CARDIOVASCULAR

SYSTEM

Jonalyn Sotero Esco RN., MAN.

Anatomy Of The Heart
 Cardiovascular disease affects people of all ages and
can take many forms.
 A consistent, methodical approach to your
assessment will help you identify abnormalities.
 As always, the key to accurate assessment is regular
practice which helps improve technique and
efficiency.
 Before you begin your physical assessment, you’ll need to obtain
a stethoscope with a bell and a diaphragm,
 An appropriate sized blood pressure cuff, a ruler, and a penlight
or other flexible light source.
 Make sure the room is quiet. Ask the patient to remove clothing
except hid underwear and to put on an examination gown.
 Have the patient lie on his back, with the head of the examination
table at a 30-40 degrees angle.
 Stand on the patient’s right side if you’re right-handed or his left
side if you’re left-handed as you can auscultate more easily.
1. Assessing the Heart
 As with assessment of other body systems, you’ll
inspect
palpate
Percuss
auscultate in your assessment of the heart.
A. Locate the following landmarks:
 Heart is located behind and to left of sternum with base at the top
and apex at the bottom.
 Find angle of Louis just below the suprasternal notch between
sternal body and manubrium (can be felt as bony prominence).
 Slip fingers down each side of angle to find the
second intercostal space.
 Space on client’s right is the :
1. Aortic arch area- 2nd right ICS
 Space on the left is the:
2. Pulmonic area- 2nd left ICS
 Carefully move fingers down left side of the
sternum to the third intercostal space.
3. Erb’s point- 3rd left ICS; left sternal border.
4. Tricuspid area- 4th to 5th left ICS; left lower sternal
border.
5. Mitral area- 5th left ICS; medial to the
midclavicular line.
6. Epigastric area-
 At the tip of the sternum
B. Use inspection and palpation simultaneously over
the six anatomic landmarks (Precordium):
Stand on client’s right side and view the chest at
an angle to the side.
 Look for visible pulsation. Palpate each site
alternating with the fingertips and ball of
the hand.
 If pulsation or vibrations are palpated, time their
occurrence in relation to systole and diastole by
auscultating heart sounds simultaneously.
C. Locate the Point of Maximal Impulse (PMI) by
palpating with fingertips along fifth intercostal space
in midclavicular line.

 In the presence of serious heart disease, the PMI

will be located to the left of midclavicular line.
D. If palpating PMI is difficult, turn client onto left
side (side lying position to the left side).
R- Maneuver moves the heart closer to the chest
wall.
E. Palpate and inspect the precordium, note visible
pulsation and more exaggerated lifts.

