Cardiovascular & Peripheral Vascular Assessment: Key Concepts and Clinical Skills

Right Atrium (RA)

Receives deoxygenated blood.

Right Ventricle (RV)

Pumps blood to lungs via pulmonary artery.

Left Atrium (LA)

Receives oxygenated blood.

Left Ventricle (LV)

Pumps blood to body via aorta.

Atrioventricular (AV) Valves

Tricuspid (RA→RV), Mitral/Bicuspid (LA→LV).

Semilunar Valves

Pulmonic (RV→Pulmonary Artery), Aortic (LV→Aorta).

Pulmonary Circulation

Heart → Lungs → Heart.

Systemic Circulation

Heart → Body → Heart.

Pericardium

Protective sac; inflammation = pericarditis → pericardial friction rub.

Myocardium

Muscle layer; ischemia causes chest pain → angina/MI.

Endocardium

Inner layer; infection = endocarditis → valve damage (often post-rheumatic fever).

SA Node

Natural pacemaker (60-100 bpm).

ECG

Shows electrical activity; used to detect dysrhythmias, ischemia, or infarction.

O-P-Q-R-S-T-U

Chest pain assessment tool (Onset, Provokes, Quality, Region, Severity, Timing, Understanding).

Paroxysmal Nocturnal Dyspnea (PND)

Waking up gasping for air = sign of heart failure.

Palpitations

Heart fluttering or skipping beats.

Dizziness/Syncope

May indicate arrhythmia or poor perfusion.

Claudication

Pain with exercise due to peripheral symptoms.

Vital Signs

Compare to baseline — HR, BP, RR, O₂ sat, temperature.

Capillary Refill

< 2 seconds = normal.

Grading Scale for Pulses

0 = absent, +1 = weak/thready, +2 = normal, +3 = bounding.

Edema Grading

Graded +1 (mild) → +4 (severe pitting).

Point of Maximum Impulse (PMI)

Located at 5th intercostal space, midclavicular line.

Jugular Venous Pressure (JVP)

Elevate HOB 30-45°.

Heart Sounds (Auscultation)

Use both diaphragm and bell. Areas: Aortic → Pulmonic → Erb's Point → Tricuspid → Mitral ("APE To Man").

S₁ ("lub")

AV valves close (start of systole), Heard Best at Apex, Indicates Normal.

S₂ ("dub")

Semilunar valves close (end systole), Heard Best at Base, Indicates Normal.

S₃

"Lub-dub-da" (ventricular gallop), Heard Best at Apex with bell, Indicates HF or fluid overload.

S₄

"Ta-lub-dub" (atrial gallop), Heard Best at Apex with bell, Indicates CAD, stiff ventricles.

Murmur

Blowing/wooshing sound, Heard at Various locations, Indicates Valvular defect (stenosis or regurgitation).

Pericardial rub

Scratchy, rubbing sound, Heard Best at LSB, Indicates Pericarditis.

Heart Failure

Right HF: JVD, peripheral edema, ascites, weight gain; Left HF: Dyspnea, orthopnea, pulmonary crackles, fatigue.

Tachycardia

Common on both sides in heart failure.

Stenosis

Narrowed valve opening → obstructed flow.

Regurgitation

Valve doesn't close completely → backflow.

Peripheral Vascular System

Arteries of the Arm: Radial, Brachial, Carotid; Arteries of the Leg: Femoral → Popliteal → Posterior Tibial → Dorsalis Pedis.

Peripheral Artery Disease (PAD)

Cause: narrowing from atherosclerosis. Symptoms: Intermittent claudication, Cool, pale, shiny skin, Weak/absent pulses, Hair loss on legs, Ulcers on toes.

Education for PAD

Don't walk barefoot (neuropathy risk), Inspect feet daily, Stop smoking.

Venous Disease

Varicose Veins: valve incompetence → pooling blood → swelling.

Venous Insufficiency

Brown discoloration of ankles, Edema, aching, Ulcers near medial malleolus.

DVT (Deep Vein Thrombosis)

Swelling, warmth, redness, pain. Homan's Sign: calf pain on dorsiflexion (not always reliable). Risk of pulmonary embolism.

Lymphedema

Blocked lymph drainage → non-pitting swelling. Common after mastectomy or radiation.

Aging Considerations

Arterial walls stiffen → ↑ systolic BP, wider pulse pressure. LV wall thickens; HR may slow slightly. Peripheral pulses may weaken slightly.

Pulse grades

0 (absent) → +3 (bounding).

Priority questions

Always treat circulation + oxygenation first.

Common test traps

Mislabeling murmurs, Forgetting that right HF = body congestion, left HF = lung congestion, Confusing arterial (cool/pale) with venous (warm/swollen).