cardiac Diagnostics
Laboratory Tests: Blood chemistry; Serum enzymes;
Isoenzymes
Radiograph; Radionuclide Studies
Magnetic Resonance Imaging (MRI)
Echocardiography
Transesophageal echocardiography
Electrocardiography
Cardiac Catheterization
Arteriography; Aortography
Nursing Management
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End of Presentation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins