CARDIOLOGY NURSING

Assessment of the CVS

PUAN ROSDIANA RAMLI

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Learning Outcomes:

At the end of the session, student will able to;

• review the anatomy and physiology of cardiovascular system.

• Taking health history for cardiac assessment.• Perform the physical examination • Outline the diagnostic test.

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THE CARDIOVASCULAR SYSTEM

HEART’S NORMAL ANATOMY• The heart is located in the LEFT side

of the mediastinum• Consists of Three layers -

epicardium, myocardium and endocardium

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THE CARDIOVASCULAR SYSTEM

• The layer that covers the heart is the PERICARDIUM

• There are two parts - parietal and visceral pericardium

• The space between the two pericardial layers is the pericardial space

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THE CARDIOVASCULAR SYSTEM

• The heart also has four chambers - two atria and two ventricles

• The Left atrium and the right atrium

• The left ventricle and the right ventricle

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The Cardiovascular System

The heart chambers are guarded by valves

• The atrio-ventricular valves - tricuspid and bicuspid

• The semi-lunar valves - pulmonic and aortic valves

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The Cardiovascular System

The Blood supply of the heart comes from the Coronary arteries

1. Right coronary artery supplies the RIGHT atrium and RIGHT ventricle, inferior portion of the LEFT ventricle, the POSTERIOR septal wall and the two nodes - AV (90%) and SA node (55%)

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The Cardiovascular System

2. Left coronary artery- branches into the LAD and the circumflex branch

• The LAD supplies blood to the anterior wall of the LEFT ventricle, the anterior septum and the Apex of the left ventricle

• The CIRCUMFLEX branch supplies the left atrium and the posterior LEFT ventricle

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The Cardiovascular System

The CONDUCTING SYSTEM OF THE HEART

Consists of the1. SA node- the pacemaker2. AV node- slowest conduction3. Bundle of His – branches into the

Right and the Left bundle branch4. Purkinje fibers- fastest conduction

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The Cardiovascular System

The Heart sounds1. S1- due to closure of the AV valves2. S2- due to the closure of the semi-

lunar valves3. S3- due to increased ventricular

filling4. S4- due to forceful atrial contraction

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The Cardiovascular System

Heart rate• Normal range is 60-100 beats per

minute• Tachycardia is greater than 100 bpm• Bradycardia is less than 60 bpm• Sympathetic system INCREASES HR• Parasympathetic system (Vagus)

DECREASES HR

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CVS Assessments

• History taking• Physical assessment• Psychosocial assessment• Laboratory assessment• Radiographic assessment• ECG• Hemodynamic monitoring

ASSESSING CARDIAC FUNCTION

• HEALTH ASSESSMENT: Health History

• PHYSICAL EXAMINATION

• DIAGNOSTIC TESTS– LABORATORY– INVASIVE TEST

• CARDIAC CATHETERIZATION

– Coronary angiography

– Coronary arteriography.

– NONINVASIVE TESTS • CXR• STRESS/EXERCISE

TEST• ECG

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CARDIAC ASSESSMENT1. Health History• Obtain description of present illness

and the chief complaint• Chest pain, SOB, Edema,

palpitations, etc.• Assess risk factors• Personal habits and nutritional

history.• Activity-exercise• Sleep-rest.

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History Taking• Personal particulars• Medical and surgical history• Family history and genetic risks• Diet history• Socioeconomic status• Risk factors – smoking, physical inactivity,

obesity, psychological factors• Present history of illness, sign & symptoms

– Chronic disease, pain, discomfort, dyspnea, fatigue,palpitations, weight gain, syncope, and extremity pain

CARDIAC ASSESSMENT

2. Physical examination• General appearance. • Vital signs- BP, PP, MAP• Inspection of the skin• Inspection of the thorax• Palpation of the point of

maximal impulse(PMI), pulses• Auscultation of the heart

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Physical Assessment

• General appearance• Skin & mucous membranes (colour,

temperature)• Extremities (clubbing, oedema, bruits, b/p,

pulse pressure)• Precordium (inspection, palpitation,

percussion & auscultation – heart sounds (paradoxical splitting, gallops & murmurs, pericardial friction rub).

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3. Peripheral vascular system:

a. Inspection:

. Skin - colour.

. Extremities:

- edema.

- clubbing of fingers.

- varicosities.

- lesions.

