Cardiac Assessment

Grading Pulses (4-point scale)

+4 = bounding

+3 = full, increased

+2 = normal

+1 = diminished, barely palpable

0 = absent

Edema Pitting Scale

0+ No pitting edema

1+ Mild pitting edema (2mm)

2+ Moderate pitting edema (4mm, usually disappears in 10-15 seconds)

3+ Moderately severe pitting edema (6mm, more than 1 min)

4+ Severe pitting edema (8mm, lasts more than 2 mins)

S1 (“lub”)

• Ventricular contraction = increased pressure

• Tricuspid and Mitral valves close

• Systole

S2 (“dub”)

• Ventricular relaxation = decreased pressure

• Aortic and Pulmonic valves close

• Diastole

S3 (“Ken-TUCK-y”)

Extra heart sound resulting from vibration of ventricles in diastole

• Increased atrial pressure

• CHF, cardiomyopathy, children, young adults

S4 (“TENN-e-see”)

Active LV filling when atrial contraction forces blood into a noncompliant LV

• HTN, pulmonary HTN, elderly

Splits

Occurs when tricuspid/mitral valves (S1) or the pulmonic/aortic valves (S2) do not close simultaneously

• Young

Snaps/Clicks

Cardiac valves are generally open without noise unless thickened, roughened, or altered because of disease

• Valvular stenosis (mitral valve snap)

• Semilunar valves (ejection systolic clicks)

• Mitral Valve Prolapse (late non-ejection systolic click)

Heart Murmurs

A gentle, blowing, swooshing sound

• Turbulent blood flow

• Children, adolescents, young athletes

Systolic Murmurs

May indicate heart disease, but often occurs when heart is normal

Diastolic murmurs

Usually indicates heart disease

Causes of Heart Murmurs

• Velocity of blood increases (ex: exercise)

• Viscosity of blood decreases (ex: anemia)

• Structural defects in the valves or unusual openings in the chambers

Grades (Intensity) of Murmurs

Grade I: Very faint

Grade II: Quiet but clearly audible

Grade III: Moderately loud

Grade IV: Loud, may be associated with a thrill

Grade V: Very loud (thrill present)

Grade VI: Loudest (thrill present)

Valvular Heart Disease

Acquired congenital disorder of:

• Stenotic valve (does not open completely)

• Incompetent valve (does not close completely)

Endocarditis

Infection of endothelial layer of the heart, including cardiac valves

Causes of Endocarditis

• Valvular heart disease

• Congenital lesions

• Direct injury

• Previous heart damage

Clinical Findings of Endocarditis

Heart sounds normal during early infection. In late infection, murmur is heard if valve damage occurs

Pericarditis

Inflammation of layers of pericardium and myocardium. Infection of the sac encasing and protecting the heart

Causes of Pericarditis

• MI

• Cancer

• Trauma

• Infections

• Cardiac surgery

Clinical Findings of Pericarditis

• Pericardial friction rub

• Angina

Venous Thrombosis

• Thrombus (clot) develops within a vein

• A DVT could present with pain, edema, erythema, and decreased pulses in the leg

Thrombophlebitis

Inflammation of vein with or without a clot

Aneurysm

Dilation of artery from weakness in arterial wall

Clinical Findings of an Aneurysm

• Abdominal aortic aneurysm

• Chest pain

• Hoarseness or dysphagia from pressure on esophagus

• Thrill or Bruit

Abdominal Aortic Dissection (AAA)

Treatment based on >6cm size prior to rupture