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Chapter 25

Assessment of
Cardiovascular Function

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Overview of Anatomy and Physiology


Three layers:
endocardium,
myocardium, epicardium

Semilunar valves: aortic


and pulmonic

Four chambers: Right


atrium and ventricle, left
atrium and ventricle

Cardiac conduction system


(electrophysiology)

Atrioventricular valves:
tricuspid and mitral

Coronary arteries

Cardiac hemodynamics

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Anatomy of the Heart

Figure 25-1
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Cardiac Conduction System:


Electrophysiology
(60-100)

(40-60)

(30-40)
(30-40)

Figure 25-3
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Question
Which of the following is the primary pacemaker for the
myocardium?
A. Atrioventricular junction
B. Bundle of His
C. Purkinje fibers
D. Sinoatrial node

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Answer
D. Sinoatrial node
Rationale: The sinoatrial node is the primary pacemaker
for the myocardium.

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Cardiac Action Potential


Depolarization: electrical activation of cell caused by
influx of sodium into cell while potassium exits cell
Repolarization: return of cell to resting state caused by
reentry of potassium into cell while sodium exits

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Cardiac Hemodynamics
Stroke volume(SV): amount of blood ejected with each
heartbeat
Preload: degree of stretch of cardiac muscle fibers at
end of diastole
Afterload: resistance to ejection of blood from
ventricle
Contractility: ability of cardiac muscle to shorten in
response to electrical impulse

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Cardiac Hemodynamics (contd)


Ejection fraction: percent of end diastolic volume ejected
with each heart beat (left ventricle)
Cardiac utput (CO): amount of blood pumped by ventricle
in liters per minute.
CO = SV HR

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Question
Which of the following best defines stroke volume?
A.The amount of blood ejected with each heartbeat
B.Amount of blood pumped by the ventricle in liters per
minute
C.Degree of stretch of the cardiac muscle fibers at the end
of diastole
D.Ability of the cardiac muscle to shorten in response to an
electrical impulse

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Answer
A. The amount of blood ejected with each heartbeat
Rationale: Stroke volume is the amount of blood ejected
with each heartbeat. Cardiac output is the amount of
blood pumped by the ventricle in liters per minute.
Preload is the degree of stretch of the cardiac muscle
fibers at the end of diastole. Contractility is the ability of
the cardiac muscle to shorten in response to an electrical
impulse.

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Health History
Demographic information
Family/genetic history
Cultural/social factors
Risk factors
Modifiable
Non-modifiable

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Most Common Clinical Manifestations


Chest pain
Dyspnea
Peripheral edema, weight gain
Fatigue
Dizziness, syncope, changes in level of consciousness

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Assessment
Physical examination
Palpation, percussion, auscultation
Medications
Nutrition
Elimination
Activity, exercise
Sleep, rest

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Assessment (contd)
Vital signs
Self-perception, self-concept
Roles, relationships
Sexuality, reproduction
Coping, stress tolerance
Prevention strategies
Family history

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Health Promotion, Perception, and


Management Questions
Ask regarding health promotion, 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 of 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?

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Health Promotion, Perception, and


Management Questions (contd)
Ask regarding health promotion, preventive practices
Do you have a cardiologist or primary health care
provider? How often do you go for checkups?
Do you use tobacco or alcohol?
What medications do you take?

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Laboratory Tests
Cardiac biomarkers
CK, CK-MB

C-reactive protein

Myoglobin
Troponin T and I
Lipid profile

Brain (B-type) natriuretic


peptide
Homocysteine
Refer to Table 25-4

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Electrocardiography
12-lead ECG
Continuous monitoring: hardwire, telemetry
Signal-averaged ECG
Continuous ambulatory monitoring
Transtelephonic monitoring
Wireless mobile monitoring

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Electrocardiography (contd)
Cardiac stress testing
Exercise stress testing
Pharmacologic stress testing
Echocardiography

Transthoracic

Transesophageal

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Diagnostic Tests
Radionuclide imaging
Myocardial perfusion imaging
Test of ventricular function, wall motion
Computed tomography
Positron emission tomography
Magnetic resonance angiography

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Cardiac Catherization
Invasive procedure study used to measure cardiac
chamber pressures, assess patency of coronary arteries
Requires ECG, hemodynamic monitoring; emergency
equipment must be available
Assessment prior to test; allergies, blood work

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Cardiac Catherization (contd)


Assessment of patient postprocedure; circulation,
potential for bleeding, potential for dysrhythmias
Activity restrictions
Patient education pre- and postprocedure

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Hemodynamic Monitoring
CVP (2-6mmHG is normal. Elevated=hypervolemia;
decreased=hypovolemia)
Pulmonary artery pressure measures left ventricular
function
Intra-arterial BP monitoring is used to obtain direct and
continuous BP measurements

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Phlebostatic Level

Figure 25-10

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Pulmonary Artery Catheter and Pressure


Monitoring System

Figure 25-12
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