Download Cardiac Examination Powerpoint 3 14 06

CARDIOVASCULAR
ASSESSMENT
AND PHYSICAL
EXAMINATION
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Review anatomy & physiology of the
cardiovascular system.
Discuss relevant aspects of the patient history.
Describe physical assessment of cardiovascular
status.
Review diagnostic procedures, tests and
medications relative to the cardiovascular
system.
Anatomy & Physiology
Functions of the heart
& CV system
 Pumps blood to
tissues to supply O2
& nutrients
 Remove CO2 &
metabolic wastes
Anatomy & Physiology
PERICARDIUM / PERICARDIAL SAC
Protects heart from trauma
 Serous fluid lubricates and
prevents friction
 Prevents heart from over filling

CORONARY ARTERIES
Right & Left arteries encircle the heart and
supply blood to the myocardium during
ventricular relaxation( diastole)
LEFT MAIN CORONARY ARTERY
L ANTERIOR DESCENDING (LAD)
L CIRCUMFLEX (LCX)
RIGHT CORONARY ARTERY
POSTERIOR
MARGINAL
CORONARY ARTERIES
(L) ARTERY
CIRCUMFLEX
(R)
ARTERY
LAD
CARDIAC LOAD
Preload = degree of myocardial fiber stretch
at the end of diastole and just before
contraction
Afterload = pressure against which
ventricles must eject blood. This pressure is
affected by systemic vascular resistance
(SVR)
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OTHER ELEMENTS OF
CARDIAC ASSESSMENT
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Previous cardiac hx
Other medical conditions that may affect heart function
Chest injury
Previous heart surgery
Past medical hx
Medications: prescribed, OTC, herbals
Activity tolerance
Health habits
Family hx
CARDIOVASCULAR
EXAMINATION
HISTORY
PHYSICAL EXAM
LAB TEST
ECG
CARDIAC IMAGING
CARDIOVASCULAR SYMPTOM
 CHEST
PAIN
SHORTNESS OF BREATH
DOE ( DYSPNEA ON EXERTION)
PND ( PAROXYSMAL NOCTURNAL
DYSPNEA)
WHEEZING
CONTINUED
 DIZZINESS
SYNCOPE
PALPITATION
FATIGUE
EDEMA
INTERMITTENT CALAUDICATION
CYANOSIS
CONTINUED
AGGRAVATING FACTORS
ALLEVIATING FACTORS
PREVIOUS LABORATORY TESTS
RISK FACTORS
EXAMINATION
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Inspection
Palpation
Percussion
Auscultation
GENERAL APPEARANCE
VITAL SIGNS
JUGULAR VEINS
HEART
PRIPHERAL PULSES
VITAL SIGNS
BP
HEART RATE
RHYTHM
RESPIRATORY RATE
TEMPERATURE
INSPECTION
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JUGULAR VEINS/ JUGULAR VENOUS
PRESSURE
RIGHT SIDE , HEAD TILTED TO L
ADJUST ANGLE OF BED TO SEE
PULSATION AT MIDNECK
RECORD DISTANCE FROM R ATRIUM
TO TOP OF PULSATION
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INSPECTION (continued)
• Lips, nail beds
• Heart:
apical impulse
point of maximal impulse
• Extremities: (edema, venous or arterial
insufficiency)
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IMPULSES – FINGER PADS
THRILLS ( vibration palpated secondrary
to a murmur – turbulant blood flow through
a heart valve)
APICAL IMPULSE ( normally 5th ICS and
medial to mid- clavicular line)
Point of max impulse
Left lateral decubitus : position apical
impulse more easily palpable
AUSCULTATION
•
Diaphragm – medium and high frequency
sounds
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Bell – low frequency sounds
•
Normally hear closure of valve
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Sounds from left side of heart louder than
equivalent sounds from right side of heart
AUSCULTATION
•
S1 – closure of mitral and tricuspid valves
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S2 – closure of aortic and pulmonic valves
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S1 systole S2 diastole S1
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Simultaneous palpation of carotid pulse can
help in differentiating S1 and S2
FIRST AND SECOND HEART SOUNDS
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Aortic component (A2) normally louder than
pulmonic component (P2)
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Mitral component (M1) normally louder than
tricuspid component (T1)
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DIAPHRAGM
•
Right 2nd intercostal space
Aortic Area
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Left 2nd intercostal space
Pulmonic Area
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Third intercostal space
Erb’s point
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Left lower sternal border
Tricuspid area
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Apex – over apical impulse
Mitral area
BELL
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Left lower sternal border
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Apex
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Apex with patient in left lateral decubitus
position
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Light pressure only!
Abnormal heart sound and murmur
S3,s4 ,click ……
Systolic murmur:
AS,MR,PS ,TR,VSD
Diastolic murmur:
AR,MS,PR,TS
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