Assessment of the Cardiovascular System Flashcards
Heart muscle =
myocardium
What is the leading cause of death for women?
CVD
Each beat of the heart pumps how much?
60 mL of blood or 5 L/min
The heart is protected by the
pericardium
Right Atrium (RA) receives
deoxygenated venous blood
The right ventricle (RV) is
muscular pump located behind the sternum that closes the TRICUSPID valve
After blood is reoxygenated in the lungs. it
flows freely from the 4 pulmonary veins into the left atrium
When the left ventricle is full, the left atrium
contracts, pumping the remaining blood volume into the left ventricle
With systolic contraction, the
left ventricle generates enough pressure to close the mitral valve and open the aortic valve
The pressure of blood in the aorta of a young adult averages about
100 to 120 mm Hg
Pressure of blood in the RA averages about
0 to 5 mm Hg
AV valves do what
separate the atria from the ventricles
The tricuspid valve does what
separates the RA from the RV
The mitral (bicuspid) valve does what
separates the LA from the LV
During systole, the valves close to prevent back flow called
valvular regurgitation of blood into the aorta
The semilunar valves are the
pulmonic valve and aortic
they prevent blood from flowing back into the ventricles during diastole
The pulmonic valve does what
separates the right ventricle from the pulmonary artery
The aortic valve does what
separates the left ventricle from the aorta
MAP=
60-70 mm Hg
Left main artery divides into two branches:
Left anterior descending branch (LAD)
Left circumflex branch (LCX)
The right coronary artery (RCA) originates from
the right sinus of Valsalva
Electrophysiologic properties of the heart muscle are responsible for
regulating heart rate (HR) and rhythm
Cardiac Output (CO) depends of relationship between
HR and SV (Stroke volume)
CO= HR x SV
Cardiac index:
can be determined by dividing the CO by the body
normal range: 2.7 to 3.2 L/min/m2
Preload:
refers to the degree of the myocardial fiber stretch at the end of diastole and just before contraction
Vascular system purposes:
- Provides a route for blood to travel from the heart to nourish the various tissues of the body
- Carries cellular wastes to the excretory organs
- Allows lymphatic flow to the drain tissue fluid back into the circulation
- Returns blood to the heart for re circulation
Arterial system: By the time blood enters the right atrium, the BP is about
0-5 mm Hg
BP=
CO x Peripheral Vascular resistance
3 mechanisms mediate and regulate BP
Autonomic nervous system (ANS)
Kidneys
Endocrine system
Baroreceptors:
arch of the aorta and at the origin of the internal carotid arteries are stimulated when the arterial walls are stretched by an increased BP
Peripheral chemoreceptors:
Several 1- to 2- mm collections of tissue have been identified in the carotid arteries and along the aortic arch
The central chemorecptors in the respiratory center of the brain are also stimulated by
hypercapnia (increase in CO2)
and acidosis
Stretch receptors are
sensitive to pressure or volume changes
The venous system completes
the circulation of blood by returning blood from the capillaries to the right side of the heart
Gravity exerts an increase in
hydrostatic pressure in the capillaries when the patient is in an upright position, delaying venous return
Cardiovascular changes associate with Aging:
loss of cardiac reserve
Record history of smoking in pack-years=
number of packs per day multiplied by the number of years the patient has smoked
Obesity is a problem for
African American women
Mexican Americans
Native Hawaiians
Cardiovascular changes associate with Aging: Cardiac valves
Calcification and mucoid degeneration occur
Cardiovascular changes associate with Aging: Conduction system
Pacemaker cells decrease in number
Few muscles fibers remain in the atrial myocardium and bundle of His
Conduction time increases
Cardiovascular changes associate with Aging: Left ventricle
