Chapter 13 Heart 2017 Cengage 2017 Learning Cengage

Chapter 13 Heart © 2017 Cengage © 2017 Learning. Cengage All. Learning. Rights Reserved. All Rights. May Reserved. not be scanned, May not be copied scanned, copied or duplicated, or or duplicated, posted toor a publicly posted to accessible a publiclywebsite, accessible in whole website, or in in part. whole or in part.

Functions of the Circulatory System • The heart is the pump that circulates blood to all parts of the body • Arteries, veins, and capillaries transport the blood • Blood carries oxygen and nutrients to the cells and carries waste products away • Lymph system returns excess fluid from the tissues the circulation © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Major Blood Circuits • Blood leaves the heart through arteries and returns by veins • Blood circulation routes – General or system circulation – Cardiopulmonary circulation • Changes in the composition of circulating blood © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

The Heart • About 5 inches long and 3. 5 inches wide • Weighs about 1 pound • Located in the thoracic cavity; the apex of the heart lies on the diaphragm and points to the left of the body © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Figure 13 -1 The heart is located in the thoracic cavity between the lungs © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

The Heart • After 4 to 5 minutes without blood flow, brain cells are irreversibly damaged • Can hear the heartbeat through a stethoscope • Cardiac arrest • Cardiopulmonary resuscitation (CPR) © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Structure of the Heart (1 of 2) • • Hollow, muscular, double pump Pericardium and pericardial fluid Epicardium Myocardium – Cardiac muscle tissue • Endocardium © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Structure of the Heart (2 of 2) • • • Superior and inferior vena cava Coronary sinus Pulmonary artery Pulmonary veins Aorta © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Figure 13 -2 Anterior external view of the heart © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Figure 13 -3 Anterior cross-sectional view of the heart © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chambers and Valves (1 of 2) • Separated into right and left halves by the septum; then each half separated into an upper and lower chamber • Upper chambers – Left and right atria © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chambers and Valves (2 of 2) • Lower chambers – Left and right ventricles • Valves keep blood flowing in one direction © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Valves • Atrioventricular valves – Tricuspid valve (separates the right atria and right ventricle) – Bicuspid or mitral valve (separates the left atria and left ventricle) • Semilunar valves – Pulmonary semilunar valve (opening of the pulmonary arteries) – Aortic semilunar valve (opening of the aorta) © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Physiology of the Heart • Double pump • Right heart – Deoxygenated blood • Left heart – Oxygenated blood © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Heart Rate and Cardiac Output • Normal adult rate is between 72 and 80 beats per minute • Cardiac output=stroke volume x heart rate • Calculating the cardiac output • Exercise increases cardiac output © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Heart Sounds • Valves make sounds when they close • Called lubb dupp sounds • Lubb – Tricuspid and bicuspid valves (S 1) • Dupp – Aortic and pulmonary valves (S 2) © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Conduction System • Electrical impulses cause rhythmic beating of the heart • Sinoatrial (SA) node or pacemaker • Atrioventricular (AV) node • Bundle of His • Purkinje fibers © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Figure 13 -7 An electrical impulse from the SA node travels to the AV node and causes the ventricle to contract © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

ECG or EKG (1 of 2) • The electrocardiogram is a device to record the electrical activity of the heart • Systole – Contraction • Diastole – Relaxation © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

ECG or EKG (2 of 2) • Positive and negative deflection • P, QRS, and T waves © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Cardiovascular Technologists and Technicians • Also known as ECG Technicians • Assist Physicians in diagnosing and treating cardiac and peripheral vascular disease. • Take electrocardiograms and the more skilled may do the Holter monitor and stress testing. © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

