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Assessment of the
Cardiovascular System
The Cardiovascular
System
Anatomy and physiology
Heart—its structure and function
Anatomy and Physiology of
the Heart
Anatomy of the Heart
Coronary Arteries
Coronary artery blood
flow to the myocardium
occurs primarily during
diastole, when coronary
vascular resistance is
minimized.
To maintain adequate
blood flow through the
coronary arteries, mean
arterial pressure (MAP)
must be at least 60 mm
Hg.
The Cardiovascular
System
Cardiac output
stroke volume
Normal: 4 to 6 liters per minute
The Cardiovascular
System
Cardiac Index
CO divided by BSA
Normal Range: 2.7 to 3.2
L/min/m2 of body surface area
heart rate
The Cardiovascular
System
Stroke volume Stroke volume is the
amount of blood
ejected by the left
ventricle during each
systole.
Heart rate, preload,
afterload, contractility,
stroke volume, and
cardiac output.
The Cardiovascular
System
Preload
According to Starling’s law of the heart, the
more the heart is filled during diastole the
more forcefully the heart contracts.
Excessive filling of the heart results in
excessive left ventricular end-diastolic volume
and pressure.
May result in decreased cardiac output
The Cardiovascular
System
Afterload
The amount of pressure or resistance the
ventricles must overcome to eject blood into
the peripheral blood vessels.
A decrease in stroke volume can result from
an increase in afterload without the benefit of
compensatory mechanisms.
The Cardiovascular
System
Contractility
Increased by factors such as
Sympathetic stimulation
Calcium release
Positive inotropic drugs
Decreased by
Hypoxia
acidemia
Blood Pressure
Blood pressure is the force of blood exerted
against the vessel walls.
BP = CO X PVR
Systolic blood pressure
Amount of pressure generated by the left ventricle to
distribute blood into the aorta
Diastolic blood pressure
The amount of pressure sustained by the arteries
during the relaxation phase of the heart
Determined primarily by the ability of the heart to rest
while filling with blood.
Increased by increased peripheral vascular resistance
Blood Pressure Regulation
History
Demographic data
Family history and genetic risk
Personal history
Diet history
Socioeconomic status
Modifiable Risk Factors
Cigarette smoking
Physical inactivity
Obesity
Psychological factors
Chronic disease (HOW!?)
Pain or Discomfort
(Continued)
Pain or Discomfort
(Continued)
Terms such as discomfort, heaviness,
pressure, indigestion, aching, choking,
strangling, tingling, squeezing,
constricting, or vise-like are all used to
describe pain.
Women often do not experience pain in
the chest but rather feelings of discomfort
or indigestion.
Pain Assessment
Onset
Manner of onset
Duration
Frequency
Precipitating factors
Location
Radiation
(Continued)
Pain Assessment (Continued)
Quality
Intensity, which can be graded from 0 to
10, associated symptoms, aggravating
factors, and relieving factors
Dyspnea
Fatigue
Palpitations
Weight gain
Syncope
Extremity pain
Physical Assessment
General appearance
Integumentary system
Skin color
Skin temperature
Extremities
Clubbing of fingers
edema
Skin integrity
Etc.
Physical Assessment
Blood pressure
High Normal
Systolic 130 to 139 mm Hg
Diastolic 85 to 89mm Hg
Pre-hypertension
Systolic 120 to 139 mm Hg
Diastolic 80 to 89 mm Hg
Postural Hypotension
Venous and arterial pulses: central and jugular
venous pressures, and jugular venous
distention
Precordium
Assessment of the precordium (area over
the heart) involves:
Inspection
Palpation
Percussion
Precardium
Auscultation
Normal heart sounds
Normal splitting may occur with both
S1 – Closure of the mitral and tricuspid valves
Beginning of ventriclar systole
S2-closure aortic and pulmonic valves
High pitched and best heard at the end of
ventricular systole
Auscultation of Heart Sounds
Precardium
Paradoxical splitting
Abnormal splitting of S2/wider split
Early closure of pulmonic valve
Delayed closure of aortic valve
Precardium
Gallops
S3 and S4
S3
early sign of heart failure over 35 years of age
S4
Hypertension
MI
Anemia
advancing age
Precardium
Murmurs
Turbulent blood flow through normal or abnormal
valves
Precardium
Pericardial friction rub
Serum Markers of
Myocardial Damage
Troponin T and I
Creatine kinase
Myoglobin
Serum lipids
Homocysteine
C-reactive protein (Marker of
inflammation)
Blood Coagulation Test
Blood Coagulation Test
PT and INR
Measures the activity of prothrombin, fibrinogen,
and factors V, VII, and X.
PTT
Measures deficiencies in all coagulation factors
except VII and XIII
Allen Test
Cardiac Catheterization
Client preparation
Possible complications: myocardial
infarction, stroke, thromboembolism,
arterial bleeding, lethal dysrhythmias, and
death
Follow-up care:
bedrest, insertion site extremity kept straight
Monitor vital signs
Assess for complications
Other Diagnostic Tests
Electrocardiography
Electrophysiologic study
Exercise electrocardiography
Echocardiography
Pharmacologic stress echocardiogram
Transesophageal echocardiogram
Imaging
Hemodynamic Monitoring