1. CARDIOLOGY
NURSING
Assessment of the CVS
PUAN ROSDIANA RAMLI
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2. 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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3. 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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4. 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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5. 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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6. 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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7. 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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8. 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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10. The Cardiovascular System
The CONDUCTING SYSTEM OF THE HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right
and the Left bundle branch
4. Purkinje fibers- fastest conduction
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12. The Cardiovascular System
The Heart sounds
1. S1- due to closure of the AV valves
2. S2- due to the closure of the semi-lunar
valves
3. S3- due to increased ventricular filling
4. S4- due to forceful atrial contraction
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13. 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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15. ASSESSING CARDIAC
FUNCTION
• HEALTH • DIAGNOSTIC TESTS
ASSESSMENT: – LABORATORY
Health History – INVASIVE TEST
• PHYSICAL • CARDIAC
CATHETERIZATION
EXAMINATION – Coronary angiography
– Coronary
arteriography.
– NONINVASIVE TESTS
• CXR
• STRESS/EXERCISE
TEST
• ECG
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16. CARDIAC ASSESSMENT
1. 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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17. 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
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18. 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 sounds
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25. Percussion
Unnecessary in the CVS examination
(except lung bases)
Percuss and listen to the lung bases
For any signs of pleural effusion (RVF) and
pulmonary oedema (LVF)
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26. 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.
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29. Laboratory studies
Laboratory Test Rationale
1. To assist in diagnosing MI
2. To identify abnormalities
3. To assess inflammation
4. To determine baseline value
5. To monitor serum level of medications
6. To assess the effects of medications
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30. 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
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31. 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
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32. 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
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34. DIAGNOSTIC TESTS
Holter 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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35. DIAGNOSTIC TESTS
Stress 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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37. 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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38. 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
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39. 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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40. 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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