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.