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Chapter 21

Chapter 21. Cardiovascular System Function, Assessment, and Therapeutic Measures. The Heart. In Mediastinum Pericardial Sac: Three Layers Fibrous Pericardium Parietal Pericardium Visceral Pericardium (Epicardium) Serous Fluid Between Inner Layers. Anterior Heart View.

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Chapter 21

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  1. Chapter 21 Cardiovascular System Function, Assessment, and Therapeutic Measures

  2. The Heart • In Mediastinum • Pericardial Sac: Three Layers • Fibrous Pericardium • Parietal Pericardium • Visceral Pericardium (Epicardium) • Serous Fluid Between Inner Layers

  3. Anterior HeartView

  4. Frontal HeartView

  5. Cardiac Structure and Vessels • Four Chambers • Right/Left Atrium, Right/Left Ventricle • Cardiac Layers • Epicardium, Myocardium, Endocardium

  6. Cardiac Structure and Vessels (cont’d) • Coronary Arteries • Valves • Tricuspid, Pulmonic, Mitral, Aortic

  7. Blood Flow Vena Cava » Right Atrium» Tricuspid » Right Ventricle» Pulmonic » Pulmonary Artery » Lungs » Pulmonary Veins» Left Atrium » Mitral » Left Ventricle» Aortic Valve » Aorta

  8. Cardiac Conduction • SA Node • AV Node • Bundle of His • Right and Left Bundle Branches • Purkinje Fibers

  9. Cardiac Output • Amount of Blood Ejected from the Left Ventricle in 1 Minute • Stroke Volume x Heart Rate = CO

  10. Nervous System Regulation of the Heart

  11. Hormones and the Heart • Epinephrine • Increases Heart Rate • Force of Contraction • Cardiac Output • Systolic BP

  12. Hormones andthe Heart (cont’d) • Aldosterone • Regulates Sodium/Potassium • Atrial Natriuretic Peptide • Excretes Sodium

  13. Blood Vessels • Arteries • Veins • Capillaries

  14. Structure of Blood Vessels

  15. Blood Pressure • Blood Force Against Blood Vessel Walls • Normal • Systolic <120 mm Hg • Diastolic <80 mm Hg

  16. Renin-Angiotensin-Aldosterone Mechanism

  17. Pathways of Circulation • Pulmonary • Systemic

  18. Aging and the Cardiovascular System

  19. Aging and the Cardiovascular System (cont’d) • Atherosclerosis • Arteriosclerosis • Blood Pressure Increases • Vein Valves More Incompetent • Heart Muscle Less Efficient • Dysrhythmias Common

  20. Cardiovascular Disease • Number 1 Killer • Healthy Lifestyle • Smoking Cessation • Dietary Fat Reduction • Two Servings of Fish Weekly • Exercise

  21. Cardiovascular Disease (cont’d) • Go Red for Women • American Heart Association’s Nationwide Movement to Celebrate the Power Women Have to Band Together to Wipe Out Heart Disease • Color Red and Red Dress Linked with This Ability

  22. Cardiovascular Assessment • Health History • Physical Assessment • Diagnostic Studies

  23. Health History • Symptoms – WHAT’S UP? • Allergies • Past Medical History • Medications • Family History • Health Promotion Methods

  24. Physical Assessment • Vital Signs • Blood Pressure • Pulse • Respirations • Temperature

  25. Physical Assessment (cont’d) • Inspection • Oxygenation, Skin Color • Extremities: Hair , Skin, Nails, Edema, Color • JVD • Capillary Refill • Clubbing

  26. Clubbing

  27. Physical Assessment (cont’d) • Palpation • Point of Maximum Impulse • Extremity Temperature • Poikilothermy • Edema • Homans’ Sign

  28. Edema

  29. Homans’ Sign

  30. Physical Assessment (cont’d) • Auscultation • Heart Sounds • S1 • S2 • S3 • S4

  31. Heart Sounds

  32. Physical Assessment (cont’d) • Auscultation (cont’d) • Murmurs • Pericardial Friction Rub

  33. Diagnostic Studies Joint Commission National Patient Safety Goal • Improve Accuracy of Patient Identification • Use at Least Two Patient Identifiers (Neither Patient's Location) Whenever Collecting Laboratory Samples or Administering Medications or Blood Products

  34. Diagnostic Studies Joint Commission National Patient Safety Goal (cont’d) • Use Two Identifiers to Label Sample Collection Containers in Presence of Patient

  35. Diagnostic Studies Joint Commission National Patient Safety Goal (cont’d) • Immediately Prior to Any Invasive Procedure, Conduct Final Verification Process to Confirm Correct Patient, Procedure, Site, and Availability of Appropriate Documents

  36. Noninvasive Diagnostic Studies • Chest X-Ray • CT Scan • Magnetic Resonance Imaging

  37. Electrocardiogram • Records Cardiac Electrical Activity • Signal-averaged ECG • Risk for Ventricular Dysrhythmias • Ambulatory Electrocardiogram Monitoring • Holter Monitoring

  38. Echocardiogram • Ultrasound • Records Motion • Heart Structures • Valves • Heart Size, Shape, Position

  39. Transesophageal Echocardiogram • Probe in Esophagus • Clearer Picture • NPO Until Gag Reflex Returns

  40. Exercise StressTest • Cardiac Stress Test • Cardiac Response to Exercise and Increased Oxygen Needs • Peripheral Vascular Stress Test • Vascular Response to Walking

  41. Cardiac Stress Test

  42. Noninvasive Diagnostic Studies • Plethysmography • Diagnoses Deep Vein Thrombosis/Pulmonary Emboli/Peripheral Vascular Disease • Pressure Measurement • BP Readings Along Extremity

  43. Noninvasive Diagnostic Studies (cont’d) • Arterial Stiffness Index • Atherosclerosis/Cardiovascular Disease • Tilt Table Test • Lying to Standing BP and HR • Doppler Ultrasound • Impaired Blood Flow Reduces Sound Waves

  44. Radioisotope Imaging • Radioisotopes IV, Gamma Camera Scan • Detects Cardiac Ischemia/ Damage/ Perfusion • Thallium Imaging • Technetium Pyrophosphate Scan • Technetium 99m Sestamibi • MUGA Scan • Positron Emission Tomography

  45. Blood Studies • Blood Lipids • Triglycerides, Cholesterol, Phospholipids • hs-CRP • Homocysteine • Cardiac Biomarkers • Creatine Kinase, Troponin, Myoglobin • Magnesium

  46. Diagnostic Studies Joint Commission National Patient Safety Goal • Improve Effectiveness of Communication Among Caregivers • For Orders/Telephonic Reporting of Critical Test Results, Verify Complete Order/Test Result by Reading Back Complete Order/ Test Result to Person Giving it

  47. Invasive Studies • Angiography • Cardiac Catheterization • Hemodynamic Monitoring • Electrophysiology Study

  48. Cardiac Catheterization

  49. Pulmonary Artery Catheter

  50. Therapeutic Interventions • Exercise: Walking Program • Cardiac Rehab • Smoking Cessation • Balanced Diet, Weight Loss • Oxygen

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