Cardiovascular System
strength of contraction; often given as anti-
Cardio – heart
Vascular – blood vessels
Heart – a pumping organ; hollow organ
- average weight: 300 grams
3 layers of the heart:
 Endocardium – innermost
 Myocardium – middle; thickest layer
(myo=muscle)
 Epicardium – outermost layer
Pericardium – not a layer; a sac that covers the heart
Chambers of the heart:
 Atria – upper chambers; smaller one
 Ventricles – lower chambers; muscular and bigger
Valves of the heart:
Valve – purpose is to maintain a unidirectional blood
flow to avoid mixture of oxygenated and
deoxygenated blood
 2 atrioventricular valves
- Tricuspid (between right atrium and ventricle)
- Bicuspid or Mitral (between left a and v)
 2 semilunar valves
- Pulmonary (right)
- Aortic (left)
Terms:
 Pulsus alternans – alternating strong and weak
pulse; could indicate left ventricular failure
 Pulsus paradoxus – decrease in BP atleast 10
mmHg with inspiration; could indicate cardiac
tamponade
- In cardiac tamponade, this is a condition
characterized by fluid located in pericardial space
so the sac around the heart is filled with fluid
possibly from infection
- As a result, whenever you inhale, the lungs
compress upon the sac of the heart thus
constricting the heart and decreasing cardiac
output and blood pressure
 Pulsus parvus – small weak pulse; left sided heart
failure
Remember: pulse – is a wave of blood created by the
contraction of the left ventricle
 Inotropic – influencing the contractility of
muscular tissue (strength of myocardial
contraction)
- Positive inotropic – something that increases
strength of the contraction of heart
Example: digoxin – often given to pts with heart
failure
- Negative inotropic – decreases contraction of the
heart
Example: calcium channel blocker – relaxes
hypertensive drug for pts with hypertension
 Chronotropic – affecting rate of rhythmic
movements such as the heart beat; all about the
speed of contraction (heart rate)
- Negative chronotropic – example is Digoxin. It
increases muscular strength of contraction but
decreases the heart rate
 Dromotropic – influencing the velocity of
conduction of excitation as in nerve or cardiac
muscle fibers (AV node conduction)
 Bathmotropic – influencing nervous and muscular
irritability in response to stimuli
Blood vessels of the heart:
a) Coronary arteries – supplies blood to the heart
(supplies blood better with diastole)
- artery most prone to atherosclerosis is LADA (left
anterior descending artery)
Atherosclerosis – obstruction by blood vessels blocked
by fats
Diastole – the point where the chamber of the heart
relaxes
b) Coronary veins – is the coronary sinus; then it
drains the deoxygenated blood from the heart
into the right atrium
Note: heart does not use the blood that passes
through its chambers; it relies on its own blood supply
in the coronary arteries
c) Aorta – one of the major vessel coming from the
heart
Aortic branches:
 Brachiocephalic trunk – which subdivides into
 Right subclavian artery leading to jugular
artery
 Right common carotid artery
 Left common carotid artery
 Left subclavian artery leading to jugular artery
Pulse – a wave of blood created by contraction of the
left ventricle (thickest chamber of the heart)
- normal PR: 60-100 bpm
Apical pulse – aka PMI (point of maximal impulse);
source of all pulses in the body
- exact location is between the 4th and 5th ICS at the
left midclavicular line
- in children: 4th ICS left MCL; if found in 5th, it may
indicate CHF which causes cardiac enlargement
ICS – intercostal space (inter is between, costal is ribs)
Clavicle – collar bone
Scapula – shoulder blade
Note: clavicle and scapula connects with each other
 Pulse pressure – difference between systolic BP
and diastolic BP; average: 30-40 mmHg
<30 mmHg – hypovolemic shock (narrow pulse
pressure)
>40 mmHg – increased ICP (widened pulse pressure)
 Pulse deficit – difference between the apical and
peripheral pulses
- If it’s present, may indicate problem with
perfusion of blood to the arteries (vascular
insufficiency)
- normal pulse deficit: 0 that means when 1 nurse
palpates apical pulse while other nurse palpates
radial pulse, result should be equal or the same
Management:
 To check pulse in unconscious pt:
Adult: carotid
Child: brachial, because carotid artery in child is
not yet fully developed
 Before giving meds that affect BP or heart, apical
pulse should be checked
Carotid massage – evidence of Marcy’s law; one of the
techniques to lower the heart of pt
 Chemical – one example is the sodium-potassium
pump (responsible for active transport and a
process that utilizes ATP)
ATP – adenosine triphosphate; a source of energy
- has 2 elements: glucose and oxygen
- generally produced by aerobic metabolism
 Mechanical – example is Frank-Starling’s Law
- it means that within normal limits, increased
preload will increase stretch of cardiac muscles
leading to increased cardiac output
- but if overly stretched especially in obese pts, the
stretches myocardium may no longer be able to
recoil back to its normal strength leading to CHF

Cardiac output – true measurement of cardiac

function; amount of blood the heart produces in a
minute
- stroke volume (75 ml) x heart rate (60-100 bpm)
= 5-6 L/min
Stroke volume – amount of blood produced by the
heart in every pump
Determinants of stroke volume:
 Preload – amount of blood presented to the
ventricle
- the higher the preload, the higher the stroke
volume; why? The preload enters the left ventricle
and it stretches the myocardium. When it recoils,
the larger the stretch, the larger will be the
strength of the recoil so therefore the greater the
preload, the greater the contraction of the heart
 Afterload – resistance to ventricular ejection
(refers to systemic blood pressure)
- greater afterload means decreased stroke volume
Cardiac contractility – strength of heart’s contraction
- preload and cardiac contractility has a direct
relationship to stroke volume
- afterload had an inverse relationship to stroke
volume

Factors affecting cardiac output:

 Neural – pertains to the nervous system
- CNS (brain and spinal cord)
- PNS – has anatomical division (cranial nerves and
peripheral nerves)
also has functional division (somatic [voluntary]
and autonomic nervous system [involuntary])
Under autonomic nervous system:
Sympathetic – fight-or-flight response
Parasympathetic – rest-digest response

Marcy’s law of the heart:

- Decreased BP causes reflex SNS response
- Increased BP causes reflex PNS or vagal response