Physical Examination of Cardiovascular System

1. ASSESMENT OFASSESMENT OF
CARDIOVASCULARCARDIOVASCULAR
SYSTEMSYSTEM
BY :
Laishram Rushila Devi M.Sc (N)
Lecturer
Dept. of Medical and Surgical Nursing
Sri Satyalaxmi College of Nursing,
Hyderabad

2. OBJECTIVE
General objective
At the end of the class, the students
 acquires knowledge regarding Physical
Assessment of Cardiovascular SystemAssessment of Cardiovascular System
 applies this knowledge in clinical setting in
providing care of clients with Cardiovascular
Disorders
 appreciates the importance of knowing the
Physical assessment of Cardiovascular System

3. SPECIFIC OBJECTIVE
At the end of the class, the student will be able to
 explains the anatomy of the heart and clarify different
parts of heart
 enumerates the blood flow through the heart
 explains the conduction system of heart explains the conduction system of heart
 identify normal and abnormal heart sounds and
electrical changes occur in the heart.
 describes the Anatomy and Physiology of Vascular
System
 explain the process of history taking of cardio
vascular assessment
 demonstrate the Physical assessment of Cardio
Vascular system

4. ANATOMY AND
PHYSIOLOGY
OF HEART

5. POSITION OF HEART
 Lies in thoracic cavity.
 Posterior end of heart is apex.
 Broad portion of heart opposite to apex is base

6. PERICARDIUM AND LAYERS OF
HEART

7. CHAMBERS OF THE HEART AND
BLOOD FLOW

8. ORGANS ASSOCIATED
WITH HEART
 Inferiorly- diaphragm
 Superiorly-Aorta, Superior Venacava,
Pulmonary Artery and Pulmonary Veins.
 Anteriorly-Sternum, Ribs and Intercoastal
musclesmuscles
 Posteriorly-Oesophagus,Trachea, Left and Right
Bronchus, Descending Aorta, Inferior Venacava
and Thoracic Vertebrae.
 Laterally- Lungs

9. BLOOD SUPPLY
 Arterial – right and left coronary arteries.
 Venous – superior vena cava, inferior vena cava and
coronary sinuscoronary sinus

10. BLOOD SUPPLY TO
MYOCARDIUM

11. VALVES OF THE HEART
AV valves
 Tricuspid valve
 Mitral valve
Semi lunar valvesSemi lunar valves
 Aortic valve
 Pulmonary valve

12. CIRCULATION OF BLOOD
 Systemic circulation
 Pulmonic circulation
SYSTEMIC CIRCULATION
 takes place in left side of the heart takes place in left side of the heart
 receives oxygenated blood from the lungs.
PULMONIC CIRCULATION
 takes place in the right side of the heart
 recieves de-oxygenated blood from the body
parts

13. Fig: Systemic and Pulmonary Circulation

14. CONDUCTION SYSTEM OF HEART
 Sino Atrial Node
 Atrio Ventricular
Node
Bundle of His Bundle of His
RBB
LBB
Purkinje fibers

15. CARDIAC CYCLE

16. HEART SOUNDS
 S1(lub)-closure of AV valves
 S2(dup)-closure of SL valves
ABNORMAL SOUNDS
S3&S4 S3&S4
 Murmurs
 Bruits

17. ELECTRICAL CHANGES IN
THE HEART
 Depolarisation-Contraction
 Repolarisation-Relaxation
 P wave-Atrial Depolarisation P wave-Atrial Depolarisation
 QRS wave-Ventricular Repolarisation
 T wave-Ventricular Repolarisation

18. ECG LEAD PLACEMENT
 V1-4th ICS at right
margin of sternum
 V2-4th ICS at left
margin of sternummargin of sternum
 V3-midway between V2
and V4

19. CONTD…..
oV4-5th ICS at junction of the left midclavicular line
oV5-at horizontal level of position V4 at left anterioroV5-at horizontal level of position V4 at left anterior
axillary line.
oV6-at horizontal level of position V4 at left mid
axillary line.

20. CARDIAC OUTPUT
o Volume of blood ejected from the left (or right
ventricle) into the aorta (or pulmonary trunk)
each minute.
STROKE VOLUME
oVolume of heart ejected by the ventricle during
each contraction.
o SV=70ml/beat

21. VASCULAR SYSTEM
Blood vessels
 Pulmonary artery - carry oxygenated blood
away from the heart.
 Pulmonary veins- carry deoxygenated blood Pulmonary veins- carry deoxygenated blood
toward the heart.
o Arteries and arterioles: Arterioles serve as the
major control of arterial blood pressure and
distribution of blood flow

22. CONTD...
Capillaries:
 The exchange of cellular nutrients and metabolic
end products takes place through these thin
walled vesselswalled vessels
Veins and venules:
 Veins are large diameter thin walled vessels that
return blood to the right atrium

23. REGULATION OF CARDIOVASCULAR
SYSTEM
Autonomic Nervous System:
 The autonomic nervous system consists of the
sympathetic nervous system and the
parasympathetic nervous system.parasympathetic nervous system.
1.Effect on the heart
2.Effect on blood vessels

24. CONTD...
Baroreceptors:
 Baroreceptors in the aortic arch and carotid sinus
are sensitive to stretch or pressure within the
arterial system.
Chemoreceptors
They are capable of causing changes in They are capable of causing changes in
respiratory rate and BP in response to increased
arterial CO2 pressure and, to a lesser degree,
decreased plasma pH (acidosis) and the arterial
O2 pressure (hypoxia).

25. BLOOD PRESSURE
 It is the pressure of blood
against arterial walls.
 Systolic and diastolic
blood pressure
 Systolic BP-maximum
pressure of blood exerted
against the artery walls
when the heart contracts

26. CONTD....
Diastolic BP – is
the force of blood
exerted against the
artery walls duringartery walls during
the hearts
relaxation phase.

27. KOROTKOFF SOUNDS
FIVE TYPES
1st - clear tapping sound heard at systolic
pressure
2nd – murmurs heard in between systolic and2 – murmurs heard in between systolic and
diastolic pressure.
3rd – loud crisp tapping sound
4th – at pressure within 10mmhg above the
diastolic pressure. thumping & muting
5th – silence when the cuff pressure drops
below diastolic BP.

28. PULSE
 Pulse is a alternative expansion and recoil of an artery as
the wave of blood is forced. Through it during the
contraction of the left ventricle. The pulse can be felt by
the fingers on point where an artery crosses a bone close
to the surface.to the surface.

29. CARDIOVASCULARCARDIOVASCULAR
ASSESSMENTASSESSMENT

30. HISTORY COLLECTION
a) Biographic data
b) Present health history
c) Past health history
d) Medications
e) Surgical history
f) Functional health pattern

31. FUNCTIONAL HEALTH PATTERN
(GORDEN’S)
1. Health perception-health management
 What are the factors which increases the
cardiovascular symptoms like chest pain , dyspnea ,
palpitation etc?
 What measures are practicing to reduce the
symptoms?

32. 2. Nutritional-metabolic pattern
 Describe your daily dietary intake?
What is your present weight and is there any gain or What is your present weight and is there any gain or
loss in weight?
 Does eating cause fatigue or shortness of breath?

33. 3. Elimination pattern
 Do your ankle or feet ever swell? If yes describe
it.
Do you have any problem or straining with Do you have any problem or straining with
bowel pattern like constipation?

34. 4. Activity exercise pattern
 Are your activities limited because of your
cardiovascular problems?
 How do the ADL affected by this problems?
 Do you experience any discomfort as a result of
exercise?

35. 5. Sleep-rest pattern
 How many pillows do you sleep on at night?
 How many times a night do you awaken to
urinate?urinate?
 Do you ever wake up suddenly and feel as if you
cant catch your breath?

