ASSESSMENT OF THE NORMAL CARDIOVASCULAR SYSTEM

Anatomy Overview
1. Heart Anatomy:
o Location: The heart is located in the mediastinum, between the second and fifth intercostal spaces, from
the right border of the sternum to the left midclavicular line.
o Chambers and Valves: The heart has four chambers (right atrium, right ventricle, left atrium, left
ventricle) and four main valves (tricuspid, pulmonary, mitral, aortic).
2. Vascular System:
o Arteries: Carry oxygenated blood from the heart to the body.
o Veins: Return deoxygenated blood to the heart.
o Capillaries: Facilitate the exchange of oxygen, nutrients, and waste products between blood and tissues.
Physical Examination Steps
The assessment of the cardiovascular system involves inspection, palpation, and auscultation. These steps help in
evaluating the heart's function and identifying any abnormalities.
1. Inspection
 Position and Preparation:
o Ensure good lighting.
o Position the patient supine with the head of the bed elevated to 30-45 degrees.
o Expose the chest while maintaining patient privacy.
 Observation Points:
o General Appearance: Look for signs of distress, cyanosis, or pallor.
o Chest Wall: Observe for any visible pulsations, lifts, or heaves.
o Jugular Veins: Inspect the neck for jugular venous distension (JVD), which can indicate right-sided heart
failure.
o Precordium: Look for any abnormal movements over the heart area.
2. Palpation
 Technique:
o Use the pads of your fingers to palpate the chest wall.
 Palpation Points:
o Apical Impulse (Point of Maximal Impulse, PMI): Locate the PMI at the fifth intercostal space,
midclavicular line. Normally, it is a brief, gentle tap.
o Thrills: Palpate for any vibratory sensations, which can indicate turbulent blood flow due to a heart
murmur.
o Heaves/Lifts: Feel for any sustained lifts of the chest wall, which may indicate hypertrophy of the heart.
3. Auscultation
 Technique:
o Use both the diaphragm and bell of the stethoscope.
o Follow a systematic pattern to auscultate all valve areas: aortic, pulmonic, tricuspid, and mitral.
 Auscultation Areas:
o Aortic Valve: Second right intercostal space at the right sternal border.
o Pulmonic Valve: Second left intercostal space at the left sternal border.
o Tricuspid Valve: Fourth left intercostal space at the left sternal border.
o Mitral Valve: Fifth intercostal space at the left midclavicular line.
 Normal Heart Sounds:
o S1: The "lub" sound, indicating the closure of the mitral and tricuspid valves. Best heard at the apex.
o S2: The "dub" sound, indicating the closure of the aortic and pulmonic valves. Best heard at the base of
the heart.
o Splitting of S2: A physiological split can occur during inspiration.
 Additional Sounds:
 o S3: A low-pitched sound heard just after S2, often found in children and young adults. In older adults, it
may indicate heart failure.
o S4: A low-pitched sound heard just before S1, often indicating a stiff or hypertrophic ventricle.
Normal Peripheral Vascular Assessment
 Pulse Points:
o Assess radial, brachial, carotid, femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
o Note the rate, rhythm, amplitude, and symmetry of the pulses.
 Capillary Refill:
o Press on a fingernail or toenail until it blanches, then release and observe the time it takes to return to its
original color (normal is less than 2 seconds).
 Edema:
o Assess for any swelling in the extremities, which can indicate fluid retention.
Conclusion
The assessment of the cardiovascular system is a fundamental skill that involves careful inspection, palpation, and
auscultation. Recognizing normal findings is crucial for detecting any deviations that may indicate cardiovascular issues.
Always ensure patient comfort and privacy during the