Cardiovascular System Assessment Lecture

Flashcards covering the assessment of the cardiovascular system, including anatomy, EKG basics, hemodynamic values, aging changes, and diagnostic procedures.

Perfusion

The priority concept for the cardiovascular chapter, referring to whether blood is successfully reaching tissues.

Fluid and Electrolyte Balance

The interrelated concept that works alongside perfusion in the assessment of the cardiac system.

Septum

The muscular layer in the middle of the heart separating the chambers.

Endocardium

The innermost layer of the heart tissue.

Myocardium

The middle muscular layer of the heart.

Epicardium

The outermost layer of the heart.

Pericardial space

The space surrounding the heart within the pericardium.

AV (atrioventricular) valves

Valves located between the atria and the ventricles.

Tricuspid valve

The AV valve located on the right side of the heart.

RAT (mnemonic)

A memory aid representing the Right AV Tricuspid valve.

Mitral or Bicuspid valve

The AV valve located on the left side of the heart.

LAM (mnemonic)

A memory aid representing the Left AV Mitral bicuspid valve.

Semilunar valves

Valves that lead into the bigger vessels, including the pulmonic and aortic valves.

Pulmonic valve

The semilunar valve that directs blood from the heart toward the lungs.

Aortic valve

The semilunar valve that directs blood out to the aorta and the rest of the body.

Mean Arterial Pressure (MAP)

The pressure within the systemic arteries at any given time used to ensure adequate perfusion to vital organs.

MAP Adult Range

The specific pressure range of $60-70\,mmHg$ required to maintain adequate perfusion to the body's organs.

Cardiac cycle

The sequence of events including contraction and relaxation represented on an EKG strip.

P wave

The first wave of the EKG representing the electricity when the atria contract.

QRS complex

The large waveform on an EKG that represents the contraction of the ventricles.

Cardiac Output (CO)

The amount of blood pumped from the left ventricle per minute.

Cardiac Output Formula

$$CO = \text{Heart Rate} \times \text{Stroke Volume}$$

Ejection Fraction (EF)

A measure of the percentage of blood leaving the heart each time it contracts; values less than $40\%$ are considered reduced.

Systolic dysfunction

A condition characterized by low ejection fraction, such as $35\%$, leading to decreased tissue perfusion.

Vascular system purpose

Acts like a highway to nourish tissues, carry waste to excretory organs, and return blood to the heart.

Arteries

Vessels that carry bright red oxygenated blood to body tissues under high pressure.

Arterial Characteristics

The presence of thicker walls, more valves to control pressure, and a high ability to constrict and contract.

Preload

The load or pressure going into the heart from the venous system before the cardiac cycle begins.

Preload Factor

The element that affects preload the most is blood volume.

Fluid volume overload (Preload effect)

A condition resulting in a higher than normal preload, forcing the heart into overdrive.

Afterload

The amount of work the heart must perform at the end of the cardiac cycle to exit blood to the tissues.

Afterload Factors

Commonly affected by blood pressure and arterial resistance.

Baroreceptors

Receptors in the vessels that sense stretching to balance and regulate pressure within the system.

Baroreceptor stimulation

A response to decreased stretching that triggers an increase in blood pressure to maintain balance.

Systolic

The phase during the contraction of the left ventricle.

Diastolic

The phase when the heart is relaxing, refilling, and getting ready to contract again.

Venous system function

Completes circulation by returning blood from capillaries back to the right side of the heart.

Aging: Cardiac valves

Valves become less efficient, calcify, harden, and develop leaks (regurgitation) over time.

Aging: SA node

The pacemaker of the heart, where cells tend to decrease with age, affecting electrical conductivity.

Aging: Conduction system changes

The loss of pacemaker cells can lead to atrial fibrillation or various heart blocks.

Aging: Left ventricle

This muscle often increases in size (enlarges) over time because it has worked too hard for too long.

Aging: Arteries

Vessels tend to stiffen, which in turn increases the patient's blood pressure.

