Cardiovascular System Assessment Quiz

The cardiovascular system is a highly complex system made up of the heart and a closed system of blood vessels.
The heart is a hollow, muscular, four-chambered organ located in the middle region of the thoracic cavity between the lungs.
The heart is about the size of a clenched fist and weighs approximately 255g in women and 310g in men.

The cardiac cycle is composed of two phases: systole and diastole.
Systole refers to ventricular contraction and begins with closure of the AV valves (S1) and ends with the closure of the aortic and pulmonic valve (S2).
Diastole refers to ventricular relaxation and begins with closure of the aortic and pulmonic valve (S2) and ends with closure of AV valves (S1).

The first heart sound (S1) is caused by the mitral and tricuspid valves closing at the beginning of systole.
The second heart sound (S2) is caused by the aortic and pulmonary valves closing at the beginning of diastole.
S1 is best heard at the apex of the heart (left MCL, 5th ICS).
S2 is best heard at the base of the heart (2nd ICS at right side for aortic valve and left side for pulmonic valve).

S3: Extra heart sound, low pitched, ending in early diastole, best heard with the bell of the stethoscope.
S4: Extra heart sound, low pitched, ending in late diastole, and best heard with the bell of the stethoscope.
Murmurs: Sounds caused by turbulent blood flow within the heart.

Carotid Artery Pulse: The right and left common carotid arteries are located in the groove between the trachea and the right and left sternocleidomastoid muscles, slightly below the mandible.
Jugular Venous Pulse and Pressure: The jugular veins return blood by way of the superior vena cava to the heart from the head and neck.

Chest pain
Dyspnea
Orthopnea
Cough
Fatigue
Cyanosis or pallor
Edema
Clubbing
Past history of hypertension, elevated cholesterol, heart murmur, rheumatic fever, anemia, heart disease
Family history of hypertension, obesity, diabetes, coronary artery disease
Lifestyle factors: diet high in cholesterol, calories, or salt; smoking; alcohol use; drugs; amount of exercise

Tachypnea: Rapid, shallow breathing.
Cheyne-Stokes respirations: a pattern of rapid respirations alternating with apnea.
Hemoptysis: Coughing up blood.
Cough
Crackles and Wheezes

Inspection: Observing the patient's appearance and any visible signs of cardiovascular disease.
Palpation: Using the hands to feel for pulses, thrills (vibrations), or any abnormalities in the chest.
Percussion: Tapping on the chest to assess the size and position of the heart.
Auscultation: Listening to the heart sounds using a stethoscope.

Patient Preparation: Explain the procedure, expose the anterior chest, place the patient in a supine position with the head elevated to about 30 degrees or left lateral position, and sitting up and leaning forward position.
Equipment: Examination gown, examination drape, stethoscope, two centimeter rulers, small pillow, penlight or movable examination light, watch with a second hand.

Jugular venous pressure (JVP) and pulsations: Assess central venous pressure.
Inspection of face, lips, hands and fingers: Look for cyanosis, pallor, and clubbing.
Precordial bulge: Abnormal protrusion of the chest wall.
Dilated veins on the chest wall: Can indicate increased pressure in the venous system.
Scars of previous operations: Inspect for evidence of prior cardiac surgeries.
Pulsations all over the chest and carotid pulse: May indicate underlying heart problems.
Inspection of the jugular venous pulse: Measure jugular venous pressure.

Carotid Pulse: Gently palpate both carotid arteries individually.
Chest: Palpate for thrills (vibrations) in the aortic, pulmonic, Erb's point, mitral, and tricuspid areas.
Apical Pulse: Palpate the apical impulse (point of maximal impulse) in the mitral area.

Percussion of the chest for cardiac border: Percussion can help determine the size of the heart.

Auscultate the following locations using the diaphragm and bell of the stethoscope:
- Aortic area: 2nd ICS at the right sternal border.
- Pulmonic area: 2nd/3rd ICS at the left sternal border.
- Erb's point: 3rd to 5th ICS at the left sternal border.
- Tricuspid area: 4th/5th ICS at the left lower sternal border.
- Apex: 5th ICS at the midclavicular line.
Auscultation of carotid arteries: Listen for bruits (abnormal sounds) in the carotid arteries.
Comparing carotid and apical pulses: The heart sound that occurs with the carotid pulse is S1.

Supine: The standard position for auscultating the heart sounds.
Lateral (Mitral Valve Disease): Leaning to the left side helps enhance mitral murmurs.
Sitting (Aortic Valve Disease): Sitting up and leaning forward enhances aortic murmurs.