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Assessment of Cardiovascular System
Copyright 2002 by Delmar, a division of Thomson Learning 7-2
The Heart
Extends from the 2ed to the 5th intercostal space
Between the R boarder of the sternum to the L midclavicular
Beats against chest wall to produce apical impulse
Palpate 5th intercostal space 7-9cm form the mid sternal line
Copyright 2002 by Delmar, a division of Thomson Learning 7-3
Anatomy and Physiology of the Heart
Four Chambers:• Right atrium• Left atrium• Right ventricle• Left ventricle
Copyright 2002 by Delmar, a division of Thomson Learning 7-4
Cycle of Cardiac Events
It has two phases:
• Diastole • ventricles relax & fill with blood (This is
2/3 of the cardiac cycle.)• Systolicheart contracts & pushes blood out of the
ventricles to:• the lungs• Systemic arteries
Copyright 2002 by Delmar, a division of Thomson Learning 7-5
Heart Sounds
• S1 – when closure of the AV valves (tricuspid & mitral) & ventricles contract
• S2 – when closure of the semilunar
valves ( pulmonic & aortic) & the ventricles relax
Copyright 2002 by Delmar, a division of Thomson Learning 7-6
Assessment of Cardiovascular System
Copyright 2002 by Delmar, a division of Thomson Learning 7-7
Preparation for Assessment
• Room that is warm & “quiet”• Examining table positioned so you
can stand on the patient’s right side• Patient Gown• A watch with a second hand• Stethoscope with diaphragm & bell• Tape measure
Copyright 2002 by Delmar, a division of Thomson Learning 7-8
Subjective Data
1. chest pain location, quality, duration & associated symptoms.- Irregular heart beat: pound too fast, jump….. Etc.2. dyspnea3. Orthopnea4. Cough5. Fatique6. cyanosis or pallor7. edema8. nocturia9. past cardiac history10. family cardiac history11. personal habits12. environment
Copyright 2002 by Delmar, a division of Thomson Learning 7-9
Risk Factors • History of hypertension, diabetes,
rheumatic fever.• Family history of heart attack, hypertension,
stroke, and diabetes• Nutritional intake • Smoke habits How much? for how long?• Working hours , coping with stress• Exercise, How often.• Exercise? How often
Copyright 2002 by Delmar, a division of Thomson Learning 7-10
During assessment the client must be in supine or sitting positing
according to his health.
Copyright 2002 by Delmar, a division of Thomson Learning 7-11
What do you hear?
S1 and S2 sound like “lub-dup”
S1 is louder than S2 at the apex
S2 is louder than S1 at the base
S1 coincides with the carotid pulsation
Copyright 2002 by Delmar, a division of Thomson Learning 7-12
Murmurs
Vibrations within the hearts chambers or major arteries from the back and
forth blood flow; swishing sound
Copyright 2002 by Delmar, a division of Thomson Learning 7-13
Assessment of the Jugular Vein
Purpose: To measure the CVP “central venous pressure”
Method: • Position patient at 45 degree• angle at the hip• Turn head slightly away• Use a strong light tangentially• Observe the external jugular over the
sternomastoid muscle
Copyright 2002 by Delmar, a division of Thomson Learning 7-14
Arterial and Venous Insufficiency of lower Extremities
Item Arterial insufficiency Venousinsufficiency
Pulses Decreased or absent Present
Color Pale on elevation and cold Pink to cyanotic, brown pigment at ankles
Temperature Cool, cold Warm
Edema Non Present
Skin Shiny skin, thick nails, absent of hair, ulcers on toes, gangrene may develop
Ulcers on ankles discolored, scaly
Sensation Leg pain aggravated by standing & relieved with rest.
Pressure on buttocks or calves or cramps during walking, parasthesia
Leg pain aggravated by standing or sitting & relieved by elevation of legs, lying down, or walking. Also relieved with use of support hose.
Copyright 2002 by Delmar, a division of Thomson Learning 7-15
Characteristics and Problems associated with Cardiac
dysrhythmias
• Heart failure.• Ischemic heart disease• Myocardial infarction• Hypertension• Cor pulmonale• Infection and inflammation.
Copyright 2002 by Delmar, a division of Thomson Learning 7-16
Copyright 2002 by Delmar, a division of Thomson Learning 7-17
Thank You
