Assessing

Heart and
Central
vessels
PRIMARY FUNCTIONS

▪Delivery of oxygenated
blood throughout body
▪Removal of metabolic
wastes
Location

▪apex of the heart, which is

normally located in the
5th leftintercostal space at
the midclavicular line
Review of anatomy
Anatomic sites of precordium
 Precordium

▪ The area of the chest overlying the

heart, is inspected and palpated for the
presence of abnormal pulsations
▪ Chambers
▪ Atria right and left
▪ Ventricles right and left
▪ Valves
▪ Atrioventricular
▪ Tricuspid
▪ Mitral
▪ Semilunar
▪ Pulmonic
▪ Aortic
▪ Pulsations- these are more visible when
patients are thin. A thick chest wall or
increased AP diameter can obscure them.
Pulsations may indicate increased blood
volume or pressure.
▪ Lift or heaves- these are forceful cardiac
contractions that cause a slight to vigorous
movement of sternum and ribs.
Normal Heart sounds

▪ S1
▪ Atrioventricular valves close
▪ Described as “lub”
▪ Dull, low pitched sound
▪ S2
▪ Closure of semilunar valves
▪ Higher pitch than s1 and shorter in duration
▪ “dub”
▪ Systole
▪ Period when ventricles contract
▪ Begins with s1 and ends at s2
▪ Diastole
▪ Ventricles relax
▪ Starts with s2 and ends at the subsequent
s1
Abnormal heart sounds

▪ S3 (ventricular gallop)
▪ Occurs early in diastole right after s2 and sounds like “lub-dub-ee” or
“kentuc-ky”
▪ Disappears when client sits up
▪ Normal in children and young adult
▪ In older adults, it may indicate failure
▪ S4 (atrial gallop)
▪ Occurs near the very end of diastole just before s1 and sounds like “dee-
lub-db”
▪ Rarely heard in young adults
▪ Can be a sign of hypertension
▪ S3 and S4 are referred to as diastolic
filling sounds or extra heart sounds,
which result from ventricular vibration
secondary to rapid ventricular filling
▪ Identify the heart rate.
▪ Tachycardia
▪ Bradycardia
▪ Identify the rhythm.
▪ Arrhythmia is a problem with the rate or rhythm of your heartbeat. It
means that your heart beats too quickly, too slowly, or with an
irregular pattern
▪ Dysrhythmias are a problem with the rate or rhythm of your heartbeat caused
by changes in your heart's normal sequence of electrical impulses. Your heart
may beat too quickly, called tachycardia; too slowly, bradycardia; or with an
irregular pattern.
Landmarking for heart sounds
Neck vessels
▪ Carotid artery
▪ Jugular veins
▪Internal
▪External
Neck vessels
 Abnormalities

▪ Bruit
▪ Auscultated in carotid
▪ Blowing or swishing sound
▪ Created by turbulence of blood flow due to either narrowed
arterial lumen or a condition such as anemia or hyperthyroidism
▪ Thrill
▪ Frequently accompanies a bruit
▪ Vibrating section like the purring of a cat or water running
through the hose
▪ Indicates turbulent blood flow due to arterial obstruction
▪ Bilateral jugular vein
distention
▪ Indicates right sided
heart failure
Peripheral Vascular System

Arteries
 Temporal artery
 Carotid artery
 Arteries in the arm
 Brachial
 Ulnar
 Radial

 Arteries in the leg

 Femoral
 Popliteal
 Dorsalis pedis
 Posterior tibial
Veins
 Jugular veins
 Veins in the arm
 Veins in the leg
 Deep veins
 Femoral
 Popliteal
 Superficial veins
 Great saphenous
 Small saphenous
 Perforators (connecting veins)
ASSESSMENT
DEVELOPMENTAL CONSIDERATIONS

▪ Infants and Children

▪ Change from fetal circulation with closure of
foramen ovale and ductus arteriosus shortly
after birth.
▪ Innocent systolic murmur commonly heard.
▪ Sinus arrhythmia with respirations common.
▪ Point of maximal impulse (PMI) at fourth
intercostal space (ICS) to age 7, to left
midclavicular line(MCL) until age 4, at MCL at
age 6, to right MCL at age 7.
DEVELOPMENTAL CONSIDERATIONS

▪ Pregnant Patients
▪ Mammary soufflé.
▪ Systolic murmur common.
▪ Displace PMI up and lateral.
▪ Blood pressure lower during first and
second trimesters with slight increase in
rate.
DEVELOPMENTAL CONSIDERATIONS

▪ Older Adults
▪ Postural hypotension.
▪ Auscultatory gaps.
▪ Incidence of coronary vascular disease
(CVD) increases with age.
SYMPTOMS

▪ Chest pain
▪ Palpitations
▪ Syncope
▪ Edema
▪ Fatigue
▪ Extremity changes
Preparing the Client

▪ Explain that they will need to expose the anterior chest.

▪ Female clients may keep their breasts covered and may
simply hold the left breast out of the way when
necessary.
▪ Explain to the client that she will need to assume several
different positions for the examination.
▪ Provide the client with as much modesty as possible
during the examination, describe the steps of the
examination, and answer any questions the client may
have
Equipment

▪ Stethoscope with a bell and diaphragm

▪ Small pillow
▪ Penlight or movable examination light
▪ Watch with second hand
▪ Centimeter rulers (two)
  
  Normal Findings Deviation from Normal

1. Simultaneously inspect and palpate the precordium

for the presence of abnormal pulsations, lifts, or    
heaves.  No pulsations Pulsations

•          Inspect
and palpate the aortic and pulmonic
   
areas, observing them at an angle and to the side,
to note the presence or absence of pulsations.  No pulsations  Pulsations
•          Inspect
and palpate the tricuspid area for No lifts No heaves
Pulsations visible
Diffuse lifts or heaves
pulsations and heaves or lifts. PMI displaced laterally or
in 50% of adults lower
•          Inspect
and palpate the apical area for pulsation, and palpable in
 
noting its specific location (it may be displaced most PMI in the
5th LICS or to MCL
laterally or lower) and diameter. If displaced
laterally, record the distance between the apex and Diameter of 1 to 2  Diameter over 2 cm
the MCL in centimeters. cm  
•          Inspect
and palpate the epigastric area at the   Bounding abdominal
pulsations
base of the sternum for abdominal aortic
pulsations.
 Aortic pulsations
 Auscultate the heart in all four
2. anatomic sites: aortic, pulmonic,
tricuspid, and apical (mitral).
3. Palpate the carotid artery.
(Use extreme caution.)
4. Auscultate the carotid artery.
5. Inspect the jugular veins for
distention.
•          The
client is placed in a semi-
Fowler’s position, with head
supported on a small pillow.
S1: Usually heard at all sites
S2: Usually heard at all sites (usually
louder at the base)
S3: In children & young adults
S4: in many older adults
S1- closure of mitral/tricuspid valves
S2- closure of aortic and pulmonic
valves
Symmetric pulse volumes;
Full pulsations, thrusting quality;
Quality remains same when client
breathes, turns head, and changes
from sitting to supine position;
Elastic arterial wall
No sound heard on auscultation
Veins not visible (indicating right side
of heart is functioning normally)
Increased or decreased intensity
Varying intensity with different beats
Increased intensity at the aortic area.
Increased intensity at the pulmonic
area
Sharp-sounding ejection clicks
S3 in older adults
S4 maybe a sign of HPN
Assymetric volumes;
Decreased pulsations;
Increased pulsations;
Thickening, hard, rigid, beaded,
inelastic walls
Presence of bruit in one or both
arteries
Veins visibly distended