cardiovascularsystem

health assessment
1
 Superior vena cava: A large vein
that receives blood from the head,
neck, upper extremities, and
thorax and delivers it to the right
atrium of the heart.

Right atrium receives

deoxygenated blood from the
body through the vena cava and
pumps it into the right ventricle
which then sends it to the lungs to
be oxygenated.
The tricuspid valve is located
between the right atrium (top
chamber) and right ventricle
(bottom chamber). Its role is to
make sure blood flows in a
forward direction from the right
atrium to the ventricle.

Pulmonic valve is one of two

valves that allow blood to leave
the heart via the arteries.
• The pulmonary arteries
send blood to the lungs to
become oxygenated.

• Pulmonary veins are

responsible for carrying
oxygenated blood from the
lungs back to the left atrium
of the heart.
• The mitral valve, is a valve with
two flaps in the heart that lies
between the left atrium and the left
ventricle. helps move blood from
the left atrium to the left ventricle.
• Aorta- is the largest artery
that carries blood from the
heart to other parts of the
body.
• Erb’s point is the
auscultation location for
heart sounds and heart
murmurs located at the third
intercostal space and the left
lower sternal border.
Left ventricular hypertrophy is enlargement and thickening
(hypertrophy) of the walls of your heart's main pumping
chamber (left ventricle).

Incompetent heart valve- is a condition in which your heart's

mitral valve doesn't close tightly, allowing blood to flow
backward in your heart.

Rheumatic heart disease is a condition in which the heart

valves have been permanently damaged by rheumatic fever.

Rheumatic fever is a complication of strep throat. If left

untreated, it can cause permanent damage to the heart.
• Polycythemia vera is a type of blood cancer. It causes your
bone marrow to make too many red blood cells. These excess
cells thicken your blood, slowing its flow, which may cause
serious problems, such as blood clots.

• Coronary artery disease develops when the major blood vessels

that supply your heart with blood, oxygen and nutrients (coronary
arteries) become damaged or diseased.

• Shock is a life-threatening condition that occurs when the body is

not getting enough blood flow.
cardiovascular systems
assessment
• An evaluation of the condition, function and abnormalities
of the heart.
 Objectives
• 1. Review the anatomy and physiology of the
Cardiovascular System.

• 2. Outline a systemic approach to Cardiovascular

assessment.

• 3. Discuss history questions that will help you focus your

Cardiovascular assessment.

• 4. Recognize abnormal cardiovascular assessment

findings associated with inspection, auscultation,
percussion and palpation.
 Preparing the client

• 1. Explain that they will need to expose the anterior chest.

• 2. Female clients may keep their breast covered and may

simply hold the left breast out of the way when necessary.

• 3. Explain to client that they will assume several different

positions for examination.
 ASSESSMENT: EQUIPMENTS:

1. Stethoscope with a bell and

diaphragm
2. Small pillow
3. Penlight or movable examination light
4. Watch with second hand
5. Centimeter ruler
I. Precordium
Assessment
1. PREPARATION PHASE
A. Introduce yourself and explain the procedure to the patient (ask
consent)

B. Prepare the equipment and wash hands.

I. Precordium
Assessment
A. Inspection
Locate the Intercostal
Spaces (ICS)- is the
anatomic space between
two ribs
I. Precordium
Assessment
A. Inspection
Locate the Midsternal Line (MSL)

Locate the Midclavicular Line

(MCL)

Locate the Anterior Axillary Line

(AAL)
 I. Precordium Assessment

B. Palpation
1. Aortic Area: 2nd ICS, Right
Sternal Border (RSB)

2. Pulmonic Area: 2nd ICS, Left

Sternal Border (LSB)

3. Erb’s Point: 3rd ICS, Left

Sternal Border

4. Tricuspid Area: 5th ICS, Left

Sternal Border

5. Mitral Area: 5th ICS, Left MCL

 I. Precordium
Assessment
B. Palpation
A. Apex Beat or Point of
Maximal Impulse (PMI)

Located at the 5th

intercostal space
midclavicular line
Palpate the apex beat with your fingers (placed
horizontally across the chest)
Lateral displacement suggests cardiomegaly

The apex of the heart moves considerably with each heartbeat,

and the point of maximal impulse (PMI) can be felt on the
chest wall above the apex.
 I. Precordium
Assessment
B. Palpation
A. Apex Beat or Point of Maximal Impulse (PMI)

The cardiac impulse is the result of the heart moving

forward and striking against the chest wall during
systole,or when the heart muscle contracts.

Located at the 5th intercostal space midclavicular line

and palpable in normal condition.

Palpate the apex beat with your fingers (placed

horizontally across the chest)

Abnormal: Double impulse, Lateral displacement of the

PMI (to left), Epigastric & subxiphoid movement, Right
2nd intercostal pulsation, Left 2nd (or 3rd) intercostal
pulsation, Retraction of chest wall= these are
indications of cardio and pulmonary problems.

