CIRCULATION

Ms. Jonalyn P. Santos

PHYSIOLOGY OF THE
CARDIOVASCULAR SYSTEM
THE HEART
 Coronary circulation
 Coronary arteries which receive blood during diastole
 Clogging may lead to Angina (Chest pain) or
Infarction (MI or heart attack)
 Cardiac cycle
 Systole: contraction
 Diastole: relaxation
 Allows filling of ventricles with blood
 Twice as long as systole
 Longer diastole=more filling of blood; shorter
diastole=less filling of blood=less cardiac output
PHYSIOLOGY OF THE
CARDIOVASCULAR SYSTEM
 Cardiac conduction system
 Sinoatrial Node: primary pacemaker
 Initiates electrical impulses that result to contraction
 Atrioventricular Node; Bundle of His; Purkinje Fibers
 Cardiac output (SV x HR)
 Amount of blood pumped out of the heart in one full
minute
 Stroke volume: amount of blood pumped out of the
heart per beat
 Factors that affect cardiac output:
 Hear rate
 Increased heart rate increases CO
 If >150bpm causes decrease in CO
PHYSIOLOGY OF THE
CARDIOVASCULAR SYSTEM
 Preload
 Degree to which the muscle fibers in ventricles are
stretched at the end of diastole
 Depends on VENOUS RETURN
 More venous return= stretching of muscles= force of
contraction= CO
 Contractility
 contractility= SV= CO
 Afterload
 Resistance against which the heart must pump to eject
blood
 Pressure exerted by heart should be greater than
VASCULAR RESISTANCE
 Constriction= PVR= afterload= cardiac workload
PHYSIOLOGY OF THE
CARDIOVASCULAR SYSTEM
THE BLOOD VESSELS
 Arterial circulation
 From heart to tissues
 Blood flows from higher to lower pressure
 Venous return
 Low pressure system
 Presence of valves: prevents backflow of blood
THE BLOOD
Functions:
 Transport
 Regulating body temperature, pH and fluid
volume
 Prevent infection and blood loss
Factors affecting Cardiovascular
Function:
RISK FACTORS
 Nonmodifiable Risk factors
 Heredity: Family history or genetics
 Age: Over 60 years
 Gender: more common in males
 Modifiable Risk Factors:
 Elevated Serum Lipid Levels
 Hypertension
 Cigarette smoking
 Diabetes: viscosity of blood
 Obesity
 Sedentary Lifestyle
Factors affecting Cardiovascular
Function:
Other factors
 Heat and Cold
 Vasodilation and vasoconstriction which alters blood pressure
and cellular demands
 Health status
 Stress and Coping
 Release of epinephrine and norepinephrine which causes
changes in cardiac activity
 Diet
 High salt and high fat intake
 Alcohol
 1-2 oz of alcohol per day reduce risk of heart disease (only true
to Caucasians)
 In excess: increases blood pressure, can cause malnutrition
Alterations in Cardiovascular
Function:
-Cardiovascular function can be altered by
the conditions that affect:
 Function of the heart as a pump
 Blood flow to the organs and tissues
 Composition of the blood and its ability to
transport oxygen and carbon dioxide
Alterations in Cardiovascular
Function:
1. DECREASED CARDIAC OUTPUT
 Conditions that may alter the cardiac
output:
 Occlusion
of vessels that supply the heart
muscle=poor contractility
 Myocardial Infarction (Heart Attack): May
result to necrosis of tissues
 Signs and symptoms: chest pain, nausea,
SOB, diaphoresis
Alterations in Cardiovascular
Function:
 Heartfailure: the heart can no
longer keep up with the demands of
the body for oxygen and nutrients
 This usually occurs due to MI
 Other causes: uncontrolled

hypertension
 Left sided heart failure: pulmonary s/s

 Right sided heart failure: systemic s/s

Alterations in Cardiovascular
Function:
 Myocarditis and cardiomyopathy:
affects cardiac muscles and interferes
with contractility
 Very irregular or excessively rapid or

slow heart rates: interfere with

adequate filling of the atria
 Alterations in the structure of the heart

such as congenital heart defects

Alterations in Cardiovascular
Function:
2. IMPAIRED TISSUE PERFUSION
 Causes:
 Atherosclerosis: the most common cause of impaired
blood flow
 Embolism

 Thrombosis

 Ischemia: lack of blood supply due to obstructed

circulation
 Coronary arteries= Myocardial Ischemia or Angina
Pectoris
 Cerebral arteries= Transient Ischemic Attack or CVA
Alterations in Cardiovascular
Function:
 Peripheral vascular diseases
 Arterial insufficiency: defective supply of
blood
 No pulses, cold, relieved by lowering the
affected extremity
 Venous insufficiency: defective return of
blood to heart
 With pulses, warm, edema, relieved by
elevating the affected extremity
 Homan’s Sign- thrombophlebitis
Alterations in Cardiovascular
Function:

3. BLOOD ALTERATIONS
 This include problems with:
 Inadequate RBC’s
 Low hemoglobin levels

 Abnormal RBC or hemoglobin

structure
 Inadequate blood volume
Nursing Interventions:
 Promoting circulation
 Changing position frequently
 Ambulation and exercise: prevents
pooling of blood in the extremities that
can lead to Thrombophlebitis-
VASCULAR:
 Elevate legs to promote venous return
 Avoid pillows under knees or more than 15

degrees of flexion to improve blood flow

Nursing Interventions:

 Avoid constricting shoes or socks or

stockings
 Leg exercises and ambulation

 Frequent position changes

 CARDIAC:
 High Fowler’s to decrease preload
 Monitor fluid status
Nursing Interventions:
 Medications
 Vasodilators and drugs that reduce cardiac
workload:
 ACE inhibitors (Captopril)
 Nitrates (Isordil)
 Calcium channel blockers (Neo-bloc)

 Inotropic agents: increase cardiac contractility

(Digitalis)
 Antihypertensives
 Beta adrenergic blockers: decrease O2 consumption
and to block SNS action on the heart (Metoprolol)
 Diuretics (Furosemide)
Nursing Interventions:
 Preventing venous stasis
 Causes or Risk Factors:
 Patients who are immobile and confined to bed have
greater risk of developing venous stasis
 Sitting in a dependent position for long periods

 Jobs that require prolonged standing or sitting

 Measures to prevent venous stasis:

 Ambulation
 Frequent position changes

 Use of anti-embolic stockings

 Avoid use of constricting clothing