Cardiovascular assessment involves evaluating factors that influence cardiovascular health such as high cholesterol, smoking, diabetes, and hypertension. It should include examining the patient's past medical history, current lifestyle, family history, and performing a physical exam. Laboratory tests such as cardiac enzymes, lipid profile, and imaging studies like ECG, echocardiogram, and cardiac catheterization are used to diagnose cardiovascular conditions. Risk scores can help predict the risk of future cardiovascular events based on multiple risk factors. A thorough cardiovascular assessment is important for identifying risks and managing cardiovascular disease.
2. Cardiovascular assessment
• Cardiovascular disease is the leading killer for both men and women
among all racial and ethnic groups in the world wide. According to
the Centers for Disease Control (CDC) studies among coronary heart
disease (CAD) patients, 90% of patients have had prior exposure to at
least one heart disease risk factor that contributed to their disease.
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3. • A thorough cardiovascular assessment will help to identify significant
factors that can influence cardiovascular health such as high blood
cholesterol, cigarette use, diabetes, or hypertension. Therefore, a
cardiovascular exam should be a part of every abbreviated and
complete assessment.
• Cardiovascular assessment An evaluation of the condition, function,
and abnormalities of the heart and circulatory system.
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4. Past Health History
• It is important to ask questions about the patient’s past health history.
• The past health history should elicit information about the following
issues: (hypertension, elevated blood cholesterol or triglycerides, heart
murmurs, congenital heart disease, rheumatic fever or unexplained joint
pains as a child or youth, recurrent tonsillitis and anemia.
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5. Current Lifestyle and Psychosocial Status
• Nutrition
• Smoking
• Alcohol
• Exercise
• Drugs
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6. Family History
• Family history is an important factor used in identifying your patient’s
risk for certain cardiovascular diseases.
• Ask to patient about any cardiovascular family history such as
hypertension, obesity, diabetes, coronary artery disease, or sudden
death.
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7. SLEEP AND REST
• Clues to worsening cardiac disease, especially HF, can be revealed by sleep-
related events. Determining where the patient sleeps or rests is important.
• Recent changes, such as sleeping upright in a chair instead of in bed,
increasing the number of pillows used, awakening short of breath at nigh,
or awakening with angina (nocturnal angina), are all indicative of
worsening HF.
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8. When assessing the cardiovascular system, other systems, such as the
circulatory and respiratory systems, also need to be evaluated to
provide a comprehensive and holistic picture.
Use the fundamental technique of physical examination:
1. INSPECTION
2. PALPATION
3. AUSCULTATION
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9. THE GENERAL PHYSICAL EXAMINATION
• General Appearance
Does the patient choose to avoid certain positions to reduce or eliminate pain?
Emaciation suggests chronic heart failure or another systemic disorder (e.g., malignancy,
infection). The vital signs, including temperature, pulse rate, blood pressure (in both arms),
respiratory rate, and peripheral oxygen saturation, dictate the pace and scope of the evaluation
and provide initial clues as to the presence of a cardiovascular disorder.
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10. Common Manifestations of cardiovascular disease
Chest pain
Shortness of breath or dyspnea
Edema and weight gain
Palpitations
Fatigue
Dizziness and syncope or loss of consciousnes
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16. Risk factors of cardiovascular disorders
• Non-modifiable risk factors:
1.Positive family history for premature coronary artery disease
2. Increasing age
3. Gender (men and postmenopausal women)
4. Race (higher incidence in African Americans than in Caucasians)
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18. LABORATORY TESTS
To assist in diagnosing an acute MI.
To identify abnormalities in the blood that affect the prognosis of a patient with a
cardiac condition.
To assess the degree of inflammation.
To screen for risk factors associated with atherosclerotic coronary artery disease.
To determine baseline values before performing therapeutic interventions.
To monitor serum levels of medications.
To assess the effects of medications
To screen generally for abnormalities
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19. Types of cardiac enzymes or cardiac biomarkers
• Troponin– contractile protein, two types:
• TROPONIN T: found in the cardiac and skeletal muscle, elevated
during kidney and skeletal muscle damage, early rise after 3-4 hours,
peak is 24 hours.
• TROPONIN I: found only in cardiac muscle, more specific but rises
later,4-6 hours, peak is at 18 hours.
Creatine Phosphokinase (CK-MB) is highly specific test for MI, elevation
of 4% and higher indicate MI.
• The time to rise is 4-6 hours, time to peak is 24 hours.
