The document discusses cardiovascular assessment and provides details on: - The anatomy and function of the heart as a muscular pump. - Components of a cardiovascular exam including inspection, percussion, auscultation of heart sounds and murmurs, and jugular vein pressure assessment. - Common heart sounds include S1, S2, S3, and S4 and details on what causes each sound. - Steps for documenting findings of the cardiovascular exam.

1. Cardiovascular
Assessment
MALAK EISA KHAN
Nova institute of Modern Studies

7. HEART
•Hollow, muscular organ
•300 grams (size of a fist)
•4 chambers
•Found in chest between lungs
•Surrounded by membrane called Pericardium
•Pericardial space is fluid-filled to nourish and protect the heart.

8. • The heart is a complex muscular pump that
maintains blood pressure and flow through
the lungs and the rest of the body.
• The heart pumps about 100,000 times and
moves 7200 liters (1900 gallons) of blood
every day.

9. HISTORY
Smoking
Stress
Exercise
Diet
Medications
Surgery
History of myocardial infarction
Family history

10. Common Concerns
Chest Pain
Pain
Fatigue
Diaphoresis
Arrhythmias
Dyspnea
Cough
Palpitations

13. INSPECTION
Position the patient supine with the head of the bed
slightly elevated..
Always examine from the patient's right side.
Note the frequency, depth and regularity of respiration.
Look for any visible pulsations, heaves or lifts at apical
area.(ventricular hypertrophy )

14. Assess for peripheral edema
Assess capillary refill time (capillary fill time (CFT) -
should be <3 seconds
Assess peripheral perfusion (blood flow) - color,
temperature, edema, hair pattern, skin changes, phlebitis

24. PERCUSSION
•Percussion of the heart is not commonly
done since chest X ray study is a more
accurate measure of heart enlargement
•The sound will change from resonance(over
the lungs) to dullness (over the heart)

26. Listen at four basic locations using the diaphragm and bell of the
stethoscope firmly applied to bare skin in a completely quiet room:
Position:
Sitting, supine & left lateral decubitus position
Area
Cardiac apex (mitral valve area)
Tricuspid area (left lower sternal border [LLSB])
Pulmonic area (left 2nd ICS)
Aortic area (right 2nd ICS)

27. Auscultation for bruits
A bruit is often, a sign of arterial
narrowing and risk of a stroke.
Place the bell of the stethoscope
over each carotid artery in turn.
Ask the patient to stop breathing
momentarily(shortly).
Listen for a blowing or rushing
sound

30. (Heart sound S1 lub)
•The first heart sound results from the closing of the mitral
and tricuspid valves.
•The sound produced by the closure of the mitral valve is
termed M1, and the sound produced by closure of the
tricuspid valve is termed T1.
•The M1 sound is much louder than the T1 sound due to
higher pressures in the left side of the heart; thus, M1
radiates to all cardiac listening posts (loudest at the apex),
and T1 is usually only heard at the left lower sternal border.
This makes the M1 sound the main component of S1.

31. (Heart sound S2 dub)
The second heart sound is produced by the closure of the
aortic and pulmonic valves. The sound produced by the
closure of the aortic valve is termed A2, and the sound
produced by the closure of the pulmonic valve is termed P2.
The A2 sound is normally much louder than the P2 due to
higher pressures in the left side of the heart; thus, A2
radiates to all cardiac listening posts (loudest at the right
upper sternal border), and P2 is usually only heard at the
left upper sternal border. Therefore, the A2 sound is the
main component of S2.

32. S3(VENTRICULAR GALLOP)
The third heart sound
A low-frequency sound (apical area)
Occurs just after S2 when the mitral valve opens,
allowing passive filling of the left ventricle
The third heart sound is caused by a sudden deceleration
of blood flow into the left ventricle from the left atrium
Requires a very compliant LV
Normal in young adult, children and pregnant women
Sounds like ken tuc ky.

33. (S4) Arterial gallop
 The fourth heart sound, also known as the “atrial
gallop,” occurs just before S1 when the atria
contract to force blood into the LV.
 If the LV is noncompliant, and atrial contraction
forces blood through the atrioventricular valves, a
S4 is produced by the blood striking the LV.
Sound like “Ten-nes-see”

38. GRADING OF MURMERS

39. Jugular venous pressure
Position the patient supine with the head of the
table elevated 30-45 degrees.
 Use tangential, side lighting to observe for venous
pulsations in the neck.
Identify the highest point of pulsation. Using a
horizontal line from this point, measure vertically
from the sternal angle.
The normal range of JVP is 3 to 8 cm H2O

42. DOCUMENTATION
No visible pulsation on anterior chest.
PMI palpable at left 5th ICS, 2 cm in diameter.
Heart Auscultation: rate 68 beats/ min, regular rhythm,
S1and S2 audible over aortic, pulmonic, erb’s point,
tricuspid and mitral areas.
No extra heart sounds, murmur, bruits or rubs heard

44. https://www.youtube.com/watch?v=pMV3y8r6WOU (normal heart
sound)
https://www.youtube.com/watch?v=FtXNnmifbhE (s1 and s2)
https://www.youtube.com/watch?v=r1FeJ5pb3TM (s3 and s4)
https://www.youtube.com/watch?v=Q5-0mSydRR4 (murmers)