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Heart's 3 layers and functions
1- Inner layer: endocardium- Endothelial tissue & lines the heart

2- Middle layer: myocardium- Muscle fibers & responsible for the
pumping action

3: Outer layer: epicardium
Heart  chambers
• Heart chambers - The pumping action of the heart is accomplished by the rhythmic relaxation and contraction of the muscular walls of its four chambers.
the heart is at rest/ ventricles are filling

• All chambers are relaxed simultaneously during this stage
Heart's 1 way valves
• Atrioventricular Valves – Tricuspid, which separates the right atrium from the left ventricle.

• Mitral/bicuspid valves separates the left atrium from the left ventricle.  open during diastole. This allows the blood to flow from the atria into the ventricle.
Heart valves during systole
• During Systole – The ventricles contract causing the blood to
move upward, however the Papillary Muscles and Chordae
Tendineae maintains the valve closure, preventing the back
flow of blood.

• The force of blood will be ejected through into the pulmonary

artery and aorta
Coronary arteries
generate from the aorta.

perfused during diastole with normal HR of 60-80 bpm
if HR increases, effect on diastole

• The patient is at risk for an MI
SA node
the primary pace maker of
the heart with a firing rate of 60 – 100 impulses a minute.
The rate changes as metabolic demand of the body changes.
AV node
• The Atrioventricular node coordinates the incoming electrical
impulses from the atria.
The inherent rate is 40 – 60bpm.
Ventricular pacemaker site-
has lowest inherent rate 30-40 bpm.

node malfunction chain reaction
• If the SA node malfunctions, the AV node takes over

-if the SA or AV nodes fail then the Ventricle will fire at it’s bradycardic rate of 30 -40- bpm.
• Systole- contraction of both atrial and ventricles but not simultaneous.
atrial contraction
• The atrial contracts first just after diastole allowing the
ventricles to fill, then the ventricles contract in order to pump
the blood from their chambers.
R side of Heart
• The right side of the heart consist of the right atrium and
right ventricle These chambers distribute venous blood
(deoxygenated blood) to the lung via the pulmonary artery.
L side of heart
• The left side of the heart consist of the left atrium and the
left ventricle. These chambers receive oxygenated blood from
the lungs via the pulmonary veins .The oxygenated blood is
distributed via the aorta.
gerontologic heart changes lead to
↓ myocardial contractility,

↑ left ventricular ejection time

delayed conduction
gerontologic common disease
CAD secondary to atherosclerosis
gerontologic chest wall changes, impact on assessment
kyphosis- altered chest landmarks for palp, perc, ausc

distant heart sounds
gerontologic myocardial hypertrophy and impact on assessment
inc collagen and scarring, dec elastin

↓ cardiac reserve, HF
gerontologic heart changes: downward displacement
diff in locating apical pulse
geron heart changes: dec CO. HR, SV response to exercise/stress
slow, dec response to exercise and stress, slowed recovery from activity
geron heart change: cellular aging and fibrosis of conduction system
↓ amplitude of QRS complex, slight lengthening of PR, QRS, and QT intervals.

irreg rhythms, dec max HR, dec HR variability
geron heart changes: valve rigidity from calcification, sclerosis/fibrosis, impeding closure of valves
syst murmur(aortic, mitral) possible w/o being indication of CV pathology
geron vessel changes: artery stiffening by loss of elastin in walls, thickening of intima of arteries, progressive fibrosis of media
inc systolic BP, inc/dec in diast BP
widened pulse pressure
pedal pulses diminished
inc in itermittant claudication
geron vessel changes: venous tortuosity inc
inflamed, painful, cordlike varicosities
dependent edema
size of heart
• SIZE – Approximately 300g (10.6 oz.)

• The size of the heart is influenced by
age, gender, body weight, extent of physical exercise and condition, and heart disease.
women heart size difference
-women's heart is smaller with smaller coronary arteries, become occluded from atherosclerosis more easily

- narrow arteris make cardiac cath and angioplasty more diff with inc incidence of post procedure complications
CV assessment- hist of present disease
- why pt came in
- explore all symptoms and how long persisted
- ask pt what alleviates/intensifies any symptoms
CV assessment- past health hist
-past history of chest pain shortness of breath
tobacco use
rheumatic fever
streptococcal sore throat
congenital heart disease
intermittent claudication varicosities
CV assessment- meds
-current and past use: OTC, herbal, prescription

Is the patient independent in taking medications?

• Are the medications taken as prescribed?

• Does the patient know what side effects to report to the prescriber?

• Does the patient understand why the medication regimen is important?

• Are doses ever forgotten or skipped, or does the patient ever
decide to stop taking a medication?
CV assessment- surg or other treatments

  • Information about specific treatments, past surgeries, or hospital admissions related to cardiovascular problems

-whether ECG/chest xray has been taken for baseline data
CV assessment- health perception
-CV risk factors- elevated serum levels, HTN, tobacco use, sedentary lifestyle, obesity, stressful lifestyle, DM

-confirmed CV illness of relatives and noncardiac conditions(asthma, renal disease, liver disease, obesity) as they can impact CV system
CV assessment- nutritional metabolic pattern
-current weight and weight hist
-daily diet
-det salt, sat fat, triglycerides in diet
-attitudes to weight management
CV Assessment- elimination pattern
-probs with incontinence/constipation, or med use for constipation

-Valsalva maneuver should be avoided in CV pt

Nocturia (awakening to urinate at night) common in patients
with HF.

• Fluid collected in the dependent tissues (extremities) during
the day redistributes into the circulatory system once the
patient is recumbent at night. The increased circulatory
volume is excreted by the kidneys, which causes nocturia.
CV assess- activity/exercise pattern
-types of exercise performed, and occurance of unwanted SE
CV assess- sleep pattern

  • Identification of paroxysmal nocturnal dyspnea, sleep apnea, and the number of pillows needed for comfort

-any of these recent changes indicate worsening HF
CV assess-cogn/perceptual pattern
CV probs like dysrhythmia, HTN, and stroke may cause probs with syncope, language, and memory

pt needs to report any pain to HCP
CV assess-self perception
-body image affected and quality of life, inquire to pt about effects of illness on pt
CV Assess- role relationship

  • Information about the patient’s gender, race, and age

can help alert you to possible areas of stress
CV assess- sex pattern
- any probs
- meds that might cause probs, fix them
CV assess- coping/ stress
-explore causes of stress and usual coping methods

CV assess- value, belief system
-find out pt beliefs and values to help you intervene during period of crisis
normal CV inspection assessment findings
-skin warm, normal color
- cap refill
normal CV palp assessment findings
-PMI palpable in 4th ICS at left MCL
- no thrills/heaves
-slight palp pulsations of abd aorta in epigastric area
-carotid and extremity pulses 2+ and = bilaterally
- no pedal edema
normal CV perc assessment findings
-cardiac dullness percussed along left MCL bw 3 and 5 ICSs
normal CV ausc assessment findings
-S1 and S2 heard
-apical-radial pulse rate equal, 72, and reg
- no murmurs or extra heart sounds
CV inspection
skin, extremities, veins.
CV palp
• Palpation: upper and lower extremities for temperature,
moisture, pulses and edema.
CV ausc
• Auscultation: carotid arteries, abdominal aorta, and femoral
arteries etc.
Men CV assessment
-onset earlier than women
-less ill on presentation
-more typical angina symptoms
-severe, substernal, crushing pain w/ radiation
-standard screening for risk of sudden cardiac death is known to be more predictive
-more invasive procedures: angiography, angioplasty, CABG surg
-larger diameter arteries: vessel diameter inversely r/t risk of restenosis after interventions
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