Assessment of Heart

1
Assessment of Heart Neck Vessels

• Taylor, ch 25
• Jensen, ch 19

2
History Collection

• Ask about
• Risk factors
• Symptom hx
• PMH
• Hospitalizations, dx tests
• Social hx
• Health maintenance activities
• Childrens hx

3
Risk Factors

• Non-modifiable
• Age
• Race
• Gender
• Fa hx

• Modifiable
• HTN
• CAD
• DM
• Smoking
• Obesity
• Inactivity
• Stress
• BCPs

4
Symptom history

• Chest pain
• Dyspnea,orthopnea, DOE, PND
• Dizziness, syncope
• Activity intolerance, fatigue
• Palpitations
• Cyanosis, pallor

• Edema/wt gain
• Coughdry or wet, productive or non
• Nocturia, oliguria
• Extremity pain
• HAs, nosebleeds, blurred vision
• Easy bruising

5
PMH (MD dx of)

• HTN
• Heart problems, i.e., murmurs, arrhythmias, MI,
  congenital, rheumatic fever
• Hyperlipidemia
• Lung disease
• Tumors
• Blood disorders
• Kidney disease

• CVA
• Thyroid disease
• Surgery
• Hospitalizations
• Dx tests
• Injuries/accidents
• Communicable diseases
• Meds
• allergies

6
History contd

• Social
• ETOH, drugs, tobacco, home and work environment
• HMA
• sleep, diet, exercise, stress management, checkups

7
Childrens history

• Feed and play without tiring?
• Cyanosis, esp with crying or exertion?
• Growth up to standard?
• Position changes during activity?
• Hx strep, unexplained joint pain, fever?
• Hx lung problems?
• HA, nosebleeds?
• Sib with heart defect?
• Chromosomal abnormalities?

8
Physical Assessment--General

• Skin
• VS
• Peripheral pulses
• Heart4 techniques
• Inspection of extremities
• Lungs
• Abdomen

9
Physical AssessmentHeart

• Inspect for apical impulse (PMI)
• Palpate for apical impulse and across
  precordiumno other impulse should be felt
  (thrill)
• Percuss starting at 5th space and anterior
  axillary line and move right
• AuscultateAPETM, supine, left side, sitting

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Auscultation

• Note rate and rhythm
• Identify S1 and S2 and assess them
• Listen for extra soundssplit S2, S3, S4
• Listen for murmurs and grade accd to loudness
  only and if heard on S1 or S2

12
Physical AssessmentNeck Vessels

• Inspect carotid and jugular pulsations
• Perform HJR
• Palpate carotids (not both at once!)
• Auscultate carotids for bruit using bell