Welcome to this video on Cardiovascular assessment
We will be looking at the various aspects of assessment that are necessary to get a good overview of a patient's cardiac condition
It's important to look at the subjective data or the patient's point of view
and the objective data. The aspects of a patient that are measurable with examination and tests.
These include inspection - looking at the patient -
palpation - feeling the patient -
and auscultation listening to the patient's heart.
Subjective Data allows you to gather the patient's common or concerning symptoms including:
Chest pain, where is the pain? When does it occur?
Describe the intensity, type, duration.
Does it radiate?
Does it come with or without exertion any?
Associated symptoms, such as shortness of breath,
sweating, nausea, palpitations, or anxiety
Does anything alleviate or aggravate the pain?
Does the patient have palpitations?
Ask if they have a sensation of racing skipping fluttering pounding or stopping of the heart
Does the patient have shortness of breath or dyspnea difficulty breathing?
Does it occur with lying down and relieved by sitting up?
Does it occur when they bend over or when they cough?
Swelling or edema when is it worse morning or evening?
Does it improve with elevation?
Ask the patient about their history and risk factors such as personal or family history
of heart disease including hypertension
Type 2 diabetes physical activity
smoking status diet and alcohol, or drug use.
Thrombophlebitis
bleeding disorders or easy bruising
Gather information regarding the patient's usual activity
such as prolonged standing walking or sitting
Does the patient experience pain in the legs during activity?
numbness or tingling
aching or cramping
swelling in the legs or feet
As the patient had any skin changes such as redness or power cold skin visible veins or lower leg ulcers
Elderly patients may complain of chest pain or they may have less obvious complaints related to a myocardial infarction
Such as dyspnea diaphoresis
Nausea and vomiting or syncope
Ask the older patient about the dizziness Syncope confusion or orthostatic hypotension
these symptoms may be related to heart or circulatory changes and
Indicate a reduced blood supply to the brain.
It is important to gather accurate objective data
including vital signs and height and weight.
Which will provide valuable information about cardiovascular function
Height and weight trends assess fluid and nutritional status
Abrupt weight change will indicate fluid gain or loss.
Weight loss over months or years may indicate advancing cardiovascular disease and be a sign of poor nutrition and muscle wasting
Weight should be measured first thing in the morning after urination, but before dressing or eating
When checking vital signs take the blood pressure pulse and respirations near the same time.
Be sure to use the appropriate blood pressure cuff size.
If the cuff is too large readings will be artificially low
and if the cuff is too small the readings will be artificially high.
If you obtain an abnormal vital sign recheck it to make sure you're getting an accurate reading.
Aspects of objective data include inspection
Begin your inspection when you first encounter the patient looking at their general appearance are they thin or obese?
What is their level of alertness anxious drowsy or Lethargic?
What about skin color Turgor texture and temperature are?
Mucous Membranes Pale
Due Fingers have clubbing or cyanosis
Observe for pulsations or retractions and symmetry of movement of the chest wall while the patient is sitting or lying flat?
Examine the extremities
for arterial or venous disorders
Noting symmetry edema weeping lesions scars and skin colour
Check for Jugular vein distension or JVD by positioning the patient on their back
Elevating the head of the bed 45 degrees and turning the patient's head slightly away from you
Look for our pulsation in the neck that occurs in several waves with each cardiac cycle
If you see a pulsation and are not sure if it's JVD or the carotid pulse
Palpate the radial pulse while watching the neck
and if the single pulsation in the neck coordinates with the radial pulse
You are seeing the carotid pulse
Normally the jugular veins are not distended when the head is elevated at 45 degrees
Palpation is sometimes overlooked, but still an important aspect of a cardiovascular assessment
Palpate the apical Impulse noting the size location Intensity
amplitude and duration it should be a gentle pulsation that coincides with the carotid pulse
Palpate the patient's extremities to assess skin temperature texture Turgor and edema
Edema is measured on a 4-point scale from 1 + if the finger leaves a slight indentation
- a 4 + if the finger leaves a deep imprint that returns to normal very slowly
Check capillary refill by pressing the nail beds on fingers and toes and refill time should be 3 seconds or less
Use the pads of your index and middle fingers to palpate all pulses
including: temporal carotid, Brachial Radial femoral, popliteal Posterior Tibial, and Dorsalis pedis
All pulses should be equal in strength and regular and rhythm
Auscultation of the heart should be done with the patient in three positions
Sitting up lying on the left side and lying on the back with the head of the bed elevated 30 to 45 degrees
Use a good quality stethoscope with Snug fitting earpieces
Use the diaphragm to hear high-pitched sounds. Use the bell how lightly against the skin to hear low pitch sound.
