exam 2 health assessment cardiovascular

S1

"LUB" →loud/long low pitches sound

AV valves close (mitral + tricuspid)

start of systole

loudest at apex →left 5th intercostal space

S2

"DUB"

semilunar valves close (aortic + pulmonic)

end of systole →closure of aortic and pulmonic sounds

loudest at base

best heard at pulmonic area

heart landmarks

"APE To Man"

aortic : 2nd ICS right

pulmonic : 2nd ICS left

erb's point : 3rd ICS left

tricuspid : 4th-5th ICS left

mitral (apex) : 5th ICS mid clavicular

subjective assessment

ask :

chest pain

dyspnea

orthopnea

fatigue

palpitations

edema

nocturia

cyanosis/pallor

past cardiac history

family history

inspection

look for :

apical impulse( found at 5th intercostal left midclavicular)

pulsations

JVD : abnormal = fluid overload/heart failure

skin color (cyanosis, pallor)

palpation : apical impulse

location : 4th-5th ICS, MCL

ask patient to exhale and hold

palpation of thrills

vibration felt on palpation = murmur

heave/lift

abnormal forceful cardiac contraction

palpation : carotid pulse

palpate one side at a time

auscultation

1. diaphragm first

2. then bell

listen for 15-30 seconds at each valve

auscultation : assess

rate

rhythm

S1 and S2

extra sounds

murmurs

auscultation : positions

supine

left lateral - S3/S4

sitting forward - murmurs

murmurs

1. timing : systolic vs diastolic (diastolic always abnormal)

2. grading :

1 = barely heard

2 = soft

3 = moderate

4 = loud and thrill(easily palpable)

5 = very loud

6 = heard without stethoscope

S3

"VENTRICULAR GALLOP"

early diastole

fluid overload

can be normal

S4

"ATRIAL GALLOP"

late diastole

stiff ventricle (HTN, CAD)

"tennessee"

split S2

aortic and pulmonic valves close at different times

happens with inspiration

normal

abnormal if fixed split

carotid artery

palpate and auscultate

one side at a time

use bell

listen for bruit (whooshing)

high priority findings

chest pain

SOB

cyanosis

JVD : backup from RIGHT side of heart

irregular HR

tachycardia/bradycardia

new murmur + symptoms

lifespan : infants

HR : 100-180

apical impulse : 4th ICS

watch for cyanosis, poor feeding

lifespan : children

murmurs common + often normal

"venous hum" = normal

lifespan : pregnancy

increase blood volume

decrease BP

increase HR

flow murmurs common

lifespan : older adults

increase systolic BP

decrease vessel elasticity

increase dysrhythmias

normal findings

split S2 with inspiration

soft murmur in child

regular rhythm

no JVD (jugular vein distention)

abnormal findings

chest pain

cyanosis

JVD

S3 (older adult)

S4 (with disease)

diastolic murmur

documentation example

regular rate and rhythm. S1 and S2 present. No murmurs, rubs, or gallops noted.

force scale for pulse

3+ = bounding

2+ = normal

1+ = weak

0 = absent

Assessment of internal jugular pulse

Observe the pulse/pressure

from the pulse you can asses the central venous pressure(CVP)

• only visible when laying with head leaning 

  • If visible when sitting- concerning

Assessment of carotid artery

Observe/inspect

• characteristics of its waveform

• Higher and medial to the SCM muscle

palpate

• gently palpate only once at a time

• feel the contour and amplitude of pulse of both side. should be 2+

Auscultate

• Assess for presence of bruit → dont compress this can cause a artificial bruit

• keep the neck in neutral position and apply stethescope at the angle of jaw, midcervical area, and base of neck

apical pulse

point of maximal impulse (PMI) during systole normally at the 5th left intercostal space in the MCL

what does a murmur sound mean/indicate

They are gentle, blowing, sowwshing sounds that can be heard on the chest wall(over the heart)

Caused by

• velocity of blood increasing

• Thickness of blood decreases

• Structural defects in valves

bruit sound

terminal whoshing sound over a BLOOD VESSEL

Cardaic thrill

Palpable vibration across chest wall

Heave

Vibration across the chest wall