CardioVascular System

OM Nursing Academy

Anil Kantiwal Gudha

• Complete Short Review of CardioVascular System •

Heart :-

 Human Heart, यह Cone shape का Muscular organ ह जो Mediastinum म थत रहता ह

( Mediastinum - यह Sternum, Vertebra एवं

दोन lungs के
बीच का space होता ह )

 Size - 12 cm long × 8 cm width × 6 cm thickness

 Heart is first functional organ to Develop in embryonic life.

 First Heartbeat at 3 weeks ( 21 Days ).

 World Heart Day - 29 September

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Layers of Heart :-
1. Pericardium :- यह Outer most layer ह जो दो ओर layers, Fibrous Pericardium व Serous
Pericardium सेबनी होती है

2. Myocardium :- यह Middle layer ह जो Bulk of Heart का नमाण करती ह, लगभग 95% Heart wall का ।

 Myocardium यह Heart के
Pumping action केलए Responsible ह ।

3. Endocardium :- inner most layer of Heart wall

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Chambers of Heart :- Heart म 4 chambers होते

ह

 Two Atrium ( Right and Left Atrium [ Auricle] )

 Two Ventricle ( Right and Left Ventricle )

 Base of Heart :- यह Heart का Superior Broad पाट ह जो

मुयतः Left Atrium से बना होता ह

 Apex of Heart :- यह Heart का Inferior end point ह जो left

ventricle का बना होता ह ।

 Thickest Chamber of Heart is Left Ventricle ( Average Thickness is 10-15 mm ).

Anil Kantiwal Gudha ( OM Nursing Academy )

Heart Valves :-

 Two AV Valve ( Atrio-Ventricular Valve )

 Tricuspid Valve :- यह Right atrium एवं

Right
Ventricle के
म य थत होता ह

 Bicuspid Valve / Mitral Valve :- यह Left Atrium

एवंLeft Ventricle के
म य थत होता ह ।

 Two Semi lunar Valve :-

 Aortic Valve :- यह Great Aorta एवं

Left Ventricle के
म य थत होता ह

 Pulmonary Valve :- यह Pulmonary Artery एवं

Right Ventricle के
म य थत होता ह ।

Note :-

 Bicuspid Valve / Mitral Valve ही एक ऐसा वा व हैजसम 2 Cusp पाये

जाते
ह, शे
ष सभी Valves म 3
Cusp पायेजातेह।

 Rheumatic Heart Disease म Streptococal infection, antibodies produce करता ह जो Heart

valve को damage करता ह Specially Mitral Valve को ।

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Conduction System :-
 SA Node :- ( SinoAtrial Node )

SA Node यह Right Atrium म Situated रहता ह

SA Node को Heart का Pacemaker कहा जाता ह, य क Heart impulse SA Node से

ही generate
होती ह ( Pacemaker cells known as P Cells ).

 Sequence of Impulse Generation :-

SA Node ---> AV Node ----> Bundles of His ----> Purkinje Fibre

Electrical Impulse Generation :-

 SA Node :- impulse generate 60-100 times/ मनट

 AV Node :- impulse generate 40-60 times/ मनट

 Purkinje Fibre :- impulse generate 20-40 times/ मनट

Note :- Purkinje fibre उसी condition म Impulse generate करता ह जब SA Node और AV Node, impulse
generate करने म अस म हो जाते ह।

Heart Block :- Heart के

Conductive system म Electical impulses के
normal transmission म
interference होना ।

Anil Kantiwal Gudha ( OM Nursing Academy )

Heart Sound :-
Normal Heart Sound :-

S1 Heart Sound :- ( First Heart Sound )

 Produced by Closures of the AV valve, The First heart Sound called "LUBB" .

S2 Heart Sound :- ( Second Heart Sound )

 Produce by Closures of Semilunar Valve, The Second Heart Sound called "DUB" .

