1. CARDIAC ASSESSMENT

2. Blood Flow thru Heart
If you know this, it will help you with heart failure. Heart Failures is just a backward FLOW through the heart

3. Conduction System
Electrical impulses that systematically depolarize the heart & begins in the SA node
Synchronized r & l ventricular contraction
Ejection of blood into pulmonary &systemic circulation
Refractory period- resting state

4. Cardiac output
CO = loc
Starling’s Law= the greater the stretch, the more forceful the contraction
Preload=volume of blood in the ventricles. This is increased by things like HTN, valve disease, hypervolemia
Afterload= peripheral resistance against which the l ventricle must pump This is affected by size of the vent, wall tension, & Bp

5. Subjective data History of present illness Past health history
Medications
Lifestyle
But if a patient is in severe pain or sob, must prioritize quickly to get the most info. may not have time to do a full health history
P. 665 Table 31-1 = health history

6. Physical exam General appearance
Inspection- skin for color, hair distribution, edema , veins in neck
Palpation- pulses in the neck, upper & lower extremities, cap refill, heaves (lifts of the chest wall in the precordial area)
Auscultation- S1= closure of tricuspid & mitral valves
s2= closure of aortic & pulmonic valves
Pulse deficit=
Aortic, pulmonic & mitral area

7. Focused assessement
P. 668
See assessment abnormalities & focused Assessment chart

8. Diagnostic tests
Biomarkers: helpful in diagnosing acs, mi neg=less than 0.5mcg/l pos= greater than 2.3mcg/l
Troponin: heart muscle protein released into circ. after cell death
Ckmb Holter monitor (loop recorder)
Homocysteine TEE
C-reactive protein stress test/nuclear cardiology
Lipids Good chart in book on labs/diag tests