PLT COLLEGE INC.

College of Nursing
Bayombong, Nueva Vizcaya

Nursing Care Management 103 (Care of the Clients with Cardiovascular & Hematologic
Diseases)

ANATOMY & PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM

Functions of the Heart

1. Managing blood supply. Variations in the rate and force of heart contraction
match blood flow to the changing metabolic needs of the tissues during
rest, exercise, and changes in body position.
2. Producing blood pressure. Contractions of the heart produce blood pressure,
which is needed for blood flow through the blood vessels.
3. Securing one-way blood flow. The valves of the heart secure a one-way
blood flow through the heart and blood vessels.
4. Transmitting blood. The heart separates the pulmonary and systemic
circulations, which ensures the flow of oxygenated blood to tissues.

Anatomy of the Heart

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 Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart
weighs less than a pound.
 Mediastinum. Snugly enclosed within the inferior mediastinum, the medial cavity
of the thorax, the heart is flanked on each side by the lungs.
 Apex. It’s more pointed apex is directed toward the left hip and rests on the
diaphragm, approximately at the level of the fifth intercostal space.
 Base. Its broad posterosuperior aspect, or base, from which the great vessels of
the body emerge, points toward the right shoulder and lies beneath the second
rib.
 Pericardium. The heart is enclosed in a double-walled sac called the
pericardium and is the outermost layer of the heart.
 Fibrous pericardium. The loosely fitting superficial part of this sac is referred to as
the fibrous pericardium, which helps protect the heart and anchors it to
surrounding structures such as the diaphragm and sternum.
 Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer
serous pericardium, where its parietal layer lines the interior of the fibrous
pericardium.

Layers of the Heart

 Epicardium. The epicardium or the visceral and outermost layer is actually a
part of the heart wall.
 Myocardium. The myocardium consists of thick bundles of cardiac muscle
twisted and whirled into ringlike arrangements and it is the layer that actually
contracts.
 Endocardium. The endocardium is the innermost layer of the heart and is a thin,
glistening sheet of endothelium that lines the heart chambers.

Chambers of the Heart

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The heart has four hollow chambers, or cavities: two atria and two ventricles.
Receiving chambers. The two superior atria are primarily the receiving chambers,
they play a lighter role in the pumping activity of the heart.
Discharging chambers. The two inferior, thick-walled ventricles are the discharging
chambers, or actual pumps of the heart wherein when they contract, blood is
propelled out of the heart and into the circulation.
Septum. The septum that divides the heart longitudinally is referred to as either
the interventricular septum or the interatrial septum, depending on which chamber
it separates.

Associated Great Vessels

Superior and inferior vena cava. The heart receives relatively oxygen-poor
bloodfrom the veins of the body through the large superior and inferior vena cava
and pumps it through the pulmonary trunk.
Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary
arteries, which carry blood to the lungs, where oxygen is picked up and carbon
dioxide is unloaded.
Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to the left
side of the heart through the four pulmonary veins.

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Aorta. Blood returned to the left side of the heart is pumped out of the heart into
the aorta from which the systemic arteries branch to supply essentially all body
tissues.

Heart Valves

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1. Atrioventricular valves. Atrioventricular or AV valves are located between the
atrial and ventricular chambers on each side, and they prevent backflow into
the atria when the ventricles contract.
2. Bicuspid valves. The left AV valve- the bicuspid or mitral valve, consists of two
flaps, or cusps, of endocardium.
3. Tricuspid valve. The right AV valve, the tricuspid valve, has three flaps.
4. Semilunar valve. The second set of valves, the semilunar valves, guards the
bases of the two large arteries leaving the ventricular chambers, thus they are
known as the pulmonary and aortic semilunar valves.

Cardiac Circulation Vessels

Coronary arteries. The coronary arteries branch from the base of the aorta and
encircle the heart in the coronary sulcus (atrioventricular groove) at the junction of
the atria and ventricles, and these arteries are compressed when the ventricles are
contracting and fill when the heart is relaxed.
Cardiac veins. The myocardium is drained by several cardiac veins, which empty
into an enlarged vessel on the posterior of the heart called the coronary sinus.

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Blood Vessels
Arteries. As the heart beats, blood is propelled into large arteries leaving the heart.
Arterioles. It then moves into successively smaller and smaller arteries and then into
arterioles, which feed the capillary beds in the tissues.
Veins. Capillary beds are drained by venules, which in turn empty into veins that
finally empty into the great veins entering the heart.