F. Inspect the epigastric area and palpate the

abdominal aorta. Note a localized strong beat.
R- Rules out reduced blood flow or diffused pulse,
which may indicate a number of abnormalities.
G. Auscultate for heart sound.
 Depending on the extent of examination, client may
be asked to assume three different positions:
1.Sitting up 2. leaning slightly forward 3.supine
and left lateral recumbent.
R- Different positions help to clarify type of sounds
heard. Sitting position is best to hear high pitched
murmurs if present. Supine is common position to hear
all sounds. Left lateral recumbent is best position to hear
low pitched sound.
H. While auscultating sounds, ask client not to speak.
 Begin with the diaphragm of the stethoscope, then
alternate with the bell.
 Then do not press bell too firmly against chest wall
because transmissions of sound will be destroyed
or it will not give the perfect sound.
 Normal sound S1 and and S2 are high pitched and
best heard with diaphragm.
Examiner must get familiar with this sound.
How?
1. Begin at the apex or PMI then move systematically
to the tricuspid area, Erb’s point and pulmonic
and aortic area ( some examiner use reverse
sequence).
 At normal slow rates S1 is high pitched and dull
in quality and sounds like a “lub”. It precedes
the systolic phase of contraction. S1 best heard
at the apex.
2. Listen for S2 at each site. It precedes the diastolic
phase and sound like “dub”.
 It is best heard at the aortic area.
3. After both sounds are heard clearly as “lub” “dub”
count each combination of S1 and S2 as one
heartbeat.
 Count the number of beats in one minute.
R- This determines apical pulse rate.
4. Assess the heart rhythm by noting the time
between S1 and S2 (Systole) and then time between
S2 and the next S1 (Diastole).
 Listen to the full cycle at each auscultation area.
 Note regular intervals between each sequence of
beat.
 There should be a distinct pause between S1 and
S2.
Common type of Dysrhythmias
1. Sinus dysrhythmias- Pulse rate changes during
respiration, increasing at peak of inspiration and
declining during expiration.
Cause: Blood is momentarily trapped in lungs
during inspiration, causing a fall in the heart’s
stroke volume.
2. Sinus tachycardia- Pulse rhythm is regular, but the
rate is accelerated to more than 100 beats per
minute.
Cause: Exercise emotional stress, caffeine and
alcohol ingestion are common factors that cause
increase firing of the Sino atrial node.
3. Sinus bradycardia- Pulse rhythm is regular, but the
rate is slower than normal at 40- 60 beats per
minute.
cause: The sinoatrial node fires less frequently.
This is common in well conditioned athletes.
And with the use of antidysrythmic
medications.
4. Premature ventricular contraction- premature beat
occurs before regularly expected heart contraction.
Cause; the ventricle contract prematurely because of
electrical impulse bypassing the normal conduction
pathway. It may occur so early that it is difficult to detect
as a second beat. It may be followed by a pause.
Normal
5. Atrial fibrillation- Rapid random contractions of
atria cause irregular ventricular contraction beats
130 to 150 beats per minute.
Cause: atria discharge very rapidly, with some
impulses not reaching the ventricle. This
conditions occurs in rheumatic heart disease
and mitral stenosis.
5. When heart rate is irregular, compare apical and
radial pulse.
 Auscultate the apical pulse and then immediately
palpate the radial pulse. A colleague assess the
radial pulse while the nurse assess the apical.
R- Determines if a pulse deficit (radial pulse is
slower than apical). Deficits indicates that
ineffective contractions of the heart fail to send pulse
waves to the periphery (side muscles of the heart).
9. Continue to auscultate for extra sounds..
a. Use the bell of the stethoscope and listen for
low pitched gallops, click and rubs.
R- S3, or a ventricular gallop, occurs just after S2
at the end of ventricular diastole.
- It sounds like “lub-dub- ee” or “kentucky”
- S4, or an atrial gallop occurs just before S1
or ventricular systole. And sounds like “dee-
lub- dub” or ‘Ten-nes-see”
 Gallops may be caused by premature rushes of
blood into a ventricle or an atrial contraction
pushing against a ventricle that is not accepting
blood.
b. Listen for clicks- shot high pitched extra sounds.
R- Clicks are caused by abnormalities such as
mitral valve, prolapse or prosthetic valves.
c. Listen for friction rubs- squeaky or rubbing sounds.
R- rubs are result of inflamed visceral and parietal
layers of the pericardium rubbing against one another.
 To listen for a pericardial friction rub, have the patient
sit upright, lean forward, and exhale.
 Listen with the diaphragm of the stethoscope over the
third intercostal space on the left side of the chest.
 Scratchy rubbing quality. If you suspect a rub but
have trouble hearing one, ask the patient to hold his
breath.
10. Auscultate for heart murmurs over each of the
auscultation sites. Note location, timing (in relation
to systole or diastole) in relation to radiation,
loudness and pitch.
R- Murmurs are sustained swishing or blowing
sound heard at the beginning, middle or end of
systole or diastole.
- they are caused by increased b;ood flow
through a normal valve.
 a. listen for a murmur over areas besides where it is
heard best.
R- assess for radiation
b. Note if the murmur is low, medium, or high in
pitch. You used the bell for low pitched sound.
When recording your findings, use Roman numerals as part of
a fraction, always with VI as the denominator. For example, a
grade III murmur would be recorded as “grade III/VI.”
1. Grade I is a barely audible murmur.
2. Grade II is audible but quiet and soft.
3. Grade III is moderately loud, without a thrust or thrill.
4. Grade IV is loud, with a thrill.
5. Grade V is very loud, with a thrust or a thrill.
6. Grade VI is loud enough to be heard before the stethoscope
comes into contact with the chest.
 The best way to hear murmurs is with the patient
sitting up and leaning forward.
 You can also have him lie on his left side.
 If heart sounds are faint or undetectable, try
listening to them with the patient seated and leaning
forward or lying on his left side, which brings the
heart closer to the surface of the chest.
Assessing the Vascular
System
 ASSESSMENT OF NECK VESSELS

