OMED 1401 - Advanced Patient Assessment (CARDIOVASCULAR ASSESSMENT) Flashcards
What is the History Needed for the Cardiovascular System?
- Dyspnoea, Orthopnoea, Paroxysmal Nocturnal Dyspnoea
- Chest Pain on Exertion
- “Cardiac” Chest Pain: Central, Crushing, Neck/Jaw/Arm Pain, Retrosternal Pain.
- Associated Symptoms E.g. Nausea, Vomiting, Sweating, Fatigue
- Transient Loss of Consciousness (TLOC)
:Blood Pressure Drops, Hypoglycaemia, Eating Disorders (Mental Health), Trauma, Dehydration, Seizures (Absent).
Cardiac Causes:
Wolf Parkinson’s White Syndrome: Makes the Heart Beat Abnormally Fast, Blood Flow doesn’t Complete it’s Full Circuit, Might Find in Children, Undiagnosed people who have never been ill. Extra Electrical Connection in the Heart.
Athletes - Cardiac Myopathy (Can go into Sudden Cardiac Arrest). - Ankle Oedema (Heart Failure)
What are the Risk Factors for CVD Disease?
Medical History - High Blood Pressure, Diabetes, High Cholesterol.
Family History - Previous Family History of CVD.
Social History - Smoking, Inactivity, Obesity, Employment
Ethnicity - Ethnic Backgrounds (South East Asian, Black African have an Increased Risk), Sickle Cell.
Demography - Age, Gender, Poverty, Poor Area.
What are the Common Conditions of the CVS?
Acute Pulmonary Oedema - Buildup of Fluid in the Lungs. Caused by Congestive Heart Failure. Excessive Shortness of Breath, Coughing up Foam, Wheezing, Chest Tightness. Requires Immediate Treatment.
Coronary Spasm - Temporary Tightening of the Muscles in the Wall of an Artery that Send Blood to the Heart. Light Chest Pain, Chest Tightness, Pain Extending from your Chest to your Necks, Arms or Jaw.
Cardiac Arrythmias - Problem with Rate or Rhythm of your Heartbeat. May beat too Quickly to Too Slowly in a Regular or Irregular Rhythm. Palpitations, Feeling Dizzy, Fainting and being Short of Breath.
Musculoskeletal Causes - Lower Rib Pain Syndrome, Fibromyalgia, Chest Trauma. Dull and Achy Pain. Across the Whole Chest or on One Side. Pain that Occurs or Worsens with Certain Movements. Swelling, Tenderness or Bruising.
Cocaine Use - Can Increase the Risk of Blood Clots, Which can cause a Heart Attack or Stroke. Causes Blood Vessels in the Heart to Narrow, Leading to Coronary Artery Disease.
Aortic Aneurysm - Bulge in the Main Blood Vessel running from your Heart to your Tummy. Dangerous if not Spotted Early. Sharp Sudden Pain in Upward Back, Pain in Chest, Neck, Jaw or Arms, Difficulty Breathing.
Acute Coronary Syndrome - Refers to a Group of Conditions including a STEMI, N-STEMI and Unstable Angina. Aching, Burning, Heaviness, Numbness, Pressure and Tightness.
Pulmonary Artery Hypertension - Type of High Blood Pressure that Affects the Arteries in the Lungs on the Right Side of the Heart. Blood Vessels in the Lungs are Narrowed, Blocked or Destroyed. Slows Blood Flow through the Lungs. Heart must Work Harder and Eventually Causes the Heart Muscle to Become Weak and Fail. Dyspnoea, Cyanosis, Chest Pressure, Dizziness and Fatigue.
Aortic Stenosis - When the Aortic Valve Narrows and Blood Cannot Flow Properly. Over time, your Hearts Left Ventricle Pumps harder to push blood through the Narrowed Aortic Valve. Irregular Heart Sounds (Murmur), Chest Pain, Palpitations.
Pericarditis and Myocarditis - Inflammation of the Lining around your Heart and Inflammation of the Muscle of the Heart. Sharp Pain in the Chest that gets Worse when you Breathe in Deeply or Lie down. Relieved when Sitting Forward.
Cardiomyopathy - Disease of the Heart Muscle that makes it Harder for the Heart to Pump blood to the Rest of the Body. Can lead to Hear Failure. Swelling of the Legs, Ankles and Feet, Cough Whilst lying down, Fatigue.
Pericardial Tamponade - Medical or Traumatic Emergency that happens when enough fluid accumulates in the Pericardial Sac compressing the Heart and Leading to a Decrease in Cardiac Output and Shock.
How to Begin a Cardiovascular Assessment?
End of Bed Assessment - DRCABCDE
Extremities
Hands and Arms - Can they Move all Limbs.
Face and Head
Neck - JVP
Chest - Palpate, Thrills and Heaves, Auscultate all 4 Valves.
Limbs and Peripherals
Full Medical Model
How to do an End of Bed Assessment for Cardiovascular Assessments?
DRCABCDE
Clues within the Environment
Associated Breathing Problems
Pallor - Well Perfused? Pale?
Behaviour - Distressed?
