Cardiovascular Lab Report PDF

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Module 03 Lab Worksheet: Cardiovascular System- Heart and Blood Vessels Introduction This week’s lab will focus on understanding the concepts of heart physiology and blood vessels of the body.

Objectives Objectives for this week’s lab include: 1) Describe and measure the changes to cardiac output and blood pressure with aerobic activity, 2) Map out the major blood vessels of the body, 3) Locate and palpate various pulses, 4) Map the flow of blood throughout the body.

Overview The cardiovascular system includes the heart and blood vessels of the body and has, in a very general concept, the responsibility of transporting nutrients throughout the body. The heart can be thought of as two pumps that work side by side that pump blood out to two different circuits of the body- pulmonary and systemic circuit. The pulmonary circuit pertains to blood flow to and from the lungs and the systemic circuit pertains to blood flow to and from the body. The cardiac cycle represents all of the events associated with one complete heartbeat including the blood flow, cardiac conduction system, heart valves, and the contraction of the heart muscle. Cardiac output and blood pressure are a result of the cardiac cycle. Cardiac output is the amount of blood pumped out by a ventricle in one minute. Blood pressure is the pressure placed or exerted on the walls of the blood vessels during the cardiac cycle. It is measured in terms of systolic (ventricular contraction) / diastolic (ventricular relaxation) and normal measurement of blood pressure is 120/80 mmHg or less. A number of factors can influence blood pressure including: Improper measurement technique, emotional state, talking, stress, alcohol, caffeine, full bladder and smoking. The blood vessels form a close circuit system that starts and ends at the heart and allows for nutrients to be transported throughout the body. Blood vessels are dynamic structures that can constrict and dilate, pulsate and even proliferate and grow into new blood vessels. There are three categories of blood vessels: Arteries, veins and capillaries. Arteries carry blood away from the heart, contain oxygenated blood (with one exception), and have the ability to constrict and dilate. Veins carry blood back to the heart, contain deoxygenated blood (with one exception), and contain valves. Capillaries are the smallest and thinnest blood vessels. Technically, capillaries only have an endothelium allowing nutrients to diffuse from the capillaries to the surrounding cells and from the body cells to the capillaries.

Determination of heart rate can be completed by palpation of an artery, typically the carotid or radial artery. There are a number of factors that can influence the palpation of blood vessel which include: Blood pressure, depth of blood vessel, emotional state, illnesses, medications, and distance measurement is taken from the heart.

Materials    

Automatic blood pressure cuff Stethoscope Large paper roll Markers/Colored Pencils/Pens- Blue, Red, Black

Pre-Lab Evaluation Questions The pre-lab evaluation questions must be answered prior to lab and demonstrated to your lab instructor. You must read through the assigned chapter readings, lab introduction, objectives, overview and procedure to answer these questions. Please cite your work for any reference source you utilize in answering these questions. 1. How does a condition like heart failure (congestive heart failure) influence cardiac output? Cardiac output is the heart rate and may or may not be affected but stroke volume will be affected. When heart failure occurs usually a side of the heart fails, fluid backs up either in the lungs or in the extremities.; thus less fluid is being pumped by the heart. Cardiac output overall can be negatively affected. 2. Why is hypertension (high blood pressure) sometimes called the ‘silent killer’? What are some of the complications of hypertension, specifically to the blood vessels? People don’t know they have high blood pressure and it can cause many negative impacts on the blood vessels. High blood pressure over a period of time causes immense damage if not treated. 120/80 used to be the standard “healthy” level, but slightly lower is better.

3. What do the Lub and Dub sounds of the heart represent specifically. How do they relate to the cardiac cycle? When is a heart murmur heard within the cardiac cycle? First and second heart sound; Lub and Dub. First is blood moving through the AV vales, second is the semilunar valves closing.

