Names: Asna Baig

Roll No: 0726

Subject Name: Health Assessment

Cardiovascular System
Study Direct Learning

1. Where is the heart located in thoracic cavity?

The heart is located in the mediastinum, which is the central compartment of the thoracic cavity. It
is positioned between the lungs, with the apex pointing towards the left side.

2. Name the chamber of the heart and their valves?

Chambers:
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
Valves:
Tricuspid Valve (between right atrium and right ventricle)
Pulmonary Valve (between right ventricle and pulmonary artery)
Mitral Valve (or Bicuspid Valve, between left atrium and left ventricle)
Aortic Valve (between left ventricle and aorta)

3. Describe the components of the cardiac cycle?

During the cardiac cycle, the heart goes through a series of events to pump blood throughout the body. It
consists of two main phases: diastole and systole.

In diastole, the heart relaxes and fills with blood. The atria contract, pushing blood into the ventricles. The
mitral and tricuspid valves open to allow blood flow.

In systole, the ventricles contract, pumping blood out of the heart. The mitral and tricuspid valves close to
prevent backflow, while the aortic and pulmonary valves open to allow blood to be ejected into the aorta
and pulmonary artery, respectively.

This cycle repeats with each heartbeat, ensuring a continuous flow of oxygenated blood to the body.

4. What is the conduction system of heart?

The conduction system of the heart is a network of specialized cells that coordinate and regulate the
heartbeat. It includes the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, bundle
branches, and Purkinje fibers. These structures work together to generate electrical impulses and ensure
proper timing and coordination of heart contractions. It's like a natural electrical system that keeps the
heart beating rhythmically.

5. What produces S1 and S2 heart sounds?

S1 and S2 heart sounds are produced by the closing of the heart valves during the cardiac cycle. S1, the
first heart sound, is caused by the closure of the mitral and tricuspid valves at the beginning of systole.

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S2, the second heart sound, is caused by the closure of the aortic and pulmonary valves at the end of
systole. These sounds can be heard with a stethoscope and are important for diagnosing heart conditions.

6. When and where do you hear S3 and S4?

S3 and S4 heart sounds are typically heard during the diastolic phase of the cardiac cycle. S3 is heard
after S2, and S4 is heard before S1. These sounds can be heard using a stethoscope, typically in specific
areas of the chest where the heart sounds are best audible. S3 is more commonly heard in children and
young adults, while S4 is more commonly heard in older adults and individuals with certain heart
conditions.

7. What is pulse of maximum impulse (PMI)?

The pulse of maximum impulse, or PMI, refers to the pulsation that can be felt at the point on the chest
where the heart's apex is closest to the chest wall. It's like the heartbeat you can feel when you place your
hand over your heart. The PMI is typically located in the fifth intercostal space, around the midclavicular
line. Healthcare providers can assess the strength and regularity of the heartbeat by feeling the pulse at the
PMI.

8. Where can you best hear the apical impulse?

We can best hear the apical impulse, also known as the point of maximal impulse (PMI), by listening with
a stethoscope at the apex of the heart. The apex is located in the fifth intercostal space, around the
midclavicular line on the left side of the chest. By listening at this spot, healthcare providers can assess
the rhythm and strength of the heartbeat.

9. What is split S2?

The split S2 refers to a sound that can be heard during the cardiac cycle when the second heart sound (S2)
is split into two distinct components. It occurs when the closure of the aortic valve and the closure of the
pulmonary valve do not happen simultaneously. This split sound can be heard best at the second
intercostal space, either on the left or right side of the sternum. It's a normal variation in heart sounds and
can be heard in certain conditions.

10. What are murmurs?

Murmurs are abnormal sounds that can be heard during the cardiac cycle. They are often described as
whooshing or swishing sounds and can indicate an underlying issue with the heart's valves or blood flow.
Murmurs can vary in intensity, pitch, and location, and they are usually detected using a stethoscope
during a physical examination. It's important for healthcare providers to evaluate murmurs to determine
their cause and appropriate treatment, if needed.

