Assessment of Cardiovascular Function PDF

Assessment of Cardiovascular Function Chapter 21 Hanan Abdelrahman RN, PhD Assistant professor, Sultan Qaboos University Learning outcomes On completion of this class, the learner will be able to: Describe the structure and function of the cardiovascular system Expla...

Assessment of Cardiovascular Function Chapter 21 Hanan Abdelrahman RN, PhD Assistant professor, Sultan Qaboos University Learning outcomes On completion of this class, the learner will be able to: Describe the structure and function of the cardiovascular system Explain and demonstrate the proper techniques to perform a comprehensive cardiovascular assessment. Discriminate between normal and abnormal assessment findings identified by inspection, palpation, percussion, and auscultation of the cardiovascular system. Identify diagnostic tests and methods of hemodynamic monitoring (e.g., central venous pressure, pulmonary artery pressure, arterial pressure monitoring) of the cardiovascular system and related nursing implications. Overview of Anatomy and Physiology Anatomy of the Heart Location Center of the thorax Hollow, muscular organ that pumps blood to the Description tissues, supplying them with oxygen and nutrients Weight Approximately 300 g Endocardium (inner layer), myocardium (middle Layers layer), epicardium (outer layer) Thin, fibrous sac composed of two layers (visceral and Pericardium parietal) Normally filled with about 20 mL of fluid to lubricate Pericardial Space the surface of the heart and reduce the friction. Three layers: Outer layer Pumping Middle layer Inner layer 20 ml  Heart Champers and valves It receives deoxygenated blood from the superior and Right Atrium inferior vena cava, and pumps it to the right ventricle through the tricuspid valve It pumps deoxygenated blood to the lungs through Right Ventricle the pulmonary artery, which is protected by the pulmonary valve It receives oxygenated blood from the lungs through Left Atrium the pulmonary veins, and pumps it to the left ventricle through the mitral valve it pumps oxygenated blood to the body through the Left Ventricle aorta, which is protected by the aortic valve Summary Anatomy and Physiology of heart https://www.youtube.com /watch?v=UMTDmP81mG4 Heart Conduction System The heart conduction system coordinates the electrical signals that regulate the Function heartbeat Is a small cluster of cells in the right atrium that initiates the electrical impulses Sinoatrial (SA) Node that regulate the heartbeat. It is often referred to as the natural pacemaker of the heart Is a cluster of cells located at the bottom of the right atrium near the ventricular Atrioventricular (AV) Node septum that receives electrical impulses from the SA node and relays them to the ventricles through the bundle of his Is a group of fibers that extends from the AV node through the ventricular septum, Bundle of His and divides into the left and right bundle branches Are specialized fibers that extend from the bundle branches through the walls of Purkinje Fibers the ventricles, and distribute the electrical impulses throughout the ventricular muscle The electrical impulses cause the heart muscle to contract, resulting in the Electrical Impulses rhythmic beating of the heart Heart Conduction System Heart Conduction System Question #1 Which of the following is the primary pacemaker for the myocardium? A. Atrioventricular junction B. Bundle of His C. Purkinje fibers D. Sinoatrial node Answer to Question #1 D. Sinoatrial node Rationale: The sinoatrial (SA) node is the primary pacemaker of the heart; the atrioventricular (AV) node is the secondary pacemaker of the heart. Both are composed of nodal cells.  Cardiac hemodynamics Cardiac Stroke Preload Output Volume Ejection Afterload Contractility fraction Cardiac Output (CO) Definition CO is the volume of blood pumped by the heart per minute Units liters per minute (L/min) Formula Cardiac output (CO) = stroke volume (SV) x heart rate (HR) Stroke Volume Stroke volume is the amount of blood ejected by each ventricle per beat Heart Rate Heart rate is the number of times the heart beats per minute Cardiac output is regulated by the autonomic nervous system, hormones such as Regulation epinephrine and norepinephrine, and other factors such as blood volume and oxygen demand The normal range for cardiac output is approximately 4-8 L/min at rest, but can Normal Values increase during exercise or in response to stress or illness How to calculate cardiac output Example: A patient's heart rate is 80 beats per minute and their stroke volume is 70 mL. To calculate their cardiac output: Cardiac Output = Stroke Volume x Heart Rate Cardiac Output = 70 mL x 80 beats per minute Cardiac Output = 5,600 mL/minute or 5.6 L/minute Stroke Volume Stroke volume is the amount of blood ejected by each ventricle per Definition beat. Units Stroke volume is measured in milliliters (mL). Stroke volume is regulated by factors such as preload, afterload, and Regulation contractility, as well as hormones and