4. How does vasoconstriction and vasodilation of an artery influence cardiac output and blood pressure? What specific portion (section) of the nervous system controls the mechanisms of vasoconstriction and vasodilation within the arteries? Vasoconstriction: Less space, blood flow is less, reduced stroke volume and cardiac output; increased blood pressure. Sympathetic nervous system, fight or flight. Vasodilation: blood vessels are bigger; more blood can flow back to heart. Can increase the amount of blood that flows out of the heart. Stroke volume and cardiac output is increased. Blood pressure goes down, there is less pressure. Parasympathetic nervous system, promotes rest and digest. Blood is in intestines. This is controlled by the autonomic nervous system. 5. Compare and contrast the characteristics of the three types of blood vessels? Three types of blood vessels: arteries, veins, and capillaries Arteries carry oxygenated blood, thicker walls, and smaller lumen, deeper in the body for protection, flow away from heart. . A vein is typically carried deoxygenated slower moving blood, less muscle, thinner walls, and is more superficial, toward heart. Capillaries connect arteries and veins and drop off oxygen and pick up carbon dioxide and act as exchange areas for carbon dioxide in the lungs with oxygen.

Part 01 Procedure: Cardiac Output and Blood Pressure 1. There are a number of factors that will influence cardiac output, blood pressure and heart rate. We are going to examine some of these factors and the relationship between cardiac output and blood pressure. 2. Locate the automatic blood pressure (BP) monitor unit. Review the instructions on how to measure the BP with this unit. Make sure it also measures and displays heart rate; if not, you will have to measure pulse rate with the following blood pressure measurements too. Have a lab partner assist in the measurement of the BP and pulse readings. 3. Take a base line BP reading after you have been sitting still for at least 60 seconds and measure the results in the chart below. Take the blood pressure measurements preferably without a shirtsleeve underneath the blood pressure cuff.

4. After your baseline BP measurement sitting, stand up for at least 60 seconds and take a baseline BP measurement standing and record the results below. 5. After your base line BP measurements, find a location where you can lay supine for at 90 seconds. After 90 seconds take your BP measurement while laying supine and record the measurement in the chart below. After the supine BP measurement is taken, quickly stand up and measure your BP right away and then after 90 seconds from when you initially stood up. Measure the results below in the chart. 6. The next measurements will compare stress levels and BP. In a seated position, close your eyes, think of relaxing items/environments and try to be as relaxed as possible. After at least 60-90 seconds, measure and record your BP. Next, try to solve the math questions on the handout from your lab instructor while your lab partners are ‘harassing’ you to hurry up and finish up. This is simulating a stressful environment. After about 45-60 seconds, measure and record your BP measurement. 7. The next BP measurements will assess the changes in BP with mild exercise and all will be taken in a seated position. Take a brisk walk (speed walk) to one end of the campus and back and measure your BP. Next perform jumping jacks or an exercise for 90 seconds. At 90 seconds, stop and measure and record your BP in a sitting position. 8. Retake your BP after 1 minute and 3 minutes of rest after your BP exercise measurement.

Cardiac Output

Situation

Position

Blood Pressure

Heart Rate

Baseline

Seated

122/70

60

4200

Baseline

Standing

118/70

68

4760

Supine

Laying down

128/72

64

4480

Standing

Standing

124/74

64

4480

Standing

110/72

72

5040

(Immediately)

Standing (90 seconds)

(Stroke Volume of 70ml)

Relaxed

Seated

112/68

64

4480

Stressed

Seated

114/66

68

4760

Brisk Walk

Seated

128/70

64

4480

Seated

162/70

64

4480

Seated

130/80

64

4480

Seated

126/76

64

4480

Exercise (Immediately after)

Post-Exercise (1 minute)

Post-Exercise (3 minutes)

A) Did any specific BP and/or pulse rate measurements surprise you? Why or why not? The BP and pulse rate that surprised me the most was the immediate post exercise. Blood pressure was 162/70 while the pulse didn’t’ really change from what was measured when resting, which was 64.

