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    Cardiacassessment

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    sas
    The document provides guidance on performing a cardiovascular system assessment. It outlines the necessary equipment, history questions to ask, and physical examination steps. A careful history and physical exam are essential to evaluate symptoms, assess risk factors, and plan appropriate testing or referral. The exam involves inspection, palpation, percussion, and auscultation of the heart, jugular veins, lungs, and peripheral vessels. Key signs like murmurs, rubs, edema, and pulses are evaluated.

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    Cardiacassessment

    Uploaded by

    sas
    42 views40 pages
    The document provides guidance on performing a cardiovascular system assessment. It outlines the necessary equipment, history questions to ask, and physical examination steps. A careful history and physical exam are essential to evaluate symptoms, assess risk factors, and plan appropriate testing or referral. The exam involves inspection, palpation, percussion, and auscultation of the heart, jugular veins, lungs, and peripheral vessels. Key signs like murmurs, rubs, edema, and pulses are evaluated.

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    The document provides guidance on performing a cardiovascular system assessment. It outlines the necessary equipment, history questions to ask, and physical examination steps. A careful history and physical exam are essential to evaluate symptoms, assess risk factors, and plan appropriate testing or referral. The exam involves inspection, palpation, percussion, and auscultation of the heart, jugular veins, lungs, and peripheral vessels. Key signs like murmurs, rubs, edema, and pulses are evaluated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views40 pages

    Cardiacassessment

    Uploaded by

    sas
    The document provides guidance on performing a cardiovascular system assessment. It outlines the necessary equipment, history questions to ask, and physical examination steps. A careful history and physical exam are essential to evaluate symptoms, assess risk factors, and plan appropriate testing or referral. The exam involves inspection, palpation, percussion, and auscultation of the heart, jugular veins, lungs, and peripheral vessels. Key signs like murmurs, rubs, edema, and pulses are evaluated.

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    of 40

    Cardiovascular

    system assessment
    • A careful and detailed clinical assessment is
    essential in order to assess the likely cause and
    severity of symptoms, arrange appropriate
    investigations and referral, avoid unnecessary
    investigations, and to assess individual risk of
    cardiovascular disease or cardiomyopathy.
    ARTICLES REQUIRED
    • A watch with a second hand
    • Stethoscope with diaphragm & bell
    • Centimeter ruler, Penlight
    • Tape measure
    • Sphygmomanometer
    STEPS
    • History collection
    • Physical examination
    HISTORY COLLECTION
    • Socio demographic data
    • Symptoms & history of present illness

    Dyspnea
    onset & duration
    Orthopnea
    Wheeze/abnormal breath sound
    Paroxysmal nocturnal Dyspnea (PND)
    Severity / grade
    Chest pain
    • O- ONSET
    • L- LOCATION
    • D- DURATION
    • C- CHARACHTERISTICS
    • A- ASSOCIATED SYMPTOMS
    • A- AGGREVATING FACTORS
    • R- RELIEVING FACTORS
    • Palpitation
    • Syncope
    Sudden onset
    Gradual onset
    Significance of associated symptoms
    Cough with expectoration
    PAST HISTORY
    • Rheumatic fever
    • Recurrent attacks of lower respiratory infections
    since childhood
    • Enquire about dental carries, the recent dental
    extraction
    • Previous history of DM & HTN
    • Previous history of angina ,MI,CABG
    FAMILY HISTORY
    • Marriage : Consanguineous
    • History of coronary artery disease,HTN,DM
    • Sudden cardiac death in family
    PERSONAL HISTORY
    • Sleep
    • Smoking:
    • Alcoholism
    • Exercise pattern / activity pattern
    • Dietary habits
    GENERAL EXAMINATION
    • Body Built
    • Nourishment:
    • Cyanosis
    Differentiating points Central cyanosis Peripheral cyanosis

    Site Skin & mucous membrane Only skin

    : tongue, lips

    On breathing 100 % O2 Cyanosis reveres if due to lung No effect at all

    disease : not if due to right to left

    shunts

    Warming the limb No effect Cyanosis decreases

    Clubbing Usually associated Not associated

    Periphery Warm Cold


    • central cyanosis is seen in the following
    cardiac condition
    • cyanosis congenital heart disease
    • reversal of left to right shunt
    • Pulmonary edema

    peripheral cyanosis occur in


    • peripheral vascular disease
    • Pedal edema
    • Clubbing
    Clubbing is caused by prolonged hypoxemia of
    the extremities. Hypoxemia causes structural changes in
    the distal phalanges over time.

