1. Chapter 26 Assessment of Cardiovascular Function Self-Review Slides

2. Overview of Anatomy and Physiology - Heart
Three layers
Endocardium
Myocardium
Epicardium
Four chambers
Heart valves
Coronary arteries
Cardiac conduction system
Cardiac hemodynamics

3. Structure of the Heart

4. Cardiac Conduction System

5. Terms - Cardiac Action Potential
Depolarization: electrical activation of cell caused by influx of sodium into cell while potassium exits
Repolarization: return of cell to resting state caused by re-entry of potassium into cell while sodium exits
Refractory periods
Effective refractory period: phase in which cells are incapable of depolarizing
Relative refractory period: phase in which cells require stronger-than-normal stimulus to depolarize

6. Cardiac Action Potential

7. Great Vessel and Heart Chamber Pressures

8. Terms - Cardiac Output
Stroke volume: amount of blood ejected with each heartbeat
Cardiac output: amount of blood pumped by ventricle in liters per minute
Preload: degree of stretch of cardiac muscle fibers at end of diastole
Contractility: ability of cardiac muscle to shorten in response to electrical impulse
After load: resistance to ejection of blood from ventricle
Ejection fraction: percent of end diastolic volume ejected with each heart beat

9. CO = SV x HR Control of heart rate
Autonomic nervous system, baroreceptors
Control of stroke volume
Preload: Frank-Starling Law
After load: affected by systemic vascular resistance, pulmonary vascular resistance
Contractility increased by catecholamines, SNS, some medications
Decreased by hypoxemia, acidosis, some medications

10. Diagnostic Tests Laboratory Tests Cardiac Biomarker Analysis CK, CK-MB
Myoglobin
Troponin T and I
Lipid profile
Brain Naturetic Peptide
C-Reactive Protein
Homocysteine

11. Diagnostic Tests Chest X-ray & Fluoroscopy Electrocardiography
Continuous Electrocardiographic Monitoring
Hardwire Cardiac Monitoring
Telemetry
Lead Systems
Ambulatory Electrocardiography
Transtelephonic Monitoring
Wireless Mobile Cardiac Monitoring Systems

12. Diagnostic Tests Cardiac Stress testing Exercise Stress Testing
Pharmacologic Stress Testing

13. Chapter 26 Assessment of Cardiovascular Function New Content

14. Diagnostic Tests Echocardiography Radionuclide Imaging
Cardiac Catheterization
Electrophysiologic Testing
Hemodynamic Monitoring

15. Diagnostic Tests Echocardiography Traditional Echocardiography
Non-invasive ultrasound which measures EF%, size, shape & cardiac structure motion
Useful for diagnosis of pericardial effusions, heart murmurs, valvular function & ventricular heart motion
May be performed with exercise or pharm stress test. Images obtained at rest.
What findings are considered to be positive & may suggest CAD?
What diagnostic tool will likely be used next if positive?

16. Diagnostic Tests
Radionuclide imaging- involves the use of radioisotopes to evaluate coronary artery perfusion.
Myocardial perfusion imaging
Test of ventricular function, wall motion
Computed tomography
Positron emission tomography
Magnetic resonance angiography

17. Cardiac Catherization**
Invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries
Requires ECG, hemodynamic monitoring; emergency equipment must be available
Assessment prior to test; allergies, blood work
Assessment of patient postprocedure; circulation, potential for bleeding, potential for dysrhythmias
Activity restrictions
Patient education pre-, postprocedure

18. Cardiac Catherization
Angiography
Aortography
Coronary Arteriography
Right Heart Catheterization
Left Heart Catheterization

19. Cardiac Catherization
Nursing Interventions Pre-procedure
Fasting 8-12 hours prior to procedure (Why?)
Pt informed of procedure, sesations to expect and medications given.
Informed consent?
Nursing Interventions Post-procedure
Catheter access site is observed for bleeding or hematoma formation
Pulses assessed. How often for how long?
Pt. position?

20. Cardiac Catherization
Nursing Interventions Post-procedure
Complications
Bleeding/hematoma at insertion site
Pulses distal to insertion site
Capillary refill
Dysrhythmias
Positioning/Client Activity?
Nephropathy
Pt. instructions when ambulating post-clearance.
Chest pain?

21. Hemodynamic Monitoring
Central Venous Pressure (CVP)
Pulmonary artery (PA) pressure
Intra-arterial BP monitoring (IABP)

22. Phlebostatic Level

23. Pulmonary Artery Catheter
Refer to fig

24. Pulmonary Artery Catheter and Pressure Monitoring System