ASESSMENT OF

CARDIOVASCULAR
FUNCTION

By: Esperancita A. Ferrer RN

MD
ANATOMY OF THE
HEART
 Hollow muscular organ located in the
MEDIASTINUM
 Weight 300 g (10.6 oz)
TERMS:
 SYSTOLE: period of ventricular contraction
resulting in ejection of blood from the ventricles
into the pulmonary artery and aorta
 DIASTOLE: period of ventricular relaxation
resulting in ventricular filling
 Heart beats 60 - 80 bpm
 Ventricle ejects 70 mL of blood per beat and
has an output of approximately 5 L/min
 LAYERS OF THE HEART
ENDOCARDIUM - inner layer
MYOCARDIUM - middle layer
EPICARDIUM - exterior layer

PERICARDIUM - a thin, fibrous

sac
VISCERAL PERICARDIUM
PARIETAL PERICARDIUM
space between these 2 layers
(PERICARDIAL SPACE) 30 mL
of fluid
Coronary Arteries
PHYSIOLOGY OF THE
HEART
 CONDUCTION SYSTEM
 Generate and coordinate the transmission
of electrical impulses to the myocardial
cells atrioventricular contraction
CHARACTERISTICS:
 Automaticity: ability to initiate an
electrical impulse
 Excitability: ability to respond to an
electrical impulse
 Conductivity: ability to transmit an
electrical impulse from one cell to another
SA Node lies at junction of the electrical
Pacemaker right atrium superior stimulation
vena cava contraction of the
of the heart
Impulse:60-100/min atria
AV Node lies at the base of the -Coordinates
interatrial septum electrical
Impulse:40-60/min impulses
from atria to
Ventricle
-delay in AV
conduction
Bundle of courses anteriorly Transmits
His membranous impulses to
interventricular septum largest chamber
Impulse:30-40/min of the heart
(ventricle)

Purkinje extends throughout the Impulse reaches

Fibers endocardium of the terminal point
right & left ventricles resulting to
Impulse:30-40/min stimulation of
myocardial cells
ventricular
contraction
Physiology of Cardiac
Conduction
 Cardiac electrical activity is the result of the
movement of ions (charged particles such as
Na, K, Ca) across the cell membrane.
CARDIAC ACTION POTENTIAL
 electrical changes recorded within a single cell

DEPOLARIZATION
 electrical activation of a cell caused by the
influx of Na into the cell while K exits the cell
REPOLARIZATION
 return of the cell to resting state, caused by
reentry of K into the cell while Na exits the cell
Cardiac Hemodynamics
 CARDIAC CYCLE
 An important determinant of blood flow in
the cardiovascular system is the principle
that fluid flows from a region of higher
pressure to one of lower pressure.
 The pressures responsible for blood flow
in the normal circulation are generated
during systole and diastole.
ATRIOVENTRICULAR VALVES: AVV
Separate atrium & ventricles
Tricuspid Valve & Mitral Valve
SEMILUNAR VALVES: SLV
The valve between right ventricle & pulmonary artery-
Pulmonic Valve
The valve between left ventricle & the aorta- Aortic
Valve

SYSTOLE AVV close DIASTOLE AVV open

SLV open SLV close
S1 S2
lub dub
 Key mediators in Blood
Pressure & Cardiac Output
Contractility & Preload & Afterload

Heart Rate (HR) x Stroke Volume (SV)

Cardiac Output (CO) x Total Peripheral

Resistance (TPR)

Blood Pressure (BP)

CONTRACTILITY: force of ventricular contraction
PRELOAD: the amount of myocardial stretch just
before systole caused by pressure created by
volume of the blood within the ventricle
AFTERLOAD: the amount of resistance to the
ejection of blood from the ventricle
STROKE VOLUME: amount of blood pumped out of
the ventricle w/ each contraction (70ml)
HEART RATE: number of beats made by the heart
in 1 minute
CARDIAC OUTPUT: total amount of blood pumped
out of the blood in 1 minute (5-6L)
TOTAL PERIPHERAL RESISTANCE: resistance
to left ventricular ejection
BLOOD PRESSURE: pressure exerted on the
walls of the arteries during ventricular systole &
diastole
expressed as a ratio of the systolic pressure
over the diastolic pressure
SYSTOLE: period of ventricular contraction
resulting in ejection of blood from the ventricles
into the pulmonary artery & aorta
DIASTOLE: period of ventricular relaxation
resulting in ventricular filling
 CONTROL OF HEART RATE
 Changes in heart rate are accomplished
by reflex controls mediated by the:
1. Autonomic nervous system ANS
SNS ↑ HR PNS ↓ HR
2. Catecholamines
3. Thyroid hormone
4. Baroreceptor activity
 HYPERTENSION HYPOTENSION
↓ ↓
Baroreceptors ↑rate of Less baroreceptor
discharge stimulation
↓ ↓
impulses to medulla ↓ PNS activity
↓ ↓
initiates PNS activity Initiatiate SNS activity
↓ ↓
↓ HR ↓ BP ↑ HR ↑ BP
CONTROL OF STROKE VOLUME
3 FACTORS:
I. Preload
degree of stretch of cardiac muscle fibers at
the end of diastole - filling volume in the
ventricles is the highest and the degree of
stretch on the muscle fibers is the greatest
Frank-Starling Law of the heart – stretching of
the myocardial fibers during diastole ↑the force
of contraction during systole; resulting to ↑SV
& ↑CO
II. Afterload
The amount of resistance to ejection of
blood from the ventricle.
Systemic vascular resistance
resistance of systemic BP to left ventricular
ejection
Pulmonary vascular resistance
resistance of the pulmonary BP to right
ventricular ejection
  inverse relationship between afterload and
stroke volume
Arteriolar Vasoconstriction Arteriolar Vasodilation
↓ ↓
↑ Afterload ↓ SV ↓ Afterload ↑ SV
III. Contractility
force of ventricular contraction
Contractility is enhanced by:
1. catecholamines
2. sympathetic neuronal activity
3. medications (eg, digoxin, intravenous
dopamine or dobutamine)
Contractility is depressed by:
1. hypoxemia
2. acidosis
3. medications (eg, beta-adrenergic blocking
agents)
 ↑ Preload ↑ Contractility ↓ Afterload

↑ Stroke Volume
EJECTION FRACTION
 percentage of the end-diastolic volume that
is ejected with each stroke
 used as an index of myocardial contractility
AEF 01-23-09