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20. Lactic dehydrogenase(LDH)
• There is LDH1 and LDH2, normally LDH2 is greater than LDH1, if LDH1
is greater than LDH2 than the person is positive for MI.
• However increase in level occurs 48 to 72 hrs after the onset of
symptoms.
Myoglobin
• Myoglobin is a muscle protein with high sensitivity, but low specificity.
• Time to rise is 1-4 hours Peak time 6-12 hours.
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21. BNP ( B- type natriuretic peptide) – BNP is synthesized in the
ventricular myocardium and released as a response to increased wall
stress.
An increased BNP level indicate patients at the risk of developing
sudden cardiac death.
C-reactive protein (CRP)
CRP is an inflammatory marker that may be an important risk factor
for atherosclerosis and ischemic heart disease.
CRP is an inflammatory marker produced by the liver in response to
systemic cytokinases.
Elevated CRP is associated with AMI, stroke, and the progression of
peripheral vascular disease.
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22. Lipid profile [The risk of CAD increases
as the ratio of LDL to HDL or the ratio of
total cholesterol (LDL +HDL) to HDL
increases].
Cholesterol levels : Cholesterol is a lipid
required for hormone synthesis and cell
membrane formation
Parameters Normal Value Higher
CK-MB 5–25 IU/L >25 IU/L
TROPONIN I 0 - 0.10 >0.1 ng/I
CRP UP TO 3 > 3 mg/Iit
HDL 40-60 ˂ 40 mg/dI
LDL 130 160-189 mg/dI
Cholesterol <200 > 200 Mg/dI
LDH 140–280 IU/L >280 IU/L
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23. Serum electrolyte levels
Sodium, potassium, and calcium are ions that are
vital to cellular depolarization and repolarization.
In addition, the serum sodium concentration
reflects relative fluid balance.
Generally, hyponatremia (low sodium level)
indicates fluid excess, and hypernatremia (high
sodium level) indicates fluid deficit
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24. BLOOD UREA NITROGEN LEVEL (BUN)
• Blood urea nitrogen (BUN) is an end product of protein metabolism and is excreted
by the kidneys.
• In the patient with cardiac disease, an elevated BUN level may reflect reduced
renal perfusion (from decreased cardiac output) or intravascular fluid volume
deficit (from diuretic therapy or dehydration)
Parameters Normal Value Higher
BUN 6-20 mg/dL > 20 mg/dI
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25. SERUM GLUCOSE LEVEL
• The serum glucose level is important to monitor, because many
patients with cardiac disease also have diabetes mellitus.
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27. Electrocardiogram (ECG)
• assess the heart’s electrical activity.
The standard 12-lead ECG is the most
commonly used tool to diagnose
dysrhythmias, conduction abnormalities,
enlarged heart chambers, myocardial
ischemia or infarction, high or low
calcium and potassium levels, and effects
of some medications.
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32. • chest pain
• Functional capacity of the heart after
an MI or heart surgery
• Effectiveness of antianginal or
antiarrhythmic medications
• Dysrhythmias that occur during
physical exercise
• specific goals for a physical fitness
program. For cardiac rehabilitation
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33. Contraindications to cardiac stress testing
• severe aortic stenosis
• acute myocarditis or pericarditis
• severe hypertension.
• CAD
• HF
• unstable angina
• Because complications associated with stress
testing can be life-threatening (MI, cardiac arrest,
HF, and severe dysrhythmias)
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34. Fletcher GF, Ades PA, Kligfield P, et al: Exercise standards for testing and training: a scientific
statement from the American Heart Association. Circulation 128:873, 2013.
34
36. Morise AP, Lauer MS, Froelicher VF: Development and validation of a simple exercise test score for
use in women with symptoms of suspected coronary artery disease. Am Heart J 144:818, 2002.
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38. Echocardiography
• The first test of choice for assessing cardiac structure and function in
most clinical situations. It is a particularly useful tool for diagnosing
pericardial effusions, determining the etiology of heart murmurs,
evaluating the function of prosthetic heart valves, determining
chamber size, and evaluating ventricular wall motion.
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40. • The chest X-ray is a noninvasive tool used to visualize internal
structures, such as the heart, lungs, soft tissues, and bones.
• A chest x-ray usually is obtained to determine the size, contour, and
position of the heart.
• It does not help diagnose acute MI but can help diagnose some
complications (e.g., HF).
• Correct placement of cardiac catheters, such as pacemakers and
pulmonary artery catheters, is also confirmed by chest x-ray.
