Assessment of Client with

Cardiovascular Disease
 
The Health Assessment Interview

It is used to determine problems with

cardiac function as a part of a health screening,
or it may focus on a chief complaint. If the
client has a problem with cardiac function,
analyze its onset, characteristics, course,
severity, precipitating and relieving factors,
and any associated symptoms, noting the
timing and circumstances.
Physical Assessment
 Assess the heart through inspection, palpation,

and auscultation over the precordium

 The equipment needed includes a stethoscope

with a diaphragm and a bell, a good light

source, and a ruler
 The client may sit or lie in the supine position.

Movements over the precordium may be more

easily seen with tangenital lighting (in which
light is directed at a right angle to the area
being observed, producing shadows
 Apical impulse is a normal visible pulsation
(thrust) in the PMI
 Retraction is a pulling in of the tissue of the
precordium; a slight retraction just medial to
the PMI is normal
 Lift is a more sustained thrust than normal
 Heave is an excessive thrust
Apical Impulse Assessment with Abnormal
Findings
 Using the finger pads palpate the precordium for
symmetry of movement and the apical impulse for
location, size, amplitude, and duration
 An enlarged or displaced heart is associated with
an apical impulse lateral to the MCL or below the
5th ICS
 Decreased amplitude is associated with a dilated
heart in cardiomyopathy
 A thrill (palpable vibration over the precordium
or an artery) may accompany severe valve stenosis
Cardiac Rate and Rhythm Assessment with
Abnormal Findings

 A heart rate exceeding 100 BPM is

tachycardia. A heart rate less than 60 BPM is
bradycardia
 Palpate the radial pulse while listening to the
apical pulse
 If the radial pulse falls behind the apical rate,
the client has a pulse deficit, indicating weak,
ineffective contractions of the left ventricle
 Auscultate heart rhythm
 Dysrhythmias may be regular or irregular in
rhythm; their rates may be slow or fast. A
pattern of gradual increase and decrease in
heart rate that is within normal heart rate and
that correlates with inspiration and expiration
is called sinus arrhythmia
Heart Sounds Assessment with Abnormal
Findings
 Identify S1 and note its intensity
 An accentuated S1 occurs in tachycardia,
fever, mitral stenosis, and exercise
 A diminished S1 occurs with mitral
regurgitation, CHF and pulmonary or systemic
HTN
 Identify S2 and note its intensity
 An accentuated S2 may be heard with HTN,
mitral stenosis, CHF, and cor pulmonale
 A diminished S2 occurs with aortic stenosis and
pulmonary stenosis
 Identify extra sounds in systole
 Ejection sounds or clicks result from the opening
of deformed semilunar valves
 A midsystolic click is heard with mitral valve
prolapse
 Identify the presence of extra heart sounds in
diastole
 An opening snap results from the opening sound
of a stenotic mitral valve
 A pathologic S3 or ventricular gallop results from
myocardial failure and ventricular volume
overload
 A S4 or atrial gallop results from increased
resistance to ventricular filling after atrial
contraction
 A less common right-sided S4 occurs with
pulmonary HTN and pulmonary stenosis
 A combined S3 and S4 is called a summation
gallop and occurs with severe CHF
 A pericardial friction rub results from the
inflammation of the pericardial sac
Murmur Assessment with Abnormal Findings
 Identify any murmurs. Note location, timing,
presence during systole or diastole, and intensity
 Midsystolic murmurs are heard with semilunar
valve disease and hypertrophic cardiomyopathy
 A late systolic murmur is heard with MVP
 Middiastolic and presystolic murmurs such as
with mitral stenosis, occur with turbulent blood
flow across the AV valves
 Continuous murmurs throughout systole and all or
part of diastole occur with patent ductus arteriosus
Central Vessels
 A bruit (a blowing or swooshing sound) is
created by turbulence of blood flow due either
to a narrowed arterial lumen or to a condition
such as anemia or hyperthyroidism, which
elevates cardiac output.
 A thrill, which frequently accompanies a bruit,
is a vibrating sensation. It indicates turbulent
blood flow due to arterial obstruction
 Palpate the Carotid artery using extreme
caution
 Decreased pulsations may indicate impaired
left cardiac output. Thickening, hard, rigid,
inelastic walls indicate arteriosclerosis
 Inspect the jugular veins for distention while
the client is placed in a semi-Fowler’s position
(30° to 45° angle), with the head supported on
a small pillow
 Veins visibly distended indicate advanced
cardiopulmonary disease
Peripheral Vascular System
 Palpate the peripheral pulses on both sides of
the client’s body.
 Increased pulse volume may indicate HTN,
high cardiac output, or circulatory overload
 Inspect the calves for redness and swelling
over the veins. Palpate the calves for firmness
or tension of the muscles, the presence of
edema over the dorsum of the foot and areas of
localized warmth
 Firmly dorsiflex the client’s foot while
supporting the entire leg in extension
(Homan’s test)
 Inspect the skin of the hands and feet for color,
temperature
Capillary Refill Test

 Squeeze the client’s fingernail or toenail

between your fingers sufficiently to cause
blanching ( about 5 seconds)
 Release the pressure and observe how quick
normal color returns. Color normally returns
immediately in less than 2 seconds