Abnormal Heart Sound :-

Third Heart Sound ( S3 Sound ) :-

 Known as Ventricle gallop ( due to rushing of Blood during Ventricular filling ).

Fourth Heart Sound (S4 Sound ) :-

 Called as Atrial gallop ( audible only in Pathological condition ).

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Cardiac Cycle :-

 Cardiac cycle यह एक Heart beat के

दौरान होने
वाली सभी Events का मह

 Normal cardiac cycle time - 0.8 Second

Atrial ( 0.8 Second ) Ventricular ( 0.8 Second )

Systole ( 0.1 second ) Diastole ( 0.7 second) Systole (0.3 second ) Diastole (0.5 second )

Cardiac Output:-
 Left and Right Ventricles के ारा एक मनट म कये
गये
Pumped Blood को Cardiac Output कहते
ह।

 एक Adult म Average cardiac output 5 liter के

approx. होता ह

 सबसेयादा Cardiac Output, liver 30% को होता ह ।

Anil Kantiwal Gudha ( OM Nursing Academy )

Blood Vessels :-
 Artery :- carry Oxygenated blood ( Pulmonary Artery एवं
Umbilical artery को छोड़कर )

 Vein :- carry De-Oxygenated Blood ( Pulmonary Vein एवं

Umbilical vein को छोड़कर )

 Arterioles को resistance vessels के

नाम से
भी जानते
ह ( Aiims 2018 )

 Capillaries को Exchange vessels के

नाम से
भी जानते
ह

Diameter of capillaries - 5-10 micrometer

 Venules - smallest vein

 Tunica media is the thickest layer in Artery and thin in Vein.

 Largest Artery in human body is Aorta.

Hypertension :-

 Hypertension को Silent killer केनाम से

भी जाना जाता ह य क यह सरेvital organs ( heart,
blood vessels, kidney & brain ) को बना कसी Pain के damage कर सकता ह ।

 Age बढ़ने
केसाथ-साथ B.P भी बढ़ता ह, य क जै
से
-जै
से
Age बढ़े
गी Artery क elasticity भी कम होगी ।

 Baro Receptor / Preso-receptor ये

wall of Aortic Arch एवं
Carotid Sinuses म पाये
जाते
ह जो
B.P को maintain करनेका काम करतेह।

 White coat Hypertension :- जब कोई Health Care Personnel कसी Patient का B.P. check करता
ह, तब B.P ले
ने
केदौरान Patient म Anxiety के
कारण B.P बढ़नेलगता ह, इस कार बढ़ेए B.P को White
Coat Hypertension कहते ह।

 Malignant Hypertension :- Rapid unchecked Rise in Diastolic BP >120 mmHg

 Postural Hypotension म अचानक Position change ( Sitting to Standing Position ) करने

पर
Systolic BP 20 mm hg एवंDiastolic BP 10 mm Hg तक गरती ह ( Aiims Bhopal & Rishikesh )

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Coronary Artery Disease :-

 Cotonary artety का nerrow एवंइसम Obstruction आना, जो मुयतः Atherosclerosis ( lipid

plaque का Coronary artery म जमाव ) के
कारण होता ह

Diagnostic Studies in CAD :-

 Stress Test or Treadmil Test

 Cardiac Catheterization :-

1. Right- sided heart Catheterization :- इसम catheter

को femoral vein एवं Antecubital Vein से insert
करवाते ह।

Anil Kantiwal Gudha ( OM Nursing Academy )

 2. Left Sided Catheterization :- इसम catheter को right Brachial artery व femoral artery से
insert करवाते
ह।

 Blood Lipid Level :-

 HDL ( High Density Lipoprotein ) :- इसेGood cholesterol के नाम से

भी जाना जाता ह य क
यह Blood म उप थत Cholesterol को Liver म transport कर देता ह जहाँLiver कोलेॉल को
तोड़कर Bile म convert कर दे
ता ह जो Fat digestion म सहायक ह ।