neurotransmitters such as epinephrine and norepinephrine. The normal range for stroke volume is approximately 60-100 Normal Values mL/beat, but can vary depending on factors such as age, sex, and fitness level. Preload, Afterload, Contractility It is the degree of stretch of the heart muscle prior to contraction and Preload is determined by factors such as the volume and pressure of blood in the ventricles at the end of diastole. It is the resistance the heart has to overcome to pump blood out of Afterload the ventricles, and is determined by factors such as the resistance of the blood vessels and the pressure in the aorta and pulmonary artery It is the strength of the heart muscle contraction, and is determined Contractility by factors such as the level of calcium in the muscle cells and the sympathetic nervous system stimulation Ejection Fraction Definition Ejection fraction is the percentage of blood ejected by the ventricles with each contraction. Units Ejection fraction is measured in percentage (%) Ejection fraction is regulated by factors such as preload, afterload, and contractility, as well Regulation as heart rate and rhythm The normal range for ejection fraction is approximately 50-70%, but can vary depending on factors such as age, sex, and underlying health conditions. An ejection fraction of less than Normal Values 50% is generally considered a sign of decreased heart function and can be a marker of heart failure or other cardiac conditions. (other refences below 40%)  what is the difference between stroke volume and ejection fraction? q Stroke Volume (SV): What It Measures: it measures the amount of blood that is pumped out of the heart with each heartbeat (each contraction). Calculation: by subtracting end-systolic volume (ESV) from end-diastolic volume (EDV). SV = EDV - ESV. EDV is the volume of blood in the ventricle at the end of diastole (when it's filled with blood), and ESV is the volume of blood in the ventricle at the end of systole (after it has contracted and ejected blood). Unit: milliliters per beat (mL/beat). Importance: It tells us how much blood the heart is able to pump in one beat, indicating the heart's efficiency. q Ejection Fraction (EF): What It Measures: it measures of the proportion of blood pumped out of the left ventricle with each contraction relative to the total volume of blood in the ventricle at the end of diastole. Calculation: EF = (SV/ EDV) × 100 Unit: Percentage (%) Importance: It provides information about the heart's pumping ability (contractility), indicating whether the heart is pumping out a normal percentage of blood with each beat (typically 50% to 70%). q Both SV and EF are essential parameters in assessing cardiac function and diagnosing heart conditions. Assessment of Cardiovascular System Assessment of Cardiovascular System Physical Diagnostic History examination studies  Assessment: 1. Health History Chest pain § Location, Character, Duration, aggravating and alleviating factors Most Common Dyspnea Peripheral edema, weight gain, abdominal symptoms distension Fatigue Dizziness, changes in level of consciousness  Assessment: 1. Health History 1. Risk factors (Modifiable vs. non) 2. Patient Knowledge 3. Medications Past Health, 4. Nutrition Family, and Social 5. Elimination 6. Activity and Exercise History 7. Sleep and Rest 8. Self-perception and Self-concept 9. Roles and Relationships 10. Sexuality and Reproduction 11. Coping and Stress  Do you have a history of heart disease or heart attack? Have you ever been diagnosed with high blood pressure (hypertension)? Have you ever been diagnosed with high cholesterol or triglycerides? Have you ever had chest pain or discomfort (angina)? Do you experience shortness of breath, especially with exertion? Have you ever had swelling in your legs or ankles? Health History Do you have a family history of heart disease or stroke? Questions for Have you ever been diagnosed with diabetes? Do you smoke or use any tobacco products? Cardiovascular How often do you exercise and what types of exercise do you do? System Assessment Have you ever had a heart rhythm disorder, such as atrial fibrillation or arrhythmia? Have you ever had a stroke or mini-stroke (transient ischemic attack)? Do you have any history of blood clots or deep vein thrombosis (DVT)? Do you have any history of heart valve disease? Have you ever been hospitalized for a cardiovascular problem? Do you take any medications or supplements for your heart or blood vessels? Have you ever had a cardiac procedure, such as angioplasty, stent placement, or bypass surgery?  