Health Assessment
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| Cardiac Assessment: | Heart and Neck Vessels
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| Precordium: | area on the anterior chest overlying the heart and great vessels.
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| Base: | superior aspect of the heart.
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| Apex: | inferior aspect of the heart.
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| Superior Vena Cava & Inferior Vena Cava: | returns unoxygenated blood to the heart.
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| Pulmonary Veins: | return the freshly oxygenated blood to the left side of the heart.
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| Aorta: | carries the freshly oxygenated blood out to the body.
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| Heart Wall: | numerous layers.
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| Pericardium: | tough, fibrous, double-walled sac that surrounds and protects the heart.
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| Myocardium: | muscular wall of the heart that does the pumping.
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| Endocardium: | thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves.
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| The four chambers (atrium and ventricles): | are separated by swinging door like structures, called valves, whose main purpose is to prevent back flow of blood.
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| The Valves: | open and close passively in response to pressure gradients in the moving blood.
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| Atrioventricular Valve (AV): | tricuspid & mitral
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| Semilunar Valve (SL): | pulmonic & aortic
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| Direction of Blood Flow: | 1)From liver to RA via inferior vena cava; superior vena cava drains venous blood from the head and upper extremities. 2)From RV, venous blood flows through pulmonic valve to pulmonary artery. 3)Pulmonary artery delivers unoxygenated blood to the lungs.
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| Direction of Blood Flow: (cont) | 4)Lungs oxygenate blood; pulmonary veins return fresh blood to LA. 5)From LA, arterial blood travels through mitral valve to LV ejects blood through aortic valve into aorta. 6)Aorta delivers oxygenated blood to body
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| Cardiac Cycle: | The rhythmic movement of blood through the heart. It has two phases: Diastole and Systole
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| Diastole: | The ventricles are relaxed, and the AV valves (tricuspid and mitral) are open. The pressure in the atria is higher than that in the ventricles, so blood pours rapidly into the ventricles.
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| Systole: | That part of the heart cycle in which the heart is in contraction (myocardial fibers are tightening and shortening). Occurs in the interval between first and second heart sounds during which blood is surged through the aorta and pulmonary artery.
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| Normal Heart Sounds: | first heart sound (S1) & second heart sound (S2)
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| The first heart sound (S1): | occurs with closure of the AV valves and thus signals the beginning of systole.
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| The second heart sound (S2): | occurs with closure of the semilunar valves and signals the end of systole.
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| Extra Heart Sounds: | third heart sound (S3) & fourth heart sound (S4)
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| Third Heart Sound (S3): | Normally diastole is a silent event. However, in some conditions, ventricular filling creates vibrations that can be heard over the chest. ie: protodiastole - ventricles are resistant to filling during early rapid filling phase.
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| Fourth Heart Sound (S4): | Occurs at the end of diastole, at presytole, when the ventricle is resistant to filling.
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| Murmur: | is a gentle, blowing, swooshing sound that can be heard on the chest wall. Velocity of blood increases (flow murmur) (exercise, thyrotoxicosis) Viscosity of blood decreases (anemia).
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| Murmur: (cont) | Structural defects in the valves (narrowed valve, incompetent valve) or unusual openings occur in the chambers (dilated chamber, wall defect)
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| Tips for Identifying Murmurs and Characteristics: | Timing during systole or diastole. Shape of murmur (crescendo or decrescendo, holosystolic). Location on the precordium
Radiation or transmission. Grade intensity 1-6
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| Tips for Identifying Murmurs and Characteristics: (cont) | Pitch – high, medium or low. Intensity (loudness) - loud or soft. Quality – blowing, harsh, rumbling, musical
Positioning of the patient. Listen in a quiet room!
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| Subjective Data: | Chest Pain, Palpitations, Dyspnea/Shortness of Breath, Cough, Edema, Nocturia, Fatigue, Cyanosis or pallor
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| Subjective Data: (cont) | Past cardiac history, Family cardiac history, Personal habits (cardiac risk factors): Nutrition, Smoking, ETOH, Exercise, Medications/Drugs.
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| Subjective Data - Pediatrics: | Mother’s health during pregnancy? Cyanosis while nursing, able to eat without tiring?Play without tiring? Blue spells? Squat to rest? Family history of structural heart problems?
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| Objective Data: | Review blood pressure, heart rate, neck (carotid pulse, auscultate, observe jugular venous pulse).
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| Carotid Pulse: | Observe and palpate (medial to the sternomastoid muscle in the neck, palpate gently).
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| Auscultate: | for presence of a bruit.
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| Observe jugular venous pulse: | external jugular veins overlying the sternomastoid muscle are better observed in supine position, disappears as person is raised up.
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| Objective Data: | Precordium (inspection & palpation)
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| Inspection and Palpation: | Describe location of apical impulse or PMI (point of maximal impulse). location - occupies only one interspace, the 4th - 5th, medial or midclavicular at apex. Size - 1cm - 2cm
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| Inspection and Palpation: (cont) | Amplitude - short, gentle tap. Duration - short, occupies only first have of systole
Note any heave (lift) or thrill.
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| Objective Data - Auscultation: | Identify the auscultatory areas where you will listen: Aortic Area, Pulmonic Area, Erb’s point, Tricuspid Area, Mitral Area
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| Objective Data - Auscultation: (cont) | Identify anatomic areas where you listen with both diaphragm (better for picking up the high pitched sounds) and bell (low pitched sounds). Note rate and rhythm of heartbeat. Identify S1 and S2 and note any variation.
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| Objective Data - Auscultation: (cont) | Listen in systole and diastole for any extra heart sounds. Listen in systole and diastole for any murmurs. Repeat sequence with bell
Listen at the apex with person in left lateral position. Listen at the base with person in sitting position.
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| Cardiovascular - Pediatrics: | Murmurs of congenital heart defects (murmurs common first 2-3 days-fetal shunt closure).
PMI 4th intercostal space/lateral to midclavicular line until age 4. 4th intercostal space at midclavicular line age 4-6.
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| Cardiovascular - Pediatrics: (cont) | Indicators of heart disease: poor weight gain, developmental delay, persistent tachycardia, tachypnea, DOE, cyanosis, clubbing. Venous hum-continuous low pitched hum throughout cycle…nl.
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