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


• Positioned behind sternum

• Apex at 5th intercostal space mid-clavicular

• Base 1.5cms left of sternum

• Approx 10cms long • Weights 270gms


Pericardium Layered fluid filled sac surrounds heart

EpicardiumSingle layer

Myocardium Muscular wall of heart

Endocardium Inner surface of heart forms valves


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

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

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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

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


• 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

Cardiac Anatomy and Physiology

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