Cardiovascular and Peripheral Vascular Assessment Quiz

Cardiovascular and Peripheral Vascular Assessment

• The objectives of the unit include identifying pertinent history questions and ROS for cardiovascular and peripheral vascular systems, describing the normal cardiac cycle and heart murmurs, and discussing the important areas to examine in the arms and legs.

• The heart is a hollow muscular organ located in the thoracic cavity between the lungs, and important landmarks in cardiac examination include the sternal notch and angle of Louis.

• Blood circulation in the heart involves the right and left coronary arteries, which supply blood to different parts of the heart.

• The cardiac cycle involves diastole and systole, and S1 and S2 sounds are produced with the opening and closing of heart valves.

• S3 and S4 sounds are extra heart sounds that may indicate ventricular dysfunction or volume overload.

• Murmurs are abnormal heart sounds produced by turbulent blood flow and are usually diagnostic of valvular heart disease.

• Jugular venous pressure is a true representation of right atrial pressure and is affected by changing pressures in the right atrium during atrial filling and contraction.

• History questions related to cardiovascular and peripheral vascular disorders include chest pain, dyspnea, pedal edema, palpitations, syncope, leg pain, and intermittent claudication.

• Atypical symptoms of acute coronary syndrome may include discomfort, fidgetiness, SOB, epigastric pain, jaw pain, palpitations, and fatigue.

• Dyspnea may be gradual or sudden, and severity is determined by the level of activity that causes it.

• Edema is often associated with SOB, jugular venous distension, and fluid overload, and may be relieved with diuretics.

• Syncope during exertion, absence of prodrome or aura, and low systolic blood pressure may indicate cardiac syncope, while leg pain during walking or exertion that is relieved with rest may indicate peripheral arterial disease.Cardiovascular System Examination Techniques

• Edema, varicose veins, and aching in the legs are symptoms of venous stasis caused by insufficient arterial supply to the legs, which may be caused by atherosclerosis.

• Equipment for cardiovascular and peripheral vascular system examination includes a stethoscope, tourniquet, sphygmomanometer, two 15 cm rulers, and a watch.

• Inspection includes vital signs, height and weight, and inspection of eyes, lips, nails, and skin of extremities for cyanosis and pallor.

• Inspection of the neck includes inspection of the carotid artery for pulsation and palpation of carotid pulse one at a time.

• Jugular venous pulsations and distention are examined by raising the head of the bed to about 30° and identifying the internal jugular venous pulsations and distention. JVP measurement is also done.

• Inspection and palpation of arms include inspection of their color, size, symmetry, swelling, venous pattern, and nail clubbing and capillary refill time, as well as palpation of the radial pulse and brachial pulse for rate, rhythm, and amplitude.

• Inspection and palpation of the precordium/anterior chest include inspection of skin color and lesions, palpation of the five specific areas for masses, tenderness, and heaves and thrills, and auscultation for normal and abnormal sounds.

• Auscultation includes using the diaphragm for picking up the relatively high-pitched sounds of S1 and S2 and few high-pitched murmurs, and using the bell for picking up the low-pitched sounds like S3, S4 and few low-pitched murmurs.

• Inspection and palpation of legs include inspection of their size, symmetry, edema, venous pattern, and any venous enlargement or varicosities, as well as palpation of the femoral pulses, popliteal pulses, dorsalis pedis pulse, and posterior tibial pulse for rate, rhythm, and amplitude.

• Blood pressure is evaluated, with normal systolic/diastolic pressure being <120/80 mmHg, and a larger cuff width being used for large arms.

• Special techniques include the Allen test for evaluating the arterial supply to the hand, and the (Trendelenburg) test for evaluating the competency of venous valves.

• The (Trendelenburg) test involves occluding the great saphenous vein in the upper thigh by manual compression, elevating one leg to about 90º to empty it of venous blood, and watching for venous filling in the leg while keeping the vein occluded.

• A negative response to the (Trendelenburg) test indicates that both steps of the test are normal and that the valves in the saphenous vein block retrograde flow.

Cardiovascular and PVS Assessment

• Objectives of the unit include identifying pertinent history questions and ROS of the cardiovascular system and peripheral vascular, describing a normal cardiac cycle, defining a heart murmur, describing the scale of grading the intensity of heart murmurs, discussing important areas to examine arms and legs, learning techniques to assess the Cardiovascular and PVS Systems, and learning special maneuvers to test arterial and venous insufficiency.
• The heart is a hollow muscular organ located within the thoracic cavity between the lungs, behind the sternum, in front of thoracic vertebrae and above the diaphragm.
• The heart lies obliquely within the mediastinum, with its base directed superiorly and the apex directed inferiorly.
• An important landmark in cardiac examination is the sternal notch and the angle of louis (sterno manubrium angle) which is formed where the sternum fuses with the manubrium.
• There are two atrioventricular valves (between atria and ventricles): the tricuspid valve and bicuspid or mitral valve.
• There are two semilunar valves (between ventricles and great vessels): the aortic and pulmonic valves.
• There are two main coronary arteries: the Right Coronary Artery (RCA) and Left Coronary Artery (LCA).
• The left coronary artery supplies blood to the anterior wall of left ventricle, anterior wall of the septum and Bundle of HIS, while the lateral wall of the left ventricle, left atrium and posterior wall of left ventricle are supplied by the left circumflex artery.
• The RCA supplies blood to the right atrium, right ventricle, SA node and AV node; any occlusion in RCA causes MI/ischemia in inferior wall of heart.
• The Sinoatrial node (SA node) is the natural pacemaker of the heart that generates electrical impulses.
• Blood flows from higher to lower pressure, and contraction increases the pressure within the chamber while relaxation decreases the pressure in the chamber.
• Atrioventricular valves (Tricuspid and Mitral Valves) are open when atrial pressures are higher than ventricular pressure and close when atrial pressure is lower than ventricular pressure.