B) What did you notice with the BP when going from a supine position to a standing or recumbent position? How does orthostatic hypotension relate to this situation- going from supine to a standing position? In our case, there was not a great difference from supine: (128/72) to standing immediately:(124/74) but after 90 seconds there was a substantial change which was: (110/72). This occurrence directly related to orthostatic hypotension which is defined as a decrease in systolic blood pressure of 20mm Hg or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing when compared with blood pressure from sitting (Lanier, Mote, & Clay, 2011). C) Explain how the changes in BP and HR relate to the cardiac output specifically with the exercise and post-exercise measurements? Exercise requires the body to need more oxygenated blood pumped to tissues more frequently then when an individual is at rest. As the vigor of exercise increases blood pressure may increase in order to achieve this. In addition, working muscles increase stroke volume by sending higher amounts of blood volume back towards the lungs for oxygen (Ross, 2017).

Part 02 Procedure: Auscultation of the Heart 1. Auscultation basically means to listen to internal organs to assist in the diagnosis and treatment of conditions. Being able to auscultate the heart, you must have a solid knowledge of the cardiac cycle and the heart valves. Locate a stethoscope and carefully determine if the diaphragm side is activated. 2. Utilizing the chart in Appendix B, locate and auscultate the four heart valves. Your lab partner should be of the same sex. Have your lab partner sitting and slightly lean forward. It is more effective to have the diaphragm of the stethoscope directly against the skin but this technique will not be utlized in our laboratory setting. Place the diaphragm side of the stethoscope directly against the clothing and have your lab partner exhale and then hold their breath while you listen to heart sounds. 3. Record your observations below: Sounds

Observations

S1: Lub

Normal

S2: Dub

Normal

Extra sounds?

Light swish in the 4th; mitral area; due to mitral valve repair

4. What sort of heart complication would be present if: a. There was an extra sound between the Lub and Dub sounds? The only extra sounds that were heard were in the mitral valve in the 4th listening position due to a mitral valve repair. The sound was a very faint and light swishing sound. b. There was an extra sound occurring after the Lub-Dub sound and before the next Lub-Dub sound? No.

Part 03 Procedure: Mapping of the Blood Vessels 1. Locate the large paper roll and cut off a section of it long enough to trace the outline of you or one of your lab partners. Roll out the section of paper you collected and with a black marker, color pencil or pen, carefully trace the outline of your lab partner’s body. Make sure not to get any of the marker on

your lab partner OR his/her clothing. 2. Once you have an outline of a human body, draw a rectangle in the appropriate anatomical location and size to represent the heart. Draw quadrants within the rectangle to represent the four heart chambers. Next, draw a small circle to represent the umbilicus (belly button) in the correct anatomical location. 3.

Utilizing the blood vessels listed in Appendix A, map out the appropriate arteries and veins. You may want to start drawing out the blood vessels with a pencil in case you make a mistake. Eventually, you will want to use the red marker to line (mark) the arteries and the blue marker to line (mark) the veins listed in Appendix A. You will need to be able to locate these blood vessels on your laboratory Mid-Term and/or Final.

4. It is recommend that you take a picture of your blood vessel mapping effort to assist your studies with the identification of these blood vessels.

Part 04 Procedure: Palpation of Pulses 1. Prior to starting this procedure, make sure you have thoroughly cleaned and/or sanitized your hands. Utilizing the chart below, palpate the pulses and note any observations of them regarding: Strength, rate, and rhythm. The rate is examining the overall pulses per minute. The rhythm is examining the consistency of the pulse; is it regular or irregular. The strength is examining the force at which the pulse can be palpated. Pulses measured on blood vessels further away from the heart will be weaker when compared to pulses taken closer to the heart. Artery

