CARDIOVASCULAR ASSESSMENT

1
CARDIOVASCULAR ASSESSMENT

• BARBARA REES, RN, DSN

2
ANATOMIC RELATIONSHIPS

• HEART LIES WITHIN THE MEDIASTINAL SPACE
• ENCLOSED IN PERICARDIUM
• a. PARIETAL - OUTER
• b. VISCERAL - INNER
• RIGHT AND LEFT SIDED PUMPS

3
SEQUENCE OF BLOOD FLOW

• VENA CAVA - VENOUS BLOOD
• RIGHT ATRIUM - RIGHT CARDIAC BORDER, BLOOD FLOWS
  THROUGH THE TRICUSPID VALVE
• RIGHT VENTRICLE - PROPELS BLOOD INTO THE PULMONIC
  CIRCULATION
• LEFT ATRIUM - BLOOD FLOWS THROUGH THE MITRAL
  VALVE
• LEFT VENTRICLE - L BORDER, THICK MUSCLE

4
BLOOD FLOW
5
VALVES

• ATRIO-VENTRICULAR VALVES
• a. MITRAL
• b. TRICUSPID
• SEMILUNAR VALVES
• a. AORTIC
• b. PULMONIC

6
CARDIAC CYCLE

• PASSIVE FILLING OF THE VENTRICLES- M1 T1 OPEN, A2
  P2 CLOSED
• RAPID FILLING OF VENTRICLES - CLOSURE OF M1 T1
• VENTRICLES ARE CLOSED CHAMBERS AND PRESSURE
  INCREASES - OPENING OF A2 P2
• BLOOD IS EJECTED AND CLOSURE OF A2 P2

7
PHYSIOLOGICAL SPLIT

• CLOSURE OF A2P2
• PHYSIOLOGICAL SPLIT ON INSPIRATION
• INCREASED BLOOD IN RIGHT ATRIUM AND VENTRICLE
  NEEDS TO FLOW ACROSS PULMONIC VALVE
• PULMONIC VALVE STAYS OPEN LONGER

8
HEALTH HISTORY

• CHIEF COMPLAINT
• CHEST PAIN
• DYSPNEA
• PND
• ORTHOPNEA
• UNEXPLAINED WEAKNESS AND FATIGUE

9
HEALTH HISTORY

• IRREGULAR HEARTBEAT
• WEIGHT CHANGE WITH EDEMA
• EXTREMITY PAIN
• HISTORY OF HYPERTENSION, HYPERLIPOPROTEINEMIA,
  DIABETES MELLITUS, RHEUMATIC FEVER
• MEDICATIONS
• FAMILY HISTORY
• ADL

10
INSPECTION

• POINTS TO REMEMBER
• a. GOOD LIGHTING
• REMOVE CLOTHING
• MAKE PATIENT COMFORTABLE AND REMOVE SOCKS

11
CHEST CONTOUR

• PECTUS EXCAVATUM - COBBLERS CHEST
• KYPHOSCOLIOSIS
• PRECORDIUM PULSATIONS - LOCATION, SIZE, AMPLITUDE
• BULGING, RETRACTIONS
• JUGULAR VENOUS PRESSURE - VOLUME AND PRESSURE
  RIGHT SIDE OF HEART
• NOTE ANGLE AND DEGRE OF BED ELEVATION
• 45 DEGREES lt3CM 30 DEGREES 3-5 CM

12
COLOR

• PERIPHERAL AND CENTRAL CYANOSIS
• PALLOR
• CAPILLARY REFILL - NORMAL lt3 SEC.

