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Presentation B. INGGRIS FIKS BUK PUPUT
Presentation B. INGGRIS FIKS BUK PUPUT
LECTURER:
Mrs Ns. Yelmi Reni Putri, S.Kep,MAN
CREATED BY:
Rosi Oktarida: 1814201054
LECTURE OBJECTIVES
1. Review anatomy & physiology of the
cardiovascular system.
2. Describe physical assessment of
cardiovascular status.
3. Review diagnostic procedures
Anatomy & Physiology
Functions of the heart & CV system
• Pumps blood to tissues to supply O2 &
nutrients
• Remove CO2 & metabolic wastes
Heart Tissue
1. Pericardium :fibrous protective sac enclosing
heart .
2. Epicardium :inner layer of pericardium.
3. Myocardium : heart muscle ,major portion of the
heart .
4. Endocardium: smooth linning of the inner surface
and cavities of the heart .
Circulation in the Heart
1.Right atrium(RA):
receives blood from
systimic circulation, from
the sup&inf vena cava .
2.Right ventricle(RV):
receives blood from RA
and pumps blood via
pulmonary artery to the
lungs for oxygenation .
3.Left atrium(LA):receives
oxygenated blood from the lung
and four pulmonary veins.
4.Left ventricle(LV):receives
blood from LA and pumps blood
via the aorta throughout the
entire systemic circulation.
NOTE: the walls of the LV are
thicker and stronger than the
RV and forms most of the left
side and apex of the heart .
VALVES
• Provide one-way flow of blood .
1.Atrioventricular valves: prevent backflow of blood into
atria during ventricular systole (valves close when
ventricular walls contract ).
(A)-Tricuspid valve (three cusps):RT heart valve.
(B)-Bicuspid or mitral valve (two cusps):LF heart valve .
2.Smilunar valves: prevent backflow of blood from aorta
and pulmonary arteries into the ventricles during diastole.
(A)-Pulmonary valve : prevent RT backflow .
(B)-Aortic vavle : prevent LF backflow .
Cardiac cycle
• The rhythmic pumping action of the heart .
1.Systole : the period of ventricular contraction .
(End-systolic volume is the amount of blood in the
ventricles after systole, about 50 ml )
2.Diastole : the period of ventricular relaxation and
filling of blood .
(End-diastolic volume is the amount of blood in the
ventricles after diastole,about 120 ml )
3.Atrial contraction occurs during the last third
of diastole and completes ventricular filling .
Coronary circulation
1. Arteries: arise directly from aorta near aortic valve.
(A).Right coronary artery (RCA):supplies RT atrium ,most of
RT ventricle, and in most individuals the INF wall of LF
ventricle, atrioventricular(AV)node and 60%of
sinoatrial(SA)node .
(B).Left coronary artery (LCA):supplies most of LF ventricle
;
has two main divisions :
I-left anterior descending (LAD):supplies LF ventricle
,interventricular septum and inferior areas of apex .
II-circumflex (Circ):supplies blood to LAT and inferior, walls
of the LF ventricle, portions of LF atrium and 40% of SA
node .
CARDIOVASCULAR EXAMINATION
1.Health history :
a- Socio - cultural history: - Name ,Age, sex, occupation, educational
level, marital status.
b- Presenting symptoms.
c- Family History
d- Psychosocial Profil
Presenting symptoms
Note onset, progression, and nature of symptoms .
1.Chest pain and shortness of breath.
2.Fatigue:generalized feeling of tiredness.
3.Palpitation:awareness by patient of heart rhythm abnormalities e.g pounding
fluttering.
4.Dizziness, syncope(transient loss of consciousness)due to inadequate
cerebral blood flow.
5.Edema:retention of fluid in the tissues especially in dependent body
parts\L.L with sudden weight gain.
6.Extremity Changes :Changes in the extremities may provide clues about
underlying cardiovascular disease. Symptoms such as Paresthesia (numbness,
tingling), coolness, and intermittent claudication (pain in calves during
ambulation) may be associated with vascular disease, coronary heart disease,
or cerebral vascular disease.
7- Dyspnea and Cough: Dyspnea may also occur with cardiac disease such as
left-sided CHF
Pitting edema
• is a depression in the skin from pressure.
• To demonstrate the presence of pitting edema, the examiner presses firmly
with his or her thumb over a bony surface
• The severity of edema is described on a five-point scale, from none (0) to
very marked (4).