36. 6. Cognitive and perceptual pattern
 Do you have any changes in your memory?
 Do you ever experience dizziness?
 Do you have any difficulty to verbally express Do you have any difficulty to verbally express
yourself?
 Describe the chest pain that you felt?

37. 7. Self perception-self concept pattern
 Have your perceptions of your self changed since
you were diagnosed with cardiovascular disease?
 How the self esteem is affected by symptoms?

38. 8. Role relationship pattern
 Describe how this illness has affected the role that
you play in your daily life?you play in your daily life?
 Describe how this illness has affected your
relationship.
 How have your significant others been affected
by your disease?

39. 9. Sexuality-reproductive pattern
 Has your sexual behavior changed?
 Do you experience any cardiac-related symptoms
during intercourse?during intercourse?
 Do any of your medication affect your ability to
participate in sexual activities?

40. 10. Coping stress tolerance pattern
 Do you practice any stress reduction technique?
 Describe your coping mechanism for stress. Describe your coping mechanism for stress.
 Do you have cardiovascular symptoms like chest
pain or palpitation during stress?

41. 11.Values-belief pattern
 What influence has your value belief system had
during your illness?
 Do you feel any conflicts between your value
belief system and your planned therapy?
 Describe any belief that may influence treatment?

42. PHYSICAL ASSESSMENT

43. GENERAL APPEARANCE
HEAD
-facial characteristics
-facial oedema (pericarditis)
-ear lobe creases-ear lobe creases

44. HEAD
EAR LOBE
CREASES
XANTHOMA

45. EYES
- Pallor (anaemia)
- Jaundice
- fundoscopical
examination {subexamination {sub
conjunctival
haemorrhage}
- Xanthoma.

46. MOUTH
 Cyanotic lips
 Lesions in buccal mucosa, palate and lips (endocarditis)
CAROTID AND JUGULAR VEINCAROTID AND JUGULAR VEIN
PULSES.
 Jugular vein distention
 Jugular vein pressure

47. JUGULAR VEIN
DISTENSION
JUGULAR VEIN PRESSURE

48. THORAX

49. INSPECTION

50. PALPATION
 Identify Intercostal
spaces
 Angle of Louis –
raised notch readily
palpable in the midpalpable in the mid
line of sternum,ie.2nd
intercostal space.

51. LOCATING THE INTERCOSTAL AREA

52. PERCUSSION
 Estimate the borders
of right and left sides
of the heart.of the heart.

53. AUSCULTATION
 S1 – 5th Intercostal
space
 S2 – Right second
Intercostal space
 S3 and S4 are S3 and S4 are
abnormal sounds.

54. PERIPHERAL VASCULAR
SYSTEM
Inspection
- arterial and venous blood flow.
HandsHands
-right and left pulses
-clubbing of fingers
-splinter hemorrhage
-capillary filling time
-colataral circulation of hands.

55. CYANOSIS
-Congenital defect
-Heart failure-Heart failure
-Vasoconstriction
-Cold environment

56. CLUBBING OF NAILS
 Endocarditis
 Congenital defects
Severe anemia Severe anemia

57. Splinter
hemorrhage

58. ALLEN’S TEST

59. LEGS
 Peripheral pulses
 Cyanosis
 Cold limbs
 Oedema
 Calf tenderness
 Clubbing of toes
 Varicose veins
 Positive Homans sign

60.  Pitting edema of lower
extremities or sacral
area
-Interruption of venous
return to heart
-Fluid in tissues

61. STASIS ULCER
 Poor venous return
 Varicose vein
 Incompetent
venous valves

62. VARICOSE VEIN
Incompetent valves
in vein

63. HOMAN’S SIGN

64. CALF TENDERNESS

65. CONCLUSION
We have discussed about assessment of
cardiovascular system which helps to identify
disease and disorders earlier and helps in better
treatment.