CARDIOVASCULAR ASSESSMENT

Assessment
It is a routine or specific examination of cardiovascular structure
and functions for the early detection of abnormality.
Uses of CVS assessment
 For the early detection of heart diseases
 Before major surgeries or anesthesia
 For recruitment to particular job and tasks e.g. pilots or driver
etc.
 In case of hereditary or familial predisposition to the cardiac
diseases.
 As a routine ICCU procedure
Approaches for CVS assessment
 Cardiovascular assessment is performed by qualified and
experienced Cardiologist, physician, cardiothoracic surgeon,
cardiothoracic nurse, anesthetic nurse, physiotherapist etc.
 It is performed usually in clinical set up with proper medical
facilities.
 Consent may be obtained by family members or patient for
CVS assessment.
 The findings of CV Ax must be properly recorded and
reported.
 The patient should be restricted from heavy meal, strenuous
exercises or medications immediately before or after Ax.
STEPS IN CVS ASSESSMENT
1. History of the patient
2. Present history of cardiac illness
 Onset of symptoms
 Chronology brief notes about illness in patient’s own words
 Current condition
 Location of symptoms like chest pain, pressure, heart burn,
Inflammation etc.

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  Severity, timing, duration, frequency of pain
 Aggravating and relieving factors
 Associated symptoms
 Affects on ADL, if previous diagnosis of heart diseases.
3. Past history of cardiac illness
 Birth history which includes history of labor i.e. normal or
assisted.
 H/O congenital abnormalities like esophageal atresia, cleft lip
etc.
 H/O congenital heart diseases like patent ductus arterioses
teratology of fallot.
 Previous H/O chest pain, shortness of breath, fainting or
syncope, palpitation , haemoptysis.
 Previous history of hypertension.
 Previous history of major infection especially rheumatic heart
disease.
 Previous history of major surgery.
 Previous history of accidents.
 Previous history of metabolic disorders like diabetes, thyroid
disorders, renal disorders, hyperplasia.

4 family history
 History of hereditary disorders in the family.
 History of major cardiovascular diseases in the family.
 History of symptoms like chest pain, dizziness, dyspnea
among family members.
 IPR among family members.
5Personal history of the patient
 Personality of the patient.
 Habits of the patient like smoking, alcoholism, tobacco
chewing etc.
 Duration of sleep.
 Friends and foes. [relation in and outside the family]

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6.Socioeconomic and occupational history
 Education of the patient.
 Social relation of the patient
 Source of income.
 Marital relationship.
 Type of job.
 Duration of working hours.
 Tenure of the job.
 Responsibilities and stress of job.
7.Nutritional history
 Nourishment of the patient.
 Type of diet.
 Numbers of meal per day.
 Frequency of meal.
 Supplements.
 Artificial food or junk foods rich in carbohydrates.
 Beverages.
B.Vital signs
These are assessed by various tools and techniques. Vital signs
are sometimes first and far most methods of diagnosing cardiac
diseases. The following signs are recorded…
Temperature: usually there is no much changes in the
temperature in cardiac diseases except endocarditis, rheumatic
heart diseases,.
Pulse : it can be recorded from the following sites…
 Temporal, Carotid, apical, radial, femoral, brachial, popliteal
fossa, dorsalias paedis, posterior tibilias.
 Apical pulse is most accurate but radial and brachial pulses
are mostly recorded. Pulse can be bounding[strong pulse],
may be thready[weak pulse]. Pulse rate in normally adult
varies from 70-80 in children it is varies between 100-120.
Respiration: it may be normal [effortless or laboured].respiration
in cardiac diseases is associated with dyspnoea, apnea, cheyne
stroke breathing, stredous etc.

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Blood pressure: it is assessed when patient is on prone or semi
prone position. It is recorded for systolic and diastolic blood
pressure.
Oxygen saturation: it is assessed by observation of skin color,
mucus membrane, conjunctiva, nail beds for bluish discoloration or
by using pulse oxymetry.
C. Medication therapy
 Patient should be assessed for drugs or medicines taken
within last 72 hours.
 Allergy to specific drugs.
 History of side effects or complications from the drugs.
 In case of new born, history of maternal drugs intake.
D. physical examination
 General appearance:-
 Physical weight of the patient: obesed, normal, lean.
 Facial expression may be dull, normal, depressed.
 Appearance of the patient in regard to age.
 Posture:- normal, lean, forward, sitting, squatting.
 Sign and symptoms of physical abnormality:-
 Cleft lip, deviated nasal septum and other congenital
abnormalities.
HEAD TO TOE EXAMINATION
 Inspection:-
 Mental status of the patient:- normal, relaxed, confused,
stressful.
 Mood of the patient:- cooperative, irritating, avoiding,
impressive, anxious.
 Scalp:- observed for injury, presence of dandruff, growth of
scalp hair.
 Face:- observed for sign and of symptoms of redness, pallor,
cyanosis, bleeding.
 Oral cavity:- sign and symptoms of dental caries,
inflammation of gums and gum bleeding.
 Tongue:-for coating, cyanosis, bleeding.

