1. Assessing the Cardiovascular system

2. Outcomes Identify pertinent cardiac history questions.
Obtain a cardiac history.
Perform a cardiac physical assessment.
(continued)

3. ….Outcomes Document cardiac assessment findings.
Identify actual & potential health problems stated as nursing dx.
Differentiate between normal & abnormal findings.

4. A & P What are the functions of...
Heart:
4 chambers (right and left atria) (right and left and ventricles)
Double Pump
Atria (right and left):
Pump blood to the ventricles
(Continued)

5. What are the functions of...
Ventricles:
Right pumps blood to pulmonary circulation; left pumps blood to systemic circulation
Valves:
AV valves: the tricuspid and mitral
Semilunar valves: the pulmonic and aortic (Continued)

6. What are the functions of...
Conduction system:
SA node to AV node to Bundle of His to Purkinje Fibers
SA Node:
Paces
AV Node:
Paces 40-60
Bundle of His:
Paces 20-40

8. Mechanisms of Heart Sounds Why do we hear what we hear (“lub dub”)?
Valves
Cardio-hemodynamic events
Electrical conduction system

9. Systolic and diastolic
The cardiac cycle =
Systolic and diastolic
Systolic = contraction or emptying phase
Diastolic = the resting or filling phase
While the atria are contracting the ventricles are relaxing (and vice versa) Pg 443

11. Cardiac Cycle The largest volume of blood in the ventricles
Happens at the end of diastole
Is called “end-diastolic”
The smallest volume of blood in the ventricles
Happens at the end of ventricular systole
Is called “end-systolic”

12. Stroke Volume Responds to changes in Preload & Afterload
Preload is the volume of blood in the ventricles at the end of diastole
The greater the preload, the greater the contractility of the ventricles, & thus the greater the stroke volume
Afterload reflects the end-systolic volume
It is affected by the amount of resistance the ventricles have to contract against
Increasing afterload results in decreasing stroke volume

13. Cardiac Output Cardiac Output = Stroke Volume x HR Measured by EF%
Normal EF = 55-70%
An ultrasound of the heart (echocardiography)
Cardiac catheterization (left ventriculogram)
A magnetic resonance imaging (MRI) scan of the heart
A nuclear medicine scan (multiple gated acquisition, or MUGA) of the heart
A computerized tomography (CT) scan of the heart

14. The Heart’s Electrical Conduction System
Review this before Basic EKG interpretation!

15. What is the relationship of the cardiovascular system to other systems?
Integumentary
Lymphatic
Urinary
Digestive
Skeletal
Muscular
Reproductive
Endocrine
Respiratory
Neurological

16. Children/Infants Pregnant clients Older adults
Developmental variations:
Children/Infants
Foramen Ovale, Ductus Arteriosus
Sinus Arrhythmia 2ndary to Resp.
Innocent murmurs
Pregnant clients
Mammary Souffle (murmur)
Older adults
Orthostatic Hypotension: CAD & Decreased
Arterial Elasticity
Medications
Korotkoff’s sounds (may have inacc. BP’s)

17. What cultural variations might be seen?
African Americans
Earlier onset & Greater severity of CAD
African American Women > CAD than European American Women
Native Americans under 35 have 2x the mortality rate from CAD as all others
Middle aged European Americans have the highest incidence of CAD
Japanese and Puerto Ricans have lower incidence of high BP & Cholesterol
Hispanics have a lower mortality rate from CAD than non-hispanics.

18. Case Study
Henry Brusca, 68-year-old, married, father of 7 children, self-employed, entrepreneur
Newly diagnosed HTN; recently discharged from hospital for uncontrolled HTN
Vasotec for HTN

19. History What can the history tell you about the cardiovascular system?
Biographical data
Current health status
Past health history
Family history
Review of systems
Psychosocial history

20. Symptoms What symptoms would signal a cardiovascular problem?
Chest pain
Palpitations
Fatigue
Changes in extremities
Dyspnea
Cough
Edema
Syncope

21. Pertinent History Findings
Recently treated for BP of 170/118, diagnosed HTN, treated
with Vasotec
EKG ventricular hypertrophy
+ Family history of CVD
Last physical exam prior to current problem, 5 years ago
(Continued)

22. Pertinent History Findings
Works 7days/week; high stress; feels tired; snores
No exercise; SOB with activity; indigestion weekly; dizzy spells; pain in legs with walking
Diet high fats, carbohydrates, and salt; 60# overweight; 1 bottle wine/day

23. Physical Assessment
Anatomical landmarks: Anterior/ posterior triangle of neck, and auscultatory sites of precordium
Approach: all 4 techniques
Position: supine, sitting, and left lateral recumbent
(Continued)

24. Physical Assessment
Tools: stethoscope with bell and diaphragm, B/P cuff, watch
General survey and head-to-toe scan

25. Inspecting/Palpating Carotid Artery, Jugular Vein, & Precordium
Large, bounding visible pulsation in neck or at suprasternal notch: HTN, aortic stenosis, or aneurysm
Elevated JVP: Right-sided HF, constrictive pericarditis, tricuspid stenosis, or superior vena cava obstruction.
Low JVP: Hypovolemia
Pulsations to right of sternum or at epigastric or sternoclavicular areas: Aortic Aneurysm
Apical pulsation displaced toward axillary line: Left Ventricular Hypertrophy
Chart: Rate, Rhythm, Symmetry, Amplitude (absent, weak, strong, or bounding— =normal)

26. Auscultation Assessment
PMI should be over apex
(left ventricular impulse)
All (Aortic)
Patients (Pulmonary)
Take (Triscuspid)
Meds (Mitral)

27. Auscultation
Cardiac Rates > 100 bpm: Sinus Tach, SVT, PAT, Uncontrolled At. Fib.
Causes: CHF, drugs (atropine, nitrates, epinephrine, isoproterenol, nicotine, caffeine) and hypercalcemia.
__________
Cardiac Rate < 60 bpm: Sinus Brady, Heart Block.
Causes: MI, drugs (Digoxin, Quinidine, Procainamide, Beta-Adrenergic Inhibitors) and Hyperkalemia.
Bruit suggests carotid stenosis.
Murmurs can also radiate up to the neck from the heart (aortic stenosis)