    • Cyanotic Congenital heart disease


    • Reversal of left to right shunts
    • Infective endocarditis
    Inspection...
    • Inspect nails. Splinter hemorrhages are
    associated with infective endocarditis
    • Inspect the face. People with supravalvular
    aortic stenosis have wide-set eyes, low-set
    ears, upturned nose, hypoplasia of the
    mandible
    • Moon face suggests pulmonic stenosis
    More inspection...
    • Expressionless face with puffy eyelids and
    loss of the outer 1/3 of the eyebrow is seen in
    hypothyroidism
    • Inspect eyes. Yellow plaques on eyelids
    (xanthelasma) may be due to
    hyperlipoproteinemia
    Assessment of Blood Pressure
    • Always measure in both arms
    sitting, standing,lying down
    Normal-15 mg reduction of systolic from lying to standing
    HR- should not increase 20 b/min from supine to standing
    Jugular Venous Pulse
    • Assesing the internal jugular vein provides
    information about right atrial pressure
    • The pulsation of the internal jugular vein are
    beneath the sternocleidomastoid muscle and are
    visible as they are transmitted through surrounding
    tissue
    • The vein itself cannot be seen
    • JVP> 4cm from sternal angle at 45’ patient position
    is said to be raised
    JVD
    JUGULAR VENOUS DISTENTION
    Heapatojuglar reflex
    • patient in 45 degree inclination .
    • The examiner standing on the right side of the patient
    should apply firm pressure over the mid abdomen for 20
    seconds
    • Patient should be asked to breathe normally (not to strain .
    In normal individual JVP rise is not more than 4 cm it is not
    sustained .
    • In RH sustained elevation of more than 4 cm is noted .
    EXAMINATION OF THE
    PRECORDIUM
    Inspection
    • The heart and chest develop at the same time in
    embryo, so anything that interferes with
    development of the chest may interfere with the
    heart
    • Pectus Excavatum (caved-in chest) is seen in
    Marfan’s syndrome and sometimes MVP
    • Pectus Carinatum (pigeon chest) also seen in
    Marfan’s syndrome
    Palpation
    • a. Apical impulse
    • b. Pulsation
    • Heaves-Sustained lifts of chest wall in precordial area
    • c. Thrills
    - Thrills – vibratory sensations
    - Thrills are best palpated with head of
    metacarpal bones
    • - Thrills suggest presence of a murmur
    • - Thrills are common with obstructive lesion with narrow orifice
    • - Diastolic thrills – MS
    • - Continuous thrill – PDA
    • Percussion
    The right and left sides of the heart can be
    estimated by percussion.The curve of the rib in the
    fourth and fifth intercoastal space starting at
    midaxillary line is percussed
    Auscultaion
    • Auscultatory areas :
    • Aortic area - Right of the sternum (in the 2nd intercostal
    space )
    • Pulmonary area – left of the sternum (2nd intercostal space )
    • Erb’s point—3rdintercostal space to the left of the sternum
    • tricuspid area—fourth intercostal spaces to the left of the
    sternum
    • mitral area—the PMI, 5th intercostal space midclavicular
    location on the chest where heart contractions can be
    palpated
    Principles of Auscultation
    • Normally only the closing of valves can be heard.
    • Closure of the tricuspid and mitral valves (AV valves)
    produce the 1st heart sound.
    • Closure of the aortic and pulmonic valves produce the 2nd
    heart sound.
    • Opening of valves can only be heard if they are very
    damaged (opening “snap” “click”)
    Third Heart Sound
    • When AV valves open, the period of rapid filling of
    ventricles occurs. 80% of ventricular filling occurs now.
    At the END of rapid filling, a 3rd heart sound may be
    heard
    • S-3 is normal in children and young adults, but not in
    people over age 30. It means there is volume overload
    of ventricle
    Fourth Heart Sound
    • At the end of diastole, atrial contraction contributes
    to the additional 20% filling of the ventricle
    • If the left ventricle is stiff and non-compliant, you
    will hear an S4.
    • It sounds like this: a-STIFF-wall, a-STIFF-wall, a-
    STIFF-wall Or sounds like TEN-ne-see
    Murmurs
    • They are produced when there is turbulent blood flow
    within the heart
    • Turbulence may be due to a narrowed opening of a
    valve (stenosis) or a valve that does not close
    completely, allowing blood to slosh backwards
    (regurgitation or insufficiency)
    The Intensity of Murmurs
    • Grade I = lowest intensity, not heard by
    inexperienced listener
    • Grade II = low intensity, usually audible to everyone
    • Grade III = medium intensity but no palpable thrill
    • Grade IV = medium intensity with a thrill
    Intensity of murmurs, con’t
    • Grade V = loudest murmur audible when stethoscope is on
    the chest. Has a thrill
    • Grade VI = loudest intensity, audible when stethoscope is
    removed from the chest. Has a thrill
    Systolic Murmurs
    • These are ejection murmurs
    • May be caused by turbulence across the aortic or pulmonic
    valves if they are stenosed
    • May be caused by turbulence across the mitral or tricuspid
    valves if they are incompetent (regurgitant)
    • The murmur falls between S1 and S2
    • Sounds like, LUB-shhh-dub
    Diastolic Murmurs
    • Mitral and tricuspid stenosis can cause a diastolic murmur
    • Aortic or pulmonic regurgitation can cause a diastolic
    murmur
    • Sounds like this: Lub-dub-shhh
    Pericardial Friction Rub
    • These are extra-cardiac sounds of short duration that have
    a sound like scratching on sandpaper
    • May result from irritation of the pericardium from infection,
    inflammation, or after open heart surgery
    • Best heard when patient sits and holds breath
    Assessment of the
    Peripheral Vascular
    System
    INSPECTION
    Edema
    cyanosis
    thrombophlebitis
    clubbing of nails
    varicosities
    lesions or ulcers
    PALPATION
    • Assess the different pulse sites
    • Temperature
    • Edema of limbs
    • Rigidity of vessels
    • Homan’s sign
    • Allens test
    Pulse Rate
    Rhythm
    Volume
    Character
    Condition of vessel wall

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