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  Inspection for visible pulsation of temporal artery.
 Neck:- visible pulsation of carotid artery, neck muscles,
movements of neck, edema, goiter.
 Thorax:- movements of chest wall. It may be uniform,
unilateral.
 Precordial areas are the specific land marks on the chest wall
in relation to cardiac assessment. The following areas are
assessed………
 Aortic area it is present on the 2nd intercostals space near at
the site of sternum.
 Pulmonic area it is present at the 2nd intercostals space on the
left side of the sternum . it corresponds to pulmonary artery.
 Tricuspid area it is present on the 4th intercostal space on
left side of the sternum. It corresponds to tricuspid valve.
 Mitral area it is present on 5th intercostal space at the lower
of the left part of the sternum.
 Erb’s point it is present on the 3rd intercostal space at the left
of sternum.
Point of maximum pulse:-it is also apical pulse. It is called as
sometimes visible on the chest wall in case of cardiac abnormality.
Inspection for pulsations normally pulsations are present only at
apex of the heart. Otherwise it considers as abnormal. Abnormal
pulsations are the following………
 Thrills :- these are abnormal roacking pulsations observed on
the chest wall.
 Lifts or heaver:-these are diffused lifting impulses which are
always abnormal.
To properly assess impulse of the apex, Patient is
made to sit in supine position or leaning forward that brings the
apex of the heart nearer to the anterior chest wall.
Upper limb in the upper limbs, the hands and arms are assessed or
inspected for the following conditions.
 Skin color, observations of the veins, lymph vessels, arteries.
 Assess for the equality of the brachial and radial pulses.

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  Assess for the clubbing of the fingers.
Capillary refilling time:- this normally less than 2 second.
This is also called as nail blench test. It is a quick test to assess
the presence of dehydration, respiratory disease, cardiac disease
and to monitor the blood flow to the tissues.
Method:- pressure is applied on the nail bed until it turns white or
pale and released by removing pressure. The time for the nail bed
to turns back to the pink color is assessed which is normally less
than 2 seconds.
 Assess for nicotine strains.
 Compare the femoral and radial pulse.
 Observe for the presence of lesions, rashes, redness etc.
Lower limbs:-
Assess for the color, pigmentation, discoloration and distribution
of the hairs, temperature, the skin texture, presence of varicose
veins, and presence of dependent edema [main sign and symptom
of cardiac failure], observe for the presence pitting edema. This is
assessed by applying pressure over edematous area while patient
on supine position. If edema persists for more than 1 minute then it
is the indication of cardiac failure.
Observe for the equality of the pulses i.e.
femoral, popliteal, posterior tibialis, dorsalis paedis. Observe for
flexion, extension of the joints and for the presence of congenital
foot disorders, capillary refilling of the toe, assess for the sensory
and motor functions.
Assessment of chest pain:-
It is one of the important sign and symptom of cardiac disease. In
physical assessment, assessment of the chest pain is one of the
important step.
Chest pain is defined as discomfort or pain that is present
anywhere along the thorax between neck and abdomen. It is
present due to numbers of reasons like asthma, pneumonia, gastric
reflux etc. in cardiac condition chest pain is described as angina.
Causes :-
 Ischemia

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  Pericarditis
 Endocarditis
 Aortic anurysum
 Pulmonary embolism
 Pneumonia
 Cor pulmonale
 GERD
Differential diagnosis of chest pain:- It helps to find out possible causes of a
chest pain. For this examiner or nurse should assess following criteria:-
 Onset of chest pain:- sudden or gradual
 Location of chest pain:- on the chest, right or left of the sternum,
precordial area.
 Focal area of chest pain:- narrow, pointed or wide.
 Duration of chest pain:- sec. to min., few min. to few hrs., few hrs to
few days.
 Radiation:- radiating pain to neck, jaws, upper arm, lower arm, back
shoulder.
 Intensity:- mild, moderate, severe.
 Quality of chest pain:- dull ache, crushing, squeezing, heaviness,
burning, stabbing, sharp.
 Precipitating or aggravating factors:- heavy work, exercise, climbing
upstairs, stress, emotional disturbances, lifting heavy objects,
medications, decreased oxygen tension.
 Relieving factors:- rest, sleep, change in the position, intake of fluids
like milk, warm water, analgesics, antacids, recreation, laughing
exercise.
 Associated sign and symptoms:- tenderness of chest wall, dyspnea,
vomiting, cough, fatigue, insomnia, hyperventilation, blurred vision,
restlessness, malaise, irritation, cyanosis, altered sensation
2. PALPATION:- it is assessment or examination with the help of sense of
touch and pressure over the skin.[when a patient himself feel heart beat is
called palpitation]
Palpation of jugular vein:-jugular vein is proximal to the heart and drain
blood from the brain and CNS. It is important to locate the pulsation of the
jugular vein in the CV assessment as these changes may be related to the
cardiac disorders like heart failure. Jugular vein is located in the neck
proximal or near the sternoclidomastoid muscle. Assessment of the jugular
vein can be done as following:

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 Provide supine position to the patient with head slightly elevated by
30 degree. A flash of light from pen torch is focused on the neck
below the ear lobes along sternoclidomastoid muscle, during this a
visible pulsation is noted along the vein which is downwards in a
phased movement.
 Assessment of jugular vein distention: with the help of index and
middle finger the jugular vein is palpated. If there is any distention or
bulging of the vein it may be related to cardiac disorders. It also helps
to assess central venous pressure.
Procedure : the patient is prepared for the test and consent is obtained
from the client. Supine position is given to the client with slightly
elevated head. Jugular vein is located by using index and middle
finger. The uppermost palpation is detected. The angle of louis is
increased more than 3cm. ( angle of louis: the vertical distance
between the straight line joining the menubrium. It is measured along
the highest point of jugular vein pulsation by using a scale. Usually
this distance is less than 3cm. if it is more it indicates increased CVP.
continued in next part….