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Chapter 16
Heart and Peripheral
Vasculature
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Identify the anatomic landmarks
of the chest and periphery.
Describe the characteristics of the
most common cardiovascular
chief complaints.
Elicit a health history from a
patient with cardiovascular
pathology.
(continues)
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Competencies
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Perform a cardiovascular assessment
of a healthy adult.
Perform a cardiovascular assessment
on a patient with cardiovascular
pathology.
Provide scientific rationale for
abnormal cardiovascular assessment
findings.
Describe the changes that occur in
the cardiovascular system in the
elderly.
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Anatomy and
Physiology
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Base
Apex
Pericardium
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Parietal
Visceral
(continues)
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Anatomy and
Physiology
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Chambers of the heart
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Right and left atria
Right and left ventricles
(continues)
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Anatomy and
Physiology
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Heart valves
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Atrioventricular valves (A-V)
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Tricuspid
Mitral
Semilunar valves
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Pulmonic
Aortic
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Coronary circulation
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Left main coronary artery
Left circumflex artery
Left anterior descending artery
Right coronary artery
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Cardiac Cycle
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Systole
Diastole
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Atrial kick
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Electrocardiogram
(EKG)
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P
Q
R
S
T
Isoelectric line
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Electrical Activity of the
Heart
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Sino-atrial (SA) node
Atrioventricular node
Bundle of HIS
Right and left bundle branches
Purkinje fibers
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Peripheral Vasculature
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Arterial system
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Three layers of arterial walls: tunica
intima, media, externa
Arteries
Arterioles
Capillaries
Venous system


Veins
Venules
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Health History
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Age
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Gender
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Childhood onset: Rheumatic fever
Adult onset: CAD, HTN, MI, CVA,
AAA, CHF
Female
Male
Race

May predispose to higher risk for
CVA, CAD, HTN, DM
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Common Chief
Complaints
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Chest pain
Syncope
Palpitations
Peripheral edema
Claudication
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Characteristics of
Chief Complaints
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Quality
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing
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Past Health History
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Medical
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Surgical
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Cardiac specific: AAA, angina,
CAD, CHF, HTN, MI, PVD,
hyperlipidemia
Noncardiac specific
Prior cardiovascular procedures
Presence of risk factors
(continues)
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Past Health History
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Common medications
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Antianginals or vasodilators
Antidysrhythmics
Anticoagulants
Antihypertensives
Antilipemics
Diuretics
Inotropics
Thrombolytics
(continues)
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Past Health History
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Communicable diseases
Childhood illnesses
Allergies
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Aspirin
IVP dye
Seafood
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Family Health History
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Assess for the following diseases
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Aneurysm
CAD
CVA
HTN
CHF
MI or sudden cardiac death
MVP
Rheumatic fever
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Social History
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Alcohol, drug, or tobacco use
Sexual practices
Travel history
Work and home environment
Hobbies and leisure
Stress
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Health Maintenance
Activities
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Sleep
Diet
Exercise
Stress management
Use of safety devices
Health checkups
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Patient Education
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Risk factor modification
Heart smart diet
Exercise
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Risk Factors
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Modifiable
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HTN, hyperlipidemia, tobacco use,
physical inactivity, diet, glucose
intolerance, stress, sedentary lifestyle,
obesity
Nonmodifiable

Age, gender, race, family history
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Heart Smart Diet
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American Heart Association
guidelines
Total fat intake < 30%
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< 10% from saturated fat
< 10% from polyunsaturated fat
10–15% monounsaturated fat
Cholesterol < 300 mg/day
Sodium < 2,400 mg/day
Carbohydrates should equal 55–
60% of total calories/day
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Exercise and
Cardiovascular Health
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Consult with primary care
provider prior to starting an
exercise program
Avoid strenuous activity in
extremes of temperature or after a
heavy meal
Immediately stop exercise if chest
pain, dizziness, faintness, lightheadedness occur
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Assessment
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Equipment
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Stethoscope
Sphygmomanometer
Watch with second hand
Tape measure
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Inspection
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Aortic
Pulmonic
Midprecordial
Tricuspid
Mitral
Normal findings: no visible
pulsations except for the PMI in the
mitral area
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Palpation
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Assess for pulsations, thrills, heaves
Assess the following areas: aortic,
pulmonic, midprecordial, tricuspid,
and mitral
Normal findings
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No pulsations, thrills, or heaves palpated,
except in the mitral area where the apical
impulse may be palpated
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Auscultation
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How?
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Patient position
Use diaphragm and bell of
stethoscope
Where?
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Aortic, pulmonic, midprecordial,
tricuspid, mitral
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Auscultation: Normal
Findings
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Aortic: S2 is louder than S1
Pulmonic: S2 is louder than S1
Tricuspid: S1 is louder than S2
Mitral: S1 is louder than S2
Mitral and tricuspid: S3 (gallop)
may be heard in children, young
adults, and pregnant women. S4
may indicate cardiac
decompensation
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Auscultation:
Abnormal Findings
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Murmurs
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Possible causes
Characteristics: location, timing,
radiation, intensity, quality, pitch,
configuration
Use stethoscope diaphragm over
aortic, pulmonic, mitral, and
tricuspid areas
Use stethoscope bell over mitral and
tricuspid areas
Normal findings: no murmurs
auscultated
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(continues)
Auscultation:
Abnormal Findings
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Pericardial friction rub
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Possible cause
Characteristics: location, timing,
radiation, quality, pitch
Patient position
Location
Abnormal finding
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of
Peripheral Vasculature
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Inspection of jugular venous
pressure
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How?
Patient position
Normal findings
Abnormal findings
Pathophysiological indications:
tricuspid regurgitation or
insufficiency, right-sided CHF
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Inspection of
Hepatojugular Reflux
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How?
Patient position
Normal findings
Abnormal findings
Pathophysiological indications:
right-sided CHF or fluid overload
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of Arterial
Pulses
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Evaluate temporal, carotid,
brachial, femoral, popliteal,
posterior tibial, dorsalis pedis
How?
Patient position
Characteristics: rate, rhythm,
amplitude, symmetry
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of Arterial
Pulses
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Auscultate temporal, carotid,
femoral pulses for bruits
Normal findings
Abnormal findings
Pathophysiological indications:
obstruction due to atherosclerotic
plaques, high output states such as
anemia or thyrotoxicosis
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Special Techniques
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Orthostatic hypotension
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How?
Patient position
Normal findings
Abnormal findings
Pathophysiological indications:
hypovolemic, neurogenic
dysfunction, or side effect from
medications
(continues)
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Special Techniques
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Pulsus paradoxus
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How?
Patient position
Normal findings
Abnormal findings
Pathophysiological indications: cardiac
tamponade, pericardial effusion,
cardiomyopathy, obstructive lung disease
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Assessment of
Peripheral Perfusion
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Evaluate peripheral pulses, color,
clubbing, capillary refill, skin
temperature, edema, ulcerations,
hair distribution
Venous system
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Homan’s sign
Arterial
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Pallor
Allen’s test
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Gerontological
Variations
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Decreased size of heart muscle
Decreased cardiac output
Arterial vessels are more rigid, less
distensible
Calcifications or fibrosis of heart
valves
Copyright 2002, Delmar, A division of Thomson Learning