Assessing the Cardiovascular System

Normal heart sounds

S1 and S2

S1 “lub” heart sound

Close of atrioventricular (mitral and tricuspid) valves, heard louder at heart apex

S2 “dub” heart sound

Close of semilunar (pulmonic and aortic) valves, heard louder at the heart base

S3 heart sound “ventricular gallop”

Occurs early in diastole, related to limitation of movement of ventricles; sometimes found in pregnant women or those under 40

S4 “atrial gallop” heart sound

Occurs at end of diastole, atria work heard to contract against a resistant left ventrical; abnormal sound

Heart murmurs

Swishing or unusually prolonged sounds indicative of turbulent blood flow in vascular system

Types of heart murmurs

Innocent or physiological; abnormal or pathological

Characteristics of heart murmurs

Intensity, timing, quality/pitch

Heart sounds

Ejection clicks, opening snap, pericardial friction rub

Ejection clicks

Reflects increased cardiac output

Opening snap

Loud high-frequency sound; caused by stenotic valve (valve not working properly); mitral valve stenosis

Pericardial friction rub

Friction of visceral and parietal layers; caused by inflammation of pericardium

Diagnostics

Lipid profile, normal and abnormal cholesterol levels, creatine kinase (myocardial band), troponin test, electrocardiogram (EKG), echocardiogram, Holter monitor, exercise stress test

Family history

Heart disease, rheumatic fever, myocardial infarction, ask about ages of family who had a medical event

Heart disease

An abnormal organic condition of the heart or of circulation

Rheumatic fever

Disease resulting from untreated streptococcal throat infection, leading to inflammation of the heart, joints, and skin

Myocardial infarction

Heart attack

Atrial fibrillation

Rapid, random, ineffective contractions of the atrium

Medications

Beta blockers, calcium channel inhibitors, nitrates, angiotensin-converting enzyme, statins

Skin color changes

Central cyanosis, peripheral cyanosis

Health promotion

Cardiologist, EKG or cardiac diagnostic tests, heart-healthy diet, reducing smoke or alcohol intake, exercise

Dyspnea

Difficulty breathing, shortness of breath

Edema

Swelling caused by excess fluid accumulation in body tissues

Nocturia

Frequent urination at night

Fainting

Temporary loss of consciousness

Agina pectoralis

Chest pain or discomfort caused by reduced blood flow to the heart

Chest pain

Most reported symptom of the cardiac system

Landmarks of the precordium

Aortic, pulmonic, Erb’s, tricuspid, mitral

Aortic area

Right sternal border, 2nd intercostal space

Pulmonic area

Left sternal border, 2nd intercostal space

Erb’s point

Left sternal border, 3rd intercostal space

Tricuspid valve

Left sternal border, 4th intercostal space

Mitral valve

Mid clavicular line, 5th intercostal space

Inspecting the anterior chest normal findings

Apical pulsation may or may not be visible, chest symmetrical, no heaves or lifts

Inspecting the anterior chest abnormal findings

Lift or heave, right ventricular heave is visualized at the sternal border, left ventricular heave is seen at the apex

Systolic murmur

Carotid pulse occurs at the same time as a murmur

Palpating the precordium and apical pulse normal findings

No pulsations felt at the five landmarks, amplitude has a regular rhythmic tap, carotid pulse synchronous with apical pulse

Palpating the precordium and apical pulse abnormal findings

Visible pulsations, leaves or lifts, thrill

Thrill

Palpable vibration over the chest wall, suggesting turbulent blood flow, often associated with heart valve abnormalities

Heave

Forceful heartbeat that raises the chest wall

Diastolic

Heart relaxes and fills with blood

Systolic

Heart contracts and pumps blood out

Auscultating heart sounds normal findings

S1 and S2 heard, regular pattern, split S2 (dub) is a normal heart sound affected by respirations

Auscultating heart sounds abnormal findings

Extra, abnormal, or murmur heart sounds heard

Modifiable risk factors for cardiovascular disease

High blood pressure, smoking, obesity, stress, diabetes, cholesterol levels

Nonmodifiable risk factors

Age, gender, family history, genetics

Brachial pulse location

Antecubital fossa

Radial pulse location

Wrist, on the thumb side

Femoral pulse location

Groin area

Popliteal pulse location

Behind the knee

Dorsalis pedalis pulse location

Top of the foot

Posterior tibial pulse

Behind the ankle, near the heel

Lift

Palpable or visible pulsation in the chest wall

Heart palpitations

Irregular or rapid heartbeat sensations that can be felt in the chest, throat, or neck