Normal HDL level is - 40-70 mg/dl

 LDL ( Low Density Lipoprotein ) :- इसेBad cholesterol भी कहतेह , य क LDL वो

molecules होतेह जो cholesterol को liver से
blood म transport करते ह जसकेकारण
Hyperlipidemia एवंAtherosclesosis क condition उ प होने लगती ह ।

Normal LDL level is - below 130 mg/dl

 Homocysteine :- यह एक amino acid ह जो endothelial को damage कर inflammation को

cause करता ह जसके कारण CAD के chance हो जातेह।

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Myocardial Infarction ( M.I. ) :-

 MI को Heart attack भी कहते

ह।

 MI म Coronary artery म Obstruction आने

केकारण Heart को O2 & Blood supply नह हो पाती
जसके कारण Myocardial muscle म necrosis होने
लगता ह ( Irreversible after 6 minnut ).

MI Diagnosis by Cardiac Marker

1. Myoglobin :- यह सबसे sensitive cardiac marker ह, लेकन specific नह ।

( Myoglobin का level, cells के
damage होने के
2 घ टे बाद ही बढ़ने
लगता ह ।

2. Troponin :- ( Best Cardiac Marker in MI detection )

• यह Specific एवंSensitive Cardiac Marker ह।
• इसका level, myocardial injury के
3 घ टे
बाद सेबढ़ने
लगता ह

3. CK-MB :- इसका level MI के6 घ टेम ही बढ़ने

लगता ह और peak level 18 घ ट तक रहता ह
इसके बाद 2-3 दन म normal level पर आ जाता ह ।

Normal Adult Serum Enzyme / Cardiac Marker

Serum Enzyme Normal Value

CK-MB 0% - 5% of total

Troponin I Below 0.6 ng/ml >1.5 ng/mL indicates MI

Troponin T < 0.01 ng/ml >0.1-0.2 ng/ml indicates MI

Myoglobin Below 90 mcg/L >90 mcg/L indicates MI

Anil Kantiwal Gudha ( OM Nursing Academy )

  Troponin I यह myocardial injury म Superior Marker ह ।

 Hallmark of MI is :- Severe pain जो Patient म Nitroglycerin दे

ने
व Position chnage करने
पर भी
relieve नह होता ।

 Irrevesible MI :- अगर Heart को Blood Supply 6 मनट सेयादा व त तक ना ह ।

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 Main Cause of M.I. - Cardiogenic Shock

 Main complication of M.I. - Dysrhythmia

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Angina :-
 Myocardial Ischemia ( Ischemia - Blood & O2 Supply क कमी )केप रणाम व प Chest Pain होना ।

Types of Angina :-

1. Stable Angina or classical angina :- इ से

Exertional angina के
नाम से
भी जाना जाता ह , इसम दद
Exrcise और Emotional stress के व त होनेलगता ह ।

2. Unstable angina or Pre-Infarction angina :- इस कार का Chest Pain, Rest क condition म

होता ह, और इसकेPain क severity एवं duration यादा होता ह जो Nitroglycerin दे
ने
केबाद भी
relieved नह होता ।

3. Variant Angina or Prinzmetal's angina :- इसे

VasoSpastic Angina भी कहते
ह य क इसम
chest pain, coronary artery के
vasospasm के कारण होता ह

 Pain occurs at Same time each day.

Angina Pain Assessment :-

 Pain substernal, crushing, squeezing pain & Pain may Radiate to the shoulders, arms,
jaw, neck or Back.

Levin Sign :- angina Pectoris म Chest Pain के

दौरान hand clutching होना ।

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Heart Failure :-

 Inability to Heart Pump adequate blood to meet the Metabolic need of the Body at the
rest or during Exercise.

 Early Sign of Heart Failure is Tachycardia.

 Main cause of Heart Failure is Ischemic heart Disease ( 60% Cases ).

