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

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.

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.

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 A MAP of between 60-70 mm Hg is needed to maintain perfusion of major body organs such as the kidneys and brain.

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

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

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

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

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

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

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

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

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

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: 30-135 units/L Males: 55-170 units/L Myoglobin <90 mcg/L

*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

Laboratory Assessment Microalbuminuria Blood coagulation studies PT/INR PTT ABG

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

Diagnostic Assessment PA and lateral CXR Angiography Cardiac catheterization

Cardiac Catheterization

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

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

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.

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.

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.

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.

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