Cardio Vascular Overview

Cardio Vascular Overview

1. Heart anatomy

   • blood flow
     • RIGHT ventricle
       • Pulmonary artery (deoxygenated)
         • lungs
           • pulmonary vein
             • left aorta. etc...
   • coronary arteries
     • left coronary (main)
       • circumflex
         • extends from left coronary and wraps around the heart
       • left anterior descending
     • right coronary
   • arteries
     • tunica externa
       • loose connective tissue
       • outermost layer
     • tunica media
       • middle layer
       • smooth muscle
     • tunica intima
       • inner most
       • simple squamous epithelium and elastic fibers
     • vs. veins...
       • arteries have more muscle
       • arteries are more round
       • veins collapse if not filled
       • valves in veins, not arteries

2. electrical activity of the heart

   • sinoatrial node
     • usually = HR
     • AV node
       • bundle of His
         • right or left bundle branch
           • purkinje fibers
             • large conducting cells, most of ventricles

3. RAAS (Renin Angiotensin Aldosterone System)

   • angiotensinogen (kidneys)
     • angiotensin I (Renin)
       • angiotensin II (ACE)
         • AT 1 (Type 1)
           • ↑ CO
           • ↑ aldosterone
             • → myocardial fibrosis
             • left ventricular hypertrophy
             • sodium retention
             • potassium loss
             • hypertension
             • sympathetic activation
           • ↑ GFR
           • ↑ ADH + thirst
         • AT 2 (Type 2)
           • vasodilation
           • anti-proliferation
           • cell differentiation
           • tissue repair

4. hemodynamic definitions

   • preload
     • pressure stretching the ventrical after diastole (also equals end diastolic volume)
   • afterload
     • end systolic volume
     • tension or pressure used to eject blood out ventricles
   • stroke volume
     • end diastolic volume - end systolic volume (preload - afterload)
   • cardiac output
     • CO = HR * SV
     • amount of blood pumped / time
   • cardiac index
     • CO adjusted for BSA
     • CI = CO/BSA
   • ejection fraction
     • fraction of blood ejected by left ventricle during contraction or ejection
     • EF = SV/EDV * 100 %
     • amount ejected after systole
   • mean arterial pressure
     • CO * SVR + CVP
     • or [(2x diastolic pressure) + systolic pressure]/3
   • pulmonary capiullary wedge pressure (PCWP)
     • provides estimate of diastolic filling and left ventricular end diastolic volume (when mitral valve is open)

5. forrester's classification

   • subset 1 (no hemodynamic compromise)
     • cardiac index (> 2.2 L/min/m^2)
     • PCWP (0-18 mm Hg)
   • subset II (pulmonary congestion)
     • cardiac index > 2.2
     • PCWP > 18
       • subset IV (pulmonary congestion and hyperfusion
         • high PCWP, low CI
   • subset III (hyperfusion)
     • PCWP < 18
     • CI < 2.2

6. hemodynamic clinical assessment

   • preload
     • hepatomegaly (megaliver)
     • daily weight
     • pulmonary crackles
     • peripheral edema
     • S3 heart sound
     • mucous membrane and skin turgor
   • afterload
     • vascular diastolic
     • pulse pressure
     • pulses

Images and files in the map