Copyright © 2008 Lippincott Williams & Wilkins. Chapter 26 Assessment of Cardiovascular Function.

Copyright © 2008 Lippincott Williams & Wilkins.

Chapter 26Assessment of Cardiovascular Function

Chapter 26Assessment of Cardiovascular Function


Overview of Anatomy and Physiology of the HeartOverview of Anatomy and Physiology of the Heart

• Three layers of the heart:

– Endocardium

– Myocardium

– Epicardium

• Four chambers

• Heart valves

• Coronary arteries

• Cardiac conduction system

• Cardiac hemodynamics


Structure of the HeartStructure of the Heart


Coronary ArteriesCoronary Arteries


Cardiac Conduction SystemCardiac Conduction System


Terms: Cardiac Action Potential Terms: Cardiac Action Potential

• Depolarization: electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell

• Repolarization: return of the cell to the resting state caused by re-entry of potassium into the cell while sodium exits

• Refractory periods:

– Effective refractory period: phase in which cells are incapable of depolarizing

– Relative refractory period: phase in which cells require a stronger-than-normal stimulus to depolarize


Cardiac Action PotentialCardiac Action Potential


Great Vessel and Heart Chamber PressuresGreat Vessel and Heart Chamber Pressures


Terms: Cardiac OutputTerms: Cardiac Output• Stroke volume: the amount of blood ejected with each

heartbeat

• Cardiac output: amount of blood pumped by the ventricle in liters per minute

• Preload: degree of stretch of the cardiac muscle fibers at the end of diastole

• Contractility: ability of the cardiac muscle to shorten in response to an electrical impulse

• Afterload: the resistance to ejection of blood from the ventricle

• Ejection fraction: the percent of end-diastolic volume ejected with each heartbeat


CO= SV x HRCO= SV x HR

• Control of heart rate

– Autonomic nervous system and baroreceptors

• Control of strike volume

– Preload: Frank-Starling law

– Afterload: affected by systemic vascular resistance and pulmonary vascular resistance

– Contractility increased by catecholamines, SNS, some medications and decreased by hypoxemia, acidosis, some medications


AssessmentAssessment

• Health history

– Demographic information

– Family/genetic history

– Cultural/social factors

• Risk factorsSee Chart 26-2

– Modifiable

– Nonmodifiable


Most Common Clinical ManifestationsMost Common Clinical Manifestations

• Chest pain

• Dyspnea

• Peripheral edema and weight gain

• Fatigue

• Dizziness, syncope, changes in level of consciousness


Assessing Chest PainAssessing Chest Pain


AssessmentAssessment

• Nutrition

• Elimination

• Activity and exercise

• Sleep and rest

• Cognition and perception

• Self-perception and self-concept

• Roles and relationships

• Sex and reproduction

• Coping and stress


Health Promotion, Perception, and Management QuestionsHealth Promotion, Perception, and Management Questions

• Ask regarding health promotion and preventive practices.

• What type of health issues do you have? Are you able to identify any family history or behaviors that put you at risk for this health problem?

• What are your risk factors for heart disease? What do you do to stay healthy?

• How is your health? Have you noticed any changes?

• Do you have a cardiologist or primary health care provider? How often do you go for check-ups?

• Do you use tobacco or alcohol?

• What medications do you take?


Laboratory TestsLaboratory Tests

• Cardiac biomarkers

• CK and CK-MB

• Myoglobin

• Troponin T and I

• Lipid profile

• Brain (B-type) natriuretic peptide

• C-reactive protein

• Homocysteine


ElectrocardiographyElectrocardiography

• 12-lead ECG

• Continuous monitoring: hardwire and telemetry

• Signal-averaged ECG

• Continuous ambulatory monitoring

• Transtelephonic monitoring

• Wireless mobile monitoring

• Cardiac stress testing

– Exercise stress testing

– Pharmacologic stress testing


Diagnostic TestsDiagnostic Tests

• Chest x-ray and fluoroscopy

• Echocardiogram and transesophageal echocardiogram

• Radionuclide imaging

• Myocardial perfusion imaging

• Equilibrium radionuclide angiocardiography (ERNA or MUGA)

• CT scans

• PET scans

• Electrophysiologic testing (EPS)


Cardiac CatheterizationCardiac Catheterization

• Invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries

• Requires ECG and hemodynamic monitoring; emergency equipment must be available

• Assessment prior to test; allergies, blood work

• Assessment of patient after procedure: circulation, potential for bleeding, potential for dysrhythmias

• Activity restrictions

• Patient education before & after procedureSee Chart 26-4


Hemodynamic MonitoringHemodynamic Monitoring

• CVP

• Pulmonary artery pressure

• Intra-arterial BP monitoring


Phlebostatic LevelPhlebostatic Level


Pulmonary Artery CatheterPulmonary Artery Catheter


Pulmonary Artery Catheter and Pressure Monitoring SystemPulmonary Artery Catheter and Pressure Monitoring System


Arterial Pressure Monitoring SystemArterial Pressure Monitoring System

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Copyright © 2008 Lippincott Williams & Wilkins. Chapter 26 Assessment of Cardiovascular Function.

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