Cardiac Assessment: Sounds, Murmurs, and Health Promotion

Midsystolic Click

Extra sound from mitral valve prolapse.

Mitral Valve Prolapse

Mitral valve leaflets balloon into left atrium.

Ejection Click

Sound from opening of semilunar valves.

Aortic Ejection Click

Occurs early in systole, unchanged by respiration.

Pulmonic Ejection Click

Sound softens with inspiration due to respiration.

Third Heart Sound (S3)

Vibration from rapid ventricular filling in diastole.

Physiologic S3

Normal sound in children, young adults, and some women.

Pathologic S3

Indicates heart failure, persists when sitting up.

Ventricular Gallop

Another name for pathologic S3 sound.

Fourth Heart Sound (S4)

Vibration from atrial contraction into noncompliant ventricles.

Physiologic S4

Normal in older adults, especially post-exercise.

Pathologic S4

Indicates decreased ventricular compliance, termed atrial gallop.

Heart Murmur

Harsh sound from turbulent blood flow.

Murmur Timing

Determines if murmur occurs during systole or diastole.

Murmur Intensity

Loudness graded from 1 to 6.

Grade I Murmur

Barely audible, heard only in quiet room.

Grade II Murmur

Clearly audible but faint.

Grade III Murmur

Moderately loud and easy to hear.

Grade IV Murmur

Loud, associated with thrill palpated on chest.

Grade V Murmur

Very loud, heard with stethoscope lifted slightly.

Grade VI Murmur

Loudest, heard with stethoscope fully lifted.

Murmur Location

Describes where murmur is best heard.

Murmur Radiation

Indicates if murmur radiates to other areas.

Murmur Pitch

Describes sound as high, medium, or low.

Murmur Quality

Describes sound as musical, blowing, harsh, or rumbling.

Murmur Timing

Occurs during diastole or systole phases.

Grade I Murmur

Barely audible; heard only in quiet room.

Grade II Murmur

Clearly audible, but faint.

Grade III Murmur

Moderately loud; easy to hear.

Grade IV Murmur

Loud; associated with palpable thrill.

Grade V Murmur

Very loud; heard with stethoscope lifted.

Grade VI Murmur

Loudest; heard with stethoscope entirely off.

Murmur Location

Described according to precordial points.

Murmur Radiation

Radiates to neck, back, or axilla.

Murmur Pitch

Described as high, medium, or low.

Murmur Quality

Described as musical, blowing, harsh, or rumbling.

Skin Characteristics

Color, texture, symmetry of extremities assessed.

Asymmetry in Extremities

Indicates edema or atrophy presence.

Skin Tone Variation

Paler or darker indicates circulation issues.

Lower Extremity Ulcers

May indicate arterial insufficiency.

Hair Distribution

Presence indicates circulation; varies with age.

Dilated Veins

Visible varicosities indicate weakened venous valves.

Nail Surface

Should be smooth, intact, with slight curve.

Clubbing of Nails

Indicates chronic low oxygen levels.

Nail Bed Color

Pallor or cyanosis indicates low oxygen.

Skin Temperature Assessment

Palpate for warmth or coolness deviations.

Skin Turgor

Indicates hydration; assessed by skin pinch.

Capillary Refill

Index of perfusion; checks color return time.

Capillary refill time

Time for nailbed color return after blanching.

Brisk capillary refill

Refill time of 2 seconds or less.

Sluggish capillary refill

Refill time of 3-4 seconds.

Abnormal capillary refill

>4 seconds refill time indicates poor perfusion.

Edema

Fluid accumulation in intercellular spaces causing swelling.

Pitting edema

Edema that leaves a pit when pressed.

1+ pitting edema

Slight pit, normal contour (2mm).

2+ pitting edema

Deeper pit, fairly normal contour (4mm).

3+ pitting edema

Puffy appearance with deeper pit (6mm).

4+ pitting edema

Extremely deep pit, definitely swollen (8mm).

Peripheral pulses

Radial, brachial, femoral, popliteal, tibial, and pedis pulses.

Oliguria

Scanty urine production indicating poor kidney perfusion.

Anorexia

Loss of appetite due to marginal GI perfusion.

Hepatic engorgement

Liver swelling from impaired heart function.

Air hunger

Impaired oxygenated blood perfusion to lungs.

Clouded sensorium

Decreased alertness indicating poor brain perfusion.

Dysphnea

Shortness of breath, early symptom of congestion.

Orthopnea

Difficulty breathing unless sitting up.

Crackles

Adventitious breath sounds indicating fluid in lungs.

Decreased blood pressure

Stimulates sympathetic nervous system response.

Fatigue

Weakness from decreased cardiac output.

Dependent edema

Pitting edema in sacrum and legs.

Ascites

Fluid accumulation in the peritoneal cavity.

Health promotion interventions

Strategies to enhance cardiac health through lifestyle.

Yearly screenings

Recommended tests for cardiovascular health monitoring.

Exercise benefits

Strengthens heart muscle, improves blood flow.

Stress reduction

Techniques to lower stress and improve heart health.

Dietary changes

Heart-healthy diet to reduce obesity and disease risk.

Tobacco cessation

Stopping smoking reduces heart disease risk.