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
 Systolic

 Maximum pressure exerted on

arterial wall during ventricular
contraction
 Diastolic

 Pressure in vasculature during

ventricular relaxation
 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
 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)
 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
 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
 Hypertension
 BP persistently > 140-160 / 90
 Secondary means cause is known
• May be a side-effect of medication

 Primary Hypertension means cause

is unknown
 Hypotension
 BP < 95 / 60
 Late sign of hypovolemia, cardiac
failure, shock
 90 / 60 not uncommon in young
females
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
Low blood pressure a late sign
of circulatory problems

 Normal compensatory mechanisms

maintain blood pressure initially
 When these fail - pressure falls
 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
 Mean arterial pressure (MAP)

 MAP < 60 mmHg inadequate

 Resistance = Pressure gradient /
Flow
 or re-arranged: MAP = C.0. x SVR
Two factors determine blood
pressure

 Cardiac output = stroke volume x

heart rate
 Systemic vascular resistance (SVR)
Stroke Volume (SV) determined
by

 Preload
 Contractility
 Afterload
 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
 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
Decreased Afterload Increases
SV
 Afterload = resistance ventricles
contract against
 Primarily systemic vascular
resistance
 Systemic vasodilation reduces
afterload
Factors afftecting Systemic
Vascular Resistance

 Radius of arterioles
 Blood volume
 Blood viscosity (Hematocrit)
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
 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
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

Heart Rate or Pulse - Evaluate
for
 Rate
 Rhythm
 Strength
Normal Heart Rate

 60 - 100 Adults
 90 - 120 Children
 70 - 170 Newborns
 < normal = bradycardia
 > normal = tachycardia
 Tachycardia

 One of the cardinal signs of hypoxemia

 Increasing heart rate increases cardiac
output
 Increase oxygen delivery to tissues
 Increasing HR increases C.O.

 Until HR > 150

 C.O. decreases due to inadequate
filling time
 Rhythm
 Regular or irregular
 Irregular beat may
indicate arrhythmias
 Strength
 Bounding?
• Arteriosclerosis
 Weak and thready?
• shock
 Pulsus Paradoxus
 Strength decreases with
spontaneous inhalation
 Increases with exhalation
 normal unless extreme
 Common in COPD
 Seen in 50% patients with
pericarditis
 Pulsus Alterans

 Alternating strong and weak pulses

 May be sign of left ventricular
failure
 Not related to respiratory disease
 Pulse Pressure
 Systolic - Diastolic
 Normal 35 - 40 mmHg
 < 30 mmHg pulse hard to detect
 Decreasing pulse pressure early
sign of inadequate circulating
blood volume
 Can estimate systolic blood
pressure if can palpate

 Carotid pulse - then systolic is at

least 60 mmHg
 Femoral 70 mmHg
 Radial 80 mmHg
Pulse sites
 Radial
 Brachial
 Carotid
 Femoral
 Dorsalis pedis
 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
 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)
 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
 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
 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