Assessment of the Cardiovascular System Chapter 35 Assessment of the Cardiovascular System

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)

Sequence of Events During the Cardiac Cycle

Mechanical Properties of the Heart Cardiac output Heart rate Stroke volume Preload Impedance Myocardial contractility

Mechanical Properties of the Heart (cont’d) 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

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

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

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

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/INT PTT ABG F&E Erythrocyte count H&H Leukocyte count

Diagnostic Assessment PA and lateral CXR Angiography Arteriography Cardiac catheterization

Cardiac Catheterization

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

Hemodynamic Monitoring Invasive system provides quantitative information about vascular capacity, blood volume, pump effectiveness, tissue perfusion Pulmonary artery catheter Invasive arterial catheter Impedance cardiography

Hemodynamic Monitoring (cont’d)

Audience Response System Questions Chapter 35 Audience Response System Questions 23

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.

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.

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.