1. Position client properly- have client remain in

sitting position.
R- allows easier mobility of the neck to expose
artery for inspection and palpation.
2. Inspect neck on both sides for obvious palpation of
artery. Ask client to turn head away slightly from artery
being examined. Sometimes pulse wave can be seen.
R- Carotids are only sites to assess quality of
pulse wave.
2. Palpate carotid artery separately.
a. Slide index and middle fingers around medial
edge of sternocleidomastoid muscle.
b. Ask client to turn head slightly toward the
side being examined.
c. Note rate and rhythm, and strength of artery.
d. Also note if pulse changes as client inspires
and expires.
e. Place bell of stethoscope over each carotid
auscultate for bruit sound.
Note: Don’t palpate both carotid arteries at the same time or press too
firmly. If you do, the patient may faint or become bradycardiac
3. Assess jugular veins
a. Have the client lie in supine with head
elevated 30 to 40 degrees.
b. Keep neck and upper thorax expose.
c. Avoid neck hyperextension or flexion.
d. Assess jugular vein distention.

NORMAL
Blood Vessels
 The vascular system delivers an oxygen, nutrients,
and other substances to the body’s cell and
removes the waste products of cellular metabolism.
 The peripheral vascular system consists of a
network of arteries, arterioles, capillaries,
venules, and veins that’s constantly filled with
about 5 L of blood.
Assessing the Vascular System
 Assessment of the vascular system is an important part of
a full cardiovascular assessment.
 Examination of the patient’s arms and legs can reveal
arterial or venous disorders.
 Examine the patient’s arms and when you take his vital
signs.
 Check the legs during the physical examination, when the
patient is lying on his back.
 Remember to evaluate leg veins when the patient is
standing.
 Physical
Assessment
Of The
Arms
Inspection
 Start your assessment of the vascular system the
same way you start as assessment of the cardiac
system by making general observations.
 observe arms size and venous pattern; also look for
edema.
 Observe coloration of hands and arms.
 Note how body hair distributed.
Palpation
 Palpate the client’s fingers, hands, and arms and
note the temperature.
 Palpate to assess capillary refill. Inaccurate reading
may result if the room is cool, if the client has
edema, anemia or if the client recently smoked a
cigarette.
 Palpate the radial pulse.
 Palpate ulnar pulse
Palpation
 You can palpate the brachial pulse if you suspect
arterial insufficiency.
 Palpate epitrochlear lymph nodes
 Perform the Allen test.
 Note lesions, scars, clubbing, and edema of the
extremities.
 If the patient is confined to bed, check the sacrum
for swelling.
 Examine the fingernails and toenails for
abnormalities.
 Physical
Assessment
Of The
Legs
 Ask patient to lie supine.
 Inspect distribution of hair.
 Inspect for lesions or ulcer.
 inspect for edema.
 Palpate bilaterally for temperature of the feet and
legs.
 Palpate the superficial inguinal lymph nodes.
 Palpate the femoral pulses.
 Palpate the popliteal pulses. If you cannot detect a
pulse, try palpating with the client in a prone
position.
 Palpate the dorsalis pedis pulses. It may be difficult
or impossible to palpate a pulse in an edematous
foot.
 palpate the posterior tibial pulses.
 inspect for varicosities or thrombophlebitis.
 Check for Homan’s sign.
 Special Test For Arterial Or Venous Insufficiency:
1. Ankle- brachial pressure index- The ankle-brachial
pressure index (ABPI) or ankle-brachial index
(ABI) is the ratio of the blood pressure at the ankle
to the blood pressure in the upper arm (brachium).
Compared to the arm, lower blood pressure in the leg
suggests blocked arteries due to peripheral artery
disease (PAD).
2. Manual compression test-
Perform the manual compression test by
having the patient stand and placing your
right hand over the distal lower part of the
suspected varicose vein and your left hand
over the proximal vein.
Your hands will be about 15-20 cm apart.
Compress the proximal portion of the vein
To test venous valve competence in
patients with varicose vein.
If no wave felt with the lower hand, the
patient have Competent valves.
If wave was felt, incompetent Valves
3. Retrograde filling ( trendelenburg test):occurs
when valves are incompetent, leading to varicose
veins.
 to assess valvular competency in both
communicating veins and saphenous system
patient will be placed in supine position.
- Raise one leg to 90 degrees ( to empty venous blood)
- Occlude great saphenous vein in the upper thigh by
manual compression
Keep the vein occluded ask the patient to stand ,
watch for venous filling in the leg ---- 35 sec
- after patient stand for 20 sec release the compression
and look for sudden additional filling ----- none
Start your inspection by observing vessels in the neck:
 The carotid artery should have a brisk, localized
pulsation.
 The internal jugular vein has a softer, undulating
pulsation.
 The carotid pulsation doesn’t decrease when the
patient is upright, when he inhales, or when you
palpate the carotid.
 On the other hand, changes in response to position,
breathing, and palpation.
 Check carotid artery pulsation.
Are they weak or bounding?
 Inspect the jugular veins.
 Inspection of these vessels can provide information
about blood volume and pressure in the right
side of the heart.
Assess each peripheral artery for following
characteristics.
 Palpation of peripheral arteries determines
adequacy of blood flow to extremities.
a. Elasticity of vessel wall (Depress and release
artery, noting ease with which it springs back to
shape).
 Determines integrity of vessels. Arteries
should be easily palpable and should return
to shape after pressure is released.
b. Rate and rhythm of pulse (measure the rate for 1
minute)
 radial pulse is chosen to assess heart rate. Other
peripheral pulses are assessed only to determine
condition of local blood flow.
c. Strength of pulse
 Measure of force ejecting blood against arterial
wall.
Rating scale for strength:
1. 0+ No pulse is palpable
2. 1+ Pulse is difficult to palpate, weak and thready
in character.sy to obliterate.