Modifiable risk factors

Lifestyle choices like smoking and diet that can be changed to reduce cardiovascular risk.

Non-modifiable risk factors

Factors like family history, genetic risk, and age that cannot be changed.

Dyspnea

Difficulty breathing, often assessed during exertion or activity in cardiac patients.

Diabetes (CV link)

A medical condition that significantly increases a patient's risk for cardiovascular disease.

High-risk populations (Hypertension)

High blood pressure is more common in African American, Hispanic, and Native American populations.

Female MI symptoms

Signs may include fatigue despite rest, indigestion, and shortness of breath (SOB).

Male MI symptoms

Commonly presenting with chest pain in addition to other cardiovascular indicators.

Past medical infections (CV assessment)

History of recurrent strep infections or tonsillitis in childhood should be noted.

Physical Assessment: Pulse check

Evaluating if skin color, temperature, and pulses are equal in the extremities to assess perfusion.

Precordium techniques

The use of inspection, palpitation, percussion, and auscultation to assess heart sounds.

Orthostatic hypotension

A drop in blood pressure occurring when moving from a supine to a sitting or standing position.

Orthostatic vital signs technique

Obtaining blood pressures in supine, sitting, and standing positions in rapid succession.

Bradycardia

A lower than normal heart rate, requiring a medication reconciliation to check for heart-rate-lowering drugs.

Six signs of perfusion/extremity check

Assessment including pain, pulses, skin color, temperature, perfusion, paralysis, and temperature regulation.

Cardiac enzymes

Laboratory tests used to look for specific markers of heart muscle damage.

Troponin

The gold standard lab test for heart damage because it is very specific to cardiac tissue.

Lipids: Total Cholesterol

A level less than $200$ is generally considered very good for cardiovascular health.

HDL (High-Density Lipoprotein)

Known as 'good' cholesterol; health providers prefer this value to be high.

LDL (Low-Density Lipoprotein)

Known as 'bad' cholesterol; health providers prefer this value to be low.

CRP (C-reactive protein)

A laboratory test that indicates the rate of inflammation occurring in the body.

INR

A lab assessment used to monitor coagulation issues.

Chest X-ray (PA and Lateral)

Imaging used to quickly determine heart size and screen for other visible abnormalities.

Angiography

A procedure using injected dye to visualize blood traveling through vessels to find blockages.

Cardiac catheterization

A procedure categorized by which side of the heart is entered (Right vs. Left).

Right-sided cardiac catheterization

A procedure focused specifically on assessing the venous system.

Left-sided cardiac catheterization

A procedure focused on the arterial system that puts the patient at higher risk for a CVA.

Pre-care: Cardiac catheterization

Requires the patient to be NPO, provide signed consent, and possibly receive IV fluids.

Post-care: Position for Cardiac cath

The patient must lay flat and remain on bed rest for two to six hours after the procedure.

Post-care: Pedal pulse assessment

If a pulse is weak after cath, the nurse should next assess skin color and temperature.

Arterial obstruction signs

Skin that becomes cool or pale following a cardiac catheterization.

CVA (Stroke) signs

Symptoms such as slurred speech and confusion, monitored specifically after left-sided cath.

Cardiac cath: Rhythm change

An assessment finding that was not present before the procedure and requires immediate notification of the provider.

Electrophysiological study (EPS)

A study looking at the cells and electrical activity to see where electricity is coming from in the heart.

Cardiac stress test

A procedure that purposefuly stresses the heart to see how it compensates during action.

Chemical stress test

Commonly called 'Lexis,' this uses IV medication to speed up the heart to mimic exercise.

Echocardiogram

An ultrasound of the heart used to see valves, chambers, and ejection fraction in real time.

TEE (Transesophageal Echocardiogram)

An ultrasound test where a camera goes down the esophagus to better visualize the right side of the heart.

Myocardial nuclear perfusion imaging

An MRI scan of the heart; requires screening for pacemakers which could be deactivated by the machine.