copyright 2002, delmar, a division of thomson learning chapter 16 heart and peripheral vasculature

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 16

Heart and Peripheral Vasculature


Competencies Identify the anatomic landmarks

of the chest and periphery. Describe the characteristics of the

most common cardiovascular chief complaints.

Elicit a health history from a patient with cardiovascular pathology.

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Competencies Perform a cardiovascular assessment

of a healthy adult. Perform a cardiovascular assessment

on a patient . Describe the changes that occur in

the cardiovascular system in the elderly.


Anatomy and Physiology Base Apex Pericardium

Parietal Visceral

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Anatomy and Physiology Chambers of the heart

Right and left atria Right and left ventricles

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Cardiac Cycle Systole Diastole

Atrial kick


Electrical Activity of the Heart Sino-atrial (SA) node Atrioventricular node Bundle of HIS Right and left bundle branches Purkinje fibers


Peripheral Vasculature Arterial system

Three layers of arterial walls: tunica intima, media, externa

Arteries Arterioles Capillaries

Venous system Veins Venules


Health History Age

Childhood onset: Rheumatic fever Adult onset: CAD, HTN, MI, CVA,

AAA, CHF Gender

Female Male

Race May predispose to higher risk for CVA,

CAD, HTN, DM


Common Chief Complaints Chest pain Syncope Palpitations Peripheral edema Claudication


Characteristics of Chief Complaints Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing


Past Health History Medical

Cardiac specific: AAA, angina, CAD, CHF, HTN, MI, PVD, hyperlipidemia

Noncardiac specific Surgical

Prior cardiovascular procedures Presence of risk factors

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Past Health History Common medications

Antianginals or vasodilators Antidysrhythmics Anticoagulants Antihypertensives Antilipemics Diuretics Inotropics Thrombolytics

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Past Health History Communicable diseases Childhood illnesses Allergies

Aspirin IVP dye Seafood


Family Health History Assess for the following diseases

Aneurysm CAD CVA HTN CHF MI or sudden cardiac death MVP Rheumatic fever


Social History Alcohol, drug, or tobacco use Sexual practices Travel history Work and home environment Hobbies and leisure Stress


Health Maintenance Activities Sleep Diet Exercise Stress management Use of safety devices Health checkups


Patient Education Risk factor modification Heart smart diet Exercise


Risk Factors Modifiable

HTN, hyperlipidemia, tobacco use, physical inactivity, diet, glucose intolerance, stress, sedentary lifestyle, obesity

Nonmodifiable Age, gender, race, family history


Heart Smart Diet American Heart Association

guidelines Total fat intake < 30%

< 10% from saturated fat < 10% from polyunsaturated fat 10–15% monounsaturated fat

Cholesterol < 300 mg/day Sodium < 2,400 mg/day Carbohydrates should equal 55–60%

of total calories/day


Exercise and Cardiovascular Health Consult with primary care

provider prior to starting an exercise program

Avoid strenuous activity in extremes of temperature or after a heavy meal

Immediately stop exercise if chest pain, dizziness, faintness, light-headedness occur


Assessment Equipment

Stethoscope Sphygmomanometer Watch with second hand Tape measure


Inspection Aortic Pulmonic Midprecordial Tricuspid Mitral Normal findings: no visible

pulsations except for the PMI in the mitral area


Palpation Assess for pulsations, thrills, heaves Assess the following areas: aortic,

pulmonic, midprecordial, tricuspid, and mitral

Normal findings No pulsations, thrills, or heaves palpated,

except in the mitral area where the apical impulse may be palpated


Auscultation How?

Patient position Use diaphragm and bell of

stethoscope Where?

Aortic, pulmonic, midprecordial, tricuspid, mitral


Auscultation: Normal Findings Aortic: S2 is louder than S1

Pulmonic: S2 is louder than S1

Tricuspid: S1 is louder than S2

Mitral: S1 is louder than S2

Mitral and tricuspid: S3 (gallop) may be heard in children, young adults, and pregnant women. S4 may indicate cardiac decompensation


Auscultation: Abnormal Findings Murmurs

Possible causes Characteristics: location, timing,

radiation, intensity, quality, pitch, configuration

Use stethoscope diaphragm over aortic, pulmonic, mitral, and tricuspid areas

Use stethoscope bell over mitral and tricuspid areas

Normal findings: no murmurs auscultated

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Auscultation:Abnormal Findings Pericardial friction rub

Possible cause Characteristics: location, timing,

radiation, quality, pitch Patient position Location Abnormal finding


Assessment of Arterial Pulses Evaluate temporal, carotid,

brachial, femoral, popliteal, posterior tibial, dorsalis pedis

How? Patient position Characteristics: rate, rhythm,

amplitude, symmetry

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Assessment of Arterial Pulses Auscultate temporal, carotid,

femoral pulses for bruits Normal findings Abnormal findings Pathophysiological indications:

obstruction due to atherosclerotic plaques, high output states such as anemia or thyrotoxicosis


Special Techniques Orthostatic hypotension

How? Patient position Normal findings Abnormal findings Pathophysiological indications:

hypovolemic, neurogenic dysfunction, or side effect from medications

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Assessment of Peripheral Perfusion Evaluate peripheral pulses, color,

clubbing, capillary refill, skin temperature, edema, ulcerations, hair distribution

Venous system Homan’s sign

Arterial Pallor Allen’s test


Gerontological Variations Decreased size of heart muscle Decreased cardiac output Arterial vessels are more rigid, less

distensible Calcifications or fibrosis of heart

valves

copyright 2002, delmar, a division of thomson learning chapter 16 heart and peripheral vasculature

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