Assessment Of The Cardiovascular System

Front 1

Diastole

Back 1

2/3 cardiac cycle, consists of relaxation and filling of atria & ventricles

Front 2

Systole

Back 2

contracting and emptying of atria and ventricles

Front 3

systolic blood pressure

Back 3

amt of pressure/force generated by left ventricle to distribute blood into the aorta w/ each contraction of the heart.

Front 4

diastolic BP

Back 4

amt of pressure/force sustained by the arteries during the relaxation phase of the heart. Determined primarily by ability of heart to rest while filling w/ blood.

Front 5

increased vascular resistance will do what to BP and CO?

Back 5

increase BP & CO

Front 6

number of times ventricles contract each minute

Back 6

HR

Front 7

HR is extrinsically controlled by

Back 7

ANS-adjusts rapidly when necessary to regulate CO.

Front 8

what influences the effects of ANS on HR

Back 8

CNS & baroreceptors. Baroreceptor reflex acts as a negative-feedback system.

during hypotension-baroreceptors sense this signal to parasympth to have less inhibotory effect on SA.

Front 9

amt of blood ejected by left ventricle during each systole.

Back 9

stroke volume

Front 10

variable affecting SV

Back 10

HR, preload, afterload & contractility

Front 11

amt of blood pumped from left ventricle each minute

Back 11

CO
adult-ranges 4-7L/min

Front 12

what does CO depend on?

Back 12

depends on relationship between HR & stroke volume. It is the product of these 2 variables. CO=HR*SV

Front 13

polarized (resting) cells

Back 13

no electrical activity
differences in concentration of Na & K
K has greater intracellular concentration
Na has greater extracellular concentration

Front 14

depolarization

Back 14

cell membrane increases permeability
-sodium and potassium exchange places
-calcium moves into the cell
-myocardial muscle contraction occurs

Front 15

repolarization

Back 15

ions return to the cell to the resting state

Front 16

electrophysiologic properties of the heart are responsible for regulating HR & rhythm. Cardiac muscle cells possess characteristics of--

Back 16

automaticity, excitability, conductivity, contractility & refractoriness

Front 17

ability of all cardiac cells to initiate an impulse

Back 17

automaticity

Front 18

the ability of the cells to respond to a stimulus by initiating an impulse

Back 18

excitability

Front 19

ability to transmit electrical impulses

Back 19

conductivity

Front 20

ability to contract in respond to an impulse

Back 20

contractility

Front 21

inability to respond to another stimuli until they recover (heart cells)

Back 21

refractoriness

Front 22

cardiac index

Back 22

adjustment for size differences
normal range 2.7-3.2L/min/m2 of body surface area

Front 23

Ejection Fraction (EF)

Back 23

amt of blood ejected by left ventricle expressed in a percentage

normal 50-70%

Front 24

preload

Back 24

degree of myocardial stretch at the end of diastole (b/c of volume)
-determined by (amt of blood returning to the heart from both venous system and pulmonary system) left ventricular end-diastolic volume (LVEDV)

-Starling's law: the more the heart is filled during diastole the more forcefully it contracts (imp SV)

-excessive filling=excessive LVEDV=decreased CO

Front 25

afterload

Back 25

-pressure ventricles must overcome to eject blood into the peripheral blood vessels
-influenced by condition of the aortic valve, pressure and distensibility of the vascular system

contractility-force of cardiac contraction independent of preload. It is increased by factors such as sympth stim, calcium release, and positive inotropic drugs. Factors such as hypoxia and acidemia decrease contractility.

