Cardiovascular Assessment Flashcards
Obtaining history of cardiac complaints
Past Medical History
Surgical History
Family Medical History
Social History
Diet & Exercise
Components of the cardiac exam with normal and abnormal findings
1- Vitals
2- Inspection
3- Auscultation
4- Palpation
2- Inspection
Inspect the great vessels of the neck:
- Jugular venous pressure
*Start with head of bed: elevated 30 degrees
Normally jugular vein will be flat at 30 degrees
Hypervolemia
*Next raise bed to 60 degrees
This is when vein should be visible in normal patients.
If not visible, patient may be hypovolemic.
- if you suspected hypovolemia: may need to lay bed flat to see jugular vein
3- Auscultation
auscultate both the carotid arteries to listen for a bruit. A bruit is a murmur-like sound arising from turbulent arterial blood flow.
Place the diaphragm near the upper end of the thyroid cartilage below the angle of the jaw, which overlies the bifurcation of the common carotid
artery into the external and internal carotid
arteries.
A bruit in this location is less likely to be confused with a transmitted murmur from the heart or subclavian or vertebral artery bruits.
In some patients, carotid bruits may only be detected by auscultation over the mastoid process, posterior to the ear.
4- Palpation
palpate
- Heaves
- PMI
Heaves palpation
To palpate heaves, use your palm and/or hold your finger pads flat or obliquely against the chest.
Heaves are sustained impulses that rhythmically lift your fingers, usually produced by an enlarged right or left ventricle and occasionally by ventricular
aneurysms.
PMI palpation
Palpate with the palm, first examining areas of visible pulsation. Even when not visible try to identify the apical impulse in approximately the left fifth interspace 7–9 cm from the midline.
Pathologic conditions such as right ventricular hypertrophy, a dilated pulmonary artery, or an aortic aneurysm may produce a different pulsation that is more prominent than the apex beat.
In dextrocardia with situs inversus, a rare congenital transposition of the heart, the heart is situated in the right chest cavity and generates a right-sided apical impulse.
Auscultate Heart Sounds (S1)
normal, closing of mitral and tricuspid valves (AV valves)
Lub
Occurs at the beginning of systole
Auscultate Heart Sounds (S2)
normal, closing of aortic and pulmonic valves (Semilunar)
Dub
Occurs at the beginning of diastole
Auscultate Heart Sounds (S3)
abnormal in adults, may be normal in kids
Just after S2, apex, left sternal border, bell, low pitch
Adults may be caused by volume overload (heart failure), Mitral or Tricuspid
regurgitation
Auscultate Heart Sounds (Extra sounds)
Snaps - OPENING of a stenotic valve
Rubs – rubbing noise caused by fluid in the pericardial sac
Murmurs
Murmurs
It’s a result from abnormal flow in any direction across the valves.
classified as systolic vs. diastolic
cardiac landmarks
“A Pretty Tough Murmur”
Aortic~ R 2nd ICS
Pulmonary~ L 2nd ICS
Tricuspid~ L 4th ICS
Mitral~ L 5th ICS
Murmur quality
Murmur Grades
Examining Peripheral Circulation
The arms
Size
Symmetry
Edematous – equal both sides or one side more than the other.
Skincolor&temperature
Pulses
Radial pulse
Brachial pulse
Pulsation Waves
Carotid artery Assessment
it is important to auscultate thecarotid arteries prior to palpating the carotid pulse
S1 and S2
the S1 and S2 sounds are the closing of valves
Dicrotic Pulse
( apulsecharacterizedbytwopeaks,thesecondpeakoccurringindiastole – causes: severe aortic regurgitation, cardiac tamponade, in an ICU IABP does this)
Bounding pulse
(many causes exercise, anxiety, fever, severe anemia)
Tardus pulse
(usually aortic stenosis)
pulsus alternanas
( heart failure, severe HTN)
Bigeminy
( arrythmias especially PVCs and PACs)
pulses paraxous
(pericarditis, tamponade or severe dehydration)
ExaminingPeripheralCirculation
Legs- Inspection
- Size, symmetry, and edema
- Venous pattern, enlargement or varicosities
- Pigmentation, rashes, scars, or ulcers
- Color, temperature and texture of skin and color of nail beds
* Paleness, coolness
* Brownish areas or increased
pigmentation near ankles
* Location, size, and depth of any
ulcers - Distribution of hair on lower legs, feet, and toes.
ExaminingPeripheralCirculation
Legs- Palpation
- Thickness of skin
- Pulses
* Femoral
* Popliteal
* Dorsalis Pedis
* Posterior Tibial
Chest Pain - Alarm symptoms
Chest pain by itself is an alarm symptom!
Associated symptoms can raise the alarm level further:
- Chest pain at rest
- Chest pain with a prior history of cardiac disease
- Severe chest pain with a “tearing” or “ripping” character
- Chest pain with diaphoresis
Chest pain at rest
ongoing myocardial ischemia
Tearing or ripping chest pain
aortic dissection, especially if the patient presents very hypertensive
Diaphoresis
associated strongly with acute MI, aortic dissection and massive pulmonary embolism
Pressure/squeezing chest pain
ischemia
Burning chest pain
might be more esophageal
Dull chest pain
might be inflammatory
Sharp
may be more pleuritic or musculoskeletal
Review of Systems of cardiovascular complain
Constitutional, Skin, CV, Pulmonary, Abdomen, Ext
