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1 Keith Rischer RN, MA, CEN Nursing Assessment of the Cardiovascular System.

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Presentation on theme: "1 Keith Rischer RN, MA, CEN Nursing Assessment of the Cardiovascular System."— Presentation transcript:

1 1 Keith Rischer RN, MA, CEN Nursing Assessment of the Cardiovascular System

2 2 Todays Objectives… Review the anatomy and physiology of the cardiovascular system. Describe cardiovascular changes associated with aging. Identify factors that place patients at risk for cardiovascular problems. Explain and describe pre- and post-care associated with diagnostic cardiovascular testing. Explain the purpose of hemodynamic monitoring.

3 3 Aortic-Pulmonic Mitral-Tricuspid

4 Coronary Arteries 4 Right Coronary Left Anterior Descending Circumflex

5 5 Cardiac Conduction SA node Both Atria AV Node Both Ventricles Bundle of His Bundle Branches- Perkinje Fibers

6 6 Diastole Diastole Lower # in BP (120/80) Lower # in BP (120/80) Ventricles are relaxed Ventricles are relaxed Passively fill from atria Passively fill from atria

7 7 Systole Higher # in BP (120/80) Higher # in BP (120/80) Ventricles are contracting and emptying Ventricles are contracting and emptying SBP accurately reflects afterload SBP accurately reflects afterload

8 8 Cardiac Output CO = Stroke volume x heart rate SV ( 80cc) x HR (80)= 6400cc (6.4 lpm) Daily pumps 1800 gallonsDaily pumps 1800 gallons 657,000 gallons every year657,000 gallons every year Over 80 year lifetime:Over 80 year lifetime: 52,560,000 gallons52,560,000 gallons

9 9 Preload: Right side of heart Preload=primarily venous blood return to RA Right and left side of heart filling pressure (atria>ventricles) Pressure/Stretch in ventricles end diastole

10 Starlings Law of the Heart 10 Maximum efficency of CO achieved when myocardium stretched appx 2 ½ times length Maximum efficency of CO achieved when myocardium stretched appx 2 ½ times length Think rubber band Think rubber band CO decreased with lower preload/filling pressures or too high CO decreased with lower preload/filling pressures or too high

11 11 AFTER load: Left side of heart Force of resistance that the LV must generate to open aortic valve Force of resistance that the LV must generate to open aortic valve Correlates w/SBP Correlates w/SBP

12 12 Contractility Ability of heart to change force of contraction without changing resting length Ability of heart to change force of contraction without changing resting length Influenced by Ca++ Influenced by Ca++ Inotropic-Influencing contractility independent of Starling mechanism Inotropic-Influencing contractility independent of Starling mechanism Positive inotropic Positive inotropic Negative inotropic Negative inotropic

13 13 Assessment Techniques History Demographic data Age Gender Pre vs. post menopause Family history and genetic risk Personal medical history DM, HTN BCP use for women Diet

14 14 Modifiable Risk Factors Cigarette smoking Physical inactivity Obesity Psychological factors Chronic disease

15 15 Changes with Aging Calcification in valves Pacemaker cells decrease in number Conduction time increases Left ventricle increases Aorta and large vessels thicken and become stiffer Baroreceptors less sensitive

16 16 Women & CAD Vague-atypical chief c/o Vague-atypical chief c/o Only 53% have CP as chief c/o Only 53% have CP as chief c/o Fatigue chief c/o Fatigue chief c/o Typically develop CAD 10+ years later then men Typically develop CAD 10+ years later then men Mortality twice as high Mortality twice as high Less likely to have definitive 12 lead EKG Less likely to have definitive 12 lead EKG Smaller coronary arteries Smaller coronary arteries Higher prevalence of silent ischemia Higher prevalence of silent ischemia CABG higher mortality rate/complications CABG higher mortality rate/complications After first MI-more likely to suffer fatal event After first MI-more likely to suffer fatal event Women > 50 pay must address HTN, high cholesterol, family history, diabetes Women > 50 pay must address HTN, high cholesterol, family history, diabetes

17 17 MenWomen MenWomen Develop years earlier Develop years earlier Initial event AMI Initial event AMI Classic CP sx Classic CP sx Develop greater collateral circulation compared to women Develop greater collateral circulation compared to women Influence of menopause…4x risk Influence of menopause…4x risk Causes more deaths in women than men Causes more deaths in women than men Initial event angina Initial event angina Atypical CP sx…fatigue Atypical CP sx…fatigue

18 18 Elderly & CAD More likely to have vague, atypical c/o More likely to have vague, atypical c/o SOB, fatigue, syncope or falls SOB, fatigue, syncope or falls Any fall must be investigated for mitigating circumstances Any fall must be investigated for mitigating circumstances Less likely to have radiation Less likely to have radiation

19 19 Clinical Manifestations:Dyspnea Can occur as a result of both cardiac and pulmonary disease Difficult or labored breathing experienced as uncomfortable breathing or shortness of breath Dyspnea on exertion (DOE) Orthopnea dyspnea when lying flat Paroxysmal nocturnal dyspnea (PND) after lying down for several hours

20 20 Other Clinical Manifestations Fatigue Palpitations Weight gain Syncope Extremity pain Ischemia Venous insufficiency

21 21 CV Physical Assessment General appearance Integumentary system Skin color Skin temperature Extremities Blood pressure Orthostatic Arterial pulses Jugular venous distention

22 22 Precordium Auscultation Normal heart sounds…S1S2 Paradoxical splitting Gallops –S3 –S4 Murmurs –Systolic most common Pericardial friction rub

23 23 Serum Markers of Myocardial Damage Troponin B-Natruetic Peptide Serum lipids C-reactive protein Lytes K+ Mg++ Blood coagulation PT & INR

24 24 Brain Natriuetic Peptide:BNP 95 % of BNP resides in ventricles 95 % of BNP resides in ventricles As pressure inc in ventricles in HF-BNP is released As pressure inc in ventricles in HF-BNP is released Bodies own ACE/B-blocker Bodies own ACE/B-blocker Only lab test that measures HF Only lab test that measures HF Normal is less than 100 Normal is less than 100 Elevated Elevated for CHF >500 + for CHF >500 Uses: dx- assess response to tx Uses: dx- assess response to tx

25 25 Cardiac Catheterization Client preparation Possible complications: myocardial infarction, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias, and death Pre-procedure: Review procedure (video) Consent NPO or light breakfast Cath site shaved Premeds - sedative

26 26 Cardiac Catheterization Procedure Pt awake – report any chest pain or symptoms May proceed to Stent Placement Follow-up care: Restricted bedrest, insertion site extremity kept straight Assess groin site and distal pulses closely Monitor vital signs Force fluids Assess for complications

27 27 Cardiac Catheterization Report

28 28 Other Diagnostic Tests 12 lead EKG Holter monitor (ambulatory) Electrophysiologic (EP) study Exercise Stress test Echocardiography Pharmacologic stress echocardiogram Transesophageal echocardiogram Thallium imaging

29 29 Hemodynamic Monitoring: Arterial Line

30 30 Hemodynamic Monitoring: Pulmonary Artery catheter

31 31 Hemodynamic Monitoring Strips


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