Front 26

ANS

Back 26

BP is regulated by balancing the sympathetic and parasym.

sensory receptors:
chemoreceptors (aortic arch and carotid bodies) sensitive to hypoxemia -activate a vasoconst response

baroreceptors(aortic arch and carotid sinuses) resp to increased BP-inhibit vasomotor center, decreases BP

stretch receptors(vena cava and right atrium) sense decreased volume-send fewer impulses to CNS. this reaction stim the sym N.S. to increase HR and constrict peripheral blood vessels

Front 27

3 mechanisms mediate and regulate BP

Back 27

ANS-excites or inhibits sym N.S. activity in response to impulses from chemoreceptors and baroreceptors

kidneys-sense a change in blood flow and activate the renin-angiotensin-aldosterone mechanism

endocrine system-which releases various hormones to stimulate the symp N.S. at the tissue level

Front 28

sympathetic system response

Back 28

(beta) increase HR, AV conduction & contractility
(alpha) vasoconstriction

Front 29

parasympathetic system response

Back 29

decreased contractility & conductivity
decreased SA firing & decreased HR

Front 30

Renal System-role in regulating cardiovascular activity

Back 30

when renal blood flow or pressure decreases, the kidneys retain sodium and water. BP tends to rise because of fluid retention and activation of the renin-angiotensin-aldosterone mechanism. This mechanism results in vasoconstriction and sodium retention (fluid retention) Vascular volume is also regulated by the release of antidiuretic hormone from the posterior pituitary gland.

Front 31

other factors that influence activity of the cardiovascular system

Back 31

-antidiuretic hormone-causes kindeys to reabosrb water: inc BP

-natiuretic peptides-causes diuresis and renal vasodilation

-emotions stim symp N.S. (excitement, pain, anger) incr BP and HR

-increased physical activity

hypothermia-tissue requires fewer nutrients and BP falls

hyperthermia-met. requirement of the tissues is greater and BP and HR rise.

Front 32

age associated changes

Back 32

valves:calcification
conduction: SA fibrotic, inc time
LV: hypertrohpy,dec filling time
large arteries: stiff, inc SVR
Baroreceptors:less sensitive

Front 33

The valve between the left atrium and left ventricle is

Back 33

mitral valve

Front 34

T or F
the 3 main arteries are the LCA, RCA, and circumflex

Back 34

True

Front 35

T or F
in most ppl, the left coronary artery supplies the right atrium and the SA node

Back 35

False

Front 36

T or F
blood flow occurs primarily during systole

Back 36

false

Front 37

T or F
blood flows from the coronary arteries from the carotid arteries

Back 37

false

Front 38

the pressure the ventricle must overcome to eject blood is

Back 38

afterload

Front 39

which of the following is not a B1 response?

1. increased HR
2. stronger contractility
3. faster conduction
4. vasoconstriction

Back 39

vasoconstriction

Front 40

symptoms identified w/ cardiovascular disease

Back 40

chest pain/discomfort
dyspnea
fatigue
palpitations
weight gain 2.2Ibs= 1 L of fluid
syncope

Front 41

chest pain or discomfort

Back 41

onset,duration, frequency, precipitating factors, location, radiation, quality, intensity, associated symptoms, aggravating factors, relieving factors

Front 42

dyspnea

Back 42

can occur w/ cardiac and pulmonary disease
objective:difficult or labored breathing
subjective: uncomfortable breathing or SOB
types:
DOE-dyspnea on exertion
orthopnea
paroxysmal nocturnal dyspnea

Front 43

physical assessment

Back 43

-general appearance
-sclera
-skin-cyanosis, edema, nails, neck
veins
-PMI
-peripheral pulses
-heart sounds
-S1S2
-S3S4
-murmurs
-rubs

Front 44

PMI

Back 44

usual location: 5 ICS MCL
-shift to left indicates left ventricular hypertrophy

-usual intensity: equal to brachial pulse
-stronger indicates left ventricular failure or aneurism

Front 45

peripheral pulses

Back 45

0-absent
1-weak
2-normal
3-bounding

Front 46

S1 is the closure of ___ & ___

Back 46

mitral and tricuspid valves (AV valves)
indicates beginning of systole

Front 47

S2 is the closure of ____ & ____

Back 47

aortic and pulmonic valves (semilunar valves)
S2 indicates the beginning of diastole

