Assessing the Cardiovascular System

Aortic Area: Right $2^{\text{nd}}$ intercostal space
Pulmonic Area: Left $2^{\text{nd}}$ intercostal space
Erb's Point ( $S_1$ , $S_2$ ): Left $3^{\text{rd}}$ intercostal space
Tricuspid Area: Lower left sternal border, $4^{\text{th}}$ intercostal space
Mitral (Apical) Area: Left $5^{\text{th}}$ intercostal space, medial to midclavicular line
Mnemonic: All People Enjoy Time Magazine

Stethoscope Diaphragm: Used to hear higher-pitched sounds
Stethoscope Bell: Used to hear lower-pitched sounds and bruits
Bruits: Sounds caused by blood swirling instead of flowing smoothly
$S_1$ ("lub"): First heart sound; dull, low-pitched; heard best over mitral and tricuspid areas
$S_2$ ("dub"): Second heart sound; higher in pitch and shorter; heard best over aortic and pulmonary areas
$S_3$ ("lub-dub-dee" / "Ken-Tuck-y"): Extra heart sound best heard at mitral area with patient lying on left side
$S_4$ ("dee-lub-dub" / "TENN-ess-ee"): Extra heart sound best heard at mitral site with patient lying on left side
Heart Murmurs: Extra sounds produced by turbulent blood flow through heart valves

Pain: Extreme pain, especially on passive motion; unlikely to be relieved by opioid analgesia
Pallor (Perfusion): Pale skin/coolness indicates decreased arterial supply; cyanosis indicates venous stasis
Peripheral Pulses: Assess presence, rate, quality, and consistency of arterial blood flow distal to affected area
Paresthesia (Sensation): Numbness, tingling, or "pins and needles" sensations
Paralysis (Movement): Ability to move extremity distal to injury
Pressure: Taut, firm area to touch with shiny surrounding skin

Older Adults:
- Difficult to palpate apical pulse and distal arteries
- More prominent blood vessels and increased varicosities
- Increased blood pressure and wide pulse pressure
Infants and Children:
- Visible cardiac pulsation
- Sinus dysrhythmia
- Increased heart rate
- $S_3$ heart sound