13
ANATOMICAL LANDMARKS

• AORTIC AREA - 2ICS,RSB
• PULMONIC AREA - 2ICS,LSB
• ERBS POINT - 3ICS,LSB
• TRICUSPID AREA - 5ICS,LSB
• MITRAL AREA - 5ICS,LMCL
• EPIGASTRIC AREA - BELOW XIPHOID

14
CARDIAC LANDMARKS
15
PALPATION - PULSE STRENGTH

• 0 NO PALPABLE PULSE
• 1 DIFFICULT TO PALPATE, WEAK AND THREADY
• 2 LIGHT PRESSURE OBLITERATE PULSE
• 3 NORMAL, EASY TO PALPATE, NOT EASILTY
  OBLITERATED
• 4 BOUNDING, CANT BE OBLITERATED

16
METHODS OF PALPATION

• PADS BEST FOR PULSATIONS
• PALM OF HANDS TO DETECT
• a. HEAVES- ASSOCIATED WITH VENTRICULAR
  HYPERTROPHY
• b. THRILLS- ASSOCIATED WITH A MURMUR

17
PALPATE THE PRECORDIUM

• AORTIC AREA - SLIGHT PULSE NORMAL
• PULMONIC AREA
• ERBS POINT
• TRICUSPID AREA
• MITRAL AREA

18
ASSESSMENT OF APICAL IMPULSE

• LOCATION - 5ICS,LMCL
• SIZE - 2 CM OR LESS, SIZE OF A QUARTER
• AMPLITUDE - SHOULD BE A SLIGHT TAP
• DURATION - LESS THAN 1/2 WAY THROUGH SYSTOLE

19
PERIPHERAL PULSES

• CAROTID - EXAMINE ONE AT A TIME, AUSCULTATE FOR
  BRUIT
• RADIAL
• ULNAR
• BRACHIAL
• FEMORAL
• POPLITEAL
• POSTERIOR TIBIAL
• DORSALIS PEDIS

20
PULSE DOCUMENTATION
21
AUSCULTATION

• USE DAIPHRAGM AND BELL IN ALL AREAS
• AROTIC AREA - 2ICS,RSB HEAR S2 , DOES NOT
  CORRESPOND WITH CAROTID PULSE
• PULMONIC AREA -2ICS,LSB , MAY HEAR A SPLIT S2
• ERBS POINT - S1 S2 SOUND ABOUT EQUAL
• TRICUSPID AREA - 5ICS,LSB, S1 IS LOUDER
• MITRAL AREA 5ICS,LMCL, S1 IS LOUDER
• EPIGASTRIC AREA

22
OTHER HEART SOUNDS

• S3 -HEARD BEST WITH THE BELL, VENTRICULAR GALLOP,
  USUALLY ASSOCIATED WITH LV FAILURE
• S4 - AN ATRIAL GALLOP, ATRIA CONTRACTING AGAINST
  A RESISTANT VENTRICLE
• SUMMATION GALLOP - S3 S4, WITH SEVERE FAILURE

23
DESCRIPTION OF MURMUR

• TIMING
• a. BETWEEN S1 S2 SYSTOLIC
• b. BETWEEN S2 S1 DIASTOLIC
• LOCATION
• TRANSMISSION
• INTENSITY - EXPRESSED WITH GRADING SCALE

24
GRADING OF MURMURS

• GRADE I/VI BARELY AUDIBLE
• GRADE II/VI SOFT AND LOW
• GRADE III/VI MODERATELY LOUD
• GRADE IV/VI HAS A THRILL
• GRADE V/VI MORE PRONOUNCED, RIM ON ONLY
• GRADE VI/VI EXTREMELY LOUD, STETHOSCOPE OVER
  CHEST

25
DESCRIPTION OF MURMURS

• PITCH
• a. HIGH - HEARD BEST WITH DIAPHRAGM
• b. LOW - HEARD BEST WITH BELL
• QUALITY - HARSH, BLOWING, WHISTLING, RUMBLING,
  MUSICAL
• CONFIGURATION- CRESCENDO, DECRESCENDO, PLATEAU

26
PERICARDIAL FRICTION RUB

• HIGH PITCHED SOUND
• HEARD BEST WITH DIAPHRAGM OF STETHOSCOPE
• HEARD IN BOTH SYSTOLE AND DIASTOLE
• MOST COMMON IN 3-4 ICS