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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


It's my heart!

Updated: Oct 18, 2023

One of the areas where I struggled in nursing school was cardiac issues and dysfunction. Left-sided, right-sided, chest pain, heart attack and then there was all the medications that a patient could take. OMG too much! So, to learn it well, I taught it! As I have said in a previous post, the best way to learn is to teach the subject. But not only did I teach it for 5 years, I figured out how to break it down into smaller, understandable pieces. Let me share my understanding with you.

Take out a piece of paper and pen/pencil. Now draw a box, then draw horizontal and vertical line, label horizontal sides Right and Left. Add a blue arrow at the top of the right and red arrow at top of left going towards the atrium, two arrows are drawn at the bottom going away from the right and left side. I draw it as a box but you can draw it like a heart.

This a simplified way to remember that oxygenated blood is coming from the lungs to the left side out to the body. Remember, Left = Lungs and the blood goes through the left side of the heart out to the Body. The Right side has deoxygenated blood coming from the body going to the lungs. But don’t forget this is a closed loop so the left oxygenated blood will release the O2 molecule in exchange for CO2 and travels back to the lungs to get oxygenated. I like to think of a train station, picking up passengers, letting off passengers and then returns to the train depot to start again.

IF there is defect or dysfunction in the Left Ventricle, which is the most common type of Cardiac dysfunction or disease (80-90% of pts have Left sided failure) then the blood will back up into the lungs, causing pulmonary issues. So a patient with left sided heart failure will have pulmonary symptoms initially.

If there is dysfunction in the right side the blood will back up into the body. So there will be issues with the body like lower extremity swelling, distended jugular veins, ascites, etc.

You also must remember that the heart is a double pump. It is a closed system but consists of 2 pumps. The right and the left side are the pumps. But you need some type of electrical system to make the pump work which is the conduction system. If we go back to the train metaphor, a train cannot run without steam (old time trains), gas or electricity. The electricity starts in the right atrium at the SA node, travels to the AV node down the Bundle of HIS, to the Left and Right Bundle Branch and the Purkinje fibers. The electricity is generated through the sodium, potassium and calcium pumps transfers.

The electrical system causes the muscular system of the heart to contract pushing the blood out to the rest of the body, then relaxes to fill up again. If the heart muscle is ineffective or damaged, then all of the blood in the ventricles (especially the left side) will not completely leave the heart leaving blood behind. And then there is a backup to the lungs. When there is blood left behind that does not leave the heart there can be clotting. Those clots can then be pushed out to the body (legs or head) and cause DVTs or strokes.

The heart beats at a rate of 72 times per minute on average, or more than 100,000 times a day.

It moves more than 2,000 gal. (7,571 L) of blood through a 60,000-mile (96,560 km) network of blood vessels in a single day. During the average lifespan of a human, the heart beats more than 2.5 billion times to keep blood moving through the circulatory system. Too little blood and the organs, tissues and cells will not get the oxygen and nutrients needed to survive. Too much blood and pressures build up in the vessels that contributes to HTN and cardiomyopathy.

The New York Heart Association classifies heart failures 4 ways. Class 1 means there is evidence of heart disease but the patient does not have symptoms.

Class 2, there are mild symptoms with ordinary activity.

Class 3 there are significant limitations and the patient is only comfortable when resting.

Class 4, severe limitations during activity and at rest.

Knowing the anatomy of the heart, the circulation of the body in terms of where blood is coming from and where it is going to, can help in assessment of heart dysfunction. There are some rare and abnormal manifestations of heart dysfunction but most of the time it is due to two factors:

1. An electrical problem – the power needed to make the heart contract is impaired.

2. A pump problem, there is too much fluid, too little fluid or there is an obstruction in the “plumbing of the heart”.

In 1981 a study was started in a retirement community in orange County CA called the Leisure World Cohort Study (LWCS). 14,000 participants completed the study and the data was kept in notebooks in storage. Many of the cohorts of the study were in their 90’s now so researchers at UC Irvine took the initial survey data from those 90+ still living and followed them until they died. There were physical assessments, cognitive assessments, MRI scans and at death a slice of their brain was evaluated for plaques and tangles. Plaques and tangles are suspected to cause Alzheimer's Disease. The 90+ Study surveyed the oldest-old to answer questions about longevity and quality of life. Every 6 months since 2003 researchers have conducted physical and neuro exams on the participants.

The data has shown some interesting results:

  1. People who drink moderate amounts of alcohol and coffee lived longer than those who didn’t.

  2. People overweight in their 70’s lived longer than normal or underweight people. (Finally, a reason to be fat!).

  3. People who exercise at least 15-45 min three times a week lived longer but increasing the amount or frequency of exercise did not increase lifespan.

  4. Vitamins like E, A, C and calcium did not increase longevity or quality of life. (So why do doctors continue to prescribe them?).

  5. Smokers died considerably sooner than non-smokers. A five-year abstinence of smoking restored lung function in a large majority of older persons.

  6. Social connection and romance increased longevity and quality of life.

What are the implications for our patients?

Exercise can prevent or decrease effects of aging and chronic conditions like CAD.

A significant finding was if a person exercised moderately in their 70’s they were far less likely to fall in their 90’s.

Heart healthy diets decrease effects of HTN and fatty deposits.

But most interesting is that in the oldest-old those with higher BP (140/90) had less risk of developing dementia.

Slightly overweight adults fare better than underweight individuals.

And the best finding: it is ok to drink alcohol in moderation and coffee has life extending qualities.

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