8. Cardiac Output
• Volume of blood ejected per minute
• Averages between 4-8L/min
• CO = Stroke volume X heart rate
=70 ml X 60 beats/min
=4,200 ml/min
9. Stroke Volume Is Determined By Three
Factors
• Preload
• Afterload
• Contractility
10. Preload
• Degree of stretch of myocardial fibers
• Determined by the volume of blood in left ventricle
(LV) at end of diastole
• Increased volume –> increased preload-> increased
cardiac output (CO)
• Decreased volume –> decreased preload –>
decreased cardiac output (CO)
• Compliance of myocardial cells also affects preload
11. Afterload
• Resistance or pressure the
ventricles must overcome to
pump blood out
• Left ventricle affected by
systemic vascular resistance
(SVR)
• Right ventricle affected by
pulmonary vascular
resistance (PVR)
12. Autonomic Nervous System (ANS)
Regulation of Cardiovascular System
• Heart rate – chronotropic effect
• Contractility – inotropic effect
• Conduction velocity at AV node –
dromotropic effect
• Afterload - vascular resistance – arterial
vasoconstriction and dilation
• Preload – venous constriction and
dilation
13. Cardiovascular Assessment
• The practice setting
and severity of
patient’s symptoms
determine focus of
questions and extent
of health history
14. Steps
• History collection
• Risk factors analysis
• Biographical and
demographical data
• Current health
history
• Past health history
• Family history
• Psychosocial history
15. Common Symptoms Of Cardiovascular
Disease
•
•
•
•
•
•
•
•
•
Chest discomfort or pain
Palpitations
Syncope
Fatigue
Dyspnea
Cough, hemoptyosis
Weight gain
Edema
Nocturia
16. Dyspnea
• Often associated with
myocardial ischemia
• Primary symptom of
pulmonary congestion from
LV failure
• Other causes
–
–
–
–
Fever
Anemia
Pulmonary disorders
Obesity
17. • Different forms of dyspnea
– Exertional dyspnea (DOE)
– Orthopnea
– Paroxysmal nocturnal dyspnea (PND)
18. Weight Gain, Dependent Edema and
Nocturia
• As heart fails, fluid accumulates
• Increase of 3 lbs or more in 24 hr or 5 lbs in one
week
• Inquire about weight gain, fitting of shoes, or
tightening of clothes around waist
• Nocturia - kidneys inadequately perfused by weak
heart and receive increased blood flow during night –
> output increases
19. Past Medical History
• Inquire about previous illnesses
– Rheumatic fever, autoimmune diseases
– Diabetes, kidney disease, HTN, dyslipidemia
– Lung disorders
– Clotting disorders
20. • Explore previous hospitalizations and
surgeries
• Evaluate use of medications, OTC drugs, herbs,
recreational drugs
– Are meds taken as prescribed
– Financial problems
– Knowledge about meds
• Any allergies
21. Family Health History
• Inquire about diabetes, kidney disease, stroke,
heart disease, hypertension (HTN)
• Inquire about health of parents and siblings
23. General Appearance
• Look at the client and consider
– Does the client lie quietly or is he restless?
– Can the client lie flat or must be upright?
– Do facial expressions reflect pain or distress?
– Are there signs of cyanosis or pallor?
• Note level of consciousness (LOC)
24. Inspection Of Skin and Nails
• Assess skin color
– Pallor
– Cyanosis
• Peripheral cyanosis-nose, ears, periphery
• Central cyanosis-mucous membranes, lips
• Assess skin temperature and moistness
• Assess for ecchymosis
• Assess for wounds, scars, implanted devices
25. • Assess eyes
– Arcus senilis-gray
ring around iris
– Xanthalasmayellow raised
plaques around
eyelids
37. Assess Neck Vessels
• Determine jugular venous pressure
– Gives an estimate of right heart function and CVP
– Measurements >3 cm are elevated – jugular venous
distention (JVD)
• Assess for hepatojugular reflux (HJR)
– Rise of more than 1 cm in internal jugular vein indicates
HJR
• Assess carotid arteries
– Assess amplitude of pulse
– Auscultate for bruits
38. Inspection and Palpation of
Precordium
• Purpose is to determine presence of normal
and abnormal pulsations or thrills
• Normally, palpate point of maximal impulse
(PMI) at 5th, left intercostal space,
midclavicular
• A thrill indicates diseased valve or obstructed
vessel
41. Cardiac Auscultation
• S1
– Caused by closure of mitral and tricuspid valves
– Signifies beginning of systole
– Best heard over apical area (left, midclavicular, 5th ICS)
• S2
– Caused by closure of aortic and pulmonic valves
– Signifies beginning of diastole
– Best heard over base area (“A” and “P” areas, 2nd ICS)
43. Gallop Sounds
• S3 – Ventricular gallop
– Heard in early diastole right after S2
– Normal in children and young adults
– Characteristic of LV failure
• S4 – Atrial gallop
– Heard in late diastole right before S1
– Heard during atrial contraction as atria force blood into
resistant ventricles
– Characteristic of HTN, heart failure, pulmonary disease
44. Pericardial Friction Rub
• Produced by
inflammation of
pericardial sac
• Heard during systole
and diastole
• Best heard with
diaphragm with client
sitting up and leaning
forward