Anil Kantiwal Gudha ( OM Nursing Academy )

Types of Heart Failure :-

1. Right Side Heart Failure :-

Sign/Symptoms :- Ascites, Hepatomegaly, Jugular vein Distension ,Oliguria and weight gain.

2. Left Side Heart Failure :-

Sign and Symptoms :- Dyspnea, Crackles & wheezes, Cough, Dyspnea.

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 Pulmonary Edema is a life threatening condition that can result of from severe heart
failure. Pulmonary edema म left ventricle पया त मा ा म Blood Eject करनेम अस म हो जाता ह ।

 Pulmonary edema के Case म Patient को तु

रत
ंHigh fowler Position with legs in dependent
position दे
, जससे
Pulmonary congestion व edema से relieve पाया जा सके ।

 Pulmonary edema म patient को Mask या cannula के ारा High Concentrations Oxygen द ।

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Inflammatory Diseases of Heart :-

 Gallop Rhythm seen in - Myocarditis

 In Endocarditis Seen :-

 Osler's nodes

 Janeway lesions

 Roth Spot

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Vascular Disorders :-
Venous Disorders :-

Types :-

1. Thrombophlebitis :- thrombus associated with inflammation

2. Phlebothrombosis :- thrombus without inflammation

3. Phlebitis :- इसम inflammation of Vein, invassive procedure के

कारण होता ह eg. IV lines

4. Deep Vein Thrombosis :- इसम Pulmonary Embolism का Risk होता ह ।

 Common site - Deep veins of Legs

 Assessment by :- Positive Homan's Sign

Anil Kantiwal Gudha ( OM Nursing Academy )

5. Vericose Vein :- Distended, Swollen and Knotted veins.

 Vericose Vein के
Assessment केलए Trendelenburg's test करते
ह।

 Vein Stripping यह Vericose vein का surgical management ह

Arterial Disorders :-

1. Raynaud's disease :- Upper एवं

lower extremities क artery व arterioles म vasospasm को
Raynaud's Disease कहते ह।

2. Buerger's Disease ( Thromboangiitis obliterans ) :- an occlusive disease of the median and

small arteries and Veins.

 Distal upper and lower limbs are affected most commonly.

 Smoking is a main cause.

3. Aneurism :- localized abnormal dilation of a Blood vessels.

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Cardiac Temponade :- Heart क Pericardium wall के

Parietal एवं
Visceral layers के
म य Fluid का
इक ा होना ।

 Normal Pericardinal fluid is - 15 to 35 ml.

Cardiomyopathy :- Acute एवं

chronic disorders of heart muscles.

Rheumatic Heart Disease :-

 Caused by - Group A beta Hemolytic Streptococcus

 Sign and Symptoms :-

 Aschoff's Bodies

 Erythema marginatum

 Sydenham's chorea

______________________________________________________________________________________________

Diagnostic Criteria :-

 Jones Criteria :- Rheumatic Fever

 Dukes Criteria :- Endocarditis

Boot Shape Heart Seen in - TOF ( Tetralogy of fallot's )

Pear shape / Flask shape heart seen in - Cardiac temponade

Anil Kantiwal Gudha ( OM Nursing Academy )

Hemodynamic Monitoring :-

CVP ( Central Venous Pressure ) is about 3 to 8 mmHg.

JVP ( Jugular Venous Pressure ) is about 6 to 8 cm H2O ( less than 9 CM H2O )

Portal Venous Pressure is 8 - 12 mmHg.

PAWP ( Pulmonary Artery wedge pressure ) range between 4 to 12 mmHg.

Right Atrial Pressure is 1 to 8 mmHg.

PAP ( Pulmonary Artery Pressure ) is 15 to 26 mmHg

MAP ( Mean Arterial Pressure ) is between 60 and 70 mmHg.

Normal Arterial PO2 is 100 mmHg.