1+ Mild pitting, slight indentation, no perceptible swelling of the leg
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains for a short time, leg looks swollen
4+ Very deep pitting, indentation lasts a long time, leg is very swollen
Risk factor
A. Positive risk factor :
1.hypercholestesterolemia.
2.hypertension
3.cigarette smoking
4. Alcohol
5.sedantary lifestyle.
6.obesity:body mass index (BMI) >30KG or waist girth
>100cm.
7.imparied fasting glucose: fasting blood glucose >110mg\dL
B. Negative risk factor :
as high serum HDL cholesterol>60mg\dL
B- Physical assessment
ASSESSMENT ARTICLES:
• A Double-Headed, Double-Lumen
Stethoscope
• A Blood Pressure Cuff
• A Moveable Light Source or Pen Light
• Sphygmomanometer
• Measure tap
• Wrist watch and pen
INSPECTION:
NECK
• Inspecting the carotid artery
and jugular venous system
• With the patient in a supine
position, inspect the carotid
and jugular venous systems
in the neck for pulsations.
• To visualize external venous
pulsations, look for
pulsations in the
supraclavicular area.
Eyes
• The presence of
yellowish plaques on
the eyelids
(xanthelasma) could
indicate
hyperlipoproteinemia,
a risk factor for
hypertension as well
as arteriolosclerosis.
Chest
• Observe the chest for
overall torso contour.
• Do you see pectus
excavatum (caved-in
chest)?
• Do you see pectus
carinatum (pigeon
chest)?
Skin
• Clubbing
The presence of
clubbing (broadening
of the extremities of
the digits,
accompanied by nails
which are abnormally
curved and shiny)
indicates chronic poor
oxygen perfusion to
the distal tissues of the
hand and feet.
Cyanosis
• The presence of
cyanosis (bluish
colour) also
denotes chronic
poor oxygen
delivery to the
peripheral tissues
of the hands and
feet.
Xanthomas
• The presence of
yellowish plaques
under the skin (noneruptive)
excoriated
through the skin
(eruptive) could
indicate
hyperlipoproteinemia,
a risk factor for
hypertension as well
as arteriolosclerosis.
Edema
• The presence of edema
(tissue swelling) can be
caused by several
factors, although most
commonly is associated
with decreased cardiac
function leading to
decreased capillary
flow.
Palpation
• Use the palm of your hand to feel the chest
wall for the "Point of Maximal Impulse“ (PMI),
which is usually found at the apex of the heart. This
apical pulse is generally located in the 5th
intercostal space, about 7-9 cm (the width of your
palm) to the left of the midline.
PALPATE THE PERIPHERAL ARTERIES. THESE
INCLUDE THE APICAL, RADIAL, CAROTID, BRACHIAL,
FEMORAL, POPLITEAL, AND PEDAL. NOTE THE CONTOUR
AND AMPLITUDE OF EACH PULSATION. THESE SHOULD FEEL
SIMILAR BILATERALLY.
*NOTE: PALATE FOR 30 SECONDS WITH REGULAR RHYTHM
AND 1-2 MIN WITH IRREGULAR RHYTHM.
1.APICAL PULSE
• Or point of maximal impulse (PMI):
• Patient is supine, palpate at 5th interspace,
midcalvicular vertical line(apex of the heart maybe
displaced upward by pregnancy or high diaphragm and
maybe displaced laterally in congestive heart failure,
cardiomyopathy ischemic heart diseases.
2.Radial :palpate radial artery ,radial wrist at base of thumb
(most common monitoring site).
3.Carotid : patient is lying down with head of bed elevated
;palpate over carotid artery ,on either side of anterior neck
between sternocliedomastoid Ms and trachea .
4.Brachial : palpate over brachial artery ,medial aspect of the
antecubital fossa ;used to monitor blood pressuer . Best in
infants.
5.Femoral : palpate over femoral artery in inguinal region .
6.Popliteal : palpate over popliteal artery ,behind the knee with
the knee flexed slightly .
7.Pedal : palpate over dorsalis pedis artery ,doersal medial aspect
of foot ;used to monitor L.L circulation.
CAROTID ARTERY PULSE
BLOOD PRESSURE
BLOOD PRESSURE CLASSIFICATION IN
ADULTS