Heart Assessment

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  1. Top of heart is called the
  2. Bottom of heart is the
  3. There are 4 chambers
    Atria: right and left

    Ventricles: right and left
  4. Right ventricle
    pumps blood to pulmonary circulation
  5. Left ventricle
    pumps blood to systemic circulation
  6. What are the AV valves
    the tricuspid and mitral
  7. What are the Semilunar valves
    the pulmonic and aortic
  8. What is Cardiac Output
    CO = Stroke Volume X Heart Rate

    Amount of blood that comes out of the heart per minute
  9. Stroke Volume equals
    • Stroke Volume = amount of blood ejected from
    • the left ventricle with each heartbeat
  10. Heart Rate ='s
    = Beats/minute
  11. Preload
    The amount of blood in left ventricle at the end of diastole

    • The greater the preload the greater the “stretch” or contractility of the heart muscle resulting in a
    • greater stroke volume (Starling’s Law)
  12. Frank- Starling Law
    The greater the stretch the greath the conratction

    Over work fibers like CHF pt or COPD pt over time it will fail if overworked

    Stretch and break fibers or overwork will fail heart

    We want some stretch
  13. Afterload
    reflects the amount of resistance the ventricles have to contract against.

    An increase in afterload results in a decrease in stroke volume
  14. Ask pt about current health such as
    problems (chest pain, dyspnea, fatigue, palpitations, weight gain, syncope (fainting) lack of o2 to the brain, extremity pain)
  15. What kind of Demographic Data are you concerned with
    you are concerned with living enviornment, Age, gender women especially after menopause
  16. Troponin
    myocardial muscle protein released after injury

    -levels are usually so low, cannot be detected

    -greater the damage the larger the troponin

    -will start to rise within hours after infarct (most patient have levels within 6 hours after attack)

    -normal levels within 12 hours after - infarction unlikely

    -levels lasts 1-2 weeks

    -levels drawn at arrival to ER and usually repeated twice within 12-16 hour window.
  17. Creatine kinase (CK)
    Elevations indicate possible brain, myocardial, and skeletal muscle necrosis or injury.

    •  Females: 30-135 units/L
    •  Males: 55-170 units/L
  18. CK-MB (CK2)
    Elevations occur with myocardial injury or after percutaneous transluminal angioplasty and intracoronary streptokinase infusion.

    • rise and fall over 2-4 days
    • - peak within 10-24 hours after infarct.
  19. Total lipids
    Elevation indicates increased risk of coronary artery disease (CAD).

    400-1000 mg/dL
  20. Cholesterol
    Elevation indicates increased risk of CAD.

    •  122-200 mg/dL, or 3.16-6.5 mmol/L
    •  Older adult (> 70 yr): 144-280 mg/dL
  21. Triglycerides
    Elevation indicates increased risk of CAD.

    •  Females: 35-135 mg/dL
    •  Males: 40-160 mg/dL
    •  Older adult (>65 yr): 55-260 mg/dL
  22. Plasma high-density lipoproteins (HDLs)
    Elevations protect against CAD.

    • Females: mean, 40 mg/dL
    •  Males: mean, 40 mg/dL
    •  Older adult range increases with age
  23. Plasma low-density lipoproteins (LDLs)
    Elevation indicates increased risk of CAD

    •  60-180 mg/dL
    •  Older adult (>65 yr): 92-221 mg/dL
  24. C-reactive protein (CRP)
    Elevation may indicate tissue infarction or damage.

     <1.0 mg/dL
  25. Homocysteine*
    Strong Independent risk factor for CVD

    Amino acid result breakdown of dietary protein

    Regulation of homocysteine can depend on a patient’s diet

    • When levels are elevated, blood clotting may
    • increase and the vascular endothelium may be damaged

    Platelet aggregation and turbulent blow flow
  26. Homocysteine levels

    l4.3 – 11.4 (Males older than 17 years)

    l3.3 – 10.4 (Females older than 17 years)

    Treat with folic acid supplements if levels are high (1-2 mg/day)

    Diet rich in folic acid and B vitamins (B6 and B12)

    (Fruits, tomatoes, vegetables, and grain products)
  27. Diagnostic Assessment
    Blood coagulation


    Electrolytes (Potassium, sodium, magnesium, calcium)


  28. Pre-op Care
    - Check allergies to iodine (allergic to shellfish)


    -baseline pulse assessment
  29. Post-Op Care
    -CV assessment (esp. pedal pulses)

    - fluids (Give fluids so you can flush the dye out and don’t want to cause concern with the kidneys pt might b nauseas and might need an IV and give fluids)

    -monitor catheter site
  30. Radiological Diagnostic Assessment
    Chest X-ray

    Cardiac catheterization (right or left- sided)
  31. Electrocardiogram
    PQRST wave forms to assess cardiac function

    Deviations from normal sinus rhythm can indicate heart abnormalities
  32. Echocardiogram
    Uses ultrasound waves

    Can measure heart structures and size, blood flow and ejection fraction

    Ejection fraction (EF) is the percentage of blood volume that is ejected during systole- Normal EF is >55%
  33. Exercise Stress Test
    Involves walking on treadmill

    Includes ultrasound before and immediately after walking

    ECG recording included before during and after exercise

    • Patient instructed to report any chest pain,
    • SOB etc immediately during procedure

    Wear comfortable shoes

    Light meal or NPO 2 hours prior

    No caffeine

    Instructed to get back on table as soon as exercises ceases so post exercise images can be obtained. (usually within 1 minute)
  34. Holter monitoring
    Recording of ECG rhythm for 24-48 hours

    Normal patient activity during recording

    Recorder stores information

    Information analyzed

    Patient needs to keep diary of activities

    No bath or shower during monitoring

    Skin irritation may develop from electrodes
  35. Nuclear Cardiology
    Studies involve injection of radioactive isotopes and uptake is measured by a scan

    Provides info regarding contractility, perfusion and cell injury

    Requires IV line

    Patient lying still on back with arms extended overhead for 20 minutes

    Scans are repeated several times after injection

    • Some tests may involve exercise or medication
    • to simulate activity
Card Set:
Heart Assessment
2011-08-17 00:00:44

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