CARDIOVASCULAR

ASSESSMENT
HEART
▪ 2nd to 5th ICS; aligns with the right border of
sternum to the left midclavicular line

CHAMBERS
▪ 2 Atria
▪ 2 Ventricles

VALVES
▪ Atrioventricular Valves (Tricuspid & Mitral)
▪ Semilunar Valves (Pulmonic & Aortic)
CARDIAC CYCLE
▪ Systole – heart contracts and sends out blood
▪ Diastole – heart relaxes and is filled with blood

Diastole parts:
▪ Ventricular Filling – 70% of blood from the atria to
ventricles (by gravity)
▪ Atrial Contraction (Atrial Kick) – 30% of blood into the
ventricles

S1 – LUB
▪ Ventricular contraction (mitral valve & tricuspid valve
snap is closed)
S2 – DUB
▪ Atrial valve & pulmonic valve shut (the atria is filled with
blood for the next period of diastolic filling)
ARTERIES
▪ away from the heart; carries oxygenated blood
VEINS
▪ towards the heart; carries unoxygenated blood

ARTERIAL PULSES
▪ pressure waves of blood generated by the
pumping action of the heart.
GERIATRIC CONSIDERATIONS:
✓ Slight decrease in heart size
✓ Loss of cardiac contractile strength & efficiency
✓ Decrease cardiac output
✓ Thickening of heart valve
✓ Increase in left ventricular wall thickness
✓ Increase aortic rigidity
✓ Decrease ability to respond to physical &
emotional stress
✓ Diminish peripheral pulses
HEALTH HISTORY
✓ Chest / jaw pain/ pain on the extremities
✓ Irregular heart beat/ palpitation
✓ SOB on exertion or at rest, lying down
✓ Cough
✓ Cyanosis/ pallor
✓ Weakness, fatigue, unexplained weight loss
✓ Swelling on the extremities
✓ Dizziness, H/A, BP changes
✓ Family history
✓ Stress
✓ Habits – smoking, alcohol, caffeine
Equipment:
✓ Stethoscope
✓ BP cuff
✓ Ruler
✓ Penlight

✓ Remove all clothing except underwear; provide

gown
✓ Lie on back, 30-to-45-degree angle
✓ Stand on side of dominant hand
REMINDER:
ANGLE OF LOUIS
▪ Located 1” below the sternal notch, where the
manubrium and the body of sternum are joined
▪ 2nd ribs extend to the right and left of this angle
▪ Once the 2nd rib is located, palpate downward
and obliquely away from the sternum to identify
the remaining ribs and intercostals spaces
 INSPECTION
▪ General appearance
▪ Skin color, temp, turgor, texture, clubbed fingers
▪ Chest – pulsations, symmetry, heaves
▪ Locate the apical impulse or point of maximum
impulse (PMI)
- 5th ICS Left midclavicular
 NORMAL FINDINGS:

⦿ No bulges on chest
⦿ Apical impulse may or may not be
observable
⦿ No other pulsations over the chest, aside
from apical impulse
PALPATION
▪ Use the ball of hands to detect vibrations, or
thrills, which may be caused by murmurs
▪ Use fingertips or palmar surface to detect for
pulsations
❑ Aortic Area – 2nd R ICS, close to sternum
❑ Pulmonic Area – 2nd L ICS, close to sternum
❑ Tricuspid Area – use palm to detect any heaving or
thrusting of precordium; 5th R ICS, next to sternum
❑ Mitral Area – 5th ICS, left, midclavicular area
 NORMAL FINDINGS:

⦿ No thrills or other pulsations

⦿ Apical pulse should be felt in the left 5th ICS,

midclavicular area – sharp, quick impulse
 PERCUSSION
▪ Percuss from anterior
axillary line towards
the sternum along the
5th ICS
▪ Sound changes from
resonance to dullness
▪ Right border of heart
cannot be percussed
 AUSCULTATION
1. Aortic – base of the
heart
2. Pulmonic
3. ERB’s Point – 3rd ICS
4. Tricuspid
5. Mitral –apex of the
heart
PERICARDIAL
FRICTION RUB

