CARDIOVASCULAR
SYSTEM
Heart Wall
Which of the following muscular layer
of the heart covers the entire heart?
a. Pericardium
b. Epicardium
c. Myocardium
d. Endocardium
Chambers
Which of the following propels
deoxygenated blood into the pulmonary
circulation via the pulmonary artery?
a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle
Valves
It is located between the left atrium
and left ventricle
a. Tricuspid valve
b. Mitral valve
c. Pulmonic valve
d. Aortic valve
Conduction system
It is also known as delayed conduction
system of the heart
a. Sinoatrial node
b. Atrioventricular node
c. Bundle of His
d. Purkinje fibers
Coronary circulation
It returns blood from the myocardium
back to the right atrium
a. Coronary artery
b. Pulmonary artery
c. Coronary sinus
d. Pulmonary vein
Vascular system
It is where the exchange of O2 and CO2,
solutes between the blood and tissues and
fluids occurs
a. Arteries
b. Veins
c. Capillaries
DIAGNOSTIC PROCEDURE
CARDIAC Proteins and enzymes
CK- MB ( creatine kinase)
Elevates in MI within 4
hours, peaks in 18 hours
and then declines till 3
days
Normal value is 0-7 U/L
CARDIAC Proteins and enzymes
Lactic Dehydrogenase (LDH)
Elevates in MI in 24 hours,
peaks in 48-72 hours
MI- LDH2 greater than LDH1
(flipped LDH pattern)
Normal value is 70-200 IU/L
CARDIAC Proteins and enzymes
Myoglobin
Rises within 1-3 hours
Peaks in 4-12 hours
Returns to normal in a day
CARDIAC Proteins and enzymes
Troponin I and T
Troponin I is usually utilized for MI
Elevates within 3-4 hours, peaks in
4-24 hours and persists for 7 days to
3 weeks!
Normal value for Troponin I is less
than 0.6 ng/mL
ELECTROCARDIOGRAM (ECG)
A non-invasive procedure that
evaluates the electrical activity
of the heart
Electrodes and wires are
attached to the patient
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
Holter Monitoring
Instruct the client to resume
normal activities and
maintain a diary of activities
and any symptoms that may
develop
ECHOCARDIOGRAM
Non-invasive test that
studies the structural and
functional changes of the
heart with the use of
ultrasound
No special preparation is
needed
CARDIAC catheterization
Insertion of a catheter into
the heart and surrounding
vessels
Used to diagnose CAD,
assess coronary atery patency
and determine extent of
atherosclerosis
CARDIAC catheterization
Pretest:
1. Ensure Consent
2. Assess for allergy to seafood and
iodine
3. Baseline VS
4. Document the peripheral pulses
CARDIAC catheterization
Intra-test:
Inform the patient that a
feeling of warmth and
metallic taste may occur
when dye is administered
CARDIAC catheterization
Post-test:
1. Monitor VS and cardiac rhythm
2. Monitor peripheral pulses, color
and sensation of the distal extremity
3. Maintain sandbag to the insertion
site
4. Monitor for bleeding
5. Maintain strict bed rest for 6-12
hours, increase fluid intake
Central venous pressure
Reveals right artial pressure,
reflecting alterations in the right
ventricular pressure
Provides information concerning
blood volume
Normal CVP is 0 to 8 mmHg or
4-10 cm H2O
Central venous pressure
Nursing responsibilities:
Position the client supine with bed
elevated at 45 degrees
Position the zero point of the CVP
line at the level of the right atrium.
Instruct the client to be relaxed and
avoid coughing and straining.
Cardiac Disorders
Myocardial infarction
The death of myocardial
cells from inadequate
oxygenation, often caused by
a sudden complete blockage
of a coronary artery
Assessment findings:
1. Chest pain
severe, persistent, crushing
substernal discomfort
radiates to the neck, arm, jaw and
back
occurs without cause, primarily early
morning
unrelieved by rest and nitroglycerine
last 30 minutes or more
Assessment findings:
2. Dyspnea
3. Diaphoresis
4. Cold clammy skin
5. Nausea and vomiting
6. Restlessness
7. Hypotension
Laboratory findings:
1. Elevated myocardial enzymes
CK-MB, LDH and Troponin
2. ECG
ST segment elevation
T wave inversion
Presence of Q wave
Nursing management:
1. Administer O2 as ordered
2. Administer medications:
Morphine
Thrombolytics
Aspirin
Anticoagulant
Stool softeners
3. Provide bed rest with semi-
fowler’s position
4. Minimize anxiety
5. Monitor ECG
6. Instruct pt to avoid
constipation, suppositories
and anal intercourse
7. Assist in treatment modalities
PTCA and CABG
8. Minimize metabolic demands
Provide soft diet
Provide a low-sodium, low
cholesterol and low fat diet
Heart Failure
Inability of the heart to pump
sufficiently
The heart is unable to maintain
adequate circulation to meet the
metabolic needs of the body
Classified according to the major
ventricular dysfunction- Left or
Right
Etiology of CHF
1. CAD
2. Hypertension
3. MI
4. Cardiomyopathy
5. Lung diseases
6. Pericarditis
7. Cardiac tamponade
LEFT SIDED CHF
ASSESSMENT FINDINGS
1. Dyspnea on exertion
2. Orthopnea
3. Pulmonary crackles/rales
4. cough with Pinkish, frothy
sputum
5. Tachycardia
LEFT SIDED CHF
ASSESSMENT FINDINGS
6. Cool extremities
7. Cyanosis
8. decreased peripheral
pulses
9. Fatigue
10. Oliguria
RIGHT SIDED CHF
ASSESSMENT FINDINGS
1. Peripheral dependent, pitting
edema
2. Weight gain
3. Distended neck vein
4. hepatomegaly
5. Ascites
6. Anorexia, nausea
LABORATORY FINDINGS
1. CXR may reveal cardiomegaly
2. ECG may identify Cardiac
hypertrophy
3. Echocardiogram may show
hypokinetic heart
4. ABG and Pulse oximetry may
show decreased O2
saturation
5. PCWP is increased in LEFT
sided CHF and CVP is
increased in RIGHT sided
CHF
NURSING INTERVENTIONS
1. Assess patient's cardio-
pulmonary status
2. Assess VS, CVP and PCWP.
Weigh patient daily to monitor
fluid retention
3. Provide a LOW sodium diet.
Limit fluid intake as necessary
4. Administer medication
- Digitalis
- Diuretics
5. Provide adequate rest
periods to prevent fatigue
6. Position on semi-fowler’s to
fowler’s for adequate chest
expansion
