2023 Lecture 1 Cardiac Assessment (1)

## Page 1: Title Slide
- **Assessment of Canadian Function**
- Presenter: Shannon Bang
- Date: Fall 2005

## Page 2: Learning Outcomes for Chapter 33
- **Physiological Integrity**
- Review cardiovascular anatomy and physiology (A&P): structures of the heart, blood flow, and relevant terms.
- Perform a focused physical assessment for patients with cardiovascular (CV) problems — collecting subjective and objective data.
- Identify assessment findings that suggest decreased cardiac output.
- Interpret laboratory test findings for patients with suspected or actual cardiovascular diseases and their clinical implications.

## Page 3: Cardiovascular Anatomy and Physiology
- **Overview of Circulation**
- **Capillaries** - involved in gas exchange.
- **Pulmonary circuit** includes:
- Pulmonary arteries (carry deoxygenated blood to lungs)
- Pulmonary veins (carry oxygenated blood back to the heart)
- **Heart chambers**:
- Right atrium and ventricle for deoxygenated blood.
- Left atrium and ventricle for oxygenated blood.
- **Vessels**:
- Aorta to systemic arteries convey oxygenated blood.
- Systemic veins return deoxygenated blood to the heart.

## Page 4: Cardiac Output
- **Cardiac Output (CO)**: 4-7 L/min
- Formula: CO = Heart Rate (HR) x Stroke Volume (SV)
- Factors affecting cardiac output:
- Preload
- Afterload
- Contractility
- **Questions for Discussion**: What interventions can affect HR, preload, afterload, and contractility?

## Page 5: Autonomic Nervous System
- **Sympathetic Nervous System**
- Release of catecholamines:
- Epinephrine
- Norepinephrine
- Results in the "fight or flight" response.

## Page 6: Stress Response and Heart Rate
- **Response Steps**:
1. Stress triggers the brain to signal adrenal glands.
2. Adrenaline is released into the bloodstream.
3. Adrenaline acts on heart cells through receptors.
4. Result: Increased heart rate and fight-or-flight reactions.

## Page 7: Sympathetic Nervous System Effects
- **Beta Adrenergic Receptors**:
- Beta 1 (Heart): Increases heart rate, contractility, conduction velocity, and automaticity.
- Beta 2 (Arteries/Vessels): Causes vasodilation and bronchodilation, stimulates renin release.

## Page 8: Parasympathetic Nervous System
- **Cholinergic System** (Acetylcholine):
- Promotes non-stressful conditions.
- Decreases heart rate and force of heart contractions, decreases rate of breathing, and lowers blood pressure.

## Page 9: Preload and Afterload
- **Definitions**:
- **Preload**: The volume of blood in the ventricles at the end of diastole.
- **Afterload**: The pressure the heart must generate to eject blood.

## Page 10: Arteriolar Tone
- **Vasoconstriction**: Increased resistance and decreased flow.
- Caused by myogenic activity, increased oxygen, and sympathetic stimulation, among other factors.
- **Vasodilation**: Decreased resistance and increased flow.
- Triggered by metabolites (NO, histamine) and other factors.

## Page 11: Contractility
- **Contractility**: Force of contraction.
- Higher contractility leads to increased cardiac output.
- Normal Ejection Fraction (EF): 50%-65%.

## Page 12: Decreased Cardiac Output Symptoms
- **Indicators**:
- Altered Level of Consciousness (LOC)/Cognition: ranging from restlessness to unresponsiveness, disorientation, and syncope.
- Urinary output < 0.5 ml/kg/hr.
- Tachycardia.
- Decreased BP.
- Skin changes: pale, central cyanosis, cold/clammy/diaphoretic.
- Weak pulses.

## Page 13: Pulse Sites
- **Common Pulse Locations**:
- Carotid
- Brachial
- Radial
- Ulnar
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis

## Page 14: Blood Pressure (BP) Concepts
- **Blood Pressure Equation**: BP = CO x Afterload
- **Systolic BP**: Maximum pressure during ventricular contraction.
- **Diastolic BP**: Minimum pressure during ventricular relaxation.
- Discuss when BP is considered too low or high.
- **Orthostatic Hypotension**: Risks and prevention strategies.

## Page 15: Blood Pressure Categories
- **Classification** (per AHA Guidelines 2017):
- Normal: SBP