Assessment: 2. Physical Assessment LOC Pulse Pressure Mental Status Postural BP changes BMI (chart 25-2) Acute obstruction of blood flow to extremities (six P’s) Blood Pressure Jugular venous General Hematoma (BP) pulsation Appearance Edema Capillary refill Clubbing of the fingers or toes Pulse rate, rhythm, contour, Palpation Heart Inspection, Skin and palpation, and Extremities Auscultation Arterial Pulses Assessment: 2. Physical Assessment Do we need to assess other Systems? Assessment: 2. Physical Assessment ü Hemoptysis üCough Lungs üCrackles ü Wheezes Assessment: 2. Physical Assessment üAbdominal Distention (Ascites) Abdomen ü Hepatojugular Reflux (Right. HF) ü Bladder Distension Testing the Hepatojugular Reflux https://www.youtube.com/ watch?v=JxyECMTEmmc Diagnostic Studies Laboratory Studies Diagnostic Studies Purpose Examples Evaluates overall health status, Hemoglobin, hematocrit, white Complete Blood Count (CBC) including anemia, infection, and blood cell count, platelet count inflammation Evaluates risk factors for Total cholesterol, LDL cholesterol, Lipid Profile cardiovascular disease HDL cholesterol, triglycerides Evaluates for cardiac damage or Troponin, creatine kinase (CK-MB), Cardiac Biomarkers dysfunction B-type natriuretic peptide (BNP) Prothrombin time (PT), Evaluates for bleeding or clotting international normalized ratio Coagulation Studies disorders (INR), activated partial thromboplastin time (aPTT) Diagnostic Studies Radiology Diagnostic Studies Purpose Evaluates for cardiomegaly, pulmonary congestion, or other Chest X-ray thoracic abnormalities Assesses cardiac structure and function, including ejection Echocardiogram fraction Assesses cardiac structure and function, and evaluates for Cardiac CT or MRI coronary artery disease Electrocardiogram (ECG) Evaluates arrhythmias, conduction abnormalities, and ischemia Other Diagnostic Studies Diagnostic Test Description Purpose Evaluates the heart's response to Diagnose coronary artery disease, evaluate Stress Test physical activity or pharmacological treatment effectiveness, assess exercise stress tolerance Involves the insertion of a catheter into Diagnose and treat coronary artery disease, Cardiac Catheterization a blood vessel and threading it to the assess heart function, evaluate heart valve heart disease Uses X-rays and a contrast dye to Diagnose and treat coronary artery disease, Angiography visualize blood vessels in the heart and peripheral artery disease, other conditions other parts of the body affecting blood vessels Diagnose abnormal heart rhythms that may A portable device that records the Holter Monitor occur intermittently and are difficult to detect heart's electrical activity for 24-48 hours on a standard ECG Stress Test Cardiac Catheterization https://www.youtube.com /watch?v=z2bvwo48RAE Cardiac Catheterization Nursing Consideration q Before the procedure: Patient should fast (8-12 hrs) Time of procedure up to 2 hours A family member should transport patient home after the procedure IV medication to comfort patient will be given Inform patients about sensation might experience (Palpitation, flushing, nausea) Encourage patient to express fear and anxiety Cardiac Catheterization Nursing Consideration qAfter the procedure: Assess catheter site for bleeding and presence of extremities pulses (15min X 1HR, 30 min X 2hr, hourly X 4 hrs) Evaluate color, temperature, capillary refill, numbness, pain of the affected extremity Assess vital signs and observe for any dysrhythmia Maintain bed rest for 6 hours, affected leg straight and bed head elevated to 30 degree. No repetitive movement of affected extremity for 24-48 hrs. Instruct patient to report any chest pain or bleeding/discomfort at the insertion site. Angiography https://www.youtube.com /watch?v=kY5gKdFWT3k Holter Monitor https://www.youtube.com /watch?v=CUghJiDNMuk Hemodynamic Monitoring Involves the insertion of a catheter into a central vein, such as the subclavian or Central Venous internal jugular vein, and measures the pressure in the right atrium or vena cava. Pressure (CVP) CVP monitoring is used to assess fluid status, cardiac function, and response to Monitoring treatment. Involves the insertion of a catheter into a pulmonary artery and measures the Pulmonary Artery pressure in the right ventricle and pulmonary artery. PAP monitoring is used to Pressure (PAP) assess cardiac function, detect pulmonary hypertension, and guide fluid and drug Monitoring therapy. Involves the insertion of a catheter into an artery, typically the radial or femoral Intra-arterial Blood artery, and measures the arterial pressure in real-time. Intra-arterial BP Pressure (BP) monitoring is used to assess blood pressure changes in critically ill patients, guide Monitoring drug therapy, and evaluate response to treatment. central venous pressure (cvp) monitoring Pulmonary Artery Catheter and Pressure Monitoring System Intra-arterial Blood Pressure (BP) Monitoring Question #3 Central venous pressure (CVP) is a measurement of the pressure in which area of the heart? A. Left ventricle B. Vena cava or right atrium C. Pulmonary artery D. Left atrium Answer to Question #3 B. Vena cava or right atrium Rationale: CVP is a measurement of the pressure in the vena cava or right atrium. The pressure in the vena cava, right atrium, and right ventricle is equal at the end of diastole; thus, the CVP also reflects the filling pressure of the right ventricle (pre-load). The normal CVP is 2 to 6 mm Hg. Questions? Thank you!