11. What are some of the related question to be asked for cardiac assessment?

Here are some related questions that can be asked during a cardiac assessment:

1. Do you experience any chest pain or discomfort?

2. Have you noticed any shortness of breath or difficulty breathing?
3. Have you ever had episodes of palpitations or an irregular heartbeat?
4. Do you have a history of high blood pressure or hypertension?

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5. Have you ever been diagnosed with a heart condition or had any heart surgeries?
6. Are you currently taking any medications for your heart?
7. Have you noticed any swelling in your legs or ankles?
8. Do you have a family history of heart disease?
9. Have you recently experienced any dizziness or fainting spells?
10. Are you experiencing any fatigue or decreased exercise tolerance?

12. List the changes in cardiovascular system because of aging process?

There are several changes that can occur in the cardiovascular system. Some of these changes include:

1. Stiffening of blood vessels

2. Thickening of the heart walls
3. Decreased maximum heart rate
4. Reduced cardiac output
5. Increased risk of cardiovascular diseases
6. Accumulation of fatty deposits
7. Decreased ability to respond to stress

Anatomy and Physiology Review – Put the Following terms in the table below

1. Aortic valve 2. Mitral valve 3. Inferior vena cava

4. Pulmonic valve 5. Left common carotid artery 6. Right common carotid artery
7. Left pulmonary artery 8. Right pulmonary artery 9. Left subclavian artery
10. Right subclavian artery 11. Superior vena cava 12. Tricuspid valve
13. Descending aorta

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 1. 1. Left Ventricle

2. Left Circumflex 2. Papillary Muscles

3. 3. Chordae Tendineae

4. Inferior Vena Cava 4. Tricuspid Valve

5. 5. Mitral Valve

6. 6.

7. 7.

8. Pulmonary Vein 8.

9. 9.

Impulse on ECG-PQRST where

1. P - Atrial systole
2. PR - Delay of impulse from SA-AV node
3. QRS - Ventricular systole
4. ST - Ventricular systole
5. ST - Ventricular muscles resting
6. T wave - Ventricular repolarization.

Heart as a pump (SV, CO) (Define the following)

Stroke volume:

Stroke volume refers to the amount of blood ejected by the left ventricle of the heart with each
contraction. It represents the volume of blood pumped out of the heart and into the circulatory system per
heartbeat. Stroke volume is influenced by factors such as the strength of the heart's contraction, the
preload (amount of blood returning to the heart), and the afterload (resistance to blood flow). It is an
important measure in assessing cardiac function.

Cardiac Output:

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Cardiac output is the measure of the amount of blood pumped by the heart in one minute. It is calculated
by multiplying the stroke volume (the amount of blood ejected with each heartbeat) by the heart rate (the
number of heartbeats per minute). Cardiac output reflects the overall efficiency of the heart in delivering
oxygenated blood to the body's tissues and organs. It is an important indicator of cardiac function and can
be influenced by factors such as physical activity, stress, and certain medical conditions.

Preload:

Preload refers to the amount of blood that fills the ventricles of the heart during diastole, which is the
relaxation phase of the cardiac cycle. It represents the volume and pressure of blood returning to the heart
from the venous circulation. The preload is determined by factors such as venous return, blood volume,
and the compliance (stretchability) of the ventricles. It is an important factor in determining the stroke
volume and cardiac output of the heart.

After load:

Afterload refers to the resistance that the heart must overcome to pump blood out of the left ventricle and
into the systemic circulation. It is primarily determined by the peripheral vascular resistance, which is the
resistance to blood flow in the arteries. The afterload is influenced by factors such as the diameter of the
blood vessels, the viscosity of the blood, and the overall vascular tone. An increased afterload can make it
more difficult for the heart to pump blood effectively, while a decreased afterload can make it easier.

Myocardial contractility:

ssMyocardial contractility refers to the strength and forcefulness of the heart's contractions. It specifically
refers to the ability of the heart muscle (myocardium) to contract and pump blood effectively. Factors
such as the calcium concentration within the heart muscle cells, sympathetic nervous system activity, and
certain hormones can influence myocardial contractility. When the contractility is increased, the heart
pumps blood with more force, resulting in a higher stroke volume and cardiac output.

