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

2. 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

3. Surface Anatomy of the Heart

4. Blood Flow Through the Heart

5. Cardiac Valves Tricuspid valve Mitral valve Pulmonic valve
Aortic valve

6. 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

7. Sequence of Events During the Cardiac Cycle

8. 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

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

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

11. 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.

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

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

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

15. 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

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

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

18. Cardiac Catheterization

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