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Cardiovascular 1

  1. Anatomy and Physiology
  2. Anatomy
    1. Layers
      1. pericardium: fibrous (illustration)
      2. epicardium: covers surface of heart
      3. myocardium: muscular portion of the heart
      4. endocardium: lines cardiac chambers and covers surface of heart valves
    2. Chambers of heart (illustration)
      1. right atrium: collecting chamber for incoming systemic venous system
      2. right ventricle: propels blood into pulmonary system
      3. left atrium: collects blood from pulmonary venous system
      4. left ventricle: thick-walled, high-pressure pump that propels blood into system
    3. Heart valves: membranous openings that allow one way blood flow
      1. atrioventricular valves: prevent backflow from ventricles to atria during systole
      2. tricuspid - right heart valve
      3. mitral - left heart valve
      4. semilunar valves prevent backflow from aorta and pulmonary arteries into ventricles during diastole
        1. pulmonic
        2. aortic (illustration)
    1. Blood supply to heart (illustration 1and illustration 2)
      1. arteries
        1. right coronary artery supplies right ventricle and part of left ventricle
        2. left coronary artery supplies mostly left ventricle
      2. veins
        1. coronary sinus veins
        2. thebesian veins
    2. Conduction system (illustration)
      1. SA (sinoatrial) node
      2. junctional tissue
      3. bundle branch Purkinje system
  3. Physiology (illustration)
    1. Function of the heart is the transport of oxygen, carbon dioxide, nutrients and waste products
    2. Cardiac cycle consists of: (illustration)
      1. systole - the phase of contraction during which the chambers eject blood
      2. diastole - the phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.
    3. Blood flow: (illustration 1  illustration 2)
      1. deoxygenated blood enters the right atrium through the superior and inferior vena cava
      2. enters the right ventricle via the tricuspid valve
      3. travels through the pulmonic valve to pulmonary arteries and lungs
      4. oxygenated blood returns from lungs through the pulmonary veins into left atrium and enters the left ventricle via bicuspid (mitral) valve.
      5. from the left ventricle, through the aortic valve through the aorta to the systemic circulation
    4. The heart itself is supplied with blood by the left and right coronary arteries (illustration)
    5. The vascular system is a continuous network of blood vessels.
      1. the arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues
      2. oxygen, nutrients and metabolic waste are exchanged at the microscopic level
      3. the venous system, veins and venules, returns the blood to the heart (illustration)
        Heart infections
  4. Pericarditis
    1. Definition and related terms
      1. in pericarditis, an infection (from a bacterium, a fungus, Systemic Lupus Erythematosus (SLE), etc.) inflames the pericardium.
      2. there may or may not be pericardial effusionor constrictive pericarditis.
      3. dressler's Syndrome, also called postmyocardial infarction syndrome, is a combination of pericarditis, pericardial effusionand constrictive pericarditis. It occurs several weeks to months after a myocardial infarction. Etiology unclear.
    1. Epidemiology
      1. may be acute or chronic and may occur at any age.
      2. pericarditis occurs in up to 15% of persons with a transmural infarction.
    2. Findings 
      1. sharp chest pain often relieved by leaning forward
      2. pericardial friction rub
      3. dyspnea
      4. fever, sweating, chills
      5. dysrhythmias
      6. pulsus paradoxus
      7. client cannot lie flat without pain or dyspnea
    1. Management
      1. antibiotics to treat underlying infection
      2. corticosteroids: usually reserved for clients with pericarditis due to SLE, or clients who do not respond to NSAID
      3. NSAIDS/Asprin for pain and inflammation
      4. oxygen: to prevent tissue hypoxia
      5. surgical
        1. emergency pericardiocentesis if cardiac tamponadedevelops
        2. for recurrent constrictive pericarditis, partial pericardiectomy (pericardial window) or total pericardiectomy
    2. Nursing interventions
      1. manage pain and anxiety
      2. the cardio-care six 
      3. maintain a pericardiocentesis set at the bedside in case of cardiac tamponade.
      4. assess respiratory, cardiovascular, and renal status often.
      5. observe for findings of infiltration or inflammation at the venipuncture site, a possible complication of long-term IV administration. Rotate the IV sites often.
      6. client and family teaching - teach the cardio five 
    3. Diagnostic studies
      1. EKG changes, arrythmias
      2. echocardiography to determine pericardial efusion or cardiac tamponade
      3. history and physical exam
  5. Myocarditis
    1. Definition - an inflammatory condition of the myocardium caused by
      1. viral infection
      2. bacterial infection
      3. fungal infection
      4. serum sickness
      5. rheumatic fever
      6. chemical agent
      7. as a complication of a collagen disease, i.e. SLE
    2. Epidemiology
      1. may be acute or chronic and may occur at any age.
      2. usually an acute virus and self-limited, but it may lead to acute heart failure.
    3. Findings
      1. depends on the type of infection, degree of myocardial damage, capacity of myocardium to recover, and host resistance
      2. may be minor or unnoticed: fatigue and dyspnea, palpitations, occasional precordial discomfort manifested as a mild chest soreness and persistent fever
      3. recent upper-respiratory infection with fever, viral pharyngitis, or tonsillitis
      4. cardiac enlargement
      5. abnormal heart soundsmurmur, S3or S4or friction rub
      6. possibly findings of congestive heart failuresuch as pulsus alternans, dyspnea, and crackles
      7. tachycardiadisproportionate to the degree of fever
    4. Diagnostic studies
      1. EKG for changes and arrythmias
      2. labs
        1. increases ESR
        2. increases myocardial enzymes such as:
          • AST
          • CK
          • LDH
      3. endomyocardial biopsy (EMB)
      4. myocardial imaging