Chapter 30/41 Cardiovascular Assessment

Arterial and Venous System First heart sound S1 (LUB!) S4

-arteries bring blood to the -occurs with the closure of the -always abnormal!!!
tissues and veins take blood t wo atrioventricular valves, -normally a person is in HF
away from the tissues back when the ventricles start to -Atrial gallop
to the heart contract -caused by an atrial
Anatomy of the Heart -systole (the pumping and contraction pushing
-KNOW IT! contraction phase) blood against a
Cardiac Cycle -S1 ventricle not accepting
Systole -closure of AV valves blood b/c of HF or other
-pumping phase, -mitral and tricuspid valves alterations
contraction! (M before T) -Occurs BEFORE S1
Events in the right and left -correlates with cartoid
side of the heart pulse Murmurs
-same events occurs, occurs -heard loudest at the apex -gentle blowing swooshing
slightly later in the right (tricuspid and mitral area) sounds
side Second heart sound S2 (DUB!) -listen for murmurs in the
-pressure in the right side is -produced by the closure of the same auscultatory sites
lower aortic and pulmonary valves with the bell
Diastole -occurs with diastole (the -heard on chest wall due
-filling phase, relaxation of filling and relaxation phase!) to turbulence
ventricles -closure of the semiunar valves -the velocity of blood
Auto-regulatory mechanism (aortic and pulmonic) increases (exercise,
of the heart -heard best over the aortic and pregnancy)
-supplied by t wo branches of pulmonic -viscosity of blood
the autonomic nervous Erb’s point (very close to decreases (anemia)
system pulmonic) -structureal defects in
-sympathetic -may hear more than one valves or chambers
(adrenergic)- fight or murmur, as murmurs may (narrow valves,
flight! overlap due to the proximity of incomplete valves, wall
-parasympathetic valves (use the bell side) defecs, dilated
(cholinergic)- rest and Extra Heart Sounds chambers
relax! -heard best over the apex of -a valve that does not
the heart while pt is lying on close effciently results in
Characteristics of Heart their left side the backflow of blood
Sounds S3 (insufficiency or
Pitch -ventricular gallop regurgitation)
High pitched- better heard -due to the premature rush of -a valve that does not
with diaphragm blood into the ventricle that is open wide enough may
Low-pitched- better heard still or dilated from HF and HTN cause backflow secondary
with bell -NORMAL in kids/ young adults to obstruction or
Intensity or someone really athletic narrowing (stenosis)
-loud, soft, bounding,etc -ABNORMAL in older adults-
Duration could signify HF
-short sounds, silent periods, -occurs after S2
normal “lub-dub”
Timing
-systole or diastole
Physical Assessment Palpation cont. Note the greater vessels
(cardiac) -palpate radial, brachial, of the neck!!
-general appearance carotid (NEVER AT THE -jugular vein (most
-mental status SAME TIME), abdominal accessible) and carotid
-VS aorta, femoral, popiteal (use artey
-pulses t wo hands), dorsalis pedis, -any distention? Could
-heart rate/ rhythm posterior tibial mean CHF
-perfusion -Grading system of pulses -right internal jugular
-edema (CHF) (0-4+) follows a more direct
-lung sounds -2+ is normal!! path to the right
-should be looking at -skin temperature atria
cardiac function: pain, -pitting edema? (This -carotid bruitis (brew-ee)
characteristics of pain, happens any time the heart -clot or cholestrol
fatigue, peripheral isnt working) build up
circulation, diet, past -depress pretibial area -use the bell, take a
history of cardiac and medial malleolus for deep breath and hold
conditions 5 seconds! (Grade 1+-4+ for a few seconds so
scale) we can hear lub-swish
Inspection -capillary refill -listen on the RIGHT
-pt should be supine -less than 2 seconds= side so have the pt
-semifolwers (45 degrees) normal turn their head to the
-inspect for visible left
palpations (you do NOT Auscultation -narrowing blood
want to see this), lifts -start with diaphragm then vessel that creates
(chest will vibrate), and use bell turbulent blood flow
heaves -listen for: -listen at carotid,
-point of maximal impulse -rate (normal, temporal (worry
(PMI) assess location at tachycardia, about stroke!),
apex (5th intercoastal bradycardia) abdominal aorta,
space) -rhythm (regular, renal, femoral, iliac
-peripheral vascular irregular)
assessment, look for: -identify S1 and S2 DVT
-skin temperature seperately (this is -blood clot, normally
-color normal!) unilateral
-pulses -listen at 6 landmarks -general signs
-cap refill -APETM (all physicians -leg pain, change in
-edema earn the money) skin color, edema,
-Aortic warmth in swelling
Palpation -Pulmonic area
-pt should be relaxed -Erb’s point -prevention is needed in
-palpate while you -Tricuspid the hospital due to
inspect! -Mitral prolonged immolbility
-PMI location -abnormal sounds -many false negatives
-left lateral position -dsyrhythmias
-peripheral vascular -extra heart sounds (S3 Ankle- brachial index test
assessment and S4) -should be equal
-palpate pulses -murmurs -checks for peripheral
bilaterally (should be arterial disease
equal!)
Heart Failure Cardiac Lab tests
-general signs -Ck or CK-MB
-short of breath -checks for inflammation
-cough (bc of poss -Troponin I
pulmonary edema) -does not rise
-weight gain immediately, rises later
(swelling and fluid, -lets us know something
the body is retaining happened to the heart
fluid) -LDH AST (SGOT)
-edema (body is -cholesterol and liver
retaining fluid) function study-> CVD can
-fatigue (legs are cause damage to other
heavy and the heart organs
isnt working -Lipids
effectively -PT/PTT
-the inability for the -tests how fast a pt can
heart to circulate blood clot
effectively enough to -ABGs
meet the body metabolic -arterial blood gas
demands measures exact O2 in
blood
Cardiac Risk Factors -Electrolytes
Nonmodifiable -are sodium/ potassium
-age affecting the heart?
-gender -CBC
-as we age, our
arteries/ ventricles Cardiac Function diagnostic
harden tests (least invasive to
-genetics most invasive)
-family history -EKG
-race/ethnicity -cardiac rhythm
-african americans -Stress test
are most at risk -Echo
-some cultures eat -Holter Monitor
more salt/fat -Cardiac Catheterization
Modifiable -Cardiac Angiography
-HTN
-diet and exercise
-Smoking
-quit!
-DM
-type II- related to
diet and exercise
-Physical inactivity
-Obesity
-High blood cholesterol