3. 2+ Pulse is less difficult to palpate, light pressure
usually locate it, discriminating touch senses it is
stronger than 1+.
4. 3+ Normal pulse, easy to palpate, not easily
obliterated.
5. 4+ Strong pulse, easily palpated, bounds
against fingertips, cannot be obliterated
d. Type of pulse
 Useful in describing nature of pulse wave,
requires experience
Pulse- the pressure of the blood felt against the
wall of an artery as the heart alternately
contracts(beats) and relaxes( rests)
1. Temporal pulse- located on the temple directly in
front of the ear (superficial temporal artery).
2. Carotid pulse- found in the neck
3. Radial pulse- the pulse site found on the inside of
the wrist. thumb side
Palpate radial pulse by lightly placing tips of first
and second fingers in groove formed along radial
side of forearm, lateral to flexor tendon of wrist.
 Pulse is relatively superficial and should
not require deep palpation.
4. Ulnar pulse - located on the medial of the wrist
(ulnar artery).
 Palpate ulnar pulse by placing fingertips along
ulnar side of forearm.
 Palpated when arterial insufficiency to hand is
expected or when norse assesses effects radial
occlusion might have on circulation to hand.
5. Brachial pulse- Pulse felt in bend of either arm
(inner side - follow arm up from pinkie finger)
 Palpate brachial pulse by locating groove between
biceps and triceps muscles above elbow at
antecubital fossa. Place tips of first three fingers in
muscle groove.
 Artery runs along medial side of extended arm,
requiring moderate palpation.
6. Femoral pulse- Pulse felt on either side of the groin
 With client supine, palpate femoral pulse by
placing first three fingers over inguinal area below
inguinal ligament, midway between pubic
symphysis and anterosuperior iliac spine.
 Supine position prevents flexion in groin area,
which interferes with artery access.
7. Popliteal pulse- pulse located behind each knee
 Palpate the popliteal pulse by having client slightly
flex knee with foot resting on table or bed.
Instruct client to keep leg muscles relaxed. Palpate
deeply into popliteal fossa with fingers of both
hands placed just lateral to midline.
 Client may also lie in prone position to achieve
exposure of artery.
 Flexion of knee and muscle relaxation improve
accessibility of artery.
Popliteal pulse is one of the more difficult pulses to
palpate.
5. Apical pulse- pulse taken with a stethoscope and
near the apex of the heart
8. Dorsalis pedis- pulse located on top of the foot
 Have client lie in supine and relaxed and palpate
dorsalis pedis pulse. Gently place fingertips between
great and first toe and slowly move along groove
between extensor tendons of great and first toe, until
pulse is palpable.
 Artery lies superficially and does not require deep
palpation. Pulse may be congenitally absent.
9. Posterior tibial pulse - located near the medial
malleolus and the Achilles tendon's insertion point.
 Palpate posterior tibial pulse by having client relax
and slightly extend feet. Place fingertips behind
and below medial malleolus (ankle bone).
 Artery is easily palpable with foot relaxed.
 In some cases, if it is difficult to palpate a pulse or
the pulse is not palpable the person assessing
can use an ultrasound stethoscope over the pulse
site.
Perform the modified Allen est
1. Have client make tight fist.
 Removes much bleed flow from hand as
possible.
2. Apply direct pressure to both radial and
ulnar.
3. Have client open hand.
 Fingers and hand should be pale and blanched
indicating of lack arterial blood flow.
4. Release pressure over ulnar artery; observe color of
fingers, thumbs and hand.
 fingers and hand should flush within 15
seconds.
 Flushing is a positive Allen’s test.
 If test is negative (no flushing). Radial artery
should be avoided. Check other hand.
 If collateral circulation is present through ulnar
artery, hand and fingers flush. Ulnar artery is
capable of supplying blood flow to hand if
radial artery is damaged or becomes occluded.
Check Capillary Refill:
Note: After assessing the upper extremities, check capillary
refill and after assessing the lower extremities check also the
capillary refill.
The capillary nail refill test is a quick test done
on the nail beds.
It is used to monitor dehydration and the amount
of blood flow to tissue.
 Normal capillary refill time is usually less than 2
seconds.
How the Test is Performed:
Pressure is applied to the nail bed until it turns white.
This indicates that the blood has been forced from the
tissue. It is called blanching. Once the tissue has
blanched, pressure is removed.
While the person holds their hand above their heart,
the health care provider measures the time it takes
for blood to return to the tissue.
Return of blood is indicated by the nail turning back to
a pink color.
Assess Pitting Edema
 Observable swelling of body tissues due to fluid
accumulation that may be demonstrated
by applying pressure to the swollen area
(such as by depressing the skin with a
finger).
How to assess the pitting edema
1. Observe for edema of the foot, ankles and legs.
2. Gently compress the patient's soft tissue with your
thumb over both shins for a few minutes.
3. Observe for indentation.
Note: In bed-ridden patients,
examine for edema over
the sacral and coccygeal
areas.
Normal: there is no indentation.
Homan's sign-
 Is often used in the diagnosis of deep venous
thrombosis of the leg.
A positive Homan's sign (calf-sural pain at
dorsiflexion of the foot) is thought to be
associated with the presence of thrombus
(blood clot)
Technique
1. In performing this test the patient will need to
actively extend his knee.
2. Once the knee is extended the examiner raises the
patient’s straight leg to 10 degrees, then
passively and abruptly dorsiflexes the foot and
squeezes the calf with the other hand.
3. Deep calf pain and tenderness may indicate
presence of DVT(deep vein thrombosis).
• DVT – deep vein thrombosis
- a serious condition that occurs when blood clot forms in a
vein located deep inside the body. A blood clot is a clump of
blood that turned to a solid state.
Deep vein blood clots typically form in the thigh or lower leg,
but they may also develop in other areas of the body.


