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Assessment of Cvs
Assessment of Cvs
CARDIOVASCULAR SYSTEM
Prepared By:
Sataish Amanat
OBJECTIVES
By the end of the unit, learners will be able to:
1. Describe the components of health history that should be elicited during the assessment of
cardiovascular system.
2.Identify the landmarks of the chest.
Describe the following:
Pulse rate, rhythm and pulsation
characteristics
PMI
Heart sounds
Discuss systolic and diastolic
murmurs
4. Assess the cardiovascular system
systematically.
ANATOMY OF THE HEART
◾ Four Chambers:
◾ Four Valves:
◾ Right atrium ◾ Two atrio-ventricular
◾ Left atrium (AV)
1. Tricuspid
◾ Right ventricle
2. Mitral
◾ Left ventricle
◾ Two semilunar (SL)
1. Pulmonic
2. Aortic
Blood Flow
S1: (Lub) Closure of Tricuspid and Mitral valve.
S2: (Dub) Closure of Pulmonic and Aortic valve.
Relevant Subjective Data
1. Chest pain
2. Dyspnea
3. Cough
4. Fatigue
5. Cyanosis or pallor
6. History of edema
7. Past cardiac history
8. Family cardiac history
9. Personal habits
10. Medications history
11. Smoking history
Preparation for Assessment
Room that is warm and “quiet”
Examining table be positioned so that you can
stand on the patient’s right side
Patient should wear a gown to ensure privacy
A watch with seconds
Stethoscope with diaphragm and bell
BP apparatus
Two scales
A light source (torch)
ASSESSMENT- CHEST PAIN
Onset
Duration
Frequency
Precipitating
factors
Location
Radiation
Quality
Intensity
PNEUMONIC……PQRSTU
◾ P- Provocative and palliative (Worse/Better)
◾ Q- Quality and Quantity (How bad)
◾ R- Region and radiating
◾ S- Severity
◾ T- Time (When did)
◾ U- Understanding (What do you think is causing the pain)
PNEUMONIC….SOAPIER
S- Subjective assessment
O- Objective assessment
A- Analysis / Diagnosis
P- plan of the treatment
I- Intervention
E- Evaluation
R- Review
EXAMINATION SEQUENCE
Examination of the CVS consists
of:
1. Examination of Pulses
2. Measurement of BP
3. Examination of Neck Vessels
4. Examination of Precordium by:
Inspection
Palpation
Percussion
Auscultation
Assessment of the Peripheral Vascular System
4) Pulsus paradoxus
This is an exaggeration of a normal phenomenon in which pulse either
becomes weak, drop (10mmHg or greater) or impalpable during
inspiration. (seen in cardiac temponade & constrictive pericarditis)
5) Pulsus alternans
A strong beat is followed by a weak beat but the interval between beats
is constant and rhythm is regular (SVT and ventricular failure).
6) Pulsus bigeminus
Similar to pulsus alternans but interval between the beats is
variable. Digoxin toxicity is the most common cause.
MEASUREMENT OF B.P
Apply the cuff closely to the upper arm so that its lower
border is not less than 2.5 cm above the cubital fossa &
tubing is on the medial side.
Pulse pressure
Normal : 70-100
It is the difference between systolic and diastolic pressure (normal ranges
30-60 mmHg).
Silent Gap
In some hypertensive patients, the Korotokof sounds
disappear for sometime between systolic and
diastolic pressure. This is called silent gap.
THE NECK VESSELS
The Carotid Artery
The Jugular Venous
Pulse & Pressures
Jugular vein has
2 components:
(a) internal
jugular
(b) external
THE NECK VESSELS
A. Carotid Arteries
Palpation
Use the flat of the palm starting from the lower part of the left side of
the chest, then along the left parasternal border & finally upper part of
the right side of the chest.
Note the following:
Apex beat
Left
parastern
al heave
(Heel of the
hand is lifted
PALPATION CONTINUE….
The Apex Beat: It is defined as the outermost & lowermost part of
the precordium where a definite cardiac impulse is felt.
Location of apex beat
Normally it is located in the 5th ICS, 1cm medial to the Mid-clavicular line (MCL).
In children less than 7-years of age, the apex beat is located in the 4th intercostal space,
lateral to the mid clavicular line.
Shift of apex beat occurs if left ventricle is enlarged.
Causes of impalpable apex beat can be:
Thick chest wall
Emphysema
Pericardial effusion
Dextrocardia (Heart is in the right chest and therefore, apex beat will be palpable on
the
right side)
PALPATION CONT…
Character of the Apex Beat
Normally apex beat is neither forceful (tapping) nor does it lift the palpating finger (heaving).
For the left border, percuss in the 3rd to 5th ICS laterally to medially,
starting in the axilla.
Venous Hum
A continuous murmur like sound audible in the neck due to kinking of
larger neck veins. It is common in children.
MURMURS
Abnormal sounds, of longer duration as compared to normal
heart
sounds. Any of the following mechanisms may be responsible.
Velocity of blood increases across a normal valve
(e.g. exercise, thyrotoxicosis).
Flow of normal amount of blood across a narrowed
valve
(e.g. aortic or mitral stenosis)
Structural defect in the valves or an unusual opening occurs in the
chambers (ASD,VSD).
Back flow of blood across abnormal valves (aortic
and
SYSTOLIC MURMURS (TWO TYPES)
Pansystolic
It starts with S1 & goes up to or beyond S2. (mitral
and tricuspid regurgitation, VSD).
Ejection Systolic Murmur
It starts slightly after S1 ends before S2. (Aortic
and pulmonary stenosis).
DIASTOLIC MURMURS (TWO TYPES)
Mid Diastolic Murmur
It is audible in the middle of diastole (Mitral and tricuspid stenosis,
ASD).
Early Diastolic Murmur
It is audible soon after S2 (aortic and pulmonary regurgitation).
PAROXYSMAL NOCTURNAL DYSPNEA
◾ Paroxysmal refers to symptoms that come on and pass quickly.
◾ Nocturnal refers to occurring at nighttime or during sleep.
◾ Dyspnea refers to difficult or uncomfortable breathing.
◾ PND causes difficulty breathing during sleep, causing people to
wake up due to
shortness of breath.
GRADING OF MURMURS
Murmurs are graded according to their intensity. Use VI point grading
scale and record as a fraction i.e. I/VI or II/VI)