Cardiac Perfusion Lewis, ch 26

About Perfusion The essential function of the CV and pulmonary systems is to provide a continuous supply of oxygenated blood to every cell in the body (see next slide). Changes in perfusion affect all human functions such as self-care, mobility, FV, respiration, tissue integrity, elimination, and comfort.

Normal Blood Flow

Perfusion and the Heart The heart muscle receives it’s blood supply from the coronary arteries during diastole (resting phase—between beats) The quality of heart perfusion depends on the condition of the coronary arteries. The quality of perfusion to the body depends on the condition of the heart. Therefore, if the heart does not have good perfusion, the body won’t either.

Heart Perfusion

Factors Affecting Perfusion Cardiac output (SV x HR) Preload, afterload, contractility Peripheral vascular resistance Blood volume Blood viscosity Artery elasticity Oxygen saturation

Assessment of Perfusion: History MI, valve disease, pacer Hypertension Diagnostic tests, hospitalizations, surgery Rheumatic fever, strep Cardiac meds Risk factors—modifiable, nonmodifiable

History cont’d S/S—pain*, wt gain, swelling, palpitations, cough, dizziness, tingling Problems with ADLs—DOE Sleep problems—PND, pillows Sexual concerns Cultural influences Problems with self image or relationships

Chest Pain Assessment* P = Precipitating events Q = Quality R = Radiation S = Severity T = Timing

Assessment of Perfusion: Physical Assessment Blood pressure Pulse rate, quality, and rhythm (see slide) Heart sounds (see next slide) Lung sounds Neck veins Breathing pattern

Heart Sounds

Pulse Sites

Assessment cont’d Skin color and temperature Ulcerations, edema Color of mucous membranes, nail beds Hair distribution on LEs Nail texture & shape Level of consciousness Urine output

Diagnostic Assessment of Cardiac Function Doppler ultrasound (duplex echo-730) Electrocardiogram (707) Echocardiograms (710) Stress test/Nuclear scan (709, 711) CXR (707) Cardiac catheterization (left) (713) Labs—troponin, CK-MB, lipids, BNP (705) Hemodynamic monitoring (715)

Conduction System

Relationship of ECG & Heart Sounds

Manifestations of Poor Perfusion Confusion Low blood pressure Rapid or irregular heart rate Shortness of breath Decreased or absent pulses Chest or extremity pain Low urine output Edema Cold skin Pale, gray, or blue skin color