The cardiac cycle, or heart beat, starts at the top of the heart at the SA node. This sends the impulses, or beat, down the cardiac muscle fibres of the atria to the AV node (Won Chung and Chung 2007). When the impulses reach here, there is a slight delay so that the atria can finish contracting before the ventricles start contracting (Porth 2005). The impulses are then sent from the AV node down through the ventricles via the AV bundles. Each one of these cycles take approximately 0.8 seconds in the normal resting adult and so the average resting adult’s heart rate is approximately 70 beats per minute (Alexander et al. 2000).
There are several functions of the cardiovascular system. One function is for the blood to deliver oxygen and nutrients from the outside environment to all cells in the body. (Klabunde 2005). The other part of this function is for waste products to be removed from the body such as carbon dioxide (Batzel et al. 2007), and for oxygen to be put back into the blood for the next cardiac cycle. These functions and systems in the body need to be controlled to ensure stability within the body by homeostasis.
Homeostasis is the relative steadiness of the inner environment of the body even though external conditions may vary (Mader 2006) and Schulkin (2003) describes homeostasis as the control and maintenance of variables within the body such as blood pressure or temperature. Homeostasis is important within the body as it allows receptors in the heart, brain and blood vessels to detect the heart beat and control it using messages from the autonomic nervous system (Elling et al. 2005). Homeostasis, with regards to heart beat, works by the nerve receptors of the body detecting what is going on in the external environment and helps the body react. The stimulation of the external environment could be fear, stress, exercise or rest. The nerve receptors of the body send messages to the CNS, which in turn send messages to the heart via a sympathetic or parasympathetic nerve, so that the heart can react to the stimulation and speed up the heart beat or slow it down respectively (Nowak and Handford 2004).
An example of how this works is if I was to start running at a steady pace, the muscles in my legs would require more oxygenated blood at a faster rate then when I am resting, so a greater portion of the oxygenated blood is directed to the active muscle (McArdle et al. 2007). The receptors in the tissue would detect this need, relay messages to the CNS, which would in turn send impulses to the heart via the sympathetic nerve to make it beat at a faster rate. This in turn would mean that oxygen rich blood would be constantly delivered to the muscles at a faster rate (Brown et al. 2006) and my respiratory rate would increase to get more oxygen into the blood. The brain also stimulates the adrenal glands so they release adrenaline as this increases oxygen intake and muscle performance according to Viru (1985).
When the human body is at rest, a mechanism called negative feedback, helps keep variables in the body, such as heart rate, close to its normal range (Bassett 2005). It does this by resisting or adjusting the variable when an abnormal change in value is detected.
Health promotion is an approach of promoting positive health to the population and identifying the risk factors of poor health and promoting strategies for good health (Bunton and Macdonald 1992). There are three types of prevention involved with health promotion. These are primary, secondary and tertiary prevention (Dever 1984). Primary prevention is the stage of health promotion where action is taken to prevent, rather than treat a disease (Department of Health 2008); Secondary prevention is where the disease is detected in its early stage and the appropriate intervention is used such as treatment or education, and tertiary prevention is where the main aim is to minimise the impact of the disease.
There are many groups and organisations who promote health preventions, but the main type that will be talked about is primary prevention. One health promotion group, whose main initiative is for a healthy heart, is the British Heart Foundation. The British Heart Foundation (2008) states that “Our vision is of a world in which people do not die prematurely of heart disease”. They have many heart health initiatives in place, with some being at least 30 minutes of exercise, five days a week, eating healthily such as five portions of fruit and vegetables a day and reducing high fat intake. The rationale behind reducing a high fat intake is to reduce the amount of cholesterol in the body. Daniels (2002) suggests that a high fat intake can cause high cholesterol which in turn can lead to atherosclerosis, and Null (2006) suggests that a high fat diet can lead to hardening of the arteries. A low cholesterol diet can reduce the chances of a person developing coronary heart disease (British Heart Foundation 2008). Cholesterol is a waxy fat that travels around the body via the bloodstream (Freeman and Junge 2005); but it is not always bad for the body. Cholesterol plays a vital part in many cellular functions (Pottle 2007). The positive and negative effects of cholesterol all depends on what type of fat is mainly eaten in a person’s diet. If a person was to have a high saturated fat intake, then this could lead to an increase in the amount of low density lipoproteins (LDL) in there blood stream (Institute of Medicine 2005); lipoproteins being made up of cholesterol and protein. These ‘bad’ LDL’s carry cholesterol around in the blood stream and deposit it in cells. This is what can cause the build up of an atheroma, an abnormal growth of cholesterol, within the arteries which can lead to atherosclerosis (Faergeman 2003). It is fats such as monounsaturated fat that is good for the body. This is found in foods such as nuts, seeds and olive oil. Monounsaturated fats’s help lower LDL in the bloodstream and keep High density lipoproteins (HDL) at a stable level within the body (British Heart Foundation 2007). It is these HDL’s that carry any surplus cholesterol out of the bloodstream back to the liver for excretion, which means that the fat is not deposited in the arteries (McArdle et al. 2007) and so the risk of coronary heart disease is lowered.