Front 48

S3

Back 48

extra sound during early ventricular filling

lubb dubb dee

normal under 30 yrs old
if older- signifies fluid volume overload to the ventricle that may be due to heart failure or mitral valve or tricuspid regurgitation

Front 49

S4

Back 49

occurs at the end of diastole just before S1

ten-ness-ee

normal in children and young adults. Over 30yrs old- signifies a noncompliant or "stiff" ventricle-coronary artery disease

Front 50

murmurs

Back 50

produced by vibrations created when blood flow is altered. Heard where there are structual abnormalities in the aortic or pulmonary arteries or defects in the heart itself or the valves.

Front 51

JVP

Back 51

jugular venous pressure can be assessed to estimate the filling volume and and pressure on the right side of the heart. An increase in JVP causes JVD.

Increases are usually caused by right ventricular failure.

Front 52

troponin

Back 52

myocardial muscle protein released into the bloodstream w/ injury to myocardial muscle. Results available within 15-20 mintues.

onset 4-6 H
peak 18-24 H
duration up to 10 days

Front 53

CK-MB

Back 53

creatine kinase (CK) an enzyme specific to cells of the brain, myocardium, and skeletal muscle.
The appearance of CK in the blood indicates tissue necrosis or injury, w/ CK levels following a predictable rise and fall during a specific period.

onset 4-12 H
peak 18-24 H
duration 36-48 H

Front 54

myoglobin

Back 54

earliest marker detected -2 H after MI w/ rapid decline after 7 H
it is not myocardial specific, also found in skeletal muscle

onset1-2 H
peak8-10 H
duration 24 H

Front 55

LDH

Back 55

onset 6-12 H
peak24-48 H
duration 6 to 8 days

Front 56

BNP

Back 56

B-Type Natriuretic Peptide
-elevations associated w/ heart failure
-secreted from the ventricles
-values:

<100pg/ml indicate no heart failure
100-300 suggest heart failure is present
>300 pg/ml indicate mild heart failure
>600 indicate moderate heart failure
>900 indicate severe heart failure

Front 57

c-reactive protein

Back 57

most studied marker for inflammation
elevations seen w/ HTN, infection, smoking

Front 58

homocysteine

Back 58

AA that is produced when proteins break down. must fast 10-12 H before test, blood must be sepatated and frozen within 1H of collection. A level of less than 12mmol/dL is considered optimal

lower:eat foods rich in vitB, esp folic acid
veggies, fruits, legumes, meats, fish, fortified grains and cereals

Front 59

blood coagulation tests

Back 59

evaluate ability of blood to clot. Impt for pts w/ greater tendency to form thrombi and for pts receiving anticoagulant therapy

PT & INR used when initiating and maintaining therapy w/ oral anticoagulants such as coumadin

PTT-assessed in pts who are receiving heparin.

Front 60

other important tests

Back 60

ABGs
serum electrolytes
CBC

Front 61

arterial insufficiency vs venous insufficiency

Back 61

arterial-pain worse when legs elevated, pain worsens w/ activity and relieved by rest(intermittent claudation)when worsens, rest doesn't relieve pain anymore, cold extremities

venous-pain intensifies w/ prolonged standing/sitting in one position, pain worse when legs are lowered and relieved when legs elevated

Front 62

Diagnostic Assessment: Radiographic Examination

Back 62

chest x-ray
angiography
cardiac catherization
electrophysiologic studies (EPS)
electrocardiography (ECG)
exercise electrocardiography (stress test)
echocardiography
myocardial nuclear perfusion imaging (MNPI)
CT scan

Front 63

angiography

Back 63

invasive diagnostic procedure that involves fluoroscopy and the use of contrast media. preformed when an arterial obstruction, narrowing, aneurysm or tumor is suspected

