ASSESSMENT CARDIOVASCULAR

SYSTEM
DR. VAISHNAVI YADAV,ASSISSTANT PROFESSOR, RAVI NAIR PHYSIOTHERAPY
COLLEGE ,DMIMS DU
 SPECIFIC LEARNING OBJECTIVES
• At the end of the lecture student should be able to
understand and
• Write about subjective assessment
• Discuss about physical examination
• Discuss about peripheral examination of
cardiovascular system
 SUBJECTIVE ASSESSMENT
• Subjective assessment is based on an
interview with the patient
• It should generally start with open-ended
questions - What is the main problem? What
troubles you most?
 CARDINAL SYMPTOMS
• HISTORY :
• Dyspnoea on exertion or breathless including PND,
orthopneoa, and trepopneoa
• Chest pain
• Cough
• Expectoration
• Haemoptysis
• Palpitation
• Syncopal attack
 CHEST PAIN

• This is the most important symptom of cardiac

disease.
• Pain could be from pulmonary, intestinal,
gallbladder, or musculoskeletal sources but it
may be from the heart itself.
• Every complaint of chest pain must be taken
very seriously!
 ANGINA
• Usually substernal.
• Radiation – chest, shoulders, neck, jaw , arms
• Deep, visceral (pressure) – intense, not excruciating
• Duration- min., not sec. (5-15 min.)
• Associated with nausea, vomiting diaphoresis,
pallor.
• Precipitated by exercise & emotion.
• Becomes Unstable when occurs during sleep, at rest,
or increases in severity/frequency
• Relief with rest or NTG.
• Description of character
• Location
• Duration/Recurrence
• Precipitating factors
• Relieving factors
• History of similar symptoms
• Angina Pectoris is the true symptom of coronary
artery disease.
• It is caused by hypoxia to the myocardium which
leads to anaerobic metabolism and the production of
lactic acid. The acid irritates the actual heart muscle
and makes it hurt
• Angina is due to an imbalance of oxygen delivery TO
the heart and the oxygen needs OF the heart
• Levine’s Sign---Patients will describe angina by
clenching their first and placing it over the sternum.
NYHA
 PALPITATIONS
• The uncomfortable sensations in the chest
associated with a range of arrhythmias.
• Patients may describe palpitations as fluttering,
skipped beats, pounding, jumping, stopping, or
irregularity
Paroxysmal Nocturnal Dyspneoa (PND)
• Occurs at night or when patient is supine.
• Patient awakens after being asleep about 2 hours
and is “smothering”. Runs to window to get
more air.
• This is a specific sign of Congestive Heart Failure.
 Orthopneoa
• Dyspneoa when lying down.
• Ask all patients: “How many pillows do you
use in order to sleep?”
• To quantify the orthopneoa, record “3-pillow
orthopneoa for the past month.
 Dyspneoa on Exertion (DOE)
• This is usually due to chronic CHF or severe
pulmonary disease.
• Quantify the severity by asking, “How many
level blocks can you walk before you get
short of breath? How many could you walk
six months ago?”
 How to Chart about Dyspneoa
• “The patient has had 1-block dyspneoa on
exertion for the past six months. Before 6
months ago, the patient was able to walk 4 blocks
without shortness of breath. In addition, during
the past month the patient has noted 4-pillow
orthopneoa. Previously he was able to sleep with
just two pillows.”
 SYNCOPE
• Fainting or syncope is the transient loss of
consciousness that is due to inadequate cerebral
perfusion
• Syncope can be from cardiac or non-cardiac causes
• Obstruction to Blood Flow:
– Valvular stenosis
– Hypertrophic cardiomyopathy
– Prosthetic valve dysfunction
– Atrial myxoma
• Obstruction to Blood Flow (cont.)
– Pericardial tamponade
– Pulmonary hypertension
– Pulmonary emboli
– Congenital heart disease
– Pump failure (MI or ischemia
 FATIGUE
• This is a common symptom of decreased cardiac
output. A common complaint from people with
CHF and mitral valve disorder.
• Fatigue may be the presenting symptom of a
woman having an MI.
• Not at all specific to heart disease, but you must
consider it always.
 Dependent Edema
• When peripheral venous pressure is high, fluid
leaks out from the veins into tissues.
• This is often the presenting symptom of right
ventricular failure.
• Edema will begin in legs and gets worse as the
day progresses. Least evident in the a.m. after
sleeping with the legs flat, worse as gravity pulls
fluid to legs.
• This indicates that there is excess fluid volume.
• People on bed rest will have edema of their sacral
area.
• In severe right or bi-ventricular heart failure,
people often have abdominal distension, liver
engorgement, constipation, and anorexia.
• Anasarca may develop. Gross generalized edema.
 CORONARY RISK FACTOR

