This document provides an overview of cardiac anatomy, physiology, and assessment. It begins with a description of the heart's structure including the coronary arteries and conduction system. Key concepts are explained such as the cardiac cycle, output, and factors that determine stroke volume like preload, afterload, and contractility. Common symptoms of cardiovascular disease are outlined. The document then details the steps and focus of a cardiac assessment including gathering a health history and examining vital signs, skin, neck, heart, lungs, and abdomen. Potential exam findings and complications are also noted.

1. CARDIAC ASSESSMENT
Sanil Varghese

2. ANATOMY AND
PHYSIOLOGY
OF HEART

4. Coronary Blood Flow
• Two coronary arteries
originate from aorta
– Right coronary artery (RCA)
• Posterior descending artery
(PDA)
– Left main (LM) coronary
artery
• Left anterior descending
(LAD)
• Circumflex (LCX)

5. Cardiac Conduction System

6. Electrophysiologic Properties of
Cardiac Cells
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•
•
•
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Excitability
Automaticity
Contractility
Refractoriness
Conductivity

7. CARDIAC CYCLE
• Systole
• Diastole

8. Cardiac Output
• Volume of blood ejected per minute
• Averages between 4-8L/min
• CO = Stroke volume X heart rate
=70 ml X 60 beats/min
=4,200 ml/min

9. Stroke Volume Is Determined By Three
Factors
• Preload
• Afterload
• Contractility

10. Preload
• Degree of stretch of myocardial fibers
• Determined by the volume of blood in left ventricle
(LV) at end of diastole
• Increased volume –> increased preload-> increased
cardiac output (CO)
• Decreased volume –> decreased preload –>
decreased cardiac output (CO)
• Compliance of myocardial cells also affects preload

11. Afterload
• Resistance or pressure the
ventricles must overcome to
pump blood out
• Left ventricle affected by
systemic vascular resistance
(SVR)
• Right ventricle affected by
pulmonary vascular
resistance (PVR)

12. Autonomic Nervous System (ANS)
Regulation of Cardiovascular System
• Heart rate – chronotropic effect
• Contractility – inotropic effect
• Conduction velocity at AV node –
dromotropic effect
• Afterload - vascular resistance – arterial
vasoconstriction and dilation
• Preload – venous constriction and
dilation

13. Cardiovascular Assessment
• The practice setting
and severity of
patient’s symptoms
determine focus of
questions and extent
of health history

14. Steps
• History collection
• Risk factors analysis
• Biographical and
demographical data
• Current health
history
• Past health history
• Family history
• Psychosocial history

15. Common Symptoms Of Cardiovascular
Disease
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•
•
•
•
•
•
•
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Chest discomfort or pain
Palpitations
Syncope
Fatigue
Dyspnea
Cough, hemoptyosis
Weight gain
Edema
Nocturia

16. Dyspnea
• Often associated with
myocardial ischemia
• Primary symptom of
pulmonary congestion from
LV failure
• Other causes
–
–
–
–
Fever
Anemia
Pulmonary disorders
Obesity

17. • Different forms of dyspnea
– Exertional dyspnea (DOE)
– Orthopnea
– Paroxysmal nocturnal dyspnea (PND)

18. Weight Gain, Dependent Edema and
Nocturia
• As heart fails, fluid accumulates
• Increase of 3 lbs or more in 24 hr or 5 lbs in one
week
• Inquire about weight gain, fitting of shoes, or
tightening of clothes around waist
• Nocturia - kidneys inadequately perfused by weak
heart and receive increased blood flow during night –
> output increases

19. Past Medical History
• Inquire about previous illnesses
– Rheumatic fever, autoimmune diseases
– Diabetes, kidney disease, HTN, dyslipidemia
– Lung disorders
– Clotting disorders

20. • Explore previous hospitalizations and
surgeries
• Evaluate use of medications, OTC drugs, herbs,
recreational drugs
– Are meds taken as prescribed
– Financial problems
– Knowledge about meds
• Any allergies