ECG Technicians Continued • Education to prepare a technician for ECG, Holter, and stress testing is usually a one year certificate program. • Job prospects are not very high for this profession since nurses and others may be trained to do procedures such as ECGs and stress testing. © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Cardiology Technologists • Specialize in cardiac catheterization procedures • Training for cardiology technologists involves a two year program. • Job prospect is very high for this profession. (Approx. 25% Increase between 2014 and 2024) • Salary Range: $28, 420 - 87, 170 – California Annual Mean Wage $71, 230 https: //www. bls. gov/oes/current/oes 292031. htm © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Effects of Aging • Heart muscle fibers replaced by fibrous tissue • Heart valves increase in thickness • Cardiac output decreases • Changes become more significant when elderly person becomes physically or mentally stressed © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Prevention of Heart Disease • Heart disease is the leading cause of death for both men and women in the US – Coronary heart disease • Risk factors • Steps to lower risk or prevent heart disease • Blood cholesterol levels and triglycerides © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diagnostic Tests – Noninvasive (1 of 2) • • • Angiography Cardiac MRI Coronary calcium scoring/heart scan Echocardiography Electrocardiogram © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diagnostic Tests – Noninvasive (2 of 2) • • Exercise stress tests Holter monitor MUGA (multiple gated acquisition scan) Nuclear perfusion © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diagnostic Tests – Invasive • Cardiac catheterization • IVUS (intravascular coronary ultrasound) • TEE © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diagnostic Tests – Blood Tests • • • Arterial blood gases BNP Lipid panel C-reactive protein Cardiac Troponin T © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diseases of the Heart – Common Symptoms • • • Arrhythmia Bradycardia Tachycardia Murmurs Mitral valve prolapse © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Diseases of the Coronary Artery • Coronary artery disease (CAD) • Angina pectoris • Myocardial infarction © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Infectious Diseases of the Heart • • Pericarditis Myocarditis Endocarditis Rheumatic heart disease © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Heart Failure (1 of 2) • When the ventricles of the heart are unable to contract effectively and blood pools in the heart • Symptoms depend on which ventricle fails © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Heart Failure (2 of 2) • Left ventricle failure – Dyspnea (shortness of breath) • Right ventricle failure – Engorgement of organs, edema of the legs and feet, and ascites © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Congestive Heart Failure • Similar to heart failure • Left-sided failure – pulmonary edema • Right-sided failure – fluid buildup throughout body • Treatment © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

EMT’s and Paramedics • Respond to medical emergencies; they determine the nature and extent of the patient’s condition, determine if the patient has preexisting medical problems, provide emergency care and transport to a medical facility. • May be registered at one of four levels by the National Registry of Emergency Medical Technicians: First Responder, EMT Basic, EMT- Intermediate, EMT- Paramedic. © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

EMT’s and Paramedics Continued • Formal Training and Certification are needed in ALL states. • Job outlook is good (Approx. 24% increase from 2014 to 2024) • Salary Range: $20, 860 - 55, 110 – California Annual Mean Wage $ 37, 410 https: //www. bls. gov/oes/current/oes 292041. htm © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Rhythm/Conduction Defects • Heart block – First-degree block – Second-degree block – Third-degree block or complete heart block • Premature contractions – Atrial fibrillation – PVCs – Ventricular fibrillation © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Types of Heart Surgery • • Angioplasty Cardiac stents Coronary bypass Transmyocardial laser revascularization © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Heart Transplants • Used as a last resort • Histocompatibility • Organ rejection © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medical Highlights • • Pacemaker Cardiac resynchronization therapy Defibrillator Heart pumps © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

How to Check a Patient’s Pulse • There are four areas you can use to check for a patient’s pulse: carotid, brachial, radial and pedal • The most common site is either the radial or carotid artery • When taking a patient’s pulse you will take two fingers, most often your index and middle finger, and lightly place them over one of these areas © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Pulse Continued • For a more accurate number the ideal time to take a pulse is 30 seconds • You will then take that number and multiply it by two to get the patient’s heart rate per minute • Normal heart rate= 60 -100 beats per minute © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Time to Practice! © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

How to Take Blood Pressure • https: //www. youtube. com/watch? v=Gmi c 13 mvsgo © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

LET’S PRACTICE! © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.