Heart Assessment

Base

Apex

Atria: right and left

Ventricles: right and left

pumps blood to pulmonary circulation

pumps blood to systemic circulation

the tricuspid and mitral

the pulmonic and aortic

CO = Stroke Volume X Heart Rate

Amount of blood that comes out of the heart per minute

• Stroke Volume = amount of blood ejected from
• the left ventricle with each heartbeat

= Beats/minute

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)

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

reflects the amount of resistance the ventricles have to contract against.

An increase in afterload results in a decrease in stroke volume

problems (chest pain, dyspnea, fatigue, palpitations, weight gain, syncope (fainting) lack of o2 to the brain, extremity pain)

you are concerned with living enviornment, Age, gender women especially after menopause

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.

Elevations indicate possible brain, myocardial, and skeletal muscle necrosis or injury.

•  Females: 30-135 units/L
•  Males: 55-170 units/L

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.

Elevation indicates increased risk of coronary artery disease (CAD).

400-1000 mg/dL

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

Elevation indicates increased risk of CAD.

•  Females: 35-135 mg/dL
•  Males: 40-160 mg/dL
•  Older adult (>65 yr): 55-260 mg/dL

Elevations protect against CAD.

• Females: mean, 40 mg/dL
•  Males: mean, 40 mg/dL
•  Older adult range increases with age

Elevation indicates increased risk of CAD

•  60-180 mg/dL
•  Older adult (>65 yr): 92-221 mg/dL

Elevation may indicate tissue infarction or damage.

 <1.0 mg/dL

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

Homocysteine

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)

Blood coagulation

ABGs

Electrolytes (Potassium, sodium, magnesium, calcium)

CBC

Microalbuminuria

- Check allergies to iodine (allergic to shellfish)

-pre-med

-baseline pulse assessment

-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

Chest X-ray

Cardiac catheterization (right or left- sided)

PQRST wave forms to assess cardiac function

Deviations from normal sinus rhythm can indicate heart abnormalities

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%

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)

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

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