Cardiovascular Assessment Flashcards
Right side (unoxygenated)
SVC and IVC to right
atrium to tricuspid
valve to right
ventricle to
pulmonic valve to
pulmonary artery to
lungs
Left side (oxygenated)
Pulmonary veins to
left atrium to mitral
valve to left ventricle
to aortic valve to
systemic circulation
2
How many chambers of the heart?
Four
Heart Valves
- Mitral
- Tricuspid
- Chordae tendineae
- Papillary muscle
- Pulmonic
- Aortic
Systole
Contraction of heart muscle
Ejection of blood from ventricles
Diastole
Relaxation of heart muscle
Ventricles fill with blood
Stroke volume (SV)
Amount of blood
ejected with each heart beat
Cardiac output (CO)
Amount of blood
pumped by each ventricle in 1 minute
Cardiac output equation
CO = SV × HR
Cardiac output normal
4 to 8 L/min
Vascular System
Blood vessels
* Blood circulates from left side
of heart
Arteries, arterioles
* Carry oxygenated
blood
Capillaries
* Venules, veins
* Carry deoxygenated
blood
- Right side of heart
Sympathetic stimulation increases
HR, speed of impulse through
AV node, and force of contractions; a-adrenergic receptors
Parasympathetic stimulation slows
HR, impulse conduction from
SA to AV node; vagus nerve
Autonomic nervous system effect on blood vessels
Sympathetic stimulation of -adrenergic receptors causes
vasoconstriction; decreased stimulation causes vasodilation
Baroreceptors
Sensitive to stretch or
pressure in arterial system
Stimulation sends
message to vasomotor
center in brainstem to
inhibit SNS and enhance
PNS to decrease HR and
peripheral vasodilation;
decreased stretch or
pressure does opposite
Chemoreceptor
Aortic and carotid bodies
and medulla
Increased CO2 results in
changes in RR and BP
Systolic blood pressure (SBP)
Peak pressure against arteries during ventricular contraction.
Normal = less than 120 mm Hg
Diastolic blood pressure (DBP)
Residual pressure in arteries during ventricular relaxation. Normal =
less than 80 mm Hg
Influencing factors for blood pressure
Cardiac output (CO) and systemic vascular
resistance (SVR)
SVR
Force opposing movement of blood
BP Equation
BP = CO x SVR
Pulse Pressure
Difference between SBP and DBP
Normally about 1/3 of the SBP
- Increased with exercise,
atherosclerosis - Decreased with heart failure,
hypovolemia
Mean Arterial Pressure (MAP)
Average pressure within arterial system
MAP = (SBP + 2 DBP) ÷ 3
MAP must be greater than 60 mm Hg to
perfuse vital organs or they will become
ischemic
S1
closure of tricuspid and mitral
valves; “lubb”; beginning of systole
S2
closure of aortic and pulmonic
valves: “dupp”; beginning of diastole
Pulse deficit
Palpate radial pulse
when listening to apical
Split S2
Pulmonic area
Normal inspiration; abnormal expiration
S3
Ventricular gallop
Left heart failure or mitral regurgitation
S4
Atrial gallop
CAD, cardiomyopathy, LV hypertrophy, aortic stenosis
Murmurs
Graded on a six-point Roman numeral scale (I to VI) of loudness and recorded as a ratio
Pericardial friction rubs—pericarditis
- Inflamed surfaces of the pericardium move against each other; high-pitched, scratchy
sounds - May be intermittent and last days to hours
- Listen at apex with patient upright, leaning forward and holding breath
CO
volume of blood pumped by heart in 1
minute
CI
CO adjusted for body surface area (BSA)
SV
volume ejected with each heartbeat
SVI
SV adjusted for BSA
Preload
Volume of blood
within ventricle at
end of diastole
PAWP
reflects left
ventricular end-
diastolic pressure
CVP
reflects right
ventricular end-
diastolic pressure
Afterload
Forces opposing
ventricular ejection
Left Ventricular Afterload
SVR and arterial
pressure indices
Right Ventricular Afterload
PVR and pulmonary
arterial pressure
indices
Vascular
resistance
Systemic (SVR) and
pulmonary (PVR)
Reflect afterload
Contractility
Strength of
ventricular
contraction
No direct clinical
measures
Troponin
- Rises within 4 to 6 hours, peaks 10
to 24 hours, detected for up to 10
to 14 days - High-sensitivity troponin (hs-cTnT,
hs-cTnI) assays may detect a heart
event within 1-3 hours
Copeptin
- Substitute marker for arginine
vasopressin (AVP) - Detected with acute MI, ischemic
stroke, HF - Copeptin + troponin = rapid
diagnosis of acute MI - High copeptin levels = increased
mortality with acute MI
