This document provides instructions for examining the cardiovascular system, including the heart and neck vessels. It describes the anatomy of the heart and major neck structures. Examination techniques are outlined for inspecting, palpating, percussing and auscultating the heart and neck vessels. Specific assessment methods are described for the carotid artery, jugular venous pulse, jugular venous pressure, apical impulse, heart sounds, and listening for extra sounds or murmurs. Abnormal findings are contrasted with normal findings. Maintaining cardiovascular health through lifestyle changes is emphasized.

1. UNIVERSITY OF EASTERN AFRICA, BARATON
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF NURSING
HEALTH ASSESSMENT
ASSIGNMENT WRITTEN IN PARTIAL FULLFILMENT OF
THE COURSE REQUIREMENT HEALTH ASSESMENT.
INSTRUCTOR: PROF AKURU EDNA
NAME: AMOS KIPROTICH MELI
ID NO: SAMOME2111
DATE DUE .25TH September, 2021

2. PHYSICAL EXAMIANTION OF CARDIOVASCULAR SYSTEM; HEART AND NECK VESSELS
Heart disease is a serious disease that affect all ages and can cause serious complications. Your ability to
examine cardiovascular system is a vital skill such as inspect, palate, percuss, and auscultate. The heart
and also normal findings and abnormal findings.
Review of the heart anatomy
Before examining the heart and neck, consider the anatomy for example ;visualize the major neck
vessels like carotid artery, internal jugular veins and external jugular veins. Carotid artery lies in the
grooves between the trachea and sternomastoid muscle. Internal jugular vein lies deep and medial to
sternomastoid muscle although thus may not be visible but it may be seen in the sternal notch. External
jugular veins is more superficial and lies lateral to sternomastoid muscle above the clavicle. Beneath the
pericardium on the anterior is enclosed the heart and great vessels. The heart is like upside down
triangle its top is broad base and its bottom is the apex which point down and to the lungs. The apex
produces an apical impulse which normally is palpated at the 5th interspace 7-9cm from the midsternal
line. The heart chambers includes; the right atrium, right ventricle, left atrium and left ventricle. On the
right is the tricuspid valve and left mitral valves.Two semi –lunar valves which are set between the
ventricles and aorta on the right is pulmonic valves and left aortic valve.
The right ventricle forms most of the anterior cardiac surface and the left ventricle lies behind it. The
right atrium lies to the right and above the right ventricle forming the left border, left atrium is located
posteriorly. The great vessel of the heart includes; superior vena cava and inferior vena cava which
returns unoxygenated venous blood to the right atrium. The pulmonary arteries which leaves the right
ventricle and carry unoxygenated blood to the lungs. The pulmonary veins which returns fresh
oxygenated blood to the left atrium and aorta which carries it out to the body.
Neck vessel examination
Carotid artery. To asses carotid artery palpate them one at a time using your index and middle finger
gently palpate the artery medial to sternomastoid muscle in the lower half of the neck. Feel the pulse
contours and amplitude of the pulse which should be the same on both sides. Contours are normally
smooth and amplitude is moderate.
Auscultate the carotid artery with the person neck in a neutral position and ask him to take a breath,
exhale and hold as he does lightly apply the stethoscope to carotid artery at the angle of the jaw
midcervical area and base of the neck. You should hear no bruits which are blowing wheezing sounds
which result from turbulence blood flow as a result of narrowing of carotid artery. For old persons
palpate and auscultate the carotid artery with caution, avoid pressure from carotid area which could
slow the heart rate and compromise the circulation.
Jugular venous pulse. To do this help the person into a supine position at a 30 degrees and turn his head
slightly away from you and erect a strong light and change to highlight position and shadows look for
the external jugular veins which usually visible over sternomastoid muscle because the internal jugular

3. veins is more reliable for assessment look for it position in sternal notch. Jugular venous pulsation
normally five component with two major upstroke beside them are more angular than carotid artery
pulsation. Which has one smooth upstroke.
Jugular venous pressure estimation. To do this, hold a ruler vertical on the sternal angles align a straight
perpendicular ruler to the level of pulsation, read the level where they intersect which should be 2 Cm
or less. If you suspect increased bleed pressure asses for hepatojaguler reflux or advanced techniques.
Press your ridge hand firmly into the abdomen and hold it for 30 second as you do watch the level of
jugular position, it should rise briefly and then fall to the previous level.
Heart examination
Inspect the pericardium and observe for apical impulse when visible it occupies the 4th and 5th
interspace and inside the midclavicular line. Note any abnormal physical position such as heaves. Heart
disease is a more problem and deadly among blacks and other racial groups. Palpate the pericardium
localizing the apical impulse. If you have difficulty ask the patient to exhale and hold. If you still can't feel
anything alternate techniques. After finding the impulse note its location like 4th or 5th interspace,
midclavicular line, size, amplitude and duration. Using the base of your fingers palpate the apex, left
sternal border and base to detect any other palpation, note any abnormal pulsation such as thrills which
are vibration that feel like a stroke.
Heart sounds
Before auscultating identify the area were you would listen, plan to listen in the area where you would
listen, plan to listen in the area where the sound are heard fast like aortic valve area and pulmonic
valves area, erbe's point, left lower tricuspid valve area, metal valve area, to hear the sound accurately.
Auscultating tips is that you note heart rate and rhythm, identify s1 and s2, asses s1 and s2 separately
and listen for extra heart sound and murmurs,. With the diaphragm of the stethoscope first not the
heart rate and rhythm of the heart beat which is normally 60-100 beats per minute and the rhythm is
regular.
In children and young adult’s sinus arrhythmia which is variable and increases with inspiration and
decreases with expiration. Next identity S1 and S2 because S1 is the start of systolic it is the reference
point of the cardiac sound. To identify S1 and S2 accurately remember that S1 is louder than S2 at the
apex and S2 is louder than S1 at the base and S1 coincide with the carotid artery pulse and S1 coincide
with the R wave on ECG monitor. Auscultation of S1 and S2 separately put the diaphragm across the
chest S1 at apex. S1 is caused by closure of semilunar valves and is louder at the end of inhalation
because deep inhalation prevent the aortic and pulmonic valve from closing at the same time.
Listen for extra heart sound and murmurs. During systolic and diastolic which usually are silent period
of you detect this sounds note the timing and characteristic you may hear a midsystolic click S3 or 3rd
sound, which may signal heart failure, S4 also Listen for midsystolic murmur that results from turbulence
blood flow. If you detect the murmurs note it's characteristics with timing like systole or diastole,

4. loudness like grade I to grade VI, pitch which may be high, medium or low, pattern which may be
crescendo, decrescendo, quality which may be musical, blowing harsh or rumbling, location of maximum
murmur intensity radiation like other areas of audible murmurs and person posture when murmurs is
heard.
Innocent murmurs characteristics is usually grade II, midsyatolic and short with crescendo-decrescendo
pattern and vibratory or musical quality.
When examination is competed review the findings and answer any question he may have based on
your findings and teach him about health promotion to improve and maintain his cardiovascular health