cardiac anatomy and physiology

Cardiac Anatomy and Physiology

Overview

• Anatomy and Physiology

• Terms

Anatomy and Physiology

• The body needs O2 to support daily activity blood is that delivery system the heart is the medium to supply the blood

• 100,000 beats in 24 hours• 5-20 litres per minute • Responds to activity

Anatomy and Physiology

Anatomy and Physiology

• Positioned behind sternum

• Apex at 5th intercostal space mid-clavicular

• Base 1.5cms left of sternum

• Approx 10cms long • Weights 270gms

Anatomy and Physiology

Anatomy and Physiology

Anatomy and Physiology

Anatomy and Physiology

Pericardium Layered fluid filled sac surrounds heart

EpicardiumSingle layer

Myocardium Muscular wall of heart

Endocardium Inner surface of heart forms valves

Anatomy and Physiology

• Aortic • Mitral • Pulmonary • Tricuspid • Control one-way flow of blood • Formed from folds of endocardium and fibrous tissue

Anatomy and Physiology

Anatomy and Physiology

Anatomy and Physiology

Terms

• Atrial kick• Pre-load• After-load• Contractility• Stroke Volume• Cardiac output• Cardiac reserve

Terms:atrial kick

• The amount of blood pumped into the ventricles resulting from atrial contraction.

Terms:pre-load

• The stretch of the myocardial fibres at end diastole,• The ventricle end diastolic pressure and volume.

Terms:after-load

• The resistance, against which the ventricle must eject its volume of blood during contraction.

• The resistance is produced by the volume blood already in the vascular system and the vessel walls.

Terms:contractility

• The ability of the cardiac muscle fibres to contract or shorten

• Frank-starlings law

Terms:stroke volume

• The amount blood ejected by ventricle during contraction,

• Ejection fraction proportion of blood expelled in contraction compared to filling volume,

• Normally 65% used as measure of normal LV function,

Terms:cardiac output

CO = HR x SV

BP = CO x SVR

Cardiac Index = cardiac output of pt per square metre of body surface area

Terms:cardiac reserve

Cardiac Assessment

Overview

• Physical Assessment– Inspection – Palpation– (Percussion)– Auscultation

• History

Assessment

• Inspection

• Palpation

• (Percussion)

• Auscultation

Assessment

• Inspection– JVP– Oedema– Colour

Assessment

• Palpation– Pulse– Oedema– Capillary refill– Blood pressure

Assessment

• Auscultation– Normal

• S1 • S2

– Abnormal • S2 split• S3• S4

Assessment

Assessment

Assessment

Pneumothorax

Myocardial Infarction

Respiratory

InfectionAngina

Musculoskeletal

PericarditisAortic Dissection

Trauma

Anxiety

Pulmonary Embolism

Oesophageal Reflux / Spasm

Causes of chest pain

Case 1:• 40 year old man• 2 hours central chest pain• Radiating to (L) arm• Pale, cold, clammy

Case 2:• 55 year old woman• 1 hour generalised weakness and unwell• Discomfort in throat

Who is having a MI?

Diabetes

High Blood Pressure

Physical

Inactivity

Over 40

Vascular Disease

High

Cholesterol

Previous MI

Obesity

SmokingFamily History

Unhealthy Dietary Habits

Risk Factors

• Early Recognition and Assessment

• Early Access

• Early CPR

• Early Defibrillation

• Early Advanced Cardiac Life Support

Chain of Survival

Case 1:• 40 year old man• 2 hours central chest pain• Radiating to (L) arm• Pale, cold, clammy

Triage:• Rapid Assessment• Prioritise Injury / Illness• Allocate Triage Category

Scenario

Primary Assessment• A – clear and open • B – spontaneous, AE R=L o added sounds • C – tachycardic - weak, diaphoretic• D – GCS 15, PEARL, full ROM / Strength / Sensation all limbs

Secondary Assessment• E – Change into patient gown• F – Observations: R: 28, P: 120, BP: 149/66, T: 372, (monitor) BSL: 6.9, Pain 5/10, SpO2 99% RA

• G – Comfort measures• H – Detailed history / Family History / heat-to-toe assessment

Time = Muscle

Assessment

lleregiesA

M

P

L

E

edications

revious medical, surgical and family history

ast meal

vents

Assessment

osition: Where is the Pain?P

Q

R

S

T

A

A

A

uality: What does the pain feel like? [sharp, dull, burning]

adiation: Does the pain move anywhere?

everity: Rate the pain on a scale between 0 and 10

iming: When did the pain start? Is it continuous?

lleviating factors: What makes it better?

ggravating factors: What makes it worse?

ssociated symptoms: e.g., nausea / pins and needles

Assessment

Inspect

Palpate

Percussion

Auscultation

Assessment

Notify Nursing Team Leader and Senior Doctor

Primary• B – Supplementary Oxygen• C – ECG

Nursing Intervention

Nursing Intervention

Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow

Notify Nursing Team Leader and Senior Doctor

Primary• B – Supplementary Oxygen• C – ECG IVC 18g Bloods to pathology (FBC, UEC, CP, CK, Troponin, ABG) Secondary• F – Observations • G – Analgesia / Medications• Reassurance, bed rest, patient and family education

Nursing Intervention

• Interpretation of ECG • Chest X-Ray• IVC bloods to pathology• Medications

• Anginine• Aspirin • Morphine• GTN infusion• Clopidogrel• Heparin• Cardiology Review

• Treatment Options• PTCA• Thrombolysis

Medical Intervention