1 / 40

Cardiovascular Assessment II

Cardiovascular Assessment II. Yuriy Slyvka MD, PhD. Cardiovascular Assessment. Cardiac Output Blood Pressure Systolic / Diastolic Pulse Perfusion. Blood Pressure. Systolic - Normal 95 - 140 mmHg Diastolic - Normal 60 - 90 mmHg Children vary with age Neonate 60 - 90 over 30 - 60 mmHg.

gella
Download Presentation

Cardiovascular Assessment II

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cardiovascular Assessment II Yuriy Slyvka MD, PhD

  2. Cardiovascular Assessment • Cardiac Output • Blood Pressure • Systolic / Diastolic • Pulse • Perfusion

  3. Blood Pressure • Systolic - Normal 95 - 140 mmHg • Diastolic - Normal 60 - 90 mmHg • Children vary with age • Neonate 60 - 90 over 30 - 60 mmHg

  4. Systolic • Maximum pressure exerted on arterial wall during ventricular contraction

  5. Diastolic • Pressure in vasculature during ventricular relaxation

  6. Indirect Blood Pressure Measurement via Cuff • Wrap blood pressure cuff around upper arm • Auscultate over artery in antecubital fossa • Inflate cuff rapidly • Deflate cuff slowly while listening

  7. Mechanism • Cuff inflated - occludes artery - no sound • Slowly deflate cuff - first sound = systolic • Continue to deflate cuff until sound disappears = diastolic • Tapping sounds heard with each heart beat called Korotkoff’s sounds (Ko rot kof)

  8. Technique • Usually use non-dominant arm • Inflate to approx 160 mmHg • Drop pressure approximately 3 mmHg/sec • Standard adult cuff 5 inches wide • Pediatric 3 inches wide

  9. Sources of Error Resulting in High BP Measurements • Cuff too narrow • Width of cuff approx 40% circumference of arm • Applied too tight or too loose • Excessive cuff pressure • should start 30 mmHg above systolic • Pressing stethoscope too tightly over artery will affect diastolic pressure

  10. Hypertension • BP persistently > 140-160 / 90 • Secondary means cause is known • May be a side-effect of medication • Primary Hypertension means cause is unknown

  11. Hypotension • BP < 95 / 60 • Late sign of hypovolemia, cardiac failure, shock • 90 / 60 not uncommon in young females

  12. Low blood pressure results in inadequate perfusion • Brain • Heart - (70% coronary artery perfusion occurs during diastole) (Diastolic pressure < 50 mmHg compromises perfusion of heart) • Kidneys

  13. Low blood pressure a late sign of circulatory problems • Normal compensatory mechanisms maintain blood pressure initially • When these fail - pressure falls

  14. Use blood pressure to calculate Mean Arterial Pressure • S - D + D 3 • MAP is average pressure for circulation • Indicator of adequate tissue perfusion • Normally 70 - 105; 90 average

  15. Mean arterial pressure (MAP) • MAP < 60 mmHg inadequate • Resistance = Pressure gradient / Flow • or re-arranged: MAP = C.0. x SVR

  16. Two factors determine blood pressure • Cardiac output = stroke volume x heart rate • Systemic vascular resistance (SVR)

  17. Stroke Volume (SV) determined by • Preload • Contractility • Afterload

  18. Increased Preload Increases SV • Preload = filling volume of ventricles • Increased blood volume stretches muscle fibers • Increases strength of contraction • Requires longer time for ventricular filling

  19. Increased Contractility Increases SV • Contractility = force of muscle contraction • No change in muscle fiber length • Increase force of contraction over same time period • Inotropic drugs

  20. Decreased Afterload Increases SV • Afterload = resistance ventricles contract against • Primarily systemic vascular resistance • Systemic vasodilation reduces afterload

  21. Factors afftecting Systemic Vascular Resistance • Radius of arterioles • Blood volume • Blood viscosity (Hematocrit)

  22. Factors affecting Cardiac Output primarily affect systolic blood pressure • Ex. Exercise using large muscle mass (legs) will require increase in cardiac output to supply more oxygen to working muscles • Will see an increase in systolic • Diastolic will stay the same or decrease since arteries of large muscle mass dilated

  23. Factors affecting Systemic Vascular Resistance will primarily affect diastolic pressure • Ex. Exercise using small muscle mass (arms) • Vasoconstriction of large muscle mass not being used • Vasoconstriction increases vascular resistance • Diastolic will increase

  24. Maximal Heart Rate correlates with Maximal O2 Consumption • HR max = 220 - age • 75% HR max ------ 60 % VO2 max • 80 ------- 70 • 90 ------- 82 • Aerobic exercise 75 - 80% HR max

  25. Heart Rate or Pulse - Evaluate for • Rate • Rhythm • Strength

  26. Normal Heart Rate • 60 - 100 Adults • 90 - 120 Children • 70 - 170 Newborns • < normal = bradycardia • > normal = tachycardia

  27. Tachycardia • One of the cardinal signs of hypoxemia • Increasing heart rate increases cardiac output • Increase oxygen delivery to tissues

  28. Increasing HR increases C.O. • Until HR > 150 • C.O. decreases due to inadequate filling time

  29. Rhythm • Regular or irregular • Irregular beat may indicate arrhythmias

  30. Strength • Bounding? • Arteriosclerosis • Weak and thready? • shock

  31. Pulsus Paradoxus • Strength decreases with spontaneous inhalation • Increases with exhalation • normal unless extreme • Common in COPD • Seen in 50% patients with pericarditis

  32. Pulsus Alterans • Alternating strong and weak pulses • May be sign of left ventricular failure • Not related to respiratory disease

  33. Pulse Pressure • Systolic - Diastolic • Normal 35 - 40 mmHg • < 30 mmHg pulse hard to detect • Decreasing pulse pressure early sign of inadequate circulating blood volume

  34. Can estimate systolic blood pressure if can palpate • Carotid pulse - then systolic is at least 60 mmHg • Femoral 70 mmHg • Radial 80 mmHg

  35. Pulse sites • Radial • Brachial • Carotid • Femoral • Dorsalis pedis

  36. Check radial pulse before and after administering therapy • Aerosol medication may produce side-effects • First cardinal sign of hypoxemia is tachycardia • After taking pulse, continue palpating pulse as count respiratory rate

  37. Assessment of Perfusion (microcirculation) • Peripheral skin temperature • cold extremities indicate reduced perfusion • Urine Output • one of the best indicators of C.O. and arterial pressure • < 20 ml/ hr oliguria ( o lig uria)

  38. Sensorium • Brain sensitive to lack of oxygen and/or lack of glucose • Both depend on blood supply to the brain - perfusion • Confusion may signal inadequate perfusion or hypoxemia

  39. Determine patient’s level of consciousness (LOC) • Oriented to person - know who they are • Oriented to place - know where they are • Oriented to time - know what today is, what year • Will typically see “Alert and oriented to PPT” in chart

  40. Summary • Patient assessment includes evaluating patient’s cardiovascular system • Cardiac Output • BP/Pulse • Perfusion • Many of the therapeutic interventions of respiratory care will affect the cv system

More Related