1. Assessment of the Cardiovascular System
Chapter 35
Assessment
of the
Cardiovascular System

2. Surface Anatomy of the Heart

3. Blood Flow Through the Heart

4. Cardiac Valves Tricuspid valve Mitral valve Pulmonic valve
Aortic valve

5. Mean Arterial Pressure (MAP)
Must be at least 60 mm Hg to maintain adequate blood flow through coronary arteries and perfuse major organs (brain)

6. Sequence of Events During the Cardiac Cycle

7. Mechanical Properties of the Heart
Cardiac output
Heart rate
Stroke volume
Preload
Impedance
Myocardial contractility

8. Mechanical Properties of the Heart (cont’d)
Cardiac Index (CI) = Cardiac Output ÷ Body Surface Area (BSA)
CI normal range = 2.7 to 3.2 L/min/m2 BSA

9. Cardiac Output Amount of blood pumped from left ventricle per minute
Heart Rate × Stroke Volume

10. Arterial System
Blood pressure is force of blood exerted against vessel walls

11. Blood Pressure Regulation
Autonomic nervous system:
Baroreceptors
Chemoreceptors—hypercapnia
Renal system
Endocrine system
External factors also affect BP

12. Cardiovascular System Assessment
Patient history
Nutritional history
Family history and genetic risk
Current health problems
Pain, discomfort
Dyspnea, DOE, orthopnea, PND
Fatigue
Palpitations
Edema
Syncope
Extremity pain

13. Point to Remember… Best indicator of fluid balance is weight
2.2 lb = 1 kg = 1 L of fluid
Custom Graphic

14. Cardiovascular System Physical Assessment
General appearance
Skin
Cyanosis, rubor
Extremities
Clubbing, edema
Blood pressure
Hypotension and hypertension
Postural (orthostatic) hypotension

15. Precordium Assessment: Inspection Palpation Percussion Auscultation
Normal heart sounds
Paradoxical splitting
Gallops and murmurs
Pericardial friction rub

16. Serum Markers of Myocardial Damage
Troponin—Troponin T and troponin I
Creatine kinase (CK)
Myoglobin
Serum lipids
Total cholesterol <200 mg/dL
Triglyceride <150 mg/dL
HDL >40 mg/ dL
LDL <70 mg/dL for cardiovascular patients
Homocysteine
Highly sensitive C-reactive protein

17. Laboratory Assessment
Microalbuminuria
Blood coagulation studies
PT/INT
PTT
ABG
F&E
Erythrocyte count
H&H
Leukocyte count

18. Diagnostic Assessment
PA and lateral CXR
Angiography
Arteriography
Cardiac catheterization

19. Cardiac Catheterization

20. Other Diagnostic Assessment
ECG
Electrophysiologic study (EPS)
Stress test
Echocardiography
Pharmacologic stress echocardiogram
TEE
Myocardial nuclear perfusion imaging (MNPI)

21. Hemodynamic Monitoring
Invasive system provides quantitative information about vascular capacity, blood volume, pump effectiveness, tissue perfusion
Pulmonary artery catheter
Invasive arterial catheter
Impedance cardiography

22. Hemodynamic Monitoring (cont’d)

23. Audience Response System Questions
Chapter 35
Audience Response System Questions 23

24. Question 1
A woman who is having a myocardial infarction may experience which set of symptoms instead of intense pain or pressure in the chest?
Indigestion, feelings of chronic fatigue, and a choking sensation
Moderate ache in the chest that is worse on inspiration
Sudden, intermittent, stabbing pain
Pain that spreads across the chest and back and/or radiates down the arm
Answer: A
Rationale: Some patients, especially women, do not experience pain in the chest with a myocardial infarction, but instead feel discomfort or indigestion. Women often present with a “triad” of symptoms. In addition to indigestion or feeling of abdominal fullness, feelings of chronic fatigue despite adequate rest and feelings of “inability to catch one’s breath” are also attributable to heart disease. The patient may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or viselike.

25. Question 2
A patient is admitted with a weight loss of 2.3 kg over 36 hours, diarrhea, nausea, and vomiting. Based on this information, the nurse should assess which cardiovascular parameter more closely?
Preload
Afterload
Stroke volume
Heart rate
Answer: A
Rationale: The variables preload, afterload, and contractility influence stroke volume and preload is determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart). Dehydration and overhydration directly influence preload. Blood flow from the heart into the systemic arterial circulation is measured clinically as cardiac output (CO), the amount of blood pumped from the left ventricle each minute. CO is derived from the patient’s heart rate and stroke volume. Stroke volume is the amount of blood ejected by the left ventricle during each contraction.

26. Question 3 What is the best indicator of fluid retention? Tachycardia
Crackles in the lungs
Weight gain
Increased blood pressure
Answer: C
Rationale: Weight gain is the best indicator of fluid retention and is commonly called edema.