1. Assessment of the Cardiovascular System
Chapter 35
Assessment
of the
Cardiovascular System

2. 1. Identify patients at risk for cardiovascular (CV) problems.
Learning Outcomes
1. Identify patients at risk for cardiovascular (CV) problems.
2. Differentiate modifiable and non- modifiable risk factors for CV disease.
3. Teach patients about ways to decrease their risk for CV health problems.
4. Explain nursing implications related to CV changes associated with aging.

3. 5. Review the anatomy and physiology of the CV system.
6. Perform focused physical assessment for patients with CV problems.
7. Interpret laboratory test findings for patients with suspected or actual CV disease.
8. Verbalize the desired range for serum lipids.

4. Surface Anatomy of the Heart

5. Blood Flow Through the Heart

6. Cardiac Valves
Tricuspid valve
Mitral valve
Pulmonic valve
Aortic valve

7. Mean Arterial Pressure (MAP)
Must be at least 60 mm Hg
A MAP of between mm Hg is needed to maintain perfusion of major body organs such as the kidneys and brain.

8. Sequence of Events During the Cardiac Cycle Focus on 1) valves opening and closing, 2) ECG and 3) Heart sounds.

9. Mechanical Properties of the Heart – What do these words mean?
Cardiac output
Heart rate
Stroke volume
Preload
Impedance
Myocardial contractility

10. Arterial System
Blood pressure is force of blood exerted against vessel walls

11. Blood Pressure Regulation
Autonomic nervous system
Renal system
Endocrine system
External factors also affect BP

12. Cardiovascular System Assessment
Patient history
What are nonmodifiable risks factors?
What are modifiable risk factors?
What patient education would you give?
Nutritional history
Family history and genetic risk

13. Cardiovascular System Assessment (cont)
Current health problems
Pain, discomfort
Dyspnea, DOE, orthopnea, PND
Fatigue
Palpitations
Edema
Syncope
Extremity pain

14. Aorta and other large arteries Baroreceptors
Chart 35-1 Changes in the Cardiovascular System Related to Aging- see book
Cardiac valves
Conduction system
Left Ventricle
Aorta and other large arteries
Baroreceptors

15. Cardiovascular System Physical Assessment
General appearance
Skin
Cyanosis, rubor
Extremities
Clubbing, edema
Blood pressure
Hypotension and hypertension
Postural (orthostatic) hypotension

16. Precordium
Assessment:
Inspection
Palpation
Percussion

17. Precordium (continued)
Assessment (continued)
Auscultation
Normal heart sounds
Paradoxical splitting
Gallops and murmurs
Pericardial friction rub

18. Troponin—Troponin T and troponin I
Labs related to the cardiovascular system and their normal healthy levels. What are these tests? What happens when they are out of range?
Troponin—Troponin T and troponin I
T<0.20 ng/mL
Creatine kinase (CK)
Females: units/L
Males: units/L
Myoglobin
<90 mcg/L

19. *Desired range for serum lipids* Total cholesterol <200 mg/dL
Labs related to the cardiovascular system and their normal healthy levels. What are these tests? What happens when they are out of range?
*Desired range for serum lipids*
Total cholesterol <200 mg/dL
Triglyceride <150 mg/dL
HDL >40 mg/ dL
LDL <70 mg/dL for cardiovascular patients
Homocysteine
C-reactive protein (CRP)
<1.0 mg/dL

20. Laboratory Assessment
Microalbuminuria
Blood coagulation studies
PT/INR
PTT
ABG

21. Laboratory Assessment
F&E
Erythrocyte count (RBC)
H&H
Leukocyte count

22. Diagnostic Assessment
PA and lateral CXR
Angiography
Cardiac catheterization

23. Cardiac Catheterization

24. Electrophysiologic study (EPS) Stress test
Other Diagnostic Assessment- How would you describe these procedures to a patient?
ECG
Electrophysiologic study (EPS)
Stress test

25. TEE Echocardiography Myocardial nuclear perfusion imaging (MNPI) MRI
Other Diagnostic Assessment (continued)- How would you describe these procedures to a patient?
Echocardiography
TEE
Myocardial nuclear perfusion imaging (MNPI)
MRI

26. Question 1
A woman who is having a myocardial infarction may experience which set of symptoms instead of intense pain or pressure in the chest?
Indigestion, feelings of chronic fatigue, and a choking sensation
Moderate ache in the chest that is worse on inspiration
Sudden, intermittent, stabbing pain
Pain that spreads across the chest and back and/or radiates down the arm
Answer: A
Rationale: Some patients, especially women, do not experience pain in the chest with a myocardial infarction, but instead feel discomfort or indigestion. Women often present with a “triad” of symptoms. In addition to indigestion or feeling of abdominal fullness, feelings of chronic fatigue despite adequate rest and feelings of “inability to catch one’s breath” are also attributable to heart disease. The patient may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or viselike.

27. Answer: A
Rationale: Some patients, especially women, do not experience pain in the chest with a myocardial infarction, but instead feel discomfort or indigestion. Women often present with a “triad” of symptoms. In addition to indigestion or feeling of abdominal fullness, feelings of chronic fatigue despite adequate rest and feelings of “inability to catch one’s breath” are also attributable to heart disease. The patient may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or viselike.

28. Question 2
A patient is admitted with a weight loss of 2.3 kg over 36 hours, diarrhea, nausea, and vomiting. Based on this information, the nurse should assess which cardiovascular parameter more closely?
Preload
Afterload
Stroke volume
Heart rate
Answer: A
Rationale: The variables preload, afterload, and contractility influence stroke volume and preload is determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart). Dehydration and overhydration directly influence preload. Blood flow from the heart into the systemic arterial circulation is measured clinically as cardiac output (CO), the amount of blood pumped from the left ventricle each minute. CO is derived from the patient’s heart rate and stroke volume. Stroke volume is the amount of blood ejected by the left ventricle during each contraction.

29. Answer: A
Rationale: The variables preload, afterload, and contractility influence stroke volume and preload is determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart). Dehydration and overhydration directly influence preload. Blood flow from the heart into the systemic arterial circulation is measured clinically as cardiac output (CO), the amount of blood pumped from the left ventricle each minute. CO is derived from the patient’s heart rate and stroke volume. Stroke volume is the amount of blood ejected by the left ventricle during each contraction.

30. What is the best indicator of fluid retention?
Question 3
What is the best indicator of fluid retention?
Tachycardia
Crackles in the lungs
Weight gain
Increased blood pressure
Answer: C
Rationale: Weight gain is the best indicator of fluid retention and is commonly called edema.

31. Answer: C
Rationale: Weight gain is the best indicator of fluid retention and is commonly called edema.