 1 mm Hg = 1.36 cm H2O ( Aiims Delhi 2018 ) & 1 Cm H2O = 0.76 mmHg

______________________________________________________________________________________

CardioVascular Medication :-

 Drug of Choice in Heart Failure :- Digoxin

 Drug of Choice in Myocardial Infarction :- Morphine Sulfate

 Drug of Choice in Angina :- Nitroglycerin ( Sublingual )

 Drug of Choice in Cardiogenic Shock :- Dopamine

 Drug of Choice in Stress test :- Dobutamine

 Drug of Choice in Supraventricular tachycardia :- Adenosine

 Drug of choice in Arrhythmias :- Amiodarone

Note :-

 1st Sign of Digoxin Toxicity is Anorexia.

 अगर कोई Patient, Digoxin क dose miss कर दे

और 4 घ टे
केभीतर missed dose को ना ले
पाये
तो,
next dose उसके schedule time पर ही द ।

 अगर Patient, Digoxin ले

ने
केबाद Vomit कर दे
तो Patient को उसी व second dose नह दगे
।

 Angina म patient को Nitroglycerin sublingual दे

ते
ह, फर Patient का pain assess करते ह अगर
pain कम नही हो तो 5 मनट बाद एक और Nitroglycerin क dose देते ह व reassess करते ह । ऐसे
Patient को Max. 3 dose दे सकतेह ( अगर फर भी Pain relieve ना ह तो इस event को Document
करके HCP को notify कर । )

Anil Kantiwal Gudha ( OM Nursing Academy )

 • Special Points •

 Most common complication of portal hypertension is - Vericeal hemorrhage.

 Elevated of a ASO ( Anti streptolysin 'o' titre ) is seen in - Rheumatic fever

 The most common site of MI is the "Anterior wall of left ventricle."

 6 second strips method used in dysrhythmia.

 Pedal pressure in Defibrillation is 25 lbs.

 In Pulmonary edema, first nursing priority is to provide high fowler position to the patient.

 Von willebrand disease :- low level of clotting protein in blood

 While measuring Central venous pressure on zero point of the manometer is adjust to
Mid axillary line.

 Sinus bradycardia is seen in athletics.

 Dyspnea is most common clinical manifestation of Pulmonary embolism.

 In a DVT patient there Venous Emboli will be lodge in - Lungs

 A Holter monitor is Continuous observation of the clients heart rate. ( 24 hour ECG
monitoring in Dysrhythmia ).

 Wolf Parkinson white syndrome is seen in shorter PR interval.

 Permanent Pacemaker are placed in subcutaneous tissue below the clavicle in body.
Aiims & PGI

 Atrial natriuretic peptide ( ANP ) is a hormone secreted by Right Atrium.

 Dressler syndrome also known as late pericarditis.

 Kussmaul's Sign - Inspiration करने

पर Jugular venus pressure का बढ़ना ।

 Cyanotic spell म Knee chest position दे

ते
ह।

 Right ventricle is the most common site of injury from blunt chest trauma.

 CABG म Sephaneous vein एवं

Internal mammary artery काम म ली जाती ह ।

 Cardiac index :- त मनट Ventricle से

पू
र ी body को कतना Blood pump होता है

Normal Value of Cardiac Index is 2.8 L/M2/Minute.

 Marfan Syndrome :- Premature degeneration of vascular elastic tissue.

Anil Kantiwal Gudha ( OM Nursing Academy )

 Endarectomy :- an opening in the artery and removing Obstructive plaque.

 The most common cause direct cause of sudden death is Coronary Artery Disease.

 Effect of repeated attack of rheumatic fever cause Valvular heart disease.

 Zero Point in CVP monitoring known as Phlebostatic Axis.

 Common cause of Aortic aneurysm is Atherosclerosis.

 Kawasaki Disease :- ( Acute systemic inflammatory disease ) known as mucocutaneous

lymph node syndrome.

Anil Kantiwal Gudha ( OM Nursing Academy )