The British Heart Foundation (2008) also suggest that swimming is a good form of exercise for the heart, but state that any form of exercise is good. They suggest that the aim is to do 30 minutes of exercise, five times per week. Part of the rationale behind this is that regular exercise has been shown to increase the amount of HDL’s in the body (Porth 2006). This means that the ‘good’ cholesterol will be increased in the body, leading to LDL levels being low. It has also been shown that people who exercise regularly could develop extra coronary arteries, which would mean that they have a richer blood supply around the heart (Corbin and Lindey 2006). The Department of Health (2004) has a report based around the five a week exercise scheme called ‘At least five a week: evidence on the impact of physical activity and its relationship to health’. In this, there are details on how to implement this initiative, but there are also warnings about how to go about it, especially if the person has an existing health problem such as a history of heart attacks. For this, they provide information on how to slowly build up an exercise plan in a safe way.
The Department of Health (2008) also carried out a recent study that found for each portion of fruit or vegetables a day, it lowered the risk of coronary heart disease by 4% and the risk of stroke by 6%. This backs up the British Heart Foundations (2008) claims as they also suggest that regular exercise can lead to a healthier heart.
The Department of Health (2008) also suggest that fruit and vegetables contain a good variance of vitamins and minerals and its not only these on their own that are good for the heart, but the way in which they interact together.
I think that the British Heart foundation presents their information well, in an easy to understand format, but they need to reach out to the wider population. I have looked in chemists and General Practitioners surgeries for British heart foundation material, but was disappointed not to see their booklets. I think they need to reach out to places like this, including clinics, so that every one can benefit from their information, not just people mainly with computers. However, everything that the British heart foundation do state has sound research behind it, and many other sources and authors i have looked at say the same, such as the Food standards agency (2008) who also state that a low fat diet can reduce the chances of narrowing of the coronary arteries so they suggest a low fat diet to keep the heart healthy. From my own point of view, I would say that these health promotion groups do make me think a little about my diet and lifestyle, but don’t have the desired impact and I do not feel empowered by them. I have not been influenced by their initiatives greatly and I think this is partly down to their sources of information not being accessible in many places. If they do want to make an impact on the general public, they need to promote themselves more!
To conclude, the cardiovascular system has many functions and plays an important role in the delivery of oxygen and nutrients around the body using the blood. The healthy functioning of this system is important to ensure the risk of coronary heart disease is reduced. There are many initiatives in place that promote this healthy functioning, such as the five fruit and vegetables a day initiative, and they are all backed up with sound research, but they all do not promote themselves well enough and so their impact will not be as much as it could be!
Reference list
Alexander, M. F., Fawcett, J. N. and Runciman, P. J. (2000) Nursing Practice: Hospital and Home: The Adult (2nd edn.) Edinburgh: Churchill Livingstone
Bassett, S. (2005) Anatomy and Physiology New Jersey: Wiley Publishing
Batzel, J. J., Kappel, F., Schneditz, D. and Tran, H. T. (2007) Cardiovascular and Respiratory systems: Modeling, Analysis and control Philadelphia: SIAM
Brinn, F. (2000) Patients with mental illness: General nurses’ attitudes and expectations, Nursing Standard Vol. 14, No. 27, March 22nd 2000, p. 32-36
British Heart Foundation (2007) Reducing Your Blood Cholesterol (3rd series) London: British Heart Foundation
British Heart Foundation (2008) Our Strategy (Accessed 21st October 2008)
Boyd, M. A. (2005) Psychiatric nursing: Contemporary practice Philadelphia: Lippincott Williams and Wilkins
Brown, S. P., Miller, W. C. and Eason, J. M. (2006) Exercise Physiology: Basis of human movement in Health and disease Philadelphia: Lippincott Williams and Wilkins
Bunton, R. and Macdonald, G. (1992) Health Promotion: Discipline and Diversity London: Routledge
Cohen, B. J. and Taylor, J. J. (2005) Memmler’s the human body in Health and Disease (10th edn.) Philadelphia: Lippincott Williams and Wilkins
Daniels, L. (2002) Diet and coronary heart disease Nursing Standard Vol. 16, No. 43, July 10th 2002, p. 47-52
Department of Health (2004) At least five a week: evidence on the impact of physical activity and its relationship to health A report from the Chief Medical Officer London: Department of Health
Department of Health (2008) Primary secondary and tertiary prevention (Accessed on 22/6/08)
Dever, A. (1984) Epidemiology in Health services Massachusetts: Jones and Bartlett Publishers
Ehrlich, A. and Schroeder, C. L. (2004) Medial terminology for Health Professions (5th edn.) Andover: Cengage learning
Elling, B., Elling, K. M. and Rothenberg, M. A. (2005) Paramedic: Anatomy and Physiology Massachusetts: Jones and Bartlett Publishers
Faergeman, O. (2003) Coronary Artery Disease: Genes, Drugs and the Agricultural Connection Massachusetts: Elsevier Health Sciences
Food standards agency (2008) Heart disease (Accessed on 22/6/08)
Freeman, M. W. and Junge, C. E. (2005) The Harvard Medical School Guide to lowering your Cholesterol New York: McGraw-Hill professional
Goffman, E. (1984) Stigma: Notes on the management of spoiled identity Middlesex: Penguin books ltd.