Risks: direct injuries involve bleeding at the puncture site
-arterial dissection
-vasovagal response
-renal, cardiac, or neurological complications
-allergic reaction to dye

Front 64

cardiac catherization

Back 64

most definitive, but most invasive test in the dx of heart disease.
indications:dx and evaluation of great vessel disease, coronary artery occlusion, valvular disease, atrial or ventricular septal defefcts
-measurement of pressures

catherization risks:
right-embolus, vagal response
left-MI, CVA, dysrhythmias, arterial bleeding
both-tamponade, hypovolemia, hematoma, pseudoaneurysms, contrast dye reaction, infection, death

Front 65

nursing considerations before cardiac cath procedure

Back 65

-food and fluids are withheld 4-6H prior to the procedure
-anticoagulation meds may be withheld prior to the procedure
-an intravenous line will be placed
-entry site will be cleansed and shaved as needed
-cardiac monitoring as well as pulse ox will be done throughout procedure
-procedure may last 1-3H

Front 66

nursing considerations after cardiac cath procedure

Back 66

ALERT! ventricular arrhythmias may occur. Resuscitation equipment must be available
-monitor VSq15 for 1H and q30 for next H
-evaluate peripheral pulses, skin color, and temp
-assess entry site (femoral artery) for bleeding; apply constant pressure PRN
-may need to be flat for 1-6H

Front 67

electrophysiologic study (EPS)

Back 67

invasive procedure during which programmed electrical stim of the heart is used to induce and evaluate lethal dysrhythmias.

Pt prep and after care parallels that for cardiac cath.

Front 68

ECG- Electrocardiography

Back 68

a study that measures the electrical activity of the heart.

electrical impulses create the waveforms that reflect activity during the cardiac cycle

waveforms can be analyzed to detect cardiac pathology

can use12-18 different leads to bisect the heart into planes

Front 69

holter cardiac monitoring

Back 69

also known as ambulatory ECG monitoring

it traces cardiac activity for 24-48H

the purpose of the holter monitoring is to detect if certain activities bring about change in cardiac functioning

Front 70

stress test

Back 70

assess cardiovascular response to an increased workload. it helps determine the functional capacities of the heart and screens for asymptomatic CAD. dysrhythmias that develop during exercise may be identified.

day of test- eat light meal 2 H before but avoid smoking, caffeine and alcohol.
before test-12-lead ECG, cardivasc Hx and physical examination performed

-treadmill or bike
the pt exercises until a predetermined HR is reached and maintained-s/s such as chest pain, fatigue, extreme dyspnea, vertigo, hypotension and ventricular dyshythmias appear.

for pts who are unable to exercise b/c of conditions such as peripheral vascular disease or arthritis, pharmacologic stress testing w/ agents such as dobutamine(incr hearts contractility), persantine or adenosine(coronary artery dialator) may be indicated.

Front 71

Dopple US

Back 71

used to assess perfusion
pulses or sounds are evaluated to assess the patency of arteries or veins

Front 72

endocardiogram

Back 72

-used to check sizes of ventricles, wall motion
-to check valve conditions, estimate of EF (ejection fraction)

common types
-2-D echo
-transesophageal echocardiography

-non-invasive, helps to dx cardiomyopathy, valvular function, ventricular function, ventricular aneurysms, and cardiac tumors

Front 73

(MNPI) myocardial nuclear perfusion Imaging

Back 73

the use of radionuclide techniques in cardiovascular assessment. cardio abnorm can be viewed, recorded, and evaluated using radioactive tracer substances . Good for detecting MI and decreased myocardial blood flow and for evaluating left ventricular ejection.

-Technetium pyrophosphate scan
(technetium scan)
isotope accumulates in damaged myocardial tissue
hot spot(doesnt show old infarction)

-Thallium imaging
stress test and then thallium injected
scan to assess myocardial perfusion
cold spot(areas not taken up w/ thallium-necrotic)