REVERSIBLE IRREVERSIBLE

TABACO,SMOKING SEX MALE

HYPERLIPIDAEMIA FAMILY H/O IHD

DIABETES TYPE A PERSONALITY

OBESITY HYPERCALCAEMIA

PHYSICAL INACTIVITY CARDIAC TRANSPLANT

STRESS TRACE ELEMENTS

 The Physical Examination
• General Appearance
• Is the patient in acute distress?
• Is breathing labored or easy?
• Is there use of accessory muscles?
• Is there cyanosis? Pallor?
• Are xanthomata present (stony hard, yellowish
masses on extensor tendons of the fingers due to
hypercholesterolemia.)
• Inspect nails. Splinter hemorrhages are
associated with infective endocarditis.
• Inspect the face. People with supravalvular aortic
stenosis have wide-set eyes, strabismus, low-set
ears, upturned nose, hypoplasia of the mandible.
• Moon face suggests pulmonic stenosis.
• Expressionless face with puffy eyelids and loss of
the outer 1/3 of the eyebrow is seen in
hypothyroidism.
• Inspect eyes. Yellow plaques on eyelids
(xanthelasma) may be due to
hyperlipoproteinemia.
• Opacities of the cornea may be sarcoidosis.
• Conjunctival hemorrhage is commonly seen with
infective endocarditis.
• Petechiae on the palate may be seen with
infectious endocarditis.
• High arched palate may be seen with Marfan’s
Syndrome.
• Arm Breadth greater that body height is also seen
in Marfan’s.
 CARDIOVASCULAR
EXAMINATION(PERIPHERAL)
• BP:
• Always measure in both arms sitting .
• Then take BP standing.
• ORTHOSTATIC HTN-Have the patient lie down for 5
minutes and measure BP and pulse.
• Have patient stand and repeat reading immediately.
Allow 90 seconds for maximum orthostatic changes.
• A drop in systolic BP of 20 mmHg or more when
standing is orthostatic.
• There is usually an increase in HR.
• Supravalvular Aortic Stenosis
• If there is hypertension in the right arm, take BP in
the left arm as well.
• supravalvular aortic stenosis: there will be
hypertension in the right arm and hypotension in the
left arm.
• Coarctation of the Aorta: If the patient is
hypertensive in both arms, have patient lie on
abdomen, put cuff around lower thigh, listen to BP at
the popliteal artery.
• A leg blood pressure lower than the arm BP suggests
coarctation.
• Normally BP higher in leg arteries than arm.
• ARTERIAL PULSE-
• RATE, RHYTHM,PULSE DEFICIT,PERIPHERAL
PULSATIONS.
• Grasp both radial arteries, count for 30 seconds, and
multiply by 2.
• Determine rhythm. The slower the rate, the longer
you should palpate.
• If the rhythm is irregular, is there a pattern to the
irregularity?
• JVP –
assess central venous pressure, CHF , right
ventricular failure.
 SUMMARY
• Write about subjective assessment.
• Discuss about physical examination.
• Discuss about peripheral examination of
cardiovascular system.
 REFERENCES
• CLINICAL TEXT BOOK Of MEDICINE: PJ MEHTA
• TEXTBOOK OF MEDICINE: API
Thank you