1. Cardiac Perfusion
Lewis, ch 26

2. About Perfusion
The essential function of the CV and pulmonary systems is to provide a continuous supply of oxygenated blood to every cell in the body (see next slide).
Changes in perfusion affect all human functions such as self-care, mobility, FV, respiration, tissue integrity, elimination, and comfort.

3. Normal Blood Flow

4. Perfusion and the Heart
The heart muscle receives it’s blood supply from the coronary arteries during diastole (resting phase—between beats)
The quality of heart perfusion depends on the condition of the coronary arteries.
The quality of perfusion to the body depends on the condition of the heart.
Therefore, if the heart does not have good perfusion, the body won’t either.

5. Heart Perfusion

6. Factors Affecting Perfusion
Cardiac output (SV x HR)
Preload, afterload, contractility
Peripheral vascular resistance
Blood volume
Blood viscosity
Artery elasticity
Oxygen saturation

7. Assessment of Perfusion: History
MI, valve disease, pacer
Hypertension
Diagnostic tests, hospitalizations, surgery
Rheumatic fever, strep
Cardiac meds
Risk factors—modifiable, nonmodifiable

8. History cont’d
S/S—pain*, wt gain, swelling, palpitations, cough, dizziness, tingling
Problems with ADLs—DOE
Sleep problems—PND, pillows
Sexual concerns
Cultural influences
Problems with self image or relationships

9. Chest Pain Assessment*
P = Precipitating events
Q = Quality
R = Radiation
S = Severity
T = Timing

10. Assessment of Perfusion: Physical Assessment
Blood pressure
Pulse rate, quality, and rhythm (see slide)
Heart sounds (see next slide)
Lung sounds
Neck veins
Breathing pattern

11. Heart Sounds

12. Pulse Sites

13. Assessment cont’d Skin color and temperature Ulcerations, edema
Color of mucous membranes, nail beds
Hair distribution on LEs
Nail texture & shape
Level of consciousness
Urine output

14. Diagnostic Assessment of Cardiac Function
Doppler ultrasound (duplex echo-730)
Electrocardiogram (707)
Echocardiograms (710)
Stress test/Nuclear scan (709, 711)
CXR (707)
Cardiac catheterization (left) (713)
Labs—troponin, CK-MB, lipids, BNP (705)
Hemodynamic monitoring (715)

15. Conduction System

16. Relationship of ECG & Heart Sounds

17. Manifestations of Poor Perfusion
Confusion
Low blood pressure
Rapid or irregular heart rate
Shortness of breath
Decreased or absent pulses
Chest or extremity pain
Low urine output
Edema
Cold skin
Pale, gray, or blue skin color