Learning Outcomes

• Conduct an assessment of the cardiovascular and peripheral vascular system (including lymphatics).
• Apply knowledge of anatomy and physiology in the examination of heart and peripheral vascular systems.
• Link this knowledge to the concept of perfusion.
• Identify significant general survey findings and relevant health history questions.
• Explain assessment techniques for examining the heart and peripheral vascular system, providing rationale.
• Interpret expected heart sounds: S1, S2, S2 physiologic split via auscultation.
• Connect these assessment techniques to a head-to-toe approach in patient examination.
• Differentiate between expected and unexpected findings.
• Document findings effectively.

Overview

• Key components:
  • Video on Heart Anatomy Review
  • Cardiac Physiology Review
  • General Survey
  • Health History Assessment
  • Physical Assessment of Peripheral Vascular and Lymphatics

Anatomy Review

• The heart is mainly located on the left side of the chest, spanning from the 2nd to the 5th intercostal space.
• Key locations:
  • Base of the heart (top, broad section)
  • Apex (bottom aspect at the 5th intercostal space, known as the apical impulse point).

Head and Neck Vasculature

• Major arteries and veins include:
  • Common Carotid Arteries (left and right)
  • Subclavian Arteries (left and right)
  • Brachiocephalic Artery, Ascending Aorta
  • Coronary Arteries (left and right)
  • External/Internal Jugular veins
  • Various cervical and thoracic arteries and veins

Physiology Review

• Blood flow pathway:
  • To Lungs -> To Left Atrium -> To Periphery (body)
  • Heart Valves involved: Tricuspid AV Valve, Bicuspid AV Valve, Pulmonic Valve, Aortic Valve.

Perfusion

• Definition: Process of delivering blood from capillaries to tissues.
• Cardiac Output (CO): Amount of blood ejected from the left ventricle each minute.
  • Formula: CO = ext{Stroke Volume} imes ext{Heart Rate}
• Factors affecting tissue perfusion need consideration in cardiac assessments.

Electrical Conduction of the Heart

• Components:
  • Sinoatrial (SA) Node: Natural pacemaker initiates cardiac cycle.
  • Atrioventricular Node: Transmits impulse to heart chambers.
  • Bundle of His and Purkinje Fibres: Conduct impulses through the ventricles.

ECG (Electrocardiogram)

• Key waves and intervals:
  • P Wave: Atrial depolarization (contraction).
  • PR Interval: Conduction from SA node to Bundle of His.
  • QRS Complex: Ventricular contraction (systole), with atrial diastole hidden.
  • T Wave: Ventricular diastole (filling).

General Survey and Vitals

• Importance of taking baseline vitals:
  • Temperature
  • Blood Pressure (BP) and Mean Arterial Pressure (MAP)
  • Pulse

Health History Assessment

• Critical questions to address:
  • History of smoking, diet, and exercise habits?
  • Family history of heart disease or congenital defects?
  • Current management of blood pressure or cholesterol?
  • Review current medications and their purposes.
• Signs/Symptoms to assess:
  • Chest pain, dyspnea, palpitations, fatigue, edema.

Jugular Vein Assessment

• Inspect jugular vein for pulsations/distension:
  • Position patient at a 30-45 degree angle with head turned slightly left.
  • Distension is not expected; measure Jugular Venous Pressure (JVP) if present.

Carotid Artery Assessment

• Inspect, auscultate for bruits, and palpate the carotid arteries bilaterally.
• Expected findings include normal rate and rhythm with no abnormal sounds.

Cardiac Inspection Techniques

• Inspect thorax and precordium for:
  • Scars, deformities, masses, and pulsations.
• Palpation:
  • Feel apical impulse at the 5th Intercostal Space at Mid-Clavicular Line (MCL).
• Auscultation:
  • Use diaphragm of stethoscope to listen for heart sounds (S1, S2).

Heart Sounds

• Normal heart sounds:
  • S1 and S2 without additional sounds are considered normal.
• Abnormal heart sounds include:
  • S3 and S4, which may indicate underlying pathology.
  • Murmurs can arise from disrupted blood flow due to various cardiac issues.

Red Flags

• Alert for:
  • Changes in level of consciousness (LOC)
  • Chest pain, shortness of breath
  • Lightheadedness, signs of fluid overload.

Peripheral Vascular System and Lymphatics

• Assess pulses, assess for edema, compartment syndrome, and deep venous thrombosis (DVT).
• Health history for peripheral symptoms includes pain, numbness, color changes, and medication use.

Lymphatics Assessment

• Check major lymph nodes: epitrochlear, supraclavicular, cervical, axillary, and inguinal nodes.
• Note size, consistency, tenderness, and mobility.

Edema Assessment

• Pitting Edema: Indentation in affected areas.
• Non-pitting Edema: Associated with thyroid or lymphatic conditions.
• Assess and treat underlying causes, using diuretics if appropriate.

Common Risks for Peripheral Conditions

• Long periods of sitting or standing
• Obesity and pregnancy as significant risk factors for edema.

Compartment Syndrome

• Characterized by pain, swelling, and paresthesia; emergency intervention may be required if complications arise.
• Understanding limb ischemia markers is crucial -- encompass the '6 Ps': pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia.

Conclusion

• Emphasize practice and integration of cardiovascular and peripheral assessments for competency in nursing.