 ABNORMAL ASSESSMENT
FINDINGS OF THE
CARDIOVASCULAR SYSTEM
1. Fatigue due to
a. Anemia – fatigue following mild activity, pallor,
tachycardia, dyspnea.
b. Depression – persistent fatigue unrelated to
exertion, headache, anorexia, constipation, sexual
dysfunction, loss of concentration, irritability.
c. Valvular heart disease – progressive fatigue, cardiac
murmur, exertional dyspnea, cough, hemoptysis
(coughing up of blood or blood stained mucus from the bronchi, larynx,
trachea or lungs).
2. Palpations due to
a. Acute anxiety attack – paroxysmal palpations,
diaphoresis, facial flushing, trembling, impending sense
of doom, hyperventilation, dizziness.
b. Cardiac arrhythmias – paroxysmal or sustained
palpations, dizziness, weakness, fatigue, irregular,
rapid, or slow pulse rate, decreased blood pressure,
confusion, diaphoresis.
c. Hypoglycemia – sustained palpation, fatigue,
irritability, hunger, cold sweats, tremors, anxiety.
3. Peripheral Edema due to
a. Heart failure – headache, bilateral leg edema with pitting
ankle edema, weight gain despite anorexia, nausea, chest
tightness, hypotension, pallor, palpations, inspiratory crackles.
b. Superior vena cava syndrome – bilateral arm edema
accompanied by facial and neck edema, edematous areas
marked by dilated veins, headache, virtigo, visual
disturbances.
c. Venous insufficiency – moderate to severe, unilateral or
bilateral leg edema, darkened skin, stasis ulcers around the
ankle.
Chest Pain
Chest pain can arise suddenly or gradually, and its
cause may be difficult to ascertain initially.
The pain can radiate to the arms, neck, jaw, or back.
It can be steady or intermittent, mild or acute.
In addition, the pain can range in character from a
sharp, shooting sensation to a feeling of
heaviness, fullness or even indigestion.
Chest pain may be caused by various disorders.