21. Family Health History
• Inquire about diabetes, kidney disease, stroke,
heart disease, hypertension (HTN)
• Inquire about health of parents and siblings

22. Psychosocial History
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•
•
•
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Education
Occupation
Marital status, children and relationships
Coping and stress tolerance
Health habits – diet, exercise, smoking,
alcohol use

23. General Appearance
• Look at the client and consider
– Does the client lie quietly or is he restless?
– Can the client lie flat or must be upright?
– Do facial expressions reflect pain or distress?
– Are there signs of cyanosis or pallor?
• Note level of consciousness (LOC)

24. Inspection Of Skin and Nails
• Assess skin color
– Pallor
– Cyanosis
• Peripheral cyanosis-nose, ears, periphery
• Central cyanosis-mucous membranes, lips
• Assess skin temperature and moistness
• Assess for ecchymosis
• Assess for wounds, scars, implanted devices

25. • Assess eyes
– Arcus senilis-gray
ring around iris
– Xanthalasmayellow raised
plaques around
eyelids

26. Peripheral cyanosis

27. Central cyanosis

28. Capillary refill

29. Clubbing

30. Skin turgor

31. Splinter hemorrhage

32. Roth’s spots

34. Assess Vital Signs
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•
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Measure BP in both arms initially
Determine pulse pressure
Perform postural checks
Assess pulse
– Rate
– Rhythm
– Quality

35. BP

36. Pulse Quality Scale
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•
•
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•
0
+1
+2
+3
+4
pulse not palpable or absent
weak, thready, difficult to palpate
diminished
easy to palpate, full pulse
strong, bounding pulse

37. Assess Neck Vessels
• Determine jugular venous pressure
– Gives an estimate of right heart function and CVP
– Measurements >3 cm are elevated – jugular venous
distention (JVD)
• Assess for hepatojugular reflux (HJR)
– Rise of more than 1 cm in internal jugular vein indicates
HJR
• Assess carotid arteries
– Assess amplitude of pulse
– Auscultate for bruits

38. Inspection and Palpation of
Precordium
• Purpose is to determine presence of normal
and abnormal pulsations or thrills
• Normally, palpate point of maximal impulse
(PMI) at 5th, left intercostal space,
midclavicular
• A thrill indicates diseased valve or obstructed
vessel

39. JVP Measurement

40. PMI – Point Of Maximum Intensity

41. Cardiac Auscultation
• S1
– Caused by closure of mitral and tricuspid valves
– Signifies beginning of systole
– Best heard over apical area (left, midclavicular, 5th ICS)
• S2
– Caused by closure of aortic and pulmonic valves
– Signifies beginning of diastole
– Best heard over base area (“A” and “P” areas, 2nd ICS)

42. Heart sounds auscultation

43. Gallop Sounds
• S3 – Ventricular gallop
– Heard in early diastole right after S2
– Normal in children and young adults
– Characteristic of LV failure
• S4 – Atrial gallop
– Heard in late diastole right before S1
– Heard during atrial contraction as atria force blood into
resistant ventricles
– Characteristic of HTN, heart failure, pulmonary disease

44. Pericardial Friction Rub
• Produced by
inflammation of
pericardial sac
• Heard during systole
and diastole
• Best heard with
diaphragm with client
sitting up and leaning
forward

46. Assess Respiratory Status
• Respiratory findings
frequently exhibited
by cardiac clients
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Tachypnea
Dyspnea
Crackles
Cough
Hemoptysis
Wheezing
• Assess O2 saturation

47. Abdominal Assessment
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Inspection may reveal ascites
Palpation may reveal an enlarged liver
Assess for elevated JVD and HJR
Auscultate for bruit over umbilicus

48. • Potential complications
– Dysrhythmias
– Perforation of heart or vessels
– Hemorrhage
– Spasm of vessels
– Thrombus or embolus formation
– Infection

49. Thank you