Maternal and Newborn Assessment:

Cardiovascular System

EUNICE OPPONG KYEKYEKU

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Cardiovascular System (CVS)

Introduction

The CVS is rather straightforward with lots of

information to be obtained from the
examination

Basic anatomy and physiology of the CVS is

essential for understanding
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Physiology
Circulation of blood.
Supply of oxygen and nutrients
Removal of carbon dioxide and waste products.

Heart and lungs

Blood returned to the heart is pumped to the lungs
for re-oxygenation by the right ventricle.
The oxygenated blood (also with carbon dioxide
removed is returned to the left atrium then into the
left ventricle.
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Vessels
Arteries…distribute blood to tissues. Arising out of
the left ventricle is the aorta. Arches and descends in
the thorax and continues into abdominal cavity.
All other artries are branches or the aorta either
directly or from another branch.

Veins return blood to the heart: 3 directly connected

to the heart are:
Superior vena cava
Inferior vena cava
Pulmonary vein
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Venous return: Blood that is returned to the heart from

tissues after oxygen is removed and carbon dioxide is
added.

From above the heart level, return is aided by the

force of gravity.

From below the heart against gravity but facilitated

by
muscle contraction;
one way valves;
negative pressure in as blood pumped out of RA.
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Cardiac Cycle
Alternate contraction and relaxation of the
Ventricular muscles of the heart.

Systole (contraction)
Diastole (relaxation)

The cycle refers to the contraction and relaxation of

the ventricles of the heart.

Note: atrial systole (contraction) occurs during

ventricular diastole
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The repetition of the cycle is controlled by the

electrical impulse from SA node through the AV node
and Bundle of His.

The coordinated nature of the cycle also ensures

blood returned to the atria is pumped into the
ventricles and then into the aorta and pulmonary
artery respectively

The cardiac cycle produces a number of clinical signs

that are assessed during the physical examination.
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1. Blood Pressure:

Systolic pressure is generated by ventricular contraction

during the cardiac cycle.

It is a measure of the force with which blood is pumped

into the aorta and arteries.

Intrinsic elasticity in arteries produce a baseline pressure

(diastolic) as a result of its resistance to flow of blood.

This pressure is maintained between each ventricular

contraction (diastole).
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2. Apex beat
The point on the chest wall where the ventricular
contraction can be seen or felt.

Every ventricular systole causes the heart to elongate and

rotate slightly. There is also a reaction force to the force
generated that is exerted on the heart.

The result is the apex of the heart hitting the anterior

chest wall. This is seen and or felt as the apex beat.
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3. Heart sounds.
These are normal sounds produced in the heart during the
cardiac cycle.
The closure of the valves in the heart and blood vessels
arising out of the ventricles to ensure the unidirectional
flow of blood produces the heart sounds. S1 and S2

S1: closure of mitral and tricuspid valves in systole.

(sounds as lub)

S2: closure of the aortic and pulmonary valves in diastole.

(sounds as dub)
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4. Pulse –
The pressure wave felt in arteries corresponding to
every ventricular systole.
As the left ventricles expel blood into the arteries
a pressure wave is set in the arteries which can be
felt.

The pulse is not the actual blood flow but produced

and propagated when blood is pumped unto blood
already in the aorta. A ripple wave is generated
that is rapidly propagated into the arterial system.
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5. Capillary fill
Measures the time it takes for the normal
pink colour of the capillary bed to refill with
blood when expressed out of it (eg at the
finger tips)

When blood supply to the periphery is

sustained as a result of the cardiac cycle,
expressing blood out of the finger tips should
refill quickly (less than 2 seconds)
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Jugular Venous Pressure - JVP
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Symptoms of CVS Disease

Angina Gastro-eosophageal
Chest pains reflux

Myocardial infarction
Eosophageal spasm

Pericarditis
Pleuritic pain

Dissecting aortic
aneurysm Musculoskeletal
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Breathlessness
Congestive heart failure with eodema in the lungs (especially in
supine position)

Dyspnoea - abnormal awareness of breathing

 More discomfort than pain

Orthopnoea

Paroxysmal Nocternal Dyspnoea

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Cough

From pulmonary oedema

Frothy white

Ankle oedema
Abdominal swelling and ascites
Fatigue – difficult to determine
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Palpitation

Syncope
Fainting attacks or transient loss of consciousness
May talk to witness

Claudication
Muscle pain on exercise
Symptom of peripheral ischaemia
Calf, thigh buttocks; foot

Pain at rest: similar but without preceding activity.

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Outline of CVS examination

Position

Exposure

Vital signs

Face and Neck

Inspection

Palpation Chest

Percussion Abdomen
Auscultation
Extremities
Special manouvers….....
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Inspection
Scars

Abnormal chest shape/movement

Implants – pacemaker/defibrillator

Visible pulsations
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Palpation
Heave – a sustained thrusting pulsation; usually at
left sternal edge. Due to enlarged ventricles

Thrill – palpable murmur

 Systolic? AS, VSD, mitral regurgitation
 Diastolic? Mitral stenosis

Apex beat (beware of dextrocardia)

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Percussion

Chest

Lungs regions
Heart area

Abdomen: ascites/ enlarged organs

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Auscultation
Heart sounds
 Normal
 Murmurs – humming sounds /musical sounds produced
by turbulent flow of blood in the heart.

Lung bases
Abdomen
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