Rate

Rhythm

Strength

Carotid

76

Steady

Light

Temporal

76

Slight irregularity

Normal

Brachial

64

Normal

Light

Radial

84

Normal

Normal

Ulnar

80

Normal

Normal

Femoral

82

Normal

Normal

Popliteal

76

Light

Light

Posterior tibial

80

Light

Light

Dorsalis pedis

80

Normal

Normal

Part 05 Procedure: Blood Flow and Cardiac Conduction System 1. Utilizing the picture found in Appendix C, describe how the intrinsic cardiac conduction system relates to the cardiac cycle and cardiac output. SA, AV, bundle of his, purkinje fibers. Heart rate. 2. If an individual had the arrhythmia condition of atrial fibrillation, the most common type of arrhythmia, what is going on with the intrinsic cardiac conduction system AND how would the cardiac cycle and cardiac output be affected? Atrial fibrillation is commonly referred to as afib and is when the atria contract very rapidly and often irregularly to the point where the ventricles do not fill up with blood effectively. Atrial fibrillation happens when erratic or extra electrical signals interfere with the normal timing of the hearts pacemaker, causing the heart to beat faster or quiver. When this happens blood can pool in the atria, and form blood clots. Excessive or irregular heartbeats can also overwork the heart muscle, which can lead to heart failure (About the Heart, 2009). In afib the heart chambers may not fill completely which will deplete cardiac output.

Post-Lab Evaluation Questions The post lab evaluation questions must be completed prior to your submission of the lab. Answers for these questions will be derived from the lab protocol, the weekly

concepts associated with the lab and possibly research content from the book and/or online resources. Please cite your work for any reference source you utilize in answering these questions.

1. Describe how cardiac output and blood pressure relate to the cardiac cycle? Can you have an increase of blood pressure and not an increase in cardiac output? Why or why not? You can have increased BP and not an increase in cardiac output if you have a damaged heart. It is possible that the blood pressure is so high that blood is not being delivered, thus stroke volume will be lower. 2. In your own words describe the term angiogenesis. How is angiogenesis important to the human to the human body? How does it relate to tumors and cancer? Angiogenesis is the production of new blood cells. New blood vessels because of a tumor may occur and then obtain their own blood supply. Blood and nutrients may be going to the cancer and not the body tissues, which may cause a cancer patient to lose weight and the cancer, may develop in the blood. 3. Individuals that have coronary artery disease (CAD), specifically arteriosclerosis will undergo angioplasty and/or coronary artery bypass graft procedures. Compare and contrast these procedures. CAD is when there is plaquing that occurs in the coronary arteries, feed the hear muscle itself. If they are blocked or clogged the blood supply to the heart can be cut off and a heart attack may occur, especially in the left ventricle. An angioplasty to clean out the artery and putting a stint in is a solution, or vessels from another part of the body and bypass that spot. 4. In your own words, define the term ischemia. Describe ways that ischemia can occur in the body and the various complications that result because of it. How do the terms ischemia, thrombus and necrosis relate to one another? Ischemia is the lack of blood supply. Can cause death of tissue, can be caused by a thrombus, could be related to a stroke which can cause regions of the brain to die and become necrotic tissue. 5. What is the electrocardiogram (EKG)? How does the EKG relate to the cardiac cycle? In general, how can an EKG determine if an individual has had a myocardial infarction (heart attack)?

An electrical impulse is sent and read of the impulse of the heart itself and reads that impulse. The depth and width of the graph indicate the regularity and consistency of the electrical impulses of the heart. Height and spacing indicates the health of the ventricles.

References:

Lanier, Jeffery.; Mote, Matthew.; Clay, Emily. Martin Army Community Hospial Family Medicine Residncy, Fort Benning, Georgia. Am. Fam. Physician. 2011 Sep 1; 84(5):527-536.

Ross, Mandy. Changes in Cardiac Output During Exercise. https://www.livestrong.com/article/307554-changes-in-cardiac-outputduring-exercise/ September 11, 2017.

Appendix A- Cardiovascular System Vessels To Identify For The Laboratory Mid-Term and Final Exams

Great vessels of the Heart  Aorta  Pulmonary arteries  Pulmonary veins  Superior vena cava  Inferior vena cave Vessels of the Neck and Head  Brachiocephalic trunk  R/L Subclavian arteries  R/L Common carotid arteries

      

R/L Internal carotid arteries R/L External carotid arteries R/L Temporal arteries R/L Vertebral arteries R/L Internal jugular veins R/L External jugular veins R/L Subclavian veins

Vessels of the Arm  R/L Subclavian arteries  R/L Axillary arteries

      

R/L Brachial arteries R/L Radial arteries R/L Ulnar arteries R/L Axillary veins R/L Brachial veins R/L Radial veins R/L Ulnar veins