Tunics
Except for the microscopic capillaries, the walls of the blood vessels have three
coats or tunics.

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Tunica intima. The tunica intima, which lines the lumen, or interior, of the vessels,
is a thin layer of endothelium resting on a basement membrane and decreases
friction as blood flows through the vessel lumen.
Tunica media. The tunica media is the bulky middle coat which mostly consists
of smooth muscle and elastic fibers that constrict or dilate, making the blood
pressure increase or decrease.
Tunica externa. The tunica externa is the outermost tunic composed largely of
fibrous connective tissue, and its function is basically to support and protect the
vessels.

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Major Arteries of the Systemic Circulation

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Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of heart as the ascending aorta.

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Coronary arteries. The only branches of the ascending aorta are the right and left
coronary arteries, which serve the heart.

Arterial Branches of the Aortic Arch

Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the aortic
arch, splits into the right common carotid artery and right subclavian artery.
Left common carotid artery. The left common carotid artery is the second
branch off the aortic arch and it divides, forming the left internal carotid, which
serves the brain, and the left external carotid, which serves the skin and muscles
of the head and neck.
Left subclavian artery. The third branch of the aortic arch, the left subclavian
artery, gives off an important branch- the vertebral artery, which serves part of
the brain.
Axillary artery. In the axilla, the subclavian artery becomes the axillary artery.
Brachial artery. the subclavian artery continues into the arm as the brachial
artery, which supplies the arm.
Radial and ulnar arteries. At the elbow, the brachial artery splits to form the
radial and ulnar arteries, which serve the forearm.

Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the
thoracic aorta.
Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of the
thorax wall.

Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity,
where it becomes the abdominal aorta.

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Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and has
three branches: the left gastric artery supplies the stomach; the splenic artery
supplies the spleen, and the common hepatic artery supplies the liver.
Superior mesenteric artery. The unpaired superior mesenteric artery supplies
most of the small intestine and the first half of the large intestine or colon.
Renal arteries. The renal arteries serve the kidneys.
Gonadal arteries. The gonadal arteries supply the gonads, and they are
called ovarian arteries in females while in males they are testicular arteries.
Lumbar arteries. The lumbar arteries are several pairs of arteries serving the
heavy muscles of the abdomen and trunk walls.
Inferior mesenteric artery. The inferior mesenteric artery is a small, unpaired
artery supplying the second half of the large intestine.
Common iliac arteries. The common iliac arteries are the final branches of the
abdominal aorta.

Major Veins of the Systemic Circulation

Major veins converge on the venae cavae, which enter the right atrium of the
heart.

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Veins Draining into the Superior Vena Cava
Veins draining into the superior vena cava are named in a distal-to-proximal
direction; that is, in the same direction the blood flows into the superior vena cava.
Radial and ulnar veins. The radial and ulnar veins are deep veins draining the
forearm; they unite to form the deep brachial vein, which drains the arm and
empties into the axillary vein in the axillary region.
Cephalic vein. The cephalic vein provides for the superficial drainage of the
lateral aspect of the arm and empties into the axillary vein.
Basilic vein. The basilic vein is a superficial vein that drains the medial aspect
of the arm and empties into the brachial vein proximally.
Median cubital vein. The basilic and cephalic veins are joined at the anterior
aspect of the elbow by the median cubital vein, often chosen as the site for
blood removal for the purpose of blood testing.
Subclavian vein. The subclavian vein receives venous blood from the arm
through the axillary vein and from the skin and muscles of the head through
the external jugular vein.
Vertebral vein. The vertebral vein drains the posterior part of the head.
Internal jugular vein. The internal jugular vein drains the dural sinuses of the
brain.
Brachiocephalic veins. The right and left brachiocephalic veins are large
veins that receive venous drainage from the subclavian, vertebral, and
internal jugular veins on their respective sides.
Azygos vein. The azygos vein is a single vein that drains the thorax and enters
the superior vena cava just before it joins the heart.

Veins Draining into the Inferior Vena Cava

The inferior vena cava, which is much longer than the superior vena cava, returns
blood to the heart from all body regions below the diaphragm.

