Professional Documents
Culture Documents
Cardiac Assessment
Cardiac Assessment
HealthHistory
1.CurrentHealthStatus
chestpain
angina
myocardialinfarction
pericarditis
dissectingaorticaneurysm pulmonaryarteryhypertension
pneumothorax
pneumonia
esophagealreflux esophagealspasm
postmyocardialsyndrome
ribfracture
esophagealrupture
shortnessofbreath
syncope
swellingofanklesorfeetheartpalpitations
fatigue
2.PastHealthHistory
congenitalheartdisease
rheumaticfever
heartmurmur
highbloodpressure,highcholesterol,diabetesmellitusconfusion
fatigue
dentalwork
3.FamilyHistory
4.PersonalHabits
smoking
alcohol
sleep&restexercise
nutrition
stress&coping
TechniquesofExamination
Thepatientshouldbesupinewithupperbodyelevatedata1530Eangle.The
roommustbequiet,warm,andhavegoodlighting.Youshouldstandtotheright
ofthepatientbeingexamined.InspectionandPalpationoftheHeart
Inspectionandpalpationreinforceeachotherandaretimesavingwhendone
together.
Tangentiallightinghelpsyoudetectpulsations.
Theballofthehand(atthebaseofthefingers)isthemostsensitiveatdetecting
thrills.
Thefingerpadsaremoresensitiveindetectingpulsations.
InspectandPalpatefor:
Pulsationsthesearemorevisiblewhenpatientsarethin.Athickchestwallor
increasedAPdiametercanobscurethem.Pulsationsmayindicateincreasedblood
volumeorpressure.
Liftorheavestheseareforcefulcardiaccontractionsthatcauseaslightto
vigorousmovementofsternumandribs.
Thrillsthesearethevibrationsofloudcardiacmurmurs.Theyfeellikethethroat
ofapurringcat.Thrillsoccurwithturbulentbloodflow.
Youshouldinspectandpalpateatthefollowingareas:
1.AorticArea(secondinterspacetotherightofthesternum).
apulsationcouldindicateanaorticaneurysm.athrillcouldindicateaortic
stenosis.
2.PulmonicArea(secondinterspacetotheleftofthesternum).apulsationcould
indicatepulmonaryhypertension.
athrillcouldindicatepulmonicstenosis.
3.ERB'sPoint(thirdinterspacetotheleftofthesternum).
findingssimilartothatofaorticandpulmonicareas.
4.TricuspidArea(RightVentricularArea)(45thinterspace;lowerhalfofthe
sternum).
asustainedsystolicliftcouldindicaterightventricularenlargement.
asystolicthrillcouldindicateaventricularseptaldefect.
inpatientswithanemia,anxiety,hyperthyroidism,fever,pregnancy,orincreased
cardiacoutput,abriefpulsationmaybefelt.
5.MitralArea(LeftVentricularArea)(5thintercostalspaceatthemidclavicular
line).ThisiswhereyoucanfindtheApicalPulseandusuallycanfindthePointof
MaximumIntensity(PMI).
identifythePMIbylocation,diameter,amplitude,duration,andrate.Tohelp
identifyit,havepatientexhalecompletelyandholdbreathorhavethepatientlean
forward.Normalisalighttap,12cmindiameteratthe5thinterspaceattheleft
midclavicularline.PMIcouldbedisplaceddownandtotheleftwithventricular
hypertrophy,pregnancy,andCHF.
normallyseeninlessthanhalfthepopulation.
increasedpulsationcouldindicateincreasedcardiacoutput,anemia,anxiety,fever,
orpregnancy.
athrillcouldindicatemitralregurgitation,ormitralstenosis.6.EpigastricArea
(belowxyphoidprocess).
increasedaorticpulsationcouldindicateAAA,andaorticregurgitationorright
ventricularpulsationofrightventricularenlargement.
7.EctopicArea(23rdinterspaceattheLMCL)
increasedpulsationsinthisareaseeninpatientswithMI'sor
coronaryheartdisease.
8.SternoclavicularArea(topofsternumatjunctionofclavicles
pulsationofaorticarchmaybefeltinathinclient.