Blood Pressure & factors affect on BP

BP stands for blood pressure. It is the force exerted by the blood against the walls of the arteries as the
heart pumps it throughout the body. Blood pressure is measured using two values: systolic pressure (the
pressure when the heart contracts) and diastolic pressure (the pressure when the heart is at rest between
beats).

Several factors can affect blood pressure. These include:

- Age: Blood pressure tends to increase with age.

- Lifestyle: Factors like diet, physical activity, and stress levels can influence blood pressure.
- Weight: Being overweight or obese can contribute to higher blood pressure.
- Family history: Genetics can play a role in blood pressure tendencies.
- Certain medical conditions: Conditions like diabetes, kidney disease, and hormonal disorders can affect
blood pressure.

Carotid pulse:
o CA lies in the neck in the groove b/w trachea & SCM muscle.
o Provide indication of Rt sided function.

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 o 2 veins a) EJV –more superficial, discrete visible above the clavicle near SCM insertion b) IJV-
larger, lie beneath SCM lateral to carotid, but their activity is reflected by a visible diffuse
pulsation in the lower part of the neck.
o JV pulses have 5 components, 3 upward stroke & 2 descent slopes.

Ventricular Systole:
o In this phase: Ventricles contract, blood ejected from RV- PA and from LV into Aorta.
o Ventricles filled with blood, Vent pressure higher than atria pressure, the AV valves snap shut.
o Vent wall begin to contract, pressure builds (iso-volumic contraction).
o Vent. Pressure exceeds than the Aortic & Pulmonic pressure the SL calves open & bid ejected.
o After that pressure in Ventricles is less than pulmonary artery & aorta so these valves close.
o While the vent is contracting, atria are filling with blood.
Ventricular Diastole
o Ventricles relax,
o Pressure in the atria is higher than in the ventricles so AV valves opens & blood flows from Atria
to ventricles. (Rapid filling-70%)
o Atria contract to eject the remaining 30% blood into the ventricle. = called atrial systole.

Production of heart sounds

o Closure of heart valves produces heart sounds
o S1 is produced by closure of AV valves
o S2 is produced by closure of SL valves
o Components of S1=T1 & M1
o Components of S2=A2 & P2
o Any sound has some characteristics
 Frequency-Pitch or tone ()
 Intensity-loudness
 Quality-musical, blowing or harsh
 Duration-short or long
 Timing-during systole

Inspect Carotid & Jugular pulse

o Direct tangential lighting
o Inspect carotid pulse for amplitude (large bounding or small weak)
o Identify JV pulse in the base of neck as a gentle wave.
o To differentiate the carotid pulse from jugular pulse, check 5 things.

 Character of the pulse

 Effect of position
 Effect of respiration
 Effect of venous compression
 Effect of abdominal pressure

Palpate carotid pulse

o Must do it on one side, not together and not very high up as can trigger carotid sinus.
o Auscultate carotid for bruits.

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Measure JVP
o JV pressure is the level at which the JV appear full.
o In normal person, filling of JV is not seen unless in supine, if visible in elevated position, then RT
side FX less competent.
o Use sternal angle as a reference point, one ruler there & other perpendicular at the level of JVP
note the height in cm.
o Normal JVP is less than 3-4 cm of water. Higher – RHF, CHF, volume overload
o Auscultate for venous hum

Percuss for cardiac dullness

o Use X-rays reliable, dullness extends to MCL, slopes toward sternum.

Auscultation areas

o 4 traditional areas: 2RICS, 2LICS, 5LICS SB, 5LICS 7- 9 cm SB(APTM)

o Do not limit here, cover all precordium

Sequence- base to apex

o Keep inching the stethoscope to cover all areas.