Creatine kinase (CK); 3
isoenzymes
- CK-MB cardiac specific; increased
with MI or cardiac injury - Rises in 3 to 6 hours, peaks in 12 to
24 hours, returns to baseline within
12 to 48 hours - Rarely used for diagnosis of acute
MI
C-reactive protein
(CRP)
- Marker for inflammation
- Linked to atherosclerosis
and first heart event;
predict risk of future heart
events
Homocysteine (Hcy)—
protein catabolism
- Hereditary or dietary
deficiency of vitamins B6,
B12, or folate - High levels—increased risk
for CVD, PVD, stroke
Cardiac natriuretic
peptide markers
B-type natriuretic peptide
(BNP)—heart failure
Diagnostic Studies
Triglycerides
storage form of lipids
Cholesterol
absorbed from food and made in liver
Phospholipids
glycerol, fatty acids, phosphates, and nitrogenous compound
Lipoprotein
- Serum lipids bind to protein to circulate in blood
- Low-density lipoproteins (LDLs)
- High-density lipoproteins (HDLs)
- Increased Triglycerides and LDL—CAD risk factor
Increased HDL decreases risk
decreased risk of CAD
HDL ratio
risk assessment
Echocardiogram
- Ultrasound waves record movement of
heart structures; with or without contrast - Determines abnormalities of heart
Measures ejection fraction
Real time 3-D
Ejection Fraction (EF)
% of end-
diastolic blood volume ejected during
systole
Stress echocardiography
- Computer compares images or wall
motion and function before and after
exercise - No exercise—use IV dobutamine and
dipyridamole for pharmacologic stress
Transesophageal
echocardiography (TEE)
- Better visualization of
heart with endoscope - Requires NPO, sedation;
check gag afterward - Complications:
perforation of esophagus,
hemorrhage,
dysrhythmias, vasovagal
reactions, transient
hypoxemia
Cardiac computed tomography
Heart anatomy, coronary
circulation, great vessels
(multidetector CT
scanning—MDCT)
CT angiography (CTA)
- Noninvasive; faster, less
risky, less radiation
exposure than cardiac
catheterization; must
have NSR - Requires contrast
Cardiovascular magnetic resonance imaging (CMRI)—no radiation
- 3-D view of MI; assess EF
- Predicts recovery from MI
- Diagnosis of congenital heart and aortic disorders and CAD
- Patients with stents can undergo CMRI 6 weeks after placement
Multigated acquisition—MUGA scan
Nuclear cardiology
Wall motion, heart valves, EF
Stress perfusion imaging
Nuclear cardiology
- Blood flow changes with exercise diagnoses CAD
- Viable heart tissue versus scar tissue
- Determine success of interventions (e.g., CABG or PCI)
- IV medications to dilate coronary arteries and simulate exercise effects
- SPECT—size of infarction
- PET stress testing—myocardial ischemia and viability
Cardiac catheterization- contrast
Complications: bleeding;
allergic reaction to contrast;
kinking of catheter; infection;
thrombus formation; aortic
dissection; dysrhythmias; MI;
stroke; puncture of ventricles,
septum, or lung tissue
Pre-Procedure Cardiac Catheterization
- Assess allergies; contrast dye (hold metformin
48 hrs before) - Baseline assessment: VS, pulse oximetry, heart
and breath sounds, neurovascular assessment
of extremities - NPO for 6 to 12 hours
- Assess lab
Patient Education Pre Cardiac Catheterization
- Procedure—local anesthesia, flushed
feeling when dye injected; fluttering of
heart - Administer sedation and other meds as ordered
Post-procedure Cardiac Catheterization
- Baseline Assessment: note hypotension or
hypertension; signs of PE - Assess neurovascular status of extremity
- Compression device over arterial site for
hemostasis; observe for hematoma and
bleeding every 15 minutes for 1 hour then per
agency policy - Bed rest as ordered
- Monitor: ECG, chest pain, IV/oral fluid intake
and urine output
Patient Education Post Cardiac Catheterization
discharge instructions,
activity limits
Intravascular ultrasound (IVUS)
- Intracoronary ultrasound (ICUS); done in cath lab
- Also uses coronary angiography to provide a 2-D or 3-D view of
the coronary artery walls - Evaluate vessel response to stent placement and atherectomy
Electrophysiology study (EPS)
Electrodes placed in heart to record and manipulate electrical
activity of heart; SA node, AV node, and ventricular conduction—
information regarding source and treatment of tachydysrhythmias
