Cardiovascular Assessment

Question 1

Obtaining history of cardiac complaints

Answer 1

 Past Medical History

 Surgical History

 Family Medical History

 Social History

 Diet & Exercise

Question 2

Components of the cardiac exam with normal and abnormal findings

Answer 2

1- Vitals
2- Inspection
3- Auscultation
4- Palpation

Question 3

2- Inspection

Answer 3

 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

Question 4

3- Auscultation

Answer 4

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.

Question 5

4- Palpation

Answer 5

palpate
- Heaves
- PMI

Question 6

Heaves palpation

Answer 6

 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.

Question 7

PMI palpation

Answer 7

 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.

Question 8

Auscultate Heart Sounds (S1)

Answer 8

normal, closing of mitral and tricuspid valves (AV valves)
 Lub
 Occurs at the beginning of systole

Question 9

Auscultate Heart Sounds (S2)

Answer 9

normal, closing of aortic and pulmonic valves (Semilunar)
 Dub
 Occurs at the beginning of diastole

Question 10

Auscultate Heart Sounds (S3)

Answer 10

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

Question 11

Auscultate Heart Sounds (Extra sounds)

Answer 11

 Snaps - OPENING of a stenotic valve
 Rubs – rubbing noise caused by fluid in the pericardial sac
 Murmurs

Question 12

Murmurs

Answer 12

It’s a result from abnormal flow in any direction across the valves.
classified as systolic vs. diastolic

Question 13

cardiac landmarks

Answer 13

“A Pretty Tough Murmur”
 Aortic~ R 2nd ICS
 Pulmonary~ L 2nd ICS
 Tricuspid~ L 4th ICS
 Mitral~ L 5th ICS

Question 14

Murmur quality

Answer 14

Question 15

Murmur Grades

Answer 15

Question 16

Examining Peripheral Circulation

Answer 16

 The arms
 Size
 Symmetry
Edematous – equal both sides or one side more than the other.

 Skincolor&temperature

 Pulses
 Radial pulse
 Brachial pulse

Question 17

Pulsation Waves

Question 18

Carotid artery Assessment

Answer 18

it is important to auscultate thecarotid arteries prior to palpating the carotid pulse

Question 19

S1 and S2

Answer 19

the S1 and S2 sounds are the closing of valves

Question 20

Answer 20

Dicrotic Pulse

( apulsecharacterizedbytwopeaks,thesecondpeakoccurringindiastole – causes: severe aortic regurgitation, cardiac tamponade, in an ICU IABP does this)

Question 21

Answer 21

Bounding pulse
(many causes exercise, anxiety, fever, severe anemia)

Question 22

Answer 22

Tardus pulse
(usually aortic stenosis)

Question 23

Answer 23

pulsus alternanas

( heart failure, severe HTN)

Question 24

Answer 24

Bigeminy
( arrythmias especially PVCs and PACs)

Question 25

Answer 25

pulses paraxous

(pericarditis, tamponade or severe dehydration)

Question 26

ExaminingPeripheralCirculation
Legs- Inspection

Answer 26

• 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.

Question 27

ExaminingPeripheralCirculation
Legs- Palpation

Answer 27

• Thickness of skin
• Pulses
  * Femoral
  * Popliteal
  * Dorsalis Pedis
  * Posterior Tibial

Question 28

Chest Pain - Alarm symptoms

Answer 28

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

Question 29

Chest pain at rest

Answer 29

ongoing myocardial ischemia

Question 30

Tearing or ripping chest pain

Answer 30

aortic dissection, especially if the patient presents very hypertensive

Question 31

Diaphoresis

Answer 31

associated strongly with acute MI, aortic dissection and massive pulmonary embolism

Question 32

Pressure/squeezing chest pain

Answer 32

ischemia

Question 33

Burning chest pain

Answer 33

might be more esophageal

Question 34

Dull chest pain

Answer 34

might be inflammatory

Question 35

Sharp

Answer 35

may be more pleuritic or musculoskeletal

Question 36

Review of Systems of cardiovascular complain

Answer 36

Constitutional, Skin, CV, Pulmonary, Abdomen, Ext