Palpate the apex beat with your fingers (placed horizontally across the chest)
Lateral displacement suggests cardiomegaly
I. Precordium
Assessment
B. Palpation
B. Heaves- is a sign of
left ventricular
hypertrophy. If heaves
are present you should
feel the heel of your
hand being lifted with
each systole.

heaves- these are forceful cardiac contractions that cause a

slight to vigorous movement of sternum and ribs.
 I. Precordium
Assessment
B. Palpation
B. Heaves- are forceful cardiac
contractions that cause a slight to
vigorous movement of sternum and ribs.

Normally no impulse or a slight inward

impulse is felt.

If heaves are present you should feel the

heel of your hand being lifted with each
systole and It is a sign of left ventricular
hypertrophy.

Place the heel of your hand parallel to the

left sternal edge (fingers vertical) to
palpate for heaves.
I. Precordium
Assessment
B. Palpation
C. Thrills- are soft
vibratory sensations
best assessed with
either the fingertips
or the palm flattened
on the chest
(a thrill is a palpable murmur
caused by an incompetent heart
valve.

caused by turbulent blood flow through a heart valve due

to incompetent heart valve
I. Precordium
Assessment
B. Palpation

C. Thrills- is a palpable murmur

caused by turbulent blood flow
through a heart valve due to
incompetent heart valve.

place your hand horizontally across

the chest wall, with the flats of your
fingers and palm over the valve to
assess for thrills.
I. Precordium
Assessment
C. Percussion: to note the location and
size of the heart

Vertical Borders:
2nd ICS to 5th ICS
at the left anterior
axillary line.

Horizontal Border:
Right Sternal Edge
to Left MCL
I. Precordium
Assessment
D. Auscultation
Aortic Area

Pulmonic Area

Tricuspid Area

Mitral Area

Locate where the S1

and S2 are best heard
II. Peripheral Vascular Assessment
A. Inspection

Inspect the skin integrity

of extremities

Describe the color of the

extremities: skin and nail
bed.

Rationale: physical
signs and symptoms
may indicate alteration
in cardiac function.
II. Peripheral Vascular Assessment

A. Inspection
Describe the
temperature

Locate scattered
sensations
II. Peripheral Vascular Assessment

A. Inspection
Note mobility of
extremities

Inspect for presence of

edema
II. Peripheral Vascular Assessment

A. Inspection
Inspect for presence of
superficial veins
 II. Peripheral Vascular Assessment
A. Inspection
Inspect for presence of
jugular vein distention.

Examination of jugular veins

can provide essential
information about the
client’s CVP and the heart’s
pumping efficiency
II. Peripheral Vascular Assessment
B. Palpation
Palpate and locate the 12 pulses

1. Temporal Pulse- on the temple

directly in front of the ear with the 2. Axillary- armpit
index finger.
II. Peripheral Vascular Assessment

B. Palpation

3. Facial Pulse- located on the mandible (lower jawbone) on a

line with the corners of the mouth.
 II. Peripheral Vascular Assessment

B. Palpation

4. Carotid Pulse- on either side 5. Radial Pulse- located on the

of the front of the neck just lateral of the wrist (radial artery).
below the angle of the jaw.
II. Peripheral Vascular Assessment

B. Palpation

7. Brachial- located on the

6. Ulnar- located on the medial bicep tendon in the area of
of the wrist (ulnar artery). the antecubital fossa.
II. Peripheral Vascular Assessment

B. Palpation

8. Apical- on the left side of the chest in the

5th intercostal space at the midclavicular line.
(on the at the apex of the heart )
II. Peripheral Vascular Assessment

B. Palpation

9. Femoral- located 10. Popliteal- behind the knees

in the inner thigh
 II. Peripheral Vascular Assessment

B. Palpation

11. Dorsalis Pedis- on top 12. Tibial- is located near

of the foot the medial malleolus
II. Peripheral Vascular Assessment

B. Palpation
Palpate and describe the radial pulse as to rate, rhythm, symmetry and
amplitude
amplitude

4 Bounding

3 Increased

2 Normal

1 Weak

Absent or
0
Nonpalpable
 II. Peripheral Vascular Assessment

Perform different Vascular Tests

a. Allen’s Test- is a test to determine the patency of the collateral

arterial blood supply to the hand
II. Peripheral Vascular Assessment

Perform different Vascular Tests

b. Buerger’s Test- is used to assess the adequacy of the

arterial supply to the leg.
 II. Peripheral Vascular Assessment

Perform different Vascular Tests

c. Capillary Refill Test- is a test done on the nail beds. It is used

to monitor dehydration and the amount of blood flow to tissue.
II. Peripheral Vascular Assessment

Perform different Vascular Tests

 II. Peripheral Vascular Assessment

Perform different Vascular Tests

e. Homan’s Sign- also called dorsiflexon sign test is a physical

examination procedure that is used to test for Deep Vein Thrombosis
(DVT).

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms
in one or more of the deep veins in your body, usually in your legs.
 II. Peripheral Vascular Assessment
C. Auscultation
Auscultate carotid artery for presence of bruits.

Bruit sound is like a “ blowing or swishing” noise and indicative of

atherosclerotic narrowing.

Rationale: a bruit over any of these areas indicates a vascular

 II. Peripheral Vascular Assessment
C. Auscultation
Assess for blood pressure

Rationale: BP measurement are an integral part of clinical practic