copyright © 2008 lippincott williams & wilkins. chapter 26 assessment of cardiovascular...
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Copyright © 2008 Lippincott Williams & Wilkins.
Chapter 26Assessment of Cardiovascular Function
Chapter 26Assessment of Cardiovascular Function
Copyright © 2008 Lippincott Williams & Wilkins.
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
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Structure of the HeartStructure of the Heart
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Coronary ArteriesCoronary Arteries
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Cardiac Conduction SystemCardiac Conduction System
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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
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Cardiac Action PotentialCardiac Action Potential
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Great Vessel and Heart Chamber PressuresGreat Vessel and Heart Chamber Pressures
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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
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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
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AssessmentAssessment
• Health history
– Demographic information
– Family/genetic history
– Cultural/social factors
• Risk factorsSee Chart 26-2
– Modifiable
– Nonmodifiable
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Most Common Clinical ManifestationsMost Common Clinical Manifestations
• Chest pain
• Dyspnea
• Peripheral edema and weight gain
• Fatigue
• Dizziness, syncope, changes in level of consciousness
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Assessing Chest PainAssessing Chest Pain
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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
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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?
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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
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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
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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)
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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
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Hemodynamic MonitoringHemodynamic Monitoring
• CVP
• Pulmonary artery pressure
• Intra-arterial BP monitoring
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Phlebostatic LevelPhlebostatic Level
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Pulmonary Artery CatheterPulmonary Artery Catheter
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Pulmonary Artery Catheter and Pressure Monitoring SystemPulmonary Artery Catheter and Pressure Monitoring System
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Arterial Pressure Monitoring SystemArterial Pressure Monitoring System