Chapter 25

Assessment of
Cardiovascular Function
Overview of Anatomy and Physiology

 Three layers:  Semilunar valves: aortic

endocardium, and pulmonic
myocardium, epicardium
 Coronary arteries
 Four chambers: Right
atrium and ventricle, left  Cardiac conduction system
atrium and ventricle (electrophysiology)

 Atrioventricular valves:  Cardiac hemodynamics

tricuspid and mitral

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Anatomy of the Heart

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Greater Vessels, Heart Chambers and
Pressures

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Cardiac Conduction System:
Electrophysiology

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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

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Answer to Question #1

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
 Refractory periods
o Effective refractory period: phase in which cells are
incapable of depolarizing
o Relative refractory period: phase in which cells
require stronger-than-normal stimulus to depolarize

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Cardiac Action Potential Cycle

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Cardiac Cycle

 Refers to the events that occur in the heart from

the beginning of one heartbeat to the next
 Number of cycles depends on heart rate
 Each cycle has three major sequential events:
o Diastole
o Atrial systole
o Ventricular systole

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Cardiac Output #2

 Stroke volume(SV): amount of blood ejected with each

heartbeat
o Preload: degree of stretch of cardiac muscle fibers at
end of diastole
o Afterload: resistance to ejection of blood from
ventricle
o Contractility: ability of cardiac muscle to shorten in
response to electrical impulse

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Cardiac Output #1

 Ejection fraction: percent of end diastolic volume ejected

with each heart beat (left ventricle)
 Cardiac output (CO): amount of blood pumped by
ventricle in liters per minute
 CO = SV × HR

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Influencing Factors

 Control of heart rate

o Autonomic nervous system, baroreceptors
 Control of stroke volume
o Preload: Frank–Starling Law
o Afterload: affected by systemic vascular resistance,
pulmonary vascular resistance

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Contractility

 Contractility increased by catecholamines, SNS,

certain medications
 Increased contractility results in increased stroke
volume
 Decreased by hypoxemia, acidosis, certain
medications

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Question #2

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 to Question #2

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 of the CV

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

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Assessment of the CV System

 Health history
 Common symptoms
o Chest pain/discomfort
o Pain/discomfort in other areas of the upper body
o SOB/dyspnea
o Peripheral edema, wt gain, abd distention
o Palpitations
o Unusual fatigue, dizziness, syncope, change in LOC

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Past Health, Family, and Social History

 Medications
 Nutrition
 Elimination
 Activity, exercise
 Sleep, rest
 Self-perception/self-concept
 Roles and relationships
 Coping and stress

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Physical Assessment of CV System

 General appearance
 Skin and extremities
 Pulse pressure
 Blood pressure; orthostatic changes
 Arterial pulses
 Jugular venous pulsations
 Heart inspection, palpation, auscultation
 Assessment of other systems

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Laboratory Tests

 Cardiac biomarkers
 Blood chemistry,
hematology, coagulation
 Lipid profile
 Brain (B-type) natriuretic
peptide
 C-reactive protein
 Homocysteine
 Refer to Table 25-4

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Electrocardiography

 12-lead ECG
 Continuous monitoring
o Hardwire
o Telemetry
o Lead systems
o Ambulatory monitoring

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Cardiac Stress Testing

 Exercise stress test

o Pt walks on treadmill with intensity progressing
according to protocols
o ECG, V/S, symptoms monitored
o Terminated when target HR is achieved
 Pharmacologic stress testing
o Vasodilating agents given to mimic exercise

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Diagnostic Tests

 Radionuclide imaging:
o Myocardial perfusion imaging
o Positron emission tomography
o Test of ventricular function, wall motion
o Computed tomography
o Magnetic resonance angiography

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Echocardiography

 Noninvasive ultrasound test that is used to:

o Measure the ejection fraction
o Examine the size, shape, and motion of cardiac
structures
 Transthoracic
 Transesophageal

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Cardiac Catheterization

 Invasive procedure used to diagnose structural and

functional diseases of the heart and great vessels
 Right Heart Cath
o Pulmonary artery pressure and oxygen saturations
may be obtained; biopsy of myocardial tissue may be
obtained
 Left Heart Cath
o Involves use of contrast agent

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Nursing Interventions-Cardiac Cath

 Observe cath site for bleeding, hematoma

 Assess peripheral pulses
 Evaluate temp, color, and cap refill of affected extremity
 Screen for dysrhythmias
 Maintain bed rest 2 to 6 hours
 Instruct patient to report chest pain, bleeding
 Monitor for contrast-induced nephropathy
 Ensure patient safety

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Hemodynamic Monitoring

 Central venous pressure

 Pulmonary artery pressure
 Intra-arterial B/P monitoring
 Minimally invasive cardiac output monitoring devices

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Pulmonary Artery Catheter and Pressure
Monitoring System

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