1. Medical-Surgical Nursing: Concepts & Practice
3rd edition
Chapter 17
The Cardiovascular System
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Overview of the Cardiovascular System
Structures of the heart
Actions of the heart
Cardiac cycle
Ejection fraction
Functions of the vascular system
Effects of aging

3. Oxygenated Blood Flow
See Figure 17-1 on p. 369.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 7, St. Louis, 2007, Mosby.

4. Cardiac Cycle
The cardiac cycle consists of contraction of the muscle (systole) and relaxation of the muscle (diastole).
The heart pumps out about 5 L of blood every minute.

5. Cardiac Cycle (Cont.)
The amount of cardiac output depends on the heart rate, the amount of blood returning to the heart (venous return), the strength of contraction, and the resistance to the ejection of the blood (pressure in the arterial system).

6. Ejection Fraction
The ejection fraction is the percentage of blood that is ejected from the heart during systole.
A normal ejection fraction is 50% to 70%.
As ejection fraction decreases with heart failure, tissue perfusion diminishes.
A decreased ejection fraction causes backup of blood into the pulmonary vessels.

7. Ejection Fraction (Cont.)
Too much blood and the increased pressure in the pulmonary vessels can cause pulmonary edema.
Stroke volume equals the amount of blood ejected by a ventricle during contraction.
Cardiac output equals stroke volume multiplied by the heart rate.

8. The Coronary Arterial System
See Figure 17-2 on p. 369.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 9, St. Louis, 2015, Mosby.

9. The Coronary Arterial System (Cont.)
See Figure 17-2 on p. 369.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 9, St. Louis, 2015, Mosby.

10. The Cardiac Conduction System
See Figure 17-3 on p. 370.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 9, St. Louis, 2015, Mosby.

11. The Renin-Angiotensin-Aldosterone System
See Figure 17-6 on p. 372
From Sole ML, Klein DG, Moseley MJ: Introduction into critical care, ed. 5, Philadelphia, 2009, Saunders Elsevier.

13. Blood Pressure Arterial blood pressure Renin and angiotensin
Systolic and diastolic blood pressure
Pulse pressure
Renin and angiotensin
Sympathetic nervous system
Atherosclerosis

14. Women and Heart Disease
Preventing cardiovascular disease in women
Obtain regular physical activity (at least 30 minutes four or five times a week).
Obtain and maintain a healthy weight because it reduces the chance of type 2 diabetes.
These factors play an even larger role in prevention of heart disease in women than in men.

15. Causes of Cardiovascular Disorders
Congenital or acquired
Heart failure
Dysrhythmias
Infection and inflammation
Diabetes mellitus and metabolic syndrome
Obesity, a sedentary lifestyle, and stress

16. Warning Signs of a Heart Attack
Chest discomfort: a feeling of tightness, pressure, or a crushing or squeezing pain lasting more than a few minutes, or it comes back; in women, discomfort in the middle of the chest
Pain or discomfort in other areas of the upper body, including the arms, shoulder, back, neck, jaw, or the top of the stomach. Women often have jaw or back pain.

17. Warning Signs of a Heart Attack (Cont.)
Shortness of breath: may occur with or without chest discomfort
Breaking out in a cold sweat, nausea, or lightheadedness with or without chest discomfort
Feeling of impending doom that doesn’t go away

18. Warning Signs of a Heart Attack (Cont.)
Chest pain unrelieved by prescribed doses of nitroglycerin
Call 911 or emergency number immediately; get help!

19. Risk Factors for Cardiovascular Disease
Nonmodifiable factors
Heredity
Race
Sex
Age
Modifiable risk factors
Obesity
High cholesterol (>200 mg/dL)
Hypertension
Diabetes
Cigarette smoking
Sedentary lifestyle
Excessive stress
Excessive alcohol intake
Cocaine use

20. Metabolic Syndrome Components
Elevated waist circumference indicating abdominal obesity; men greater than 40 inches (102 cm), women greater than 35 inches (88 cm)
Elevated triglycerides (>150 mg/dL)
Reduced high-density lipoprotein cholesterol (men <40 mg/dL and women <50 mg/dL)
Elevated blood pressure at or above 130/85 mm Hg
Elevated fasting glucose indicating insulin resistance; glucose 100 mg/dL
See Box 17-1 on p. 369.

21. Diagnostic Tests and Procedures
Chest radiography
Nuclear imaging and exercise electrocardiography (stress test)
Echocardiography with esophagogastroscope
Digital subtraction angiography
Magnetic resonance arteriography
Electron-beam computed tomography for coronary artery calcium scoring
Stress echocardiogram
Cardiac monitoring

22. Cardiac Treadmill Stress Test
See Figure 17-7 on p. 375.

25. Specific Tests for Vascular Disorders
Diagnosing a vascular problem begins with a history and physical examination that includes a variety of tests for risk factors for vascular disorders
Complete blood count, urinalysis, blood lipid and cholesterol, or sequential multiple analyzer (SMA) panel
Doppler flow studies
Angiography
Nuclear medicine scans

26. Ankle-Brachial Index (ABI)
It evaluates arterial status in the lower extremities.
It is calculated by dividing the ankle pressure by the brachial pressure.
Normal: 1 or more
Intermittent claudication
The ABI is an inexpensive, noninvasive screening test to evaluate arterial status in the lower extremities. A regular blood pressure cuff is placed above the malleolus. Another blood pressure cuff is positioned over the brachial artery. A Doppler probe is used to check the systolic end point at the dorsalis pedis and the posterior tibial sites. The brachial blood pressure is measured. The ABI is calculated by dividing the ankle pressure by the brachial pressure. An ABI of 1 or more is considered normal. An abnormal ABI indicates arterial disease and can confirm a vascular cause for ischemic pain in the legs at rest and claudication (cramping pain in the calves) when walking.

27. Nursing Management Assessment (data collection) History-taking
Risk factors
Dyspnea
Chest pain
Focused assessment
Cultural considerations—dyspnea as the major symptom
African Americans often experience dyspnea as the most acute symptom during myocardial infarction. Dyspnea is more common than the more classic chest discomfort in this group. For this reason, they may delay seeking assistance.

28. Common Problems of Patients with Cardiovascular Disorders
Fatigue and dyspnea
Fluid overload
Pain
Altered tissue perfusion
Impaired tissue integrity
A weight gain of 3 lb or more in a 24-hour period indicates fluid retention.