A quiet environment is essential to hear heart sounds accurately evaluate
So turning off the TV or other background noises may be necessary
Auscultation is best performed directly on bare skin as clothing can mimic abnormal sounds.
Hair on the chest can also cause friction under the stethoscope.
This can be minimized by lightly wetting the hair before auscultation.
As you listen to the heart over the entire procore diem or anterior chest wall,
use a zig zag pattern
Starting at the base of the heart and working downwards toward the apex
Normal heart sounds S1 and S2 are caused by events in the cardiac cycle.
As blood flows from the atria to the ventricles it goes through the tricuspid and bicuspid valve
These valves then snap shut making the first heart sound or S1. This is the lub in lub dub.
As these two vows snap shut the pulmonary and Aortic valves just opened
This is the beginning of sicily or contraction of the ventricles.
As the ventricles contract blood is pumped through the pulmonary valve
leading to the lungs and the Aortic valve, leading to the Aorta and rest of the body
These valves and snap shut making the second heart sound S2
or dub and lub dub
This is the end of systole and the beginning of diastole
When listening over the procore diem there are five precordial landmarks.
Where you can best hear sound from each heart valve.
The sites of auscultation are actually not at the exact anatomic site
But the stethoscope is positioned downstream from the flow of blood through the valves
Use the diaphragm of the stethoscope
Switching to the bell to hear lower pitched sounds
The Aortic valve area is on the right side of the second intercostal space
The next three listening points lie along the left sternal border
The Pulmonic valve area is at the left base of the heart located in the second intercostal space
Herbs point is at the left third intercostal space lying halfway between the base and the apex
The tricuspid valve area is at the left fourth intercostal space
and the final listening area is at the apex
Normally at the left fifth intercostal space at the mid-clavicular line
Called The Mitral valve area
You can remember these locations using the mnemonic a-p-e-t-m.
All people enjoy Time Magazine
As you listen to each of these listening points use the diaphragm and
Inch your stethoscope from one point to the next.
So you can track the sounds and concentrate on identifying S-1 and S2
To differentiate S1 and S2
concentrate on the rhythm
Normally systole is shorter than diastole
So there is a longer pause after S2.
S2 is also louder at the base while S1 is louder at the apex
S1 also coincides with the carotid pulse
Also listen for abnormal heart sounds
In patients with congestive heart failure you may hear an S3 following S2
and S4 sound is associated with hypertension,
coronary artery disease, and often a myocardial infarction
S3 and S4 are low pitched and better heard using the bell of the stethoscope
After listening to all points with the diaphragm,
use the bell with very light pressure to listen over the five areas again
Blood should be flowing smoothly over the valves.
However, if a valve is stenotic
or it doesn't open widely, blood flow will be turbulent
causing a swishing or whooshing sound. This is a murmur.
Murmur can also be caused by a valve that is regurgitant, or does not close tightly?
Murmurs are graded according to their loudness from grade one to grade six
If you hear a high-pitched scratchy sound similar to sandpaper rubbing together.
It is likely a pericardial friction rub. In which the pericardium the membrane surrounding the heart becomes inflamed
Friction Rubs can be heard during systole and diastole
and are generally loudest over the apex of the heart
Listening to heart sounds takes concentration and practice.
If you're having difficulty hearing heart sounds. Ask the patient to change position
To bring his heart closer to the chest wall
Be sure to reduce background noises and place your stethoscope directly on the chest wall
Don't hesitate to make adjustments as needed.
So your findings from this crucial assessment are as accurate as possible
Thank you for watching this video tutorial on cardiovascular assessment
For more information be sure to check out our other videos and follow us on Social Media