Anatomical and

Physiological overview of
the heart
 The Heart

 Hallow, muscular
organ

 Weight???? (300 g)
 The Heart

 Occupies the middle of the

thorax
 between the two lung
 Rests on the diaphragm
Pumping
  The heart is enclosed
with a sac called
pericardium

 Pericardium consists of
Visceral and parietal
pericardium

 Pericardial fluid occupies

20 ml the space between the
two layers (why?)
Heart Champers and conduction
System
Heart valves
 Cardiac hemodynamics

Cardiac Output
 Total amount of blood ejected from one of the ventricles in Liter per
minutes (4-6 L/Min)
Stroke Volume X Heart Rate
Stroke Volume
 Amount of blood ejected with each heartbeat
Cardiac Hemodynamics

Stroke volume(SV)

 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
 Cardiac Hemodynamics

Ejection fraction (EF)

 Percentage of end-diastolic volume ejected with each heart beat

(left ventricle)

 What is the normal EF?

55% - 65%
Assessment of
Cardiovascular System
 Do cardiovascular assessment of patient in ED
differs than patient examined in an outpatient
clinic?

 Yes Priorities
Time
Type of diagnostics
Assessment of Cardiovascular System

1. Health
History
 Assessment: 1. Health History

 Chest pain
 Location, Character, Duration, aggravating and
alleviating factors
Most Common  Dyspnea
symptoms  Peripheral edema, weight gain, abdominal
distension
 Fatigue
 Dizziness, syncope, changes in level of
consciousness
 Assessment: 1. Health History

1. Risk factors (Modifiable vs. non)

2. Patient Knowledge
3. Medications Past Health,
4. Nutrition Family, and Social
5. Elimination History
6. Activity and Exercise
7. Sleep and Rest
8. Self-perception and Self-concept
9. Roles and Relationships
10. Sexuality and Reproduction
11. Coping and Stress
Assessment of Cardiovascular System

2. Physical
Assessment

1. Health
History
 Assessment: 2. Physical Assessment

• LOC • Pulse Pressure

• Mental • Postural BP
Status changes (chart 25-
• Acute obstruction of
• BMI 2)
blood flow to
Jugular
extremities (six P’s) Blood Pressure
General venous
• Hematoma (BP)
Appearance pulsation
• Edema
• Capillary refill
• Clubbing of the
fingers or toes • Pulse rate,
rhythm, contour, Heart Inspection,
Skin and Palpation palpation, and
Extremities Auscultation
Arterial
Pulses
Assessment: 2. Physical Assessment

Do we need to assess other

Systems?
Assessment: 2. Physical Assessment

Do we need to
assess other
Systems?
 Assessment: 2. Physical Assessment

 Hemoptysis

 Cough
Lungs
 Crackles

 Wheezes
Assessment: 2. Physical Assessment

ABDOMEN
 Abdominal Distention (Ascites)

 Hepatojugular Reflux

 Bladder Distension
 Assessment of Cardiovascular System

3. Diagnostic 2. Physical
Evaluation Assessment

1. Health
History
Assessment: 3. Diagnostic Evaluation

 A wide range of diagnostic studies may be performed

in patients with cardiovascular conditions.

What the nurse should do regarding these

diagnostics?
 Assessment: 3. Diagnostic Evaluation

LABARATORY TESTS
Cardiac Biomarker Analysis
 Enzymes:
 Creatine Kinase (CK), CK isoenzymes (CK-MB)
 Proteins:
 Myoglobin, Troponin T and Troponin I
Assessment: 3. Diagnostic Evaluation

LABARATORY TESTS
Blood Chemistry, Hematology, and
Coagulation
 Lipid Profile
 Cholesterol, LDL, HDL, triglyceride
 C-Reactive Protein (CRP)
 Brain Natriuretic Peptide (BNP)
 Neurohormone
Assessment: 3. Diagnostic Evaluation

Chest X-ray
 Size and position
of the heart
Assessment: 3. Diagnostic Evaluation

Electrocardiography
 Graphic representation of the electrical conduction of the heart
Assessment: 3. Diagnostic Evaluation

