CARDIOVASCULAR

ASSESSMENT

AND PHYSICAL

EXAMINATION

1. Review anatomy & physiology of the cardiovascular system.

2. Discuss relevant aspects of the patient history.

3. Describe physical assessment of cardiovascular status.

4. Review diagnostic procedures, tests and medications relative to the cardiovascular system.

Anatomy & Physiology

Functions of the heart & CV system

Pumps blood to tissues to supply O2

& nutrients

Remove CO2 & metabolic wastes

PERICARDIUM / PERICARDIAL SAC

Protects heart from trauma

Serous fluid lubricates and

prevents friction

Prevents heart from over filling

Anatomy & Physiology

CORONARY ARTERIES

Right & Left arteries encircle the heart and supply blood to the myocardium during

ventricular relaxation( diastole)

LEFT MAIN CORONARY ARTERY

L ANTERIOR DESCENDING (LAD)

L CIRCUMFLEX (LCX)

RIGHT CORONARY ARTERY

POSTERIOR

MARGINAL

CORONARY ARTERIES

(R)

ARTERY

(L) ARTERY

LAD

CIRCUMFLEX

CARDIAC LOAD

Preload = degree of myocardial fiber stretch

at the end of diastole and just before

contraction

Afterload = pressure against which

ventricles must eject blood. This pressure is

affected by systemic vascular resistance

(SVR)

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OTHER ELEMENTS OF

CARDIAC ASSESSMENT Previous cardiac hx

Other medical conditions that may affect heart function

Chest injury

Previous heart surgery

Past medical hx

Medications: prescribed, OTC, herbals

Activity tolerance

Health habits

Family hx

CARDIOVASCULAR

EXAMINATION

HISTORY

PHYSICAL EXAM

LAB TEST

ECG

CARDIAC IMAGING

CARDIOVASCULAR SYMPTOM

CHEST PAIN

SHORTNESS OF BREATH

DOE ( DYSPNEA ON EXERTION)

PND ( PAROXYSMAL NOCTURNAL

DYSPNEA)

WHEEZING

CONTINUED

DIZZINESS

SYNCOPE

PALPITATION

FATIGUE

EDEMA

INTERMITTENT CALAUDICATION

CYANOSIS

CONTINUED

AGGRAVATING FACTORS

ALLEVIATING FACTORS

PREVIOUS LABORATORY TESTS

RISK FACTORS

EXAMINATION

Inspection

Palpation

Percussion

Auscultation

GENERAL APPEARANCE

VITAL SIGNS

JUGULAR VEINS

HEART

PRIPHERAL PULSES

VITAL SIGNS

BP

HEART RATE

RHYTHM

RESPIRATORY RATE

TEMPERATURE

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INSPECTION

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JUGULAR VEINS/ JUGULAR VENOUS

PRESSURE

RIGHT SIDE , HEAD TILTED TO L

ADJUST ANGLE OF BED TO SEE

PULSATION AT MIDNECK

RECORD DISTANCE FROM R ATRIUM

TO TOP OF PULSATION

INSPECTION (continued)

• Lips, nail beds

• Heart: apical impulse

point of maximal impulse

• Extremities: (edema, venous or arterial

insufficiency)

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IMPULSES – FINGER PADS

THRILLS ( vibration palpated secondrary

to a murmur – turbulant blood flow through

a heart valve)

APICAL IMPULSE ( normally 5th ICS and

medial to mid- clavicular line)

Point of max impulse

Left lateral decubitus : position apical

impulse more easily palpable

AUSCULTATION

• Diaphragm – medium and high frequency

sounds

• Bell – low frequency sounds

• Normally hear closure of valve

• Sounds from left side of heart louder than

equivalent sounds from right side of heart

AUSCULTATION

• S1 – closure of mitral and tricuspid valves

• S2 – closure of aortic and pulmonic valves

• S1 systole S2 diastole S1

• Simultaneous palpation of carotid pulse can help in differentiating S1 and S2

FIRST AND SECOND HEART SOUNDS

• Aortic component (A2) normally louder than

pulmonic component (P2)

• Mitral component (M1) normally louder than

tricuspid component (T1)

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DIAPHRAGM

• Right 2nd intercostal spaceAortic Area

• Left 2nd intercostal spacePulmonic Area

• Third intercostal spaceErb’s point

• Left lower sternal border Tricuspid area

• Apex – over apical impulseMitral area

BELL

• Left lower sternal border

• Apex

• Apex with patient in left lateral decubitus

position

• Light pressure only!

31

Abnormal heart sound and murmur

S3,s4 ,click ……

Systolic murmur:

AS,MR,PS ,TR,VSD

Diastolic murmur:

AR,MS,PR,TS