1. Assessment of the Cardiovascular System

2. The Cardiovascular System  Anatomy and physiology  Heart—its structure and function  Valves, arteries  Cardiac output, cardiac index, heart rate  Stroke volume  Preload  Afterload  Vascular system  Contractility

3. The Cardiovascular System

4. Blood Pressure  Blood pressure is the force of blood exerted against the vessel walls.

6. Blood Pressure Regulation  Autonomic nervous system  Baroreceptors  Chemoreceptors  Renal system  Endocrine system  External factors also affect BP

8. Venous System  Structure: a series of veins located adjacent to the arterial system  Function: completes the circulation of blood by returning blood from the capillaries to the right side of the heart  Cardiovascular changes in the older adult: only evident when the person is active or under stress

9. Venous System

10. Assessment Techniques  History  Demographic data  Family history and genetic risk  Personal history  Diet history  Socioeconomic status

11. Assessment

12. Modifiable Risk Factors  Cigarette smoking  Physical inactivity  Obesity  Psychological factors  Chronic disease

13. Risk Factors

14. Pain or Discomfort  Pain or discomfort can result from ischemic heart disease, pericarditis, and aortic dissection.  Chest pain can also result from noncardiac conditions such as pleurisy, pulmonary embolus, hiatal hernia, and anxiety. (Continued)

15. Pain or Discomfort (Continued)  Terms such as discomfort, heaviness, pressure, indigestion, aching, choking, strangling, tingling, squeezing, constricting, or vise-like are all used to describe pain.  Women often do not experience pain in the chest but rather pain in the chest but rather feelings of discomfort or indigestion.

16. Pain Assessment  Onset  Manner of onset  Duration  Frequency  Precipitating factors  Location  Radiation (Continued) (Continued)

18. Pain Assessment (Continued)  Quality  Intensity, which can be graded from 0 to 10, associated symptoms, aggravating factors, and relieving factors

19. Dyspnea  Can occur as a result of both cardiac and pulmonary disease  Difficult or labored breathing experienced as uncomfortable breathing or shortness of breath  Dyspnea on exertion (DOE)  Orthopnea: dyspnea when lying flat  Paroxysmal nocturnal dyspnea after lying down for several hours

22. Other Manifestations  Fatigue  Palpitations  Weight gain  Syncope  Extremity pain

23. Physical Assessment  General appearance  Integumentary system  Skin color  Skin temperature  Extremities  Blood pressure  Venous and arterial pulses: central and jugular venous pressures, and jugular venous distention

24. Precordium  Assessment of the precordium (area over the heart) involves:  Inspection  Palpation  Percussion  Auscultation  Normal heart sounds  Paradoxical splitting  Gallops and murmurs  Pericardial friction rub

26. Serum Markers of Myocardial Damage  Troponin  Creatine kinase  Myoglobin  Serum lipids  Homocysteine  C-reactive protein  Blood coagulation tests

27. Cardiac Catheterization  Client preparation  Possible complications: myocardial infarction, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias, and death  Follow-up care:  Restricted bedrest, insertion site extremity kept straight  Monitor vital signs  Assess for complications

28. Cardiac Catheterization

29. Other Diagnostic Tests  Electrocardiography  Electrophysiologic study  Exercise electrocardiography  Echocardiography  Pharmacologic stress echocardiogram  Transesophageal echocardiogram  Imaging

30. Electrocardiography

31. Hemodynamic Monitoring  Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion  Pulmonary artery catheter  Systemic intra-arterial monitoring monitoring  Impedance cardiography

32. Catheters