. Neck

- large veins.

Diploma in Nursing , School of Nursing Faculty of Health Science

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PallorPallor

ClubbingClubbing22

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b. Palpation:

. Upper and lower extremities:

- temperature.

- pulses.

- edema.

Diploma in Nursing , School of Nursing Faculty of Health Science

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Percussion 

Unnecessary in the CVS examination (except lung bases)

Percuss and listen to the lung basesFor any signs of pleural effusion (RVF)

and pulmonary oedema (LVF)

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Auscultation• Heart sound• 1st heart sound – closure of

tricuspid and mitral valve.• 2nd heart sound – closure of aortic

and • pulmonary valves.• 3rd and 4th heart sound – extra

heart sound.• Murmur – sounds occuring between

normal heart sound.• Pericardial friction rub – scratchy

sound between S1 and S2.26

PREKORDIUMPREKORDIUM

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Laboratory studies

Laboratory Test Rationale1. To assist in diagnosing MI2. To identify abnormalities3. To assess inflammation4. To determine baseline value5. To monitor serum level of medications6. To assess the effects of medications

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Laboratory Assessment

• Serum Markers Troponin Creatine Kinase (CK)-MB

• Serum Lipids• Homocysteine• C-Reactive Protein• Blood Coagulation Tests

Prothombin Time & International Normalised Ratio (INR) Partial Thromboplastin Time (PTT)

• Arterial Blood Gases• Serum Electrolytes• Complete Blood Count

April 10, 2023

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Radiographic Assessment

• Chest Radiography Size of heart, pulmonary congestion, position of heart

and catheters Preparation of patient

• Angiography Invasive diagnostic procedure when suspect arterial

obstruction, narrowing or aneurysm. A contrast media is used and fluoroscopy to see the flow of contract

Preparation of patient

• Cardiac Catheterization To study right, left heart and coronary arteries Preparation of patient

April 10, 2023

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Electrocardiogram (ECG)

• Resting 12 lead or rythmn continous monitoring

• Ambulatory (Holter monitoring) 24 hrs ECG recording to detect dysrythmias

• Exercise ECG – stress test Assess CVS responds to increased workload Helps to determine functional capacity of the heart and

screens for asymptomatic coronary artery disease Preparation

• Echocardiography Ultrasound waves to assess cardiac structure and

mobility especially of valves

April 10, 2023

DIAGNOSTIC TESTS

ELECTROCARDIOGRAM (ECG)

• A non-invasive procedure that evaluates the electrical activity of the heart.

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DIAGNOSTIC TESTSHolter Monitoring• A non-invasive test in which

the client wears a Holter monitor and an ECG tracing recorded continuously over a period of 24 hours

• Instruct the client to resume normal activities and maintain a diary of activities and any symptoms that may develop.

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DIAGNOSTIC TESTSStress Test• A non-invasive test that studies

the heart during activity and detects and evaluates CAD

• Exercise test, pharmacologic test and emotional test

• Used to determine CAD, Chest pain causes, drug effects and dysrhythmias in exercise

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DIAGNOSTIC TESTSECHOCARDIOGRAM• Non-invasive test

that studies the structural and functional changes of the heart with the use of ultrasound

• No special preparation is needed

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DIAGNOSTIC TESTS

CARDIAC catheterization• Insertion of a catheter into the

heart and surrounding vessels• Determines the structure and

performance of the heart valves and surrounding vessels.

• Used to diagnose CAD, assess coronary atery patency and determine extent of atherosclerosis.

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Hemodynamic monitoring

• An invasive monitoring system esp in ICU• Directly measures pressures in the heart and great

vessels.Measuring:

Vascular capacity Blood volume Pump effectiveness Tissue perfusion

• Right Atrial Pressure• Pulmonary Artery Pressure• Pulmonary Artery Wedge Pressure• Cardiac output – Thermodilution method

DIAGNOSTIC TESTS

CVP• The CVP is the

pressure within the Superior Vena Cava

• Reflects the pressure under which blood is returned to the SVC and right atrium

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DIAGNOSTIC TESTS

CVP• Normal CVP is 0 to 8 mmHg/ 4-10

cm H2O• Elevated CVP indicates increase in

blood volume, excessive IVF or heart/renal failure

• Low CVP may indicated hypovolemia, hemorrhage and severe vasodilatation

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THANK YOU

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