Size increases
Becomes stiff and less distensible
Fibrotic changes decrease the speed
Cardiovascular changes associate with Aging: Aorta and Other large arteries
Thicken and become stiffer and less distensible
Systolic pressure increases
Systemic vascular resistance increases
Left ventricle pumps greater resistance = ventricular hypertrophy
Cardiovascular changes associate with Aging: Baroreceptors
become less sensitive
Note patient’s medical history:
Any major illness such as diabetes mellitus, renal disease, anemia, hypertension, bleeding disorders, etc
Social history =
information about patient’s living situation, domestic partner, other members, environment, and occupation
Nutritional history=
24 hr recall
Family history to indicate
genetic risk
Current Health problems such as
Pain or discomfort: traditional
Dyspnea: both cardiac and pulmonary disease
Dyspnea on exertion (DOE): indicates heart failure
Orthopnea: measured by pillows to provide restful sleep
Paroxysmal nocturnal dyspnea: after hrs of lying down
Fatigue: indicates heart disease in women
Palpitations: feeling of fluttering/irregular heart beat
Sudden increase in weight 1kg=excess fluid
Edema
Syncope: brief loss of consciousness
Near syncope: dizziness w/ inability to remain upright position
Intermittent claudication: mod-severe cramping in legs/buttocks when walking - decreased arterial tissue perfusion
Extremity pain may be caused by two conditions:
Ischemia from atherosclerosis
Venous insufficiency of the peripheral blood vessels
Angina pain:
squeezing, viselike pain
Left side of chest w/o radiation
Relieving factors: Rest, nitrate adm, or O2
Myocardial infarction pain:
Intense stabbing, viselike pain or pressure, severe
May spread throughout anterior chest and to arms, jaw, back, or neck
Relieving factors: morphine, cardiac drugs, O2
Pericarditis pain:
sharp, stabbing, mod-severe
Spreads to the left side or the back
Relieving factors: sitting upright, analgesia, or adm of antiinflammatory agents
Pleuropulmonary pain:
moderate ache, worse on inspiration
Lung fields
Relieving factors: rest
Esophageal-gastric pain:
squeezing, heartburn, variable severity
May spread to shoulders or the abdomen
Relieving factors: Antacid adm, food intake, sitting postition
Anxiety pain:
dull ache to sharp stabbing, numbness in fingers
Not well located, no radiation
Relieving factors: last few minutes
Poor cardiac output and decreased cerebral perfusion may cause
confusion, memory loss, and slowed verbal responses, especially in older adults
Late signs of severe right-sided heart failure=
ascites
jaundice
anasarca (generalized edema) result of prolonged congestion of the liver
If there is normal blood flow to a given area in light colored skin=
appears pink, rosy, and is warm
Decreased perfusion manifested as
cold, pale (anemia), and moist skin
2 types of cyanosis:
Central: arterial blood in the lungs and appears as a bluish tinge of the conjunctivae and the mucous membranes of the mouth and tongue - indicate impaired lung function
Peripheral: when blood flow to the peripheral vessels is decreased by peripheral vasoconstriction
Rubor=
dusky redness that replaces pallor in a dependent foot suggests arterial insufficiency
Clubbing=
nail straightens out to an angle of 180 degrees and the base of the nail becomes spongy
Paradoxical blood pressure:
exaggerated decrease in systolic pressur eby more than 10 mm Hg during the inspiratory phase of the respiratory cycle (normal= 3-10)
Difference of systolic and diastolic values is referred to as
pulse pressure
What can be used to assess the vascular status of the lower extremities
Ankle Brachial index (ABI)
ABI normal values:
1 or higher because BP in the legs is usually higher than in the arms
Values less than 0.8 indicates moderate vascular disease
Less than 0.5 indicate severe vascular compromise
What may be performed instead of or in addition to the ABI to determine arterial perfusion in the feet and toes?