Use of stethoscope (both sides)

o All HS are low pitched but we still use both sides

Position of patient
o Position used – sitting/ learning forward/ supine/ it lateral recumbent

Carotid and Venous sound

o Carotid bruit & venous hum

Rate & Rhythm

o 60-100 listen for sinus arrhythmias in adults
o Identify S1 & S2
o S1 louder- apex S2 louder at base.
o Listen to S1& S2 separately, if normal, diminished, split etc.

Characteristics of S1 & S2
o S1: Closure of AV valves, signals beg of systole, heard over entire precordium but loudest at
apex, hear with diaphragm, any position, Split is normal but rare.
o S2: Closure of SL valves, signals end of systole, or beg of diastole, hear with diaphragm, over
entire precordium, loudest at base.

Variation in S1 & S2 (splitting)

o S2 splitting is normal toward inspiration due to effect of inspiration, pulmonic valve closes later
then A2, heard only in pulmonic area. Do not ask to hold breath but see the respiration chest rise
& fall.

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Extra sounds in systole
o Ejection clicks
o Systolic clicks
o Significance of clicks

Extra sounds in diastole

o Opening snap (OS)
A sharp sound occurring at the beginning of diastole, associated with the opening of the AV valves

o Ventricular gallop (S3)

Extra heart sound occurring early in diastole, after S2.

Characteristics: Low-pitched sound resembling the word "Kentucky."
Significance: Often indicates heart failure or volume overload.

o Significance of OS, S3 & S4

Opening Snap (OS): Indicates early diastolic filling and increased pressure.
Ventricular Gallop (S3): Suggests heart failure or volume overload.
Atrial Gallop (S4): Indicates stiffness in the ventricle, often due to hypertension or aortic stenosis.

Murmurs (List down the types and Causes)

Abnormal sounds caused by turbulent blood flow.

Types: Systolic, Diastolic, Continuous.
Causes: Valvular diseases, structural abnormalities, heart defects, etc.
Attributes: Timing (systolic or diastolic), grading (intensity), shape, quality, or location.
Understanding these sounds and their characteristics is crucial for diagnosing and interpreting cardiac
conditions during auscultation.

o Attributes: timing, grading, shape, quality or location

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 Assessment of Cardiovascular System

Faculty Name & Signature: Date:

Marking Criteria: Done = 02, Not Done Correctly = 01, Omitted = 0

S No Activity Mark N/A

Preparation
1. Introduced self
2. Explained examination
3. Gave proper instructions
4. Assembled needed equipment
5. Arranged for proper environment
Health History
6. Review Cardiovascular system
7. Determine Positive Past History
8. Determine history smoking and alcoholism
9. Determine dietary habits and exercise habits
10. Determine Positive Family History
Inspection
11. Inspect skin color for Cyanosis, Polycythemia, Hemochromatosis
12. Inspect Skin for varicosities, extremity, hair distribution, edema &
ulcers

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 13. Inspect for lid edema, xanthomata, Corneal Arcus and Blue sclera
14. Inspect for Central cyanosis and Torso palatine
15. Inspect nails for Clubbing, Splinter hemorrhage
17. Inspect neck for JVP pulsations or distention
18. Measure neck for JVP
19. Inspect general chest contour and movements
20. Inspect Chest for Apical impulse, Heaves and Thrills
Palpation & Auscultation
21. Obtain carotid, ulnar, radial, brachial, femoral, popliteal, dorsalis
pedis, and posterior Tibial pulse bilaterally.
22. Auscultate carotid artery for bruits
23. Palpate carotid artery for rate, rhythm and amplitude
24. Palpate Apical impulse
25. Locate PMI, aortic area, pulmonic area, right Ventricular area and
apical area.
26. Obtain blood pressure bilaterally
27. Survey for Heaves and thrills
28. Survey with diaphragm—aortic, pulmonic, mitral, tricuspid, apical
areas and identify S1 and S2 sounds
29. Survey with bell—aortic, pulmonic, mitral, tricuspid, apical areas
Approach to the client:
30. Followed logical exam sequence
31. Positioned client properly
32. Draped client properly
33. Finding explained to client

Comments:

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