ASSESSMENT OF CARDIOVASCULAR SYSTEM

Inspection and Palpation of Pericardium Position: Supine Normal No pulsations, thrills (vibrations), lifts or heaves (similar to wheezing sound) Pulsations are visible to 50% of adults & Palpable at Point of Maximal Impulse or PMI (Apical Pulse in Mitral Area) located at 5th Left ICS medial to MCL Abnormal: Presence of Pulsations

Inspection of Jugular Distention Position: Supine with head of bed elevated at 30 45 degree angle (Semi Fowler) Measure in cm from the level of highest visible point of distention to the level of sternal angle. Normal: No visible veins (indicates normal functioning of right side of the heart) Abnormal: Veins visibly distended (indicates Congestive Heart Failure or CHF)

Auscultation of Heart Sounds Position Supine w/ head of bed elevated in 30 45 degree angle (Semi Fowler) Reassess in upright sitting position (certain sounds are more audible) Use both bell and diaphragm Normal Assessment 1. S1 (Lub) AV valve closes; low pitched, dull sound Best heard with diaphragm over Mitral Area heard 2. S2 (Dub) SV valve closes; high pitched sound shorter than S2 Best heard with diaphragm over Aortic area. 3. S3 (Sounds like Ken tuc ky) Position: Left Lateral / Sims / Semi Prone Extra heart sound after S2 Normal in Children & in Young Adults; Disappears while sitting Abnormal in Adults Best heard with bell over Mitral Area. Abnormal Heart Sound: 4. S4 (Sounds like Ten nes see)

Position: Supine Sign of Hypertension; Common in Older Adults Best heard with bell over Mitral Area.

Grading Heart Murmurs (blowing sound) Use bell w/c is effective for low frequency sounds like heart murmurs 1. Grade 1 barely audible 2. Grade 2 audible but soft and quiet 3. Grade 3 moderately loud, without thrills or thrust 4. Grade 4 loud with thrills 5. Grade 5 very loud with thrills or thrust 6. Grade 6 loud enough to be heard before the stethoscope comes in contact with the chest. Auscultation Tips: When you auscultate a patients heart 1. 2. 3. 4. Concentrate as you listen to each heart sound Dont auscultate through clothing or wound dressing b/c it can block the sound. Keep away the stethoscope tubing from the patients body and other surfaces. Until you became proficient on auscultation and can examine a patient quickly, explain to patient that even though you may listen to his chest for a long period, it doesnt mean something is wrong. 5. Ask the patient to breathe normally and hold his breath periodically to enhance the sound that is difficult to hear. Chronological: 5 Areas for Cardiac Auscultation or Heart Sound Sites 1. Aortic second right interspace close to sternum (second ICS right parasternal) 2. Pulmonic - second left interspace close to sternum (second ICS left parasternal) 3. Erbs Point third left interspace close to sternum; can hear murmurs of aortic and pulmonic area. 4. Tricuspid fourth to fifth left interspace close to sternum 5. Mitral or Apical fifth left interspace medial to midclavicular line (fifth ICS left midclavicular line)