Assessing Cardiovascular

Function: Physical Examination

Dr. Alma Sorrera-Banua

Faculty, BUCN
Assessment
1. History taking
2. Physical Examination
3. Diagnostic Examinations
 Learning outcomes:
At the end of the lesson the student will be
able to:
1. State the importance of physical
examination
2. Identify the specific areas assessed per
specific P.E. technique?
3. Enumerate vital signs to be checked

4. Differentiate normal from abnormal findings

 Physical Examination
n Relate the function n What is the
of the heart importance of
/cardiovascular physical
system with P.E.
examination?
n What techniques will be used for
clients with cardiac problem?
n What vital signs will be checked?
P.E. : Inspection
n Color: cyanosis, pallor
n Jugular venous vein-pressure
P.E. : Inspection
n General appearance
n Color: Cyanosis (Central/Peripheral)

n Central Cyanosis

n Decreased SaO2 – usually

< 80%
n Seen in buccal mucosa,
conjunctiva
n Indicates cardiopulmonary
disease
P.E. : Inspection
n General appearance: Color
n Peripheral Cyanosis

n Reduced blood flow to

extremity
n Seen on tip of nose, ears,

distal extremities
n Indicates low CO as in late

heart failure or shock

 P.E.: Inspection
n Jugular Venous Pressure
n

n Anatomy of Internal Jugular

Vein
n •Straight line with RA

n •Manometer reflecting
Central
n Venous Pressure (CVP)
P.E.: Inspection
n Extremities
n Arterial insufficiency

n 4 P’s of blocked arteries

n Pulseless

n Pallor

n Pain

n Paralysis
Palpation
n Capillary refill time (CRT)
n Edema

n Pulses- pulse rating

P.E. Palpation
n CRT
n Delayed capillary filling

n Provides estimate of
peripheral blood flow
n Normal return < 2 seconds ;
if more indicates low CO,
low volume, low SVR
P.E. Palpation
n Edema
n Usually not detectable until interstitial fluid

volume is 30% above normal (7-10lbs)

n Bilateral edema

n Progression from ankles,legs,thighs,

genitalia,and abdomen, presacral for

bedrest
n Indicative of heart failure or bilateral

venous insufficiency
 P.E. Palpation
n Anasarca
n Generalized edema

n Seen in severe heart failure, hepatic

cirrhosis, and nephrotic syndrome
n Edema scale : evaluated by pressing
thumb for 5 seconds
 P.E. Palpation

Grading for Edema scale

n 0 = absent
n +1 = slight indentation : disappears rapidly

n +2 = indentation readily noticeable : disappears

within 10-15 seconds

n +3 = deep indentation ; disappears within 1-2

minutes
n +4 = marked, deep indentation ; may be visible

in >5min
 P.E. Palpation
Arterial Pulses:
n Rate and rhythm

n Pulse volume

n Simultaneous bilateral evaluation required

n Common abnormalities

n Weak, thready pulse

n Bounding pulse

n Pulsus alternans

n Bigeminal pulse

n Pulsus Paradoxus
 P.E. Palpation
n Pulse Rating
n 0 = absent, may be heard with doppler

n 1 = feeble, difficult to palpate, fades in and out

n 2 = faint, easily obliterated

n 3 = normal, easily palpated, not easily obliterated

n 4 = bounding, strong, hyperactive, not obliterated

by pressure
n D = doppler only
P.E. Auscultation
n BP
n Heart Sounds –S1, S1
n S3, S4
n Murmurs
n Extra Heart sounds
 P.E. Auscultation
n Blood pressure: Overall reflection of LV function
n Systolic represents force of contraction
n Diastolic represents vascular resistance
(afterload)
n Pulse pressure
n Widening
n Narrowing
n Orthostatic changes – minimum 3 minutes wait ;
>10mm Hg drop
 P.E. Auscultation

n Heart Borders
n Specific areas for examination

n Aortic area: 2
nd ICS, RSB

n Pulmonic area: 2
nd ICS, LSB

n Tricuspid area: 5th ICS, LSB

n Mitral or Apical area: 5
th ICS,

MCL
 P.E. Auscultation
n Heart Sounds: Closure of valves
n S1: 1
st heart sound “lub”;

n closure of AV valves heard loudest at mitral

and tricuspid areas; usually lower pitch

than S2
n S2: 2nd heart sound “ dub”;
n closure of semilunar valves; heard best at
aortic and pulmonic areas
P.E. Auscultation

n S3: Ventricular gallop

n Heard in early diastole, just after S2

n “Ken-tuc’-ky”

n Due to rapid, early ventricular filling

n Heard best : bell, mitral area if

produced by left heart ; along sternal

borders if produced by right heart
P.E. Auscultation

n S4: Atrial gallop

n Heard in late diastole, just before
S1
n “Ten-nes-see”

n Seen in: ventricular hypertrophy,

ischemic heart disease, MI,
hypertension, mitral regurgitation
P.E. Auscultation

n Murmurs
n Produced by increased or
turbulent blood flow
n Often imply significant disease of
heart valves, great vessels, or
septal defects
 P.E. Auscultation
n Extracardiac Sounds
n Pericardial Friction Rubs
n Caused by inflammation of pericardium

n Rough, scratchy, squeaky sound “like two

pieces of leather rubbing against each other
n Best heard with patient leaning forward,
holding breath in full expiration
n Clicks
 Let’s Review and Summarize

1. What techniques are used?

2. What specific areas are assessed
per specific technique?
3. What vital signs will be checked?
4. What is the importance of P.E.
 References
1. Hinkle and Cheever (2018) Brunner &
Suddarth’s Medical and Surgical Nursing,
14th Ed, Lippincott & Willims & Wilkins

1. Medina J, (2012) Critical Care & Emergency

Services, California Hospital Medical Center