CARDIOVASCULAR INVESTIGATIONSMRS. M.I BASTOS Chief Nursing Officer Lagos University Teaching Hospital

OUTLINEy INTRODUCTION

Brief anatomy of the heart and blood vessels 2. Brief statement on cardiac cycle 3. Brief statement on the electrical activity of the heart1.

WHY CARDIOVASCULAR INVESTIGATIONS ? 1. Cardiovascular diseases y WHAT PREDISPOSES TO CARDIOVASCULAR DISEASE ? y TYPES OF CARDIOVASCULAR INVESTIGATIONSy

INTRODUCTIONy The term CARDIOVASCULAR is gotten from two terms y CARDIO which means heart and y VASCULAR which means the blood vessels

Brief Anatomy of the Heart and blood vessels y The heart can be likened to a pump and the blood vessels to pipes which help distribute blood to all the different parts of the body. y It is a vital organ of the human body and can be referred to as the pumping machine of the body

ANATOMY OF THE HEART

INTRODUCTIONy The heart begins its existence from the 8th week of intra-

uterine life i.e. the baby's heart is formed and starts beating by the time its mother is 8 weeks pregnant. y The heart never stops pumping blood from this period until death. y The heart has four chambers : upper left and right atria, divided by the inter atrial septum and lower left and right ventricles separated by an interventricular septum

The Cardiac Cycley Blood flow in the heart is in one direction y Blood enters the heart through the atria and leave through the y y

y y

ventricles On the right side, used blood from the whole body enters the right atrium from where it flows into the right ventricle. The right ventricle then pumps the blood to the lungs through a major vessel called the pulmonary artery. In the lungs, the blood receives oxygen. This oxygen rich blood is transported to the left atrium where it flows to the left ventricle. The left ventricle pumps this blood through another major vessel called the aorta to the rest of the body.

Electrical Activity of The Heart

Electrical Activity of The Hearty As blood enters both atria, the sino-atrial node (a specialised

body) sends electrical messages to other parts of the hearts muscle such as the atrio-ventricular node, bundle of His and Purkinje fibres. y This stimulates the muscles of the heart to contract, therby pumping blood through the great vessels to the lungs and general body respectively.

Why Cardivascular Investigations?y Cardiovascular investigations are special techniques or procedures

used to examine the heart and blood vessels to make a diagnosis of heart diseases/problems y They can also be used to assess the functions of a normal heart.y Such investigations may need to be carried out on a person for one

or more of the following cardiovascular diseases 1. Heart failure: pump failure i.e. heart fails to pump blood to meet the demands of the body. There is usually shortness of breath, tiredness/weakness (easy fatigability), leg swelling, abdominal swelling, chest pain, fainting (syncope)

Cardiovascular Diseases2. Heart Attack: (myocardial infarction) this is as a result of reduction of blood supply to the heart muscles. It leads to sudden, excruciating, strangulating chest pain.

3. Stroke: Sudden inability to move one side of the body, talk or sudden loss of consciousness.

Cardiovascular Diseases4. Congenital heart disease: (inborn) there are many types which range from a hole in the heart to abnormal connections of the great vessels. Common examples include: Ventricular septal defect, Atrial septal defect, patent ductus arteriosus, single ventricle and single atrium.

5. Conduction disturbances: which could manifest as fainting, palpitations.

What predisposes to Cardiovascular Disease?1. y y y 2. y y y y

Hypertension: A silent killer High blood pressure > 140/90 mmHg It usually will not give rise to any symptoms until much damage has been done to the heart, blood vessels and other organs of the body. Treatment of high blood pressure is for life. Diabetes Mellitus: excess sugar in the blood stream due to deficiency of insulin or inability of the body to respond to insulin. This also damages the heart, blood vessels and other organs of the body (D.M retinopathy, nephropathy, neuropathy, foot syndrome) Blocks the blood vessels with fatty deposits (atherosclerosis) Treatment is also for life.

What predisposes to Cardiovascular Disease?3.y y y y y

Smoking: Causes raised blood pressure Destroys the muscles of the heart Destroys the inner lining and causes hardening of blood vessels Predisposes to clot formation in the blood vessels Beware of being a passive smoker

What predisposes to Cardiovascular Disease?4. Alcohol: y This causes enlargement of the heart. y It is poisonous (toxic) to the heart muscles. 5. Obesity: y Can be described as being overweight, this causes problems for the heart by predisposing to hypertension, diabetes and atherosclerosis. y How can one know that he/she is obese? By measuring the Body Mass Index (BMI) which is calculated by dividing the weight in kilograms of a person by the square of his/her height in meters y i.e. WEIGHT HEIGHT X HEIGHT

What predisposes to Cardiovascular Disease?6. Sedentary Lifestyle: y Inactivity predisposes to obesity and all its risks 7. Bad diet: y Consumption of junk food y consumption of food high in salt, cholesterol and fat. 8. Infections: a. HIV (Human Immunodeficiency Virus) attacks the heart muscle lining, causing pericardial effusion(fluid in the lining of the heart); pericarditis (inflammation of the lining of the heart) b. Rheumatic heart disease: which affects the valves of the heart. c. Tuberculosis: also causes pericarditis and pericardial effusion.

Investigationsy These begin with physical examination and observation of the y

y y y

individual. The doctor is looking out for signs and symptoms of heart disease such as shortness of breath, flaring of the nose, blueness or darkening of the lips and tongue, finger clubbing, swelling of the feet and abdomen. Height and weight are measured The pulse is also checked for irregularities in rate and rhythm The blood pressure is measured by using the sphygmomanometer

Investigations

Investigationsy Blood tests: especially cholesterol and blood sugar levels. y ECG (electrocardiography): this is used to monitor the

electrical activity of the heart by using special sensors on the surface of the chest and limbs.

Investigationsy Types of E.C.G include resting ECG ,stress ECG

(monitoring under excercise), holter monitor (carried with the patient for 24 hour monitoring)

Investigationsy Chest X-ray y Which could show enlargement of the heart, and other

features in the chest indicative of heart disease

Normal Chest Xray

Chest Xray Showing Enlarged Heart

Investigationsy Echocardiography y This is essentially an ultrasound scan of the heart

Summaryy Cardiovascular diseases are real and could result in severe y y

y y y

illness, physical disability and death if not treated promptly. Regular medical checkups help in early diagnosis and treatment of these diseases. It is essential to keep blood pressure at bay by regular measurements and compliance with treatment where applicable Heart friendly diet- low salt, low fat and low cholesterol Exercise regularly, see your doctor for advice on the type of exercise that suits you. Avoid alcohol and smoking.