Common cardiovascular causes include angina,

myocardial infarction, and cardiomyopathy.

Chest pain may be provoked or aggravated by

stress, anxiety, exertion, deep breathing, or eating
certain foods.
Use the following to help you more
accurately assess chest pain
1. Aching, squeezing, pressure, heaviness, burning
pain; usually subsides within 10 minutes located in
substernal areas; may radiate to jaw, neck, arms, and
back.
a. Worsened by eating, physical effect, smoking,
cold weather, stress, anger, hunger, lying down;
relieved by rest, nitroglycerin, and oxygen
(note: unstable angina appears even at rest).
b. Due to angina pectoris.
2.Tightness or pressure; burning, aching pain, possibly
accompanied by shortness of breath, diaphoresis,
weakness, anxiety, or nausea; sudden onset; last 30
minutes to 2 hours found
typically across chest but may radiate to jaw,
neck, arms, or back.
a. Worsened by exertion, anxiety and relieved by
opioid analgesics such as morphine sulfate, nitroglycerin,
oxygen, reperfusion of blocked coronary artery.
b. Due to acute myocardial infarction.
3. Sharp and continuous; may be accompanied by
friction rub; sudden onset found in substernal
regions; may radiate to neck or left arm.
a. Worsened by deep breathing, supine position
and relieved by sitting up, leaning forward,
anti-inflammatory drugs.
b. Due to Pericarditis.
4. Excruciating, tearing pain; may be accompanied by
blood pressure difference between right and left
arm; sudden onset found in retrosternal areas, upper
abdominal, or epigastric; may radiate to back, neck,
or shoulders.
a. Due to dissecting aortic aneurism.
b. Relieved by analgesics, surgery.
5. Sudden, stabbing pain; may be accompanied by
cyanosis, dyspnea, or cough with hemoptysis over
lung area.
a. Due to Pulmonary embolus.
b. Worsened by inspiration, relieved by analgesics.
6. Sudden and severe pain, sometimes accompanied
by dyspnea, increased pulse rate, decreased breath
sounds (especially on one side), or deviated trachea
found in lateral thorax.
a. Worsened by normal respirations, relieved by
analgesics, chest tube insertion.
b. Due to pneumothorax.
7. Dull pressure like, squeezing pain found in
substernal, epigastric areas
a. Worsened by food, cold liquids, exercise,
relieved by nitroglycerin, calcium channel
blockers.
b. Due to esophageal spasm.
8. Sharp severe pain in the lower chest or upper
abdomen worsened by a heavy meal, bending, lying
down.
a. Due to hiatal hernia and relieved by antacids,
walking, semi-Fowler’s position.
9. Burning feeling after eating sometimes
accompanied by hematemesis or tarry stools: sudden
onset that generally subsides within 15 to 20
minutes found in the epigastric area.
a. Worsened by lack of food or highly acidic
foods due to peptic ulcer.
b. Relieved by antacids.
10. Gripping, sharp pain; possibly nausea and
vomiting found in the right epigastric or abdominal
areas; possible radiation to shoulder.
a. Worsened by eating fatty food, lying down,
relieved by rest analgesics, surgery.
b. Due to cholecystitis.
11. Continuous or intermittent sharp pain; possibly
tender to touch; gradual or sudden onset found
anywhere in chest and worsened by movement.
a. Due to chest wall syndrome.
b. Relieved by time, analgesics, and heat
applications.
12. Dull or stabbing pain usually accompanied by
hyperventilation or breathlessness; sudden onset;
lasting less than 1 minute or as long as several day
found anywhere in chest.
a. Worsened by increased respiratory rate, stress
or anxiety and relieved by slowing of
respiratory rate, stress relief.
b. Due to acute anxiety.
Palpitation
Palpitations, defined as a conscious awareness of one’s
heartbeat are usually felt over the precordium or in the
throat or neck.
The patient may describe them as pounding, jumping,
turning, fluttering or flopping, or as missed or skipped
beats.
Palpitations may be regular or irregular, fast or slow,
paroxysmal or sustained. Although usually insignificant,
palpations may result from a cardiac or metabolic
disorder or from the effects of certain drugs.
Non-pathologic palpations may occur with a newly
implanted prosthetic valve because the valve’s
clicking sound heightens the patient’s awareness of
his heartbeat.
Transient palpations may accompany emotional
stress (such as fright, anger, or anxiety) or
physical stress (such as exercise or fever).
Stimulants such as tobacco and caffeine may also
cause palpation.
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