AuscultationoftheHeart
1.AorticArea2ndrightinterspaceclosetothesternum.
2.PulmonicArea
3.ERB'sPoint
4.TricuspidArea
5.MitralArea(Apical)5thleftinterspacemedialtotheMCL
2ndleftinterspace.
3rdleftinterspace.
5thleftinterspaceclosetothesternum.
1.Withyourstethoscope,identifythefirstandsecondheartsounds(S1andS2).
attheaorticandpulmonicareas(base).S2isnormallylouderthanS1.S2is
consideredthedubof'lubDUB.'S2iscausedbytheclosureoftheaorticand
pulmonicvalves.
atthetricuspidandmitralarea(apex)S1isoften,butnotalwayslouderthanS2.
S1isconsideredthelubof'LUBdub.'S1iscausedbytheclosureofthemitral
andtricuspidvalves.
S1issynchronouswiththeonsetoftheapicalimpulse.2.Identifytheheartrate.
tachycardia
bradycardia
3.Identifytherhythm.
ifitisirregular,trytoidentifythepattern.
Doearlybeatsappearonaregularrhythm?
Doestheirregularityvaryconsistentlywithrespiration?Isrhythmtotally
irregular?
4.ListentoS1first,thenS2atthepreviouslymentionedareasusingthe
diaphragmandthenthebell.
noteitsintensity.
arethereanysplittingsoundscheckduringinspirationwhereS2usuallysplitsat
pulmonicandERB'spoint.
athickchestwallorincreasedAPdiametermaymakeS2inaudible.
AlterationsinS1
a.S1isaccentuatedinexercise,anemia,
hyperthyroidism,andmitralstenosis.
b.S1isdiminishedinfirstdegreeheartblock.
c.S1splitismostaudibleintricuspidarea(Tlubdub).
AlterationsinS2
a.NormalphysiologicalsplittingofS2isbestheardatpulmonicarea.Itoccurson
inspiration(lubTdub,lubdub).
b.SplittingofS2canindicatepulmonicstenosis,atrialseptaldefect,right
ventricularfailure,andleftbundlebranchblock(lubTdub).
5.ListenforS3(ventriculargallop).
aphysiologicS3isfrequentlyheardinchildrenandinpregnantwomen.
itoccursearlyindiastoleduringrapidventricularfilling.Itisheardbestatthe
apexintheleftlateraldecubitusposition.
itisheardbestusingthebell.
apathologicS3occursinpeopleovertheageof40.Causeisusuallymyocardial
failure.
soundslikelubdubdee(or'Kentucky').6.ListenforanS4(atrialgallop).
itoccursbeforeS1
itislowpitchedandbestheardwiththebell.
oftennormalinolderadults.
itisheardbestattheapexintheleftlateraldecubitusposition.
itmaybecausedbycoronaryarterydisease,hypertension,myocardiopathy,or
aorticstenosis.
soundslikedeelubdub(or'Tennessee').7.Listenformurmurs.
CHECKTIMING.Aretheysystolicordiastolic?
(systolicmurmursmaybebenign.Diastolicmurmursareneverbenign).
LOCATIONOFMAXIMALINTENSITY.Whereisthemurmurbestheard?
FREQUENCY(pitch).
Thisvariesfromlowpitched,causedbyslowvelocityofbloodflow,tohigh
pitched,causedbyarapidvelocityofbloodflow.
INTENSITY.theloudnessofamurmurisdescribedonascaleof1to6:
Grade Intensity/Sounds
veryfaint,easilymissed
quiet,barelyaudible
moderatelyloudbuteasilyheard.SameintensityasS1orS2.
loudbutusuallynothrillpresent
veryloudthrillpresent
heardwithstethoscopeoffofchest.Thrillpresent.
RADIATION.somemurmursradiateinthedirectionofthebloodstreamby
whichtheyareproduced.Listenoverneck,back,shoulders,andleftaxilla.
QUALITY.
aorticmurmursareheardbestinfullexpirationwithpatientleaningforward.
mitralmurmursareheardbestafterexerciseinleftsidelyingposition.
AssessmentofExtraHeartSounds
musical
ejectionclick
openingsnap
midsystolicclick
blowing
harsh
rumbling