Toe Brachial pressure index (TBPI)
An increase in Jugular venous pressure (JVP) causes
Jugular venous distention (JVD)
Arterial pulses provide info about
vascular integrity and circulation
Hypokinetic pulse is a
weak pulse indicative of narrow pulse pressure
Swishing sounds that may occur from turbulent blood flow in narrowed or atherosclerotic arteries
Bruit
pulses in the Mitral area (apex) =
apical or point of maximal impulse (PMI)
Splitting of S2, wider split heard on expiration=
paradoxical splitting
S3 =
ventricular gallop
S4 =
atrial gallop
originates from the pericardial sac and occurs with the movements of the heart during the cardiac cycle=
pericardial friction rub
Acute myocardial infarction (MI) also known as acute coronary syndrome can be confirmed by
abnormally high levels of certain proteins or isoenzymes
Serum studies are refered to as cardiac markers and include troponin, creatine kinase - MB, and myoglobin
Troponin is a
myocardial muscle protein released into the bloodstream with injury to myocardial muscle
Creatine Kinase (CK) =
Enzyme specific to cells of the brain, myocardium, and skeletal muscle
Myoglobin=
low-molecular-weight heme protein found in cardiac and skeletal muscle, is the earliest marker detected, as early as 2 hours after an MI w/ rapid decline after 7 hours
Serum lipids =
Cholesterol, triglycerides, the protein components of high-density lipoproteins (HDLs) and low density lipoproteins (LDLs) are evaluated to assess the risk for CAD
Other lab test= an amino acid that is produced when proteins break down
Homocysteine
Most studied marker of inflammation =
Highly sensitive C-reactive protein (hsCRP)
Small amounts of protein in the urine, has been shown to be a clear marker of widespread endothelial dysfunction in cardiovascular disease (along w/ elevated CRP)
Microalbuminuria
Used when initiating and maintaining therapy w/ oral anticoagulants such as sodium warfarin=
PT and INR
Assessed in patients who are receiving heparin=
PTT
Obtained in patients with CVD:
ABG
RBC count is usually low in
rheumatic fever and infective endocarditis
Decreased hematocrit and hemoglobin levels caused by
hemmorrhage or hemolysis from prosthetic valves
An invasive diagnostic procedure that involves fluoroscopy and the use of contrast media =
Arteriography
Cardiac catherterization studies include
studies of the right or left side of the heart and the coronary arteries
Common complications of coronary arteriography:
MI Stroke Arterial bleeding Thromboembolism Lethal dysrhythmias Arterial dissection Death
What is catheterized first and may be the only side examined?
Right side of the heart
In a left sided heart catheterization, the cardiologist
advances the catheter against the blood flow from the femoral, brachial, or radial artery up the aorta, across the valve and into the left ventricle
What is the same technique for left sided catherterization?
coronary arteriography
An alternative to injecting a medium into the coronary arteries is ____________ which introduces a flexible catheter w/ a miniature transducer at the distal tip to view the coronary arteries
Intravascular ultrasonography (IVUS)
Follow up care for catheterization
HOB up to 30 degrees during period of bed rest
Monitor vitals every 15 min for 1 hr, then every 30 min for 2 hr until vitals are stable, and then every 4 hr
An invasive procedure during which programmed electrical stimulation of the heart is used to cause and evaluate lethal dysrhythmias and conduction abnormalities
Electrophysiologic study (EPS)
What assesses cardiovascular response to an increased workload
Exercise electrocardiography
Exercise tolerance or Stress Test
Stress test: Patient exercise until one of these findings occur
A predetermined HR is reached and maintained
Signs and symptoms of chest pain
Significant ST-segment depression or T wave inversion
20 min protocol is completed
Stress test: follow up care
avoid a hot shower for 1-2 hours after the test
-may cause hypotension
What uses ultrasound waves to assess cardiac structure and mobility, particularly of the valves
Echocardiography
Prep for Echocardiography
inform patient that the test is painless and takes 30-60 min to complete
During Echocardiography
small transducer lubricated with gel to facilitate movement and conduction is placed on the patient’s chest at the level of the third or fourth intercostal space near the left sternal border
Slightly more aggressive Echocardiography is called ________ using either dobitamine or dipyridamole
pharmacologic stress echocardiogram
Examines cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach
Transesophageal Echocardiography (TEE)
Studies useful for detecting myocardial infarction (MI) and decreased myocardial blood flow and for evaluating left ventricle ejection
-Cardiovascular abnormalities can be viewed, recorded, and evaluated using radioactive tracer substances
Myocardial nuclear perfusion imaging (MNPI)
Before a MNPI, advise patient to avoid
cigarettes and caffeinated food or drinks for 4 hours before adm of the vasodilator
Radioisotopes accumulate in damaged myocardial tissue, which appears as a “hot spot” during the scan
Technetium scan
During a _________ scan, necrotic or ischemia tissue does not absorb the radioisotope and appears as “cold spots” on the scan
Thallium imaging
Thallium imaging scan may be performed during
an exercise test or w/ patient at rest
If patient cannot exercise on a bike or treadmill,
dipyridamole or dobutamine hydrochloride is adm to stimulate the effects of exercise
Noninvasive test for evaluating cardiac motion and calculating ejection fraction
Cardiac blood pool imaging
The computer breaks the time between R waves on the ECG into fractions of a second, called “gates”
Multigated blood pooling scanning
Used to compare cardiac perfusion and metabolic function and differentiate normal from diseased myocardium
Positron emission tomography (PET)
Another noninvasive diagnostic option, image of the heart or great vessels =
MRI
