Chapter 26

Assessment of
Cardiovascular Function

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Overview of Anatomy and Physiology Heart

Three layers
Endocardium
Myocardium
Epicardium
Four chambers
Heart valves

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Overview of Anatomy and Physiology

Heart (contd)
Coronary arteries
Cardiac conduction system
Cardiac hemodynamics

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Structure of the Heart

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Cardiac Conduction System

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Terms - 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
re-entry of potassium into 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 stronger-than-normal stimulus to depolarize
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Cardiac Action Potential

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Great Vessel and Heart Chamber

Pressures

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Terms - Cardiac Output

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

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Terms - Cardiac Output (contd)

After load: resistance to ejection of blood from ventricle
Ejection fraction: percent of end diastolic volume ejected
with each heart beat

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CO = SV x HR
Control of heart rate
Autonomic nervous system, baroreceptors
Control of strike volume
Preload: Frank-Starling Law
After load: affected by systemic vascular resistance,
pulmonary vascular resistance
Contractility increased by catecholamines, SNS, some
medications
Decreased by hypoxemia, acidosis, some
medications
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Question
Which of the following is the normal 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 normal pacemaker
for the myocardium.

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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

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Assessment
Health history
Demographic information
Family/genetic history
Cultural/social factors
Risk factors
Modifiable
Nonmodifiable

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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
Medications

Self-perception, selfconcept

Nutrition

Roles, relationships

Elimination
Activity, exercise
Sleep, rest

Sexuality, reproduction
Coping, stress tolerance
Prevention strategies

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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 check-ups?
Do you use tobacco or alcohol?
What medications do you take?

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Question
Where does the nurse auscultate the apex of the heart?
A.Erbs point
B.Fifth intercoastal space
C.Pulmonic area
D.Tricuspid area

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Answer
B. Fifth intercoastal space
Rationale: The nurse auscultates the apex of the heart at
the fifth intercoastal space.

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Laboratory Tests
Cardiac biomarkers
CK, CK-MB
Myoglobin
Troponin T and I
Lipid profile
Brain (B-type) natriuretic peptide
C-reactive protein
Homocysteine
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Electrocardiography
12 lead ECG
Continuous monitoring: hardwire, telemetry
Signal-averaged electrocardiogram
Continuous ambulatory monitoring
Transtelephonic monitoring
Wireless mobile monitoring

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

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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
Assessment of patient postprocedure; circulation,
potential for bleeding, potential for dysrhythmias
Activity restrictions
Patient education pre-, postprocedure
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Hemodynamic Monitoring
CVP
Pulmonary artery pressure
Intra-arterial BP monitoring

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Phlebostatic Level

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Pulmonary Artery Catheter

Refer to fig. 26-11

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Pulmonary Artery Catheter and Pressure

Monitoring System

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