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Tibial veins. The anterior and posterior tibial veins and the fibular vein drain
the leg; the posterior tibial veins becomes the popliteal vein at the knee and
then the femoral vein in the thigh; the femoral vein becomes the external
iliac vein as it enters the pelvis.
Great saphenous veins. The great saphenous veins are the longest veins in
the body; they begin at the dorsal venous arch in the foot and travel up the
medial aspect of the leg to empty into the femoral vein in the thigh.
Common iliac vein. Each common iliac vein is formed by the union of the
external iliac vein and the internal iliac vein which drains the pelvis.
Gonadal vein. The right gonadal vein drains the right ovary in females and
the right testicles in males; the left gonadal veins empties into the left renal
veins superiorly.
Renal veins. The right and left renal veins drain the kidneys.
Hepatic portal vein. The hepatic portal vein is a single vein that drains the
digestive tract organs and carries this blood through the liver before it enters
the systemic circulation.
Hepatic veins. The hepatic veins drain the liver.

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Physiology of the Heart
As the heart beats or contracts, the blood makes continuous round trips- into and
out of the heart, through the rest of the body, and then back to the heart- only to
be sent out again.

Intrinsic Conduction System of the Heart

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Cardiac muscle cells. Cardiac muscle cells can and do contract spontaneously
and independently, even if all nervous connections are severed.
Rhythms. Although cardiac muscles can beat independently, the muscle cells in
the different areas of the heart have different rhythms.

Intrinsic conduction system. The intrinsic conduction system, or the nodal system,
that is built into the heart tissue sets the basic rhythm.

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Composition. The intrinsic conduction system is composed of a special tissue found
nowhere else in the body; it is much like a cross between a muscle and nervous
tissue.
Function. This system causes heart muscle depolarization in only one direction- from
the atria to the ventricles; it enforces a contraction rate of approximately 75 beats
per minute on the heart, thus the heart beats as a coordinated unit.

Sinoatrial (SA) node. The SA node has the highest rate of depolarization in the
whole system, so it can start the beat and set the pace for the whole heart; thus the
term “pacemaker“.
Atrial contraction. From the SA node, the impulse spread through the atria to the
AV node, and then the atria contract.
Ventricular contraction. It then passes through the AV bundle, the bundle branches,
and the Purkinje fibers, resulting in a “wringing” contraction of the ventricles that
begins at the heart apex and moves toward the atria.
Ejection. This contraction effectively ejects blood superiorly into the large arteries
leaving the heart.

The Pathway of the Conduction System

 SA node. The depolarization wave is initiated by the sinoatrial node.

 Atrial myocardium. The wave then successively passes through the atrial
myocardium.
 Atrioventricular node. The depolarization wave then spreads to the AV node,
and then the atria contract.
 AV bundle. It then passes rapidly through the AV bundle.
 Bundle branches and Purkinje fibers. The wave then continues on through the
right and left bundle branches, and then to the Purkinje fibers in the ventricular

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walls, resulting in a contraction that ejects blood, leaving the heart.

Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to relax,
contraction of the ventricles begin.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.
 Cardiac cycle. The term cardiac cycle refers to the events of one complete
heartbeat, during which both atria and ventricles contract and then relax.
 Length. The average heart beats approximately 75 times per minute, so the
length of the cardiac cycle is normally about 0.8 second.
 Mid-to-late diastole. The cycle starts with the heart in complete relaxation; the
pressure in the heart is low, and blood is flowing passively into and through the
atria into the ventricles from the pulmonary and systemic circulations; the
semilunar valves are closed, and the AV valves are open; then the atria
contract and force the blood remaining in their chambers into the ventricles.
 Ventricular systole. Shortly after, the ventricular contraction begins, and the
pressure within the ventricles increases rapidly, closing the AV valves; when
the intraventricular pressure is higher than the pressure in the large arteries

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 leaving the heart, the semilunar valves are forced open, and blood rushes
through them out of the ventricles; the atria are relaxed, and their chambers
are again filling with blood.
 Early diastole. At the end of systole, the ventricles relax, the semilunar valves
snap shut, and for a moment the ventricles are completely closed chambers;
the intraventricular pressure drops and the AV valves are forced open; the
ventricles again begin refilling rapidly with blood, completing the cycle.
 First heart sound. The first heart sound, “lub”, is caused by the closing of the AV
valves.
 Second heart sound. The second heart sound, “dub”, occurs when the
semilunar valves close at the end of systole.

Cardiac Output
Cardiac output is the amount of blood pumped out by each side of the heart in
one minute. It is the product of the heart rate and the stroke volume.

Stroke volume
Stroke volume is the volume of blood pumped out by a ventricle with each
heartbeat.

Regulation of stroke volume. According to Starling’s law of the heart, the critical
factor controlling stroke volume is how much the cardiac muscle cells are stretched
just before they contract; the more they are stretched, the stronger the contraction
will be.

Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of
respiratory rate and body temperature, are referred to collectively as vital signs in

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clinical settings.
 Arterial pulse. The alternating expansion and recoil of an artery that occurs with
each beat of the left ventricle creates a pressure wave-a pulse- that travels
through the entire arterial system.
 Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals
the heart rate, so the pulse averages 70 to 76 beats per minute in a normal
resting person.
 Pressure points. There are several clinically important arterial pulse points, and
these are the same points that are compressed to stop blood flow into distal
tissues during hemorrhage, referred to as pressure points.
 Blood pressure. Blood pressure is the pressure the blood exerts against the inner
walls of the blood vessels, and it is the force that keeps blood circulating
continuously even between heartbeats.
 Blood pressure gradient. The pressure is highest in the large arteries and
continues to drop throughout the systemic and pulmonary pathways, reaching
either zero or negative pressure at the venae cavae.
 Measuring blood pressure. Because the heart alternately contracts and relaxes,
the off-and-on flow of the blood into the arteries causes the blood pressure to
rise and fall during each beat, thus, two arterial blood pressure measurements
are usually made: systolic pressure (the pressure in the arteries at the peak of

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 ventricular contraction) and diastolic pressure (the pressure when the ventricles
are relaxing).
 Peripheral resistance. Peripheral resistance is the amount of friction the blood
encounters as it flows through the blood vessels.
 Neural factors. The parasympathetic division of the autonomic nervous system
has little or no effect on blood pressure, but the sympathetic division has the
major action of causing vasoconstriction or narrowing of the blood vessels,
which increases blood pressure.
 Renal factors. The kidneys play a major role in regulating arterial blood pressure
by altering blood volume, so when blood pressure increases beyond normal,
the kidneys allow more water to leave the body in the urine, then blood volume
decreases which in turn decreases blood pressure.
 Temperature. In general, cold has a vasoconstricting effect, while heat has a
vasodilating effect.
 Chemicals. Epinephrine increases both heart rate and blood pressure; nicotine
increases blood pressure by causing vasoconstriction; alcohol and
histamine cause vasodilation and decreased blood pressure.
 Diet. Although medical opinions tend to change and are at odds from time to
time, it is generally believed that a diet low in salt, saturated fats,
and cholesterol help to prevent hypertension, or high blood pressure.

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Entrance to the heart Blood enters the heart through two large veins (the
inferior and superior vena cava) emptying oxygen-poor blood from the body
into the right atrium of the heart.

Atrial contraction. As the atrium contracts, blood flows from the right atrium to the
right ventricle through the open tricuspid valve.

Closure of the tricuspid valve. When the ventricle is full, the tricuspid valve shuts to
prevent blood from flowing backward into the atria while the ventricle contracts.

Ventricle contraction. As the ventricle contracts, blood leaves the heart through the
pulmonic valve, into the pulmonary artery and to the lungs where it is oxygenated.

Oxygen-rich blood circulates. The pulmonary vein empties oxygen-rich blood from
the lungs into the left atrium of the heart.

Opening of the mitral valve. As the atrium contracts, blood flows from your left
atrium into your left ventricle through the open mitral valve.
Prevention of backflow. When the ventricle is full, the mitral valve shuts. This prevents
blood from flowing backward into the atrium while the ventricle contracts.

Blood flow to systemic circulation. As the ventricle contracts, blood leaves the heart
through the aortic valve, into the aorta and to the body.

Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their
concentration gradients.
Capillary network. Capillaries form an intricate network among the body’s

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cells such that no substance has to diffuse very far to enter or leave a cell.
Routes. Basically, substances leaving or entering the blood may take one of
four routes across the plasma membranes of the single layer of endothelial
cells forming the capillary wall.
Lipid-soluble substances. As with all cells, substances can
diffuse directly through their plasma membranes if the substances are lipid-
soluble.
Lipid-insoluble substances. Certain lipid-insoluble substances may enter or
leave the blood and/or pass through the plasma membranes within vesicles,
that is, by endocytosis or exocytosis.
Intercellular clefts. Limited passage of fluid and small solutes is allowed by
intercellular clefts, so most of our capillaries have intercellular clefts.
Fenestrated capillaries. Very free passage of small solutes and fluid is allowed
by fenestrated capillaries, and these unique capillaries are found where
absorption is a priority or where filtration occurs.

“The Pessimist sees Difficulty In Every Opportunity. The Optimist Sees

Opportunity In Every Difficulty.” – Winston Churchill

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