1. Chapter 26 Assessment of Cardiovascular Function

2. Overview of Anatomy and Physiology - Heart
Three layers
Endocardium
Myocardium
Epicardium
Four chambers
Heart valves

3. Overview of Anatomy and Physiology – Heart (cont’d)
Coronary arteries
Cardiac conduction system
Cardiac hemodynamics

4. Structure of the Heart

5. Cardiac Conduction System

6. Terms - Cardiac Action Potential
Depolarization: electrical activation of cell caused by influx of sodium into cell while potassium exits cell
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

7. Cardiac Action Potential

8. Great Vessel and Heart Chamber Pressures

9. 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

10. Terms - Cardiac Output (cont’d)
After load: resistance to ejection of blood from ventricle
Ejection fraction: percent of end diastolic volume ejected with each heart beat

11. CO = SV x HR Control of heart rate
Autonomic nervous system, baroreceptors
Control of strike 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

12. Question
Which of the following is the normal pacemaker for the myocardium?
Atrioventricular junction
Bundle of His
Purkinje fibers
Sinoatrial node

13. Answer D. Sinoatrial node
Rationale: The sinoatrial node is the normal pacemaker for the myocardium.

14. Question Which of the following best defines stroke volume?
The amount of blood ejected with each heartbeat
Amount of blood pumped by the ventricle in liters per minute
Degree of stretch of the cardiac muscle fibers at the end of diastole
Ability of the cardiac muscle to shorten in response to an electrical impulse

15. Answer A. The amount of blood ejected with each heartbeat
Rationale: Stroke volume is the amount of blood ejected with each heartbeat. Cardiac output is the amount of blood pumped by the ventricle in liters per minute. Preload is the degree of stretch of the cardiac muscle fibers at the end of diastole. Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse.

16. Assessment Health history Demographic information
Family/genetic history
Cultural/social factors
Risk factors
Modifiable
Nonmodifiable

17. Most Common Clinical Manifestations
Chest pain
Dyspnea
Peripheral edema, weight gain
Fatigue
Dizziness, syncope, changes in level of consciousness

18. Assessment Medications Nutrition Elimination Activity, exercise
Sleep, rest
Self-perception, self- concept
Roles, relationships
Sexuality, reproduction
Coping, stress tolerance
Prevention strategies

19. Health Promotion, Perception, and Management Questions
Ask regarding health promotion, preventive practices
What type of health issues do you have? Are you able to identify any family history or behaviors that put you at risk of this health problem?
What are your risk factors for heart disease? What do you do to stay healthy?
How is your health? Have you noticed any changes?

20. Health Promotion, Perception, and Management Questions (cont’d)
Ask regarding health promotion, preventive practices
Do you have a cardiologist or primary health care provider? How often do you go for check-ups?
Do you use tobacco or alcohol?
What medications do you take?

21. Question Where does the nurse auscultate the apex of the heart?
Erb’s point
Fifth intercoastal space
Pulmonic area
Tricuspid area

22. Answer B. Fifth intercoastal space
Rationale: The nurse auscultates the apex of the heart at the fifth intercoastal space.

23. Laboratory Tests Cardiac biomarkers CK, CK-MB Myoglobin
Troponin T and I
Lipid profile
Brain (B-type) natriuretic peptide
C-reactive protein
Homocysteine

24. Electrocardiography 12 lead ECG
Continuous monitoring: hardwire, telemetry
Signal-averaged electrocardiogram
Continuous ambulatory monitoring
Transtelephonic monitoring
Wireless mobile monitoring

25. Electrocardiography (cont’d)
Cardiac stress testing
Exercise stress testing
Pharmacologic stress testing

26. Diagnostic Tests Radionuclide imaging Myocardial perfusion imaging
Test of ventricular function, wall motion
Computed tomography
Positron emission tomography
Magnetic resonance angiography

27. 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

28. Hemodynamic Monitoring
CVP
Pulmonary artery pressure
Intra-arterial BP monitoring

29. Phlebostatic Level

30. Pulmonary Artery Catheter
Refer to fig

31. Pulmonary Artery Catheter and Pressure Monitoring System