cardiac

MELISSA DEAN

Objectives
Basic Anatomy
Functions
Heart
Chambers
Valves
Blood Flow

Conduction
Circulatory
Arteries
Veins
Flow through the body

Cardiac Assessment
Auscultation
S1, S2
Adventitious Heart Sounds

Pulses
Cap refill

Disease Processes

Circulatory Functions
Delivery system

Oxygen
Nutrients
Hormones
Blood Cells
RBCs
WBCs
Platelets

Removal system
Waste products

Heart
Basic anatomy

Heart
Exterior anatomy

Blood supply to the heart

Coronary arteries perfuse

during diastole
LCA Lead Coronary Artery
Circumflex artery
LAD Left anterior descending

RCA
Coronary veins

Heart
Internal anatomy

Blood Flow Through the Heart

Heart
Chambers

Right atrium
Right ventricle
Left atrium
Left ventricle

Valves

Tricuspid
Mitral
Pulmonic
Aortic
Heart Chambers

Cardiac conduction
Specialized cells
Send messages that cause
contraction

SA node - sinoatrial
AV node - atrioventricular
Bundle of His
Bundle branches
Purkinje fibers

Cardiac conduction
SA node
Pacemakers
SA and AV nodes

Regulated by the autonomic

nervous system
Neural impulses not needed to
maintain
Heart will beat without nervous
connection

Sympathetic/parasympathet
ic
Regulates heart rate

Impulse origin
Regulates
Both atria left and right
AV node

AV node
Regulates
Both ventricles left and right
Septum

Delays conduction
Boosts ventricular filling

Cardiac conduction
Bundle of His
Muscle fibers
Also called AV bundle

Bundle branches
Left
Right

Purkinje fibers

Cardiac conduction

Heart Conduction

Vascular
There and back again

Vascular
Arteries

Veins

Moved blood away from heart

Returns blood to the heart

Distributes oxygen rich blood

Deoxygenated blood

Pulmonary artery

Pulmonary veins

Only artery that has deoxygenated

blood

Only vein with oxygenated blood

Muscular walls

Non elastic walls

High pressure

Low pressure

No valves

Valves

Anatomy

Cardiac
Assessment

Heart Sounds Auscultation

S1
S2
Extra heart sounds
S3
S4

Murmurs

Heart Sounds

Heart Sounds S1 and S2

S1 Closure of valves
Mitral
Tricuspid

S2 Closure of valves
Aortic
Pulmonic

Heart Sounds - Gallops

S3 Ventricular gallop
Normal in children
Over 35, early heart failure

S4 Arterial gallop
HTN
Anemia
Stenosis
Aortic
Pulmonary

Pulmonary emboli

Heart Sounds

Heart Sounds - Murmurs

Systolic
Aortic stenosis
Mitral regurgitation
Between S1 and S2

Diastolic
Aortic regurgitation
Pulmonic regurgitation
Between S2 and S1

Grades
I- VI
I Very faint
II Faint but recognizable
III Loud but moderate
IV Loud with thrill
V Loud, thrill, stethoscope
partially touching
VI Audible without
stethoscope

Heart Sounds

Stethoscope
Placement

Pulses and related items

Locations
Amplitude
Weak, faint, strong, bounding

Rate
Absence
Cap refill
Brisk, sluggish

Color
Pink and healthy, cyanotic,
dusky

What about the

lungs?
EVERYTHING ELSE?

Cardiac tests
Blood work
X ray

Stress test

CT

SPECT

MRI

Elecrophysiology studies

Electrocardiogram

Angiography

Echocardiogram

Dopplers
Vitals signs

Common cardiac tests

Blood work
Cardiac enzymes
Troponin
CK
CK-MB

ProBNP
Cholesterol
CBC
CMP
RFP
Clotting studies
CRP

Common cardiac tests

X ray
Structure/size
Pulmonary edema
Ventricular hypertrophy
Pericardial disease

Vitals signs
Simplest test
Can reveal a lot

Common cardiac tests

Electrocardiogram
Basic 5 lead basic info
12 lead
Better view of all parts of the
heart
Can tell us
Dysrhythmias
Ischemia
Cardiac enlargement

Common cardiac tests

Echocardiogram
Uses Doppler
Views the heart
TEE

Common cardiac tests

Stress test
Echo
EKG
Induced by
Medications
Exercise

Dopplers
Views structure
Veins
Arteries

Common cardiac tests

Angiography
Evaluation
Interventions
Stent placement
Clot removal
Minimally invasive surgeries

Cardiovascular
DISEASE

Disease
MI myocardial infarction
CAD coronary heart
disease
CHF congestive heart
failure

Atherosclerosis
PVD peripheral artery
disease
DVT Deep vein thrombosis

Dysrhythmias

Aneurysm

Congenital heart disease

Raynauds disease

Pericardial disease

Buergers disease

Hypertrophy

MI myocardial infarction
Blood flow
Damage
Symptoms
Chest pain
Radiated pain
S.O.B.
Nausea
Diaphoresis
Syncope

30% have atypical symptoms

Especially women

MI interventions
Treatment varies
Oxygen
Pain relief
Medications
Tests
12 lead
Lab work
Chest X-ray

Thrombolytics
Surgical
Goal reperfusion

MI
STEMI or NSTEMI?
STEMI

 A patient with negative troponins

and stress test results reports
recurring chest pain that is similar
to the patients pain on admission.
The nurses next action is to:
A. Activate the cardiac cath team
B. administer analgesics
C. Obtain a 12 lead EKG
D. Promote relaxation and monitor the
response.

C
Obtain a 12 lead EKG

Heart Failure
Left sided CHF
EF - <40%
Ventricular remodeling
Lungs
S.O.B.

Systolic - Heart doesnt pump the way

it should

Right sided diastolic

EF preserved
Ventricular remodeling
Veins
swelling

Diastolic - Heart doesnt fill up the way

it should

Heart Failure

Heart failure - interventions

Treatment
severity based
Cause based
CAD, HTN, DM

Reduce symptoms
Tests
Lifestyle changes
Quit smoking
Monitor weight

Medications
Surgery

 A patient underwent percutaneous,

transluminal coronary angioplasty 4
weeks ago and has a subsequent
EF of 30%. The patient returns for
a f/u. Examine reveals clear lungs
and slight pedal edema. Patient is
on digoxin, Lasix, enalapril, and
aspirin. Patient reports 5 pound
weight gain in 2 days. The nurses
initial reaction is to:
A. Document and reassess on next visit
B. Inquire about med compliance
C. Notify the physician
D. Review patients recent nuclear scan

B
Inquire about medication
compliance

PVD peripheral vascular disease

Vessels narrow, occlude, spasm
Causes arteriosclerosis, smoking,
genetics
Symptoms
Reduced hair growth
Skin color
Wounds
Paresthesias
Pain

Types
Functional
Raynauds disease

Organic structure change

PVD peripheral vascular disease

Tests
Dopplers,
Angiography
MRI
ABI

Treatment
Lifestyle changes
Medications
Manage DM if applicable
Surgery

 In an assessment for intermittent

claudication, the nurse assesses for
pain and cramping during exertion,
then askes the patient:
A. Does shortness of breath accompany
the leg pain?
B. Does the same type of pain occur
without activity?
C. Is the leg pain relieved by rest?
D. Is the leg pain relieved with elevation?

C
Is the leg pain relieved by rest?

Next week - Molly

The Lungs
October 27th