Position
How to Access the Hands and Arms in a Cardiovascular Assessment?
Circulation
Capillary Refill
Nicotine Staining - Yellow Tinge.
Clubbing
Splinter Haemorrhage - Tiny Blood Clots under the Nail Beds Produced by Defective Heart Valves. (Bacterial Endocarditis)
Temperature
Pulses
How to Access the Face and Head in a Cardiovascular Assessment?
Colour/Perfusion
Eyes:
- Jaundice (Yellow Colour in the Eyes, Sign of Liver Failure, May have an Element of Clotting Disorders or Protein Dysfunction).
- Arcus Senilis (Rings on the Outer Region of Cornea, White/Grey/Blue Tinge in Corneal Margin, Sign of Hyperlipidaemia, can be Benign in the Elderly.)
- Xanthelasma (White Nodules on Eyelids, Signs of High Cholesterol, Hyperlipidaemia)
- Anaemia
Malar Flushing (Caused by CO2 Retention and the Resultant Vasodilator Effect, Flushing in the Cheeks, Can be Caused by Mitral Valve Stenosis) - Whooshing Sound on Auscultation due to Back Flow.
Cyanosis - Gums, Eyelids, Back of Hands. (Mind the Gap - Ethnicity for References).
How to Access the Neck in a Cardiovascular Assessment?
Feel the Carotid Arteries on Both Sides by Checking Pulses. (Not at the Same Time)
Locate the External Jugular Vein (Runs from the Angle of the Jaw to the Mid-Clavicle)
Notice the Location of the Internal Jugular Vein.
THE POSITIONING AND MEASUREMENT OF THE INTERNAL JUGULAR VEIN PRESSURE:
1. Lay the PT down to Approximately 30-45 Degrees
2. Move the PT’s Head so they are Facing Away.
3. Look for the Pulsation of the IJV.
4. Measure the Point from the Sternal Notch.
Measure of Ventricular Failure.
Right Ventricular Failure - Pulsation is Higher up.
Note Location - NO NEED TO MEASURE
If High it is Abnormal and the PT has an Issue with Back Flow in the Heart.
How to Inspect the Chest in a Cardiovascular Assessment?
Related Breathing Difficulties, Including Bilateral Chest Equality
Chest Expansion, Movement, any Grimace when Moving.
Chest Wall Abnormalities
Pacemaker
Scars - What Kind might you see?
Colouring/Pallor
Masses - Remember to Inspect for Pulsation
Athletes have an Enlarged Heart or can be a Sign of Infection.
How to Palpate the Chest in a Cardiovascular Assessment?
General Palpation for Pain
Locate Pericardium
Thrills
Heaves
General Rule - Fingertips (Feel Pulsations), Base of Fingers (Thrills), Base of Hands (Heaves)
Stenosis
How to Locate the Apex Beat of the Heart?
Location: 5th Intercostal Space (Mid-Clavicular Line)
Technique: Hands Horizontally across Chest, Apex beat can be Found with Fingers.
Indications - Laterally Displaces Heart = Cardiomegaly - Discover Dextrocardia
When Palpating the Chest, What is a Thrill in a Cardiovascular Assessment?
A Palpable Vibration caused by Turbulent Blood Flow through a Heart Valve (the Thrill is a Palpable Murmur)
You Should assess for a Thrill across each of the Heart Valves in Turn.
Place your Hand Horizontally across the Chest Wall, with the Flats of your Fingers and Palm over the Valve to be Assessed.
When Palpating the Chest, What is a Heave in a Cardiovascular Assessment?
Precocial Impulse that can be Palpated.
Present in PT’s with Right Ventricular Hypertrophy
Place the Heel of your Hand Parallel to the Left Sternal Edge (Fingers Vertical) to Palpate the Heaves.
If Heaves are Present you should feel the Heel of your Hand being Lifted with each Systole.
How to Auscultate the Chest in a Cardiovascular Assessment?
Auscultation is Performed for all Four Valves of the Heart.
Mitral Valve - Apex of the Heart
Tricuspid Valve - Left edge of Sternum in the 4th ICS.
Pulmonary Valve - Left Edge of Sternum in 2nd ICS.
Aortic Valve - Right Edge of Sternum in 2nd ICS.
WHAT ARE YOU LISTENING FOR?
Note how many Heart Sounds you can Hear
Any Additional Sounds
Are there any Murmurs (longer Noise)
Heart Sounds Normal in Character?
Auscultate for Crackles to Suggest Heart Failure with the Normal Side of the Heart Failures. Auscultate the Back and Lungs for Fluid and Crackles.
What is an Abdominal Aortic Aneurysm and its Signs and Symptoms?
Occurs when part of the Aorta wall becomes Weakened and the Large Amount of Blood that Passes through it puts Pressure on the Weak Spot, Causing it to Bulge outwards to Form an Aneurysm.
- Pulsating Mass near Bellybutton
- Different Blood Pressures in Both Arms; More than a Difference of 20 in the Systolic Pressure.
- Deep, Constant Pain in Belly Area or Side of Belly.
- Back Pain.
- Blood Pressure may Drop
- Hypovolemic Shock
