Assessment of the Cardiovascular System Chapter 33-Iggy Assessment of the Cardiovascular System

Objectives Review basic heart function and anatomy. Differentiate modifiable and non modifiable risk factors for cardiovascular health problems Verbalize nursing implications related to cardiovascular changes that effect circulation, perfusion and cardiac output Describe the unique characteristics for heart disease in women Interpret common labs associated with persons at high risk or whom have a suspected cardiovascular injury Discuss basic cardiovascular assessment techniques

Surface Anatomy of the Heart

Blood Flow Through the Heart

Cardiac Valves Tricuspid valve Mitral valve Pulmonic valve Aortic valve

Mean Arterial Pressure (MAP) Must be at least 60 mm Hg to maintain adequate blood flow through coronary arteries and perfuse major organs (brain) Systolic + 2X the diastolic divided by 3 - MAP

Sequence of Events During the Cardiac Cycle

Mechanical Properties of the Heart Cardiac output Heart rate Stroke volume Preload Afterload Myocardial contractility Cardiac Index (CI) = Cardiac Output ÷ Body Surface Area (BSA) CI normal range = 2.7 to 3.2 L/min/m2 BSA

Cardiac Output Amount of blood pumped from left ventricle per minute Heart rate × Stroke volume

Blood Pressure Regulation Autonomic nervous system: Baroreceptors Chemoreceptors – Hypercapnia Renal system Endocrine system External factors also affect BP

Cardiovascular System Assessment Patient history Nutritional history Family history and genetic risk Current health problems Pain, discomfort Dyspnea, DOE, orthopnea, PND Fatigue Palpitations Edema Syncope Extremity pain Intermittent claudication DOE, Dyspnea on exertion; PND, paroxysmal nocturnal dyspnea.

Point to Remember… Best indicator of fluid balance is weight 2.2 lb = 1 kg = 1 L of fluid

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

Precordium Assessment Inspection Palpation Percussion Auscultation Normal heart sounds Paradoxical splitting Gallops and murmurs Pericardial friction rub

Serum Markers of Myocardial Damage Troponin: Troponin T and troponin I Creatine kinase (CK) Myoglobin Serum lipids Total cholesterol < 200 mg/dL Triglyceride < 150 mg/dL HDL > 40 mg/dL LDL < 70 mg/dL for cardiovascular patients Homocysteine Highly sensitive C-reactive protein

Laboratory Assessment Microalbuminuria Blood coagulation studies PT/INR PTT ABG F&E Erythrocyte count H&H Leukocyte count

Diagnostic Assessment PA and lateral CXR Angiography Arteriography Cardiac catheterization CXR, Chest x-ray; PA, posteroanterior.

Cardiac Catheterization

Other Diagnostic Assessment ECG Electrophysiologic study (EPS) Stress test Echocardiography Pharmacologic stress echocardiogram TEE Myocardial nuclear perfusion imaging (MNPI) ECG, Electrocardiogram; TEE, transesophageal echocardiogram.