Hargrove-Huttel, R. A. (2004) Medical-Surgical Nursing: The ideal study guide (4th edn.) Philadelphia: Lippincott Williams and Wilkins
Hills, B. A. (1988) The body of surfactant Cambridge: Cambridge University Press
Hinshaw, S. P. (2007) The mark of shame: Stigma of mental illness and the agenda for change USA: Oxford University Press US
Institute of Medicine (U.S.) (2005) Dietary Reference Intakes for Energy, Carbohydrate, Fibre, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids Washington D.C.: National Academies Press
Katz, A. M. (2006) Physiology of the Heart (4th edn.) Philadelphia: Lippincott Williams and Wilkins
Klabunde, R. E. (2005) Cardiovascular Physiology Concepts Philadelphia: Lippincott Williams and Wilkins
Mader, S. S. (2006) Human Biology (9th edn.) New York: McGraw-Hill
Margulies, S. (2004) The fascinating body Maryland: Rowman and Littlefield Publishers inc.
Marieb, E. Essentials Of Human Anatomy and Physiology (8th edn.) San Francisco: Benjamin Cummings
McArdle, W. D., Katch, F. and Katch, V. L. (2007) Exercise Physiology: Energy, Nutrition and Human Performance Philadelphia: Lippincott Williams and Wilkins
McCall, R. E. and Tankersley, C. M. (2007) Phlebotomy Essentials (4th edn.) Philadelphia: Lippincott Williams and Wilkins
Mental Health Europe (2008) From Exclusion to Inclusion – The way forward to promoting social inclusion of people with mental health problems in Europe. Europe: European Union
Nowak, T. J. and Handford, A. G. (2004) Pathophysiology: Concepts and Applications for Health Care Professionals (3rd edn.) New York: McGraw-Hill
Null, G. (2006) Get Healthy Now: A Complete Guide to Prevention, Treatment and Healthy Living New York: Seven Stories Press
Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives
Porth, C. (2005) Pathophysiology: Concepts of Altered Health States (7th edn.) Philadelphia: Lippincott Williams and Wilkins
Porth, C. (2006) Essentials of Pathophysiology: Concepts of Altered Health States (2nd edn.) Philadelphia: Lippincott Williams and Wilkins
Pottle, A. (2007) Measuring Cholesterol Levels Nursing Standard Vol. 21, No. 46, July 25th 2005, p. 24-47
Sartorius, N. and Schulze, H. (2005) Reducing the Stigma of Mental Illness: A Report from a Global Programme of the World Psychiatric Association Cambridge: Cambridge University Press
Schulkin, J. (2003) Rethinking Homeostasis: Allostatic regulation in Physiology and Pathophysiology USA: MIT Press
Seifter, J., Sloane, D. and Ratner, A. (2005) Concepts in medical physiology Philadelphia: Lippincott Williams and Wilkins
Viru, A. A. (1985) Hormones in Muscular Activity: Adaptive effect of hormones in exercise (2nd Vol.) London: CRC Press
Waugh, A. and Grant, A. (2006) Ross and Wilson: Anatomy and physiology in Health and Illness (10th edn.) USA: Churchill Livingstone
Won Chung, K. and Chung, H. M. (2007) Gross Anatomy (6th edn.) Philadelphia: Lippincott Williams and Wilkins
World Health Organisation (2005) Mental Health: Facing the challenges, Building Solutions: Report from the WHO European Conference Regional office-Europe: World Health Organisation