Electrocardiography

 Graphic representation of the electrical conduction of the heart

 Assessment: 3. Diagnostic Evaluation

Electrocardiography: Nursing Consideration

 Age, gender, weight, BP, symptoms, medications
 Skin Assessment
 Proper Electrodes (Leads) position
 Avoid artifacts (Distortion)
 Ready to respond to ECG alarms
 Electrodes should be cleaned before use between
patients.
 Assessment: 3. Diagnostic Evaluation

Cardiac Stress Test

 Non-invasive to Evaluate response of cardiovascular systems to stress.
 Uses:
 diagnosis of CAD, cause of chest pain, evaluate treatment, heart function after
MI/Surgery
 Contraindications: Severe Hypertension, severe aortic stenosis, HF, unstable
angina
 Types:
 Exercise stress test
 Pharmacological Stress test (Dipyridamole & adenosine)
 Assessment: 3. Diagnostic Evaluation

Cardiac Stress Test: Nursing Consideration

 Staff and equipment must be ready for any complication
 Patients must fast 4 hours and no stimulant taken.
 Appropriate clothes and sneakers
 Educate the patient regarding the test.
 Monitor patients 5-10 min after the test.
 Should know when to stop the test
 Assessment: 3. Diagnostic Evaluation

Transthoracic Echocardiography
 Non-invasive
 Uses:
 Examination of cardiac size, movement, EF, function of champers and
valves, direction and velocity of blood flow

 Performed in addition to ECG, STRESS test

 Assessment: 3. Diagnostic Evaluation

Echocardiography: Nursing Consideration

 Staff and equipment must be ready for any complication

 Educate the patient regarding the test and it is painless
 Patient might be asked to turn to left side or hold breath
 Test time is 30 – 45 min.
 Assessment: 3. Diagnostic Evaluation

Radionuclide Imaging
Computed Tomography (CT)
 Use of radioisotopes (contrast) to evaluate coronary artery perfusion
Uses:
 X-Ray: provide imaging of anatomical part of the heart champers, valves,
arteries, veins, pericardium
 Contraindicated: Pregnancy and Renal insufficiency
CT Coronary angiography
 Assessment: 3. Diagnostic Evaluation

CT angiography: Nursing Consideration

 Educate the patient regarding the test and it is painless

 Assess patient for fear of close spaces
 Renal function should be assessed
 IV hydration before and after the scan
 Patient must lie completely still during the exam
 Patient should told he might experience transient flushing, metallic
taste, nausea, bradycardia during the contrast infusion.
 Assessment: 3. Diagnostic Evaluation

Cardiac Catheterization

 Invasive

 https://www.youtube.com/watch?v=-DJiW1YADoE
 Case Study

The nurse working in the cardiac procedures area receives a patient who has
undergone a cardiac catheterization via the right femoral artery for
evaluation of unstable angina. Prior to the procedure, the patient was NPO for
12 hours, and received a sedative. An IV catheter was placed for
administration of the contrast agents and for access in case of an emergency
situation.

 What is the rationale for assessing distal pulses immediately after the catheterization?
 What other assessments should the nurse perform to check for arterial insufficiency?
 The patient asks why he needs to stay in bed with the leg extended for 2 to 6 hours. How should the
nurse respond?
 After the procedure, why is it important to assess the patient’s BUN, creatinine, and fluid volume
status?
 Assessment: 3. Diagnostic Evaluation

Cardiac Catheterization: Nursing Consideration

 Before the procedure:
 Patient should fast (8-12 hrs)
 Time of procedure up to 2 hours
 A family member should transport patient home after the procedure
 IV medication to comfort patient will be given
 Inform patients about sensation might experience (Palpitation, flushing,
nausea)
 Encourage patient to express fear and anxiety
 Assessment: 3. Diagnostic Evaluation

Cardiac Catheterization: Nursing Consideration

 After the procedure:
 Assess catheter site for bleeding and presence of extremities pulses (15min X 1HR, 30
min X 1hr, hourly X 4 hrs)
 Evaluate color, temperature, capillary refill, numbness, pain of the affected extremity
 Assess vital signs and observe for any dysrhythmia
 Maintain bed rest for 6 hours, affected leg straight and bed head elevated to 30
degree.
 No repetitive movement of affected extremity for 24-48 hrs.
 Instruct patient to report any chest pain or bleeding/discomfort at the insertion site.
Thank You