- scratchy, rubbing
quality
- audible medical sign of
pericarditis.
 HEART MURMURS
▪ Turbulent blood flow caused by structural
defects in chambers & valves
▪ GRADE SYSTEM:
o I – barely audible murmur
o II – audible but quiet & soft
o III – moderately loud without thrust or thrill
o IV – loud with a thrill
o V – very loud, with thrust or thrill
o VI – loud enough to be heard before stethoscope
comes in contact
ADVENTITIOUS HEART SOUNDS
➢ S1 (“lub”) – systole; ventricular contraction; AV
valves closed; blood to lungs & system

➢ S2 (“dub”) – diastole; ventricular relaxation; SL

valves closed; blood filling

➢ S3 (lub-dub-“ta”) – ventricular gallop; normal in

children; abrupt ventricular distention

➢ S4 (“ta”-lub-dub) – atrial gallop; forceful atrial

ejection
 NORMAL FINDINGS:
⦿ 2 heart sounds heard – S1 & S2

⦿ Heart sounds in regular rate of 60 to 100

bpm

⦿ In athlete or jogger, the resting pulse may be

between 40 to 60 bpm
 VASCULAR SYSTEM
INSPECTION:
❑ Arms & legs – equal & symmetrical, lesions,
clubbing, edema
❑ Skin color & body hair distribution
❑ Neck
✓ Carotid artery – brisk, localized pulsation; no
changes in position changes
✓ Internal jugular vein – softer, undulating
pulsation; changes
PALPATION:
✓ Skin temperature
✓ Texture
✓ Turgor
✓ Capillary refill – not more than 3 seconds
✓ Edema
GRADING:
▪ +1= leaves slight imprint
▪ +2
▪ +3
▪ +4= deep imprint; slowly returns to normal
 PULSE PALPATION
▪ Regular in rhythm, equal in strength
▪ Cephalocaudal approach
▪ Gloves for femoral pulse
▪ GRADING:
0 = absent
1+ = weak
2+ = normal
3+ = increased
4+ = bounding
AUSCULTATION:

✓ Use bell – follow path of palpation

✓ Carotid artery
▪ N: No sounds heard
▪ Abn: Bruit – indicates arteriosclerotic plaque
formation
✓ Auscultate other sites
▪ Upper abdomen – (+) pulsation (AAA)
 ABNORMAL FINDINGS
1. CHEST PAIN – sudden, gradual, radiating,
steady, intermittent, mild or acute, sharp,
shooting, feeling of fullness, or indigestion

2. PALPITATION – conscious awareness of one’s

heartbeat (pounding, jumping, fluttering, missed,
or skipped beats)

3. FATIGUE – feeling of excessive tiredness, lack of

energy

4. Skin & Hair Abnormalities

ARTERIAL VENOUS INSUFFICIENCY
INSUFFICIENCY
PULSES: (+)/ difficult to palpate
PULSES: decreased/absent due to edema

▪ Cool, pale, shiny ▪ Cyanotic when on dependent

▪ Decreased hair position
▪ Ulceration - ankle
▪ (+) pain legs & feet
▪ DVT (thrombophlebitis)
▪ Ulceration - toes
▪ Varicosities
▪ Turns deep red on
dependent position
▪ Nails - thick & ridged
 TERMS
❑ BRUIT – murmur like sound of vascular in origin
(auscultation); blowing, swishing
❑ MURMUR – blowing, swooshing
❑ THRILLS – palpable vibration
❑ Heave – lifting of the chest wall felt during
palpation
❑ Cardiomegaly – abnormal enlargement of the
heart.
 ABNORMAL PULSATIONS:
1. Displaced apical impulse – enlarged L ventricle
(heart failure & HTN)
2. Forceful apical impulse – increased CO
3. Epigastric pulsation – early HF or AAA
4. Sternoclavicular pulsation – aortic aneurysm
5. Weak arterial pulse – decreased CO
6. Strong/bounding pulse – increased CO, HTN

ANEURYSM – balloon-like swelling in the wall of an

artery
Abnormal Sounds
Murmurs – due to turbulent blood flow
A. Cresendo – increasing intensity
B. Decresendo – decreasing intensity

Bruits – murmur-like sound of vascular rather

than cardiac in origin