PROBLEMS OF

CARDIAC OUTPUT AND

TISSUE PERFUSION

CHARLES Z. ARIOL A JR., RN., MSN., LPT.

Instructor I
 ASSESSMENT OF THE
CARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEM
- comprises the heart and the blood
vessels (both arteries and veins)

- responsible for supplying oxygen to

body organs and tissues called
PERFUSION.
 ASSESSMENT OF THE
CARDIOVASCULAR SYSTEM

MYOCARDIUM - the heart muscle that

must receive sufficient oxygen to pump
blood to other parts of the body.

ARTERIES -must be patent so that the

pumped blood can reach the rest of the
body.
ANATOMY AND PHYSIOLOGY
OF THE HEART
 ANATOMY AND PHYSIOLOGY
OF THE HEART

STRUCTURE

- the heart is fist-sized, muscular organ

located in the mediastinum between the
lungs.
- each beat of the heart pumps about
60 ml of blood or 5 L/min which doubles
during strenous physical activity.
PERICARDIUM
- is a covering that protects the heart

SEPTUM
- muscular wall that separates the
heart into two halves (left and right) and
each half has upper chamber (Atrium) and
lower chamber (Ventricle)
RIGHT ATRIUM (RA)
- receives deoxygenated blood
(venous return) from the body through the
superior and inferior vena cava.
- it also receives blood from the heart
muscle through coronary sinus.

RIGHT VENTRICLE (RV)

- muscular pump located behind the
sternum.
 - it generates enough pressure to close
the tricuspid valve, open the pulmonic
valve and propel blood to the pulmonary
artery and the lungs.

LEFT ATRIUM (LA)

- receives reoxygenated blood from
- blood flows then through the mitral
valve and into the left ventricle.
LEFT VENTRICLE (LV)
- generates enough pressure to close
the mitral valve and open the aortic valve.
Blood is propelled into the aorta and into
the systemic arterial circulation.

100 to 120 mm Hg- pressure of blood in

aorta

0 to 5 mm Hg - pressure of blood in RA
FOUR CADIAC VALVES
- maintain the forward flow of blood
through the chambers of the heart
- classified into two:
1. Atrioventricular valve (AV)
2. Semilunar valve (SV)
ATRIOVENTRICULAR VALVES
- separates the atria from the ventricles

a. Tricuspid valve- separates RA from RV

b. Mitral valve - separates LA from LV

* during ventricular diastole, these valves act as

funnels and help blood move from atria to
ventricles.
* during systole, the valves close to prevent
backflow of blood into the atria.
SEMILUNAR VALVES
- prevent blood from flowing back
into the ventricles during diastole.

Pulmonic Valve - separates the right

ventricle from pulmonary artery

Aortic Valve - separates left ventricle from

aorta.
BLOOD FLOW TO THE HEART
CORONARY ARTERIAL SYSTEM
CORONARY ARTERIAL SYSTEM

Left Main Coronary Artery (LMCA)

- supplies the left heart

Right Coronary Artery (RCA)

- supplies the right heart and inferior wall
of the heart

Mean Arterial Pressure (MAP) - 60 to 70 mmHg

which should be maintained in the coronary
blood flow.
Left Main Coronary Artery (LMCA)
- divides into two branches: Left
Anterior Descending Artery (LAD) and
Left Circumflex Coronary Artery (LCX).

LAD - descends toward the anterior wall of

the ventricle and apex.
LCX -descends toward the lateral wall of
ventricles and apex
SEQUENCE OF EVENTS DURING THE
CARDIAC CYCLE

DIASTOLE - relaxation and filling of the

atria and ventricles
SYSTOLE- contraction and emptying of
the atria and ventricles
MYOCARDIAL CONTRACTION -
results from the release of large numbers of
calcium ions.
MECHANICAL PROPERTIES OF THE
HEART

CARDIAC OUTPUT - amount of blood

pumped from the left ventricle each minute.
Depends on the relationship between the heart
rate and the stroke volume.

CO = HR X Stroke Volume

Normal CO: 4 to 7 L/min

HEART RATE

- refers to the number of times the

ventricles contract each minute.
- normal heart rate is between 60 to 100
beats/min.
-controlled by the Autonomic Nervous
System (ANS)
- can be affected by catecholamines
STROKE VOLUME
- amount of blood ejected by the left
ventricle during each contraction.
PRELOAD
- refers to the degree of myocardial stretch
at the end of diastole and just before contraction.
- determined by the amount of blood
returning to the heart from venous system (right
heart) and pulmonary system (left heart)
AFTERLOAD- the pressure or resistance that
the ventricles must overcome to eject blood to
the semilunar valves and into the peripheral
blood vessels.
MYOCARDIAL CONTRACTILITY
- affects stroke volume and CO and is the
force of contraction independent of cardiac
preload.

- increased by factors such as sympathetic

stimulation, calcium release and positive
inotropic drugs.
- decreased by factors such as hypoxia.
VASCULAR SYSTEM
- provides route for blood to travel
from the heart to nourish variou stissues of
the body
- carries cellular waste to excretory
organs
- returns blood to the heart for
circulation
- divided into ARTERIAL SYSTEM
and VENOUS SYSTEM
Arterial System
- blood moves from the larger arteries
to a network of smaller blood vessels called
arterioles, which meet in the capillary bed.

Venous System
- blood travels from capillaries to the
venules and to the larger system of veins
ARTERIAL SYSTEM

Blood Pressure - force of blood exerted

against the vessal walls. Pressure in the
larger arterial blood vessels is about 80 to
100 mm Hg and decreases as blood reaches
capillaries ( about 25 mm Hg)

BP = CO X PVR
MECHANISMS THAT AFFECT BP

1. Autonomic Nervous System

2. Kidney
3. Endocrine System

SYSTOLIC BP - pressure or force

generated by the left ventricle to distribute
blood into the aorta with each contraction
of the heart.
BARORECEPTORS
- located lin the arch of aorta and the
origin of carotid arteries which are
stimulated when the arterial walls stretched
by an increased BP
- impulses from these inhibit the
vasomotor center.

PERIPHERAL CHEMORECEPTORS
- sensitive to hypoxemia
KIDNEYS
- help regulate cardiovascular activity.

- activation of Renin-Angiotensin-
Aldosterone Mechanism
- Antidiuretic hormone
OTHER FACTORS THAT INFLUENCE
ACTIVITY OF CARDIOVASCULAR
SYSTEM

1. Emotional Behaviors (Excitement, pain,

anger)
2. Stimulation of SNS
3. Increased physical activity
4. Body Temperature