Faculty of Nursing-IUG Chapter (10) Assessment of Cardiovascular System Faculty of Nursing-IUG

Right side pumps blood to lungs Left side pumps blood to body Anatomy of the Heart Right Atrium Right Ventricle Left Ventricle Left Atrium Superior and Inferior Vena Cava Pulmonary Artery Pulmonary Vein Aorta TWO PUMPS Right side pumps blood to lungs Left side pumps blood to body

Two Atrioventricular Valve (AV) FOUR VALVES Two Atrioventricular Valve (AV) Tricuspid Valve (right atrioventricular valve) Mitral (left atrioventricular valve) Two Semilunar Valve (SL) Aortic valve (left semilunar valve) Pulmonary valve (right semilunar valve) Subjective data: 1. Assessment of chief complaints: Chest pain: location, quality, duration & associated symptoms. Irregular heart beat: too fast, jump etc.

2. Assessment of risk factors: Ask about history of hypertension, diabetes, and rheumatic fever Ask about family history of heart attack, hypertension, stroke, and diabetes Describe your nutritional intake: high cholesterol, triglyceride level. Do you smoke? How much? And for how long? How do you view yourself? What do you do to relax? How many hours a day do you work? How do cope with stress. Exercise: what do you do for exercise? How often? Pain in calves, feet, buttocks or legs? What aggravates the pain (walking, sitting long periods, standing long periods, sleep) what relieves the pain “elevating legs, rest, lying down”. In what type of chair does client usually sit? Does he/she cross legs frequently?

Inspection: Assessment the client must be is in supine or sitting positing according to his health By inspection and palpation you may detect ventricular hypertrophy. Use source of light to inspect subtle movements in chest e.g.: pulsation, retraction etc. Apical pulse in left fifth intercostal space, if deviation in site observed may indicate cardiac enlargement 6th intercostal space. Retractions may be seen around site of apical pulse, marked retraction may indicate pericardial disease.

Palpation (supine position) Palpate from apex, moving to external border to base Detect abnormalities in site of palpation and abnormal sounds especially for thrill “abnormal flow of blood” Describe in terms: locations of pulsation in relation to mid-sternal, mid-clavicular or axillary lines. Palpation of apical pulse, strength differs from thin person to obese. Conditions such as anxiety, anemia, fever, and hyperthyroidism may increase in force and duration of apical pulse (you feel lifting sensation under your fingers). Palpation of pulse at base of the heart (putting your hand at second left intercostal spaces at sternal borders). Percussion: “not used in cardiac assessment”

Auscultation: All heart sounds are generally low pitched “low frequency” and difficult for the human ear to hear. Auscultation can be started from base to apex or from apex to the base. Assess: Rate and rhythm of the heart beat. Concentrates initially on sound "1", noting its intensity and variations, possible duplication and effects of respiration. Sound 1 caused by the closing of the tricuspid and mitral valves. Systole begins with Sound "1" & extends to Sound "2" Then listen to Sound "2" for same characteristics. Sound "2": results from closing of the aortic & pulmonary valves Diastole begins with Sound "2" and extends to next Sound "1" Sound "2" louder than Sound "1" at the base of heart, and is lighter than Sound "1" at the apex.

Finally listen for extra sounds and for murmurs Sound "3": During diastole, rapid filling and distention of ventricles occur causes vibrations of ventricular walls" and this known as sound "3" ". Sound "3" best heard at the apex with bell of stethoscope. Its indicate Pathological alterations in ventricular filling in early diastole. it represents a normal finding in children Sound "4": occur after Sound "3" (late diastolic filling), occur from vibrations of ventricular wall or vibrations of the valves. It’s usually associated with cardiac disease, often that with altered ventricular compliance Gallop Sound: a gallop characterized by the superimposition of abnormal third and fourth heart sounds, usually indicative of myocardial disease.

Special maneuvers for vascular assessment Heart murmurs (abnormal sounds produced by vibrations within the heart or in the walls of large vessels “during systole or diastole”. Murmurs occurrence result from valve defects, changes in the blood vessels or an increased flow of blood through a normal structure (eg, with fever, pregnancy, hyperthyroidism). Special maneuvers for vascular assessment Check for deep phlebitis by quickly squeezing calf muscles against tibia (normally no pain) Check Homan's sign by extending leg and dorsi-flexing foot (normally no pain).

Arterial and venous insufficiency of lower extremities