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41. Nuclear Cardiology
• Nuclear cardiology studies use noninvasive
techniques to assess myocardial blood flow,
evaluate the pumping function of the heart
as well as visualize the size and location of
a heart attack. Among the techniques of
nuclear cardiology, myocardial perfusion
imaging is the most widely used.
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42. Cardiovascular Magnetic Resonance Imaging((MRI)
• provides morphologic and functional information relevant to a broad
array of cardiovascular diseases.
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43. Cardiac Computed Tomography
• arterial wall left ventricular (LV) and
right ventricular (RV)
• systolic function
• cardiac valve morphology
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44. Holter monitor
• The Holter monitor is a type of portable
electrocardiogram (ECG). It records the
electrical activity of the heart
continuously over 24 hours or longer
while you are away from the doctor's
office. A standard or "resting" ECG is one
of the simplest and fastest tests used to
evaluate the heart.
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45. Invasive cardiac diagnostic procedures..
• Cardiac catheterization
• Angiography
• Hemodynamic monitoring
• A) central venous pressure monitoring
• B) pulmonary artery pressure monitoring
• C) intra-arterial blood pressure monitoring
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47. • Pressures and oxygen saturations in the four heart chambers are
measured.
• Cardiac catheterization is used to diagnose CAD, assess coronary
artery patency, and determine the extent of atherosclerosis based on
the percentage of coronary artery obstruction.
• These results determine whether revascularization procedures
including PTCA or coronary artery bypass surgery may be of benefit to
the client.
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48. Indications & contra indications to cardiac catheterization
• Angiography is usually combined with heart catheterization for
coronary artery visualization.
• Contraindications for cardiac catheterization include:
1. Uncontrolled ventricular irritability.
2. Uncorrected electrolyte hyperkalemia, hypokalemia, hypercalcemia,
or hypocalcemia.
3. Digoxin toxicity.
4. Decompensated heart failure.
5. Severe renal insufficiency or anuria, unless renal dialysis will be
performed following procedure
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49. Relative contraindications for cardiac catheterization
• Recent stroke (within the past month).
• Active GI bleeding.
• Active infection.
• Uncontrolled hypertension.
• Patient's refusal of therapeutic intervention
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51. Coronary angiography
• Coronary angiography is interventional diagnostic procedure in which
a radio contrast is injected directly into the coronary arteries, allowing
visualization and quantification of stenosis and/or obstruction.
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52. HEMODYNAMIC MONITORING
Critically ill patients require continuous assessment of their cardiovascular
system to diagnose and manage their complex medical conditions.
This is most commonly achieved by the use of direct pressure monitoring
systems, often referred to as hemodynamic monitoring.
Central venous pressure (CVP), pulmonary artery pressure, and intra-
arterial BP monitoring are common form of hemodynamic monitoring.
Hemodynamic monitoring is the assessment of the patient's circulatory
status; it includes measurements of heart rate, intra-arterial pressure, PAP,
and pulmonary capillary wedge pressure (PCWP), central venous pressure
(CVP), CO, and blood volume.
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54. Reynolds Risk Score
• If you are a healthy woman or man without diabetes, the Reynolds
Risk Score is designed to predict your risk of having a future heart
attack, stroke, or other major heart disease in the next 10 years. In
addition to your age, blood pressure, cholesterol levels and whether
you currently smoke, the Reynolds Risk Score uses information from
two other risk factors, a blood test called hsCRP (a measure of
inflammation) and whether or not either of your parents had a heart
attack before they reached age 60 (a measure of genetic risk).
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57. Reference
• De Koning L, Merchant AT, Pogue J, Anand SS: Waist circumference and waist to hip ratio as predictors of
cardiovascular events: Meta-regression analysis of prospective studies. Eur Heart J 28:850, 2007.
• Morise AP, Lauer MS, Froelicher VF: Development and validation of a simple exercise test score for use in
women with symptoms of suspected coronary artery disease. Am Heart J 144:818, 2002.
• Fletcher GF, Ades PA, Kligfield P, et al: Exercise standards for testing and training: a scientific statement from
the American Heart Association. Circulation 128:873, 2013.
• Maria Odette Gore et al: Combining Biomarkers and Imaging for Short-Term Assessment of
Cardiovascular Disease Risk in Apparently Healthy Adults.J Am Heart Assoc. 2020 Aug
4;9(15):e015410. doi: 10.1161/JAHA.119.015410. Epub 2020 Jul 23.
• Braunwald’s Heart Disease_ A Textbook of Cardiovascular Medicine.10th edition. 2015
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