Cardiac Assessment Comprehensive Cardiac Assessment l Health History

Comprehensive Cardiac Assessment l Health History l Inspection l Normal/abnormal l Palpation-4 landmark areas

Auscultation l Normal l Rate l Rhythm Regular l Irregular l l Strength (intensity)

Anatomical Landmarks Heart Sounds Aortic Area: 2 nd intercostal space (ICS), right sternal border

S 1: Systole l l l First heart sound Closure of the AV valves

S 2: Diastole l l l “dub” High pitch Shorter Semilunar valves close –loudest

S 3 l l l l Beginning of diastole Position on L side Mitral

S 4 l Before S 1 l Position on L side l Mitral area

Murmur l l l Turbulence of blood flow Increased blood flow Incomplete valve closure

Classification of Murmurs l Location l Intensity l Pitch l Quality l Timing l

Other Abnormal Heart Sounds l Pericardial Friction Rub l a scratching high pitched sound

Cardiac Assessment Auscultation l l l Quiet environment Consistent /Systematic Method– with bell and

Auscultation Tips l Diaphragm l l Bell l l high-pitched sounds such as S

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Cardiac Assessment

Comprehensive Cardiac Assessment l Health History l Inspection l Normal/abnormal l Palpation-4 landmark areas Normal/abnormal l Technique l l Auscultation

Auscultation l Normal l Rate l Rhythm Regular l Irregular l l Strength (intensity) l Extra Sounds

Chest Landmarks

Anatomical Landmarks Heart Sounds Aortic Area: 2 nd intercostal space (ICS), right sternal border l Pulmonic Area: 2 nd ICS, left sternal border l Tricuspid Area: 5 th ICS, left sternal border l Mitral or Apical Area: 5 th ICS, medial to the midclavicular line l l AP TO MAN

S 1: Systole l l l First heart sound Closure of the AV valves – loudest at the tricuspid and mitral landmarks “lub” Dull, low pitched Longer than S 2 Carotid pulse

S 2: Diastole l l l “dub” High pitch Shorter Semilunar valves close –loudest at the pulmonic or aortic valves landmarks S 1 and S 2 within 1 second or less

S 3 l l l l Beginning of diastole Position on L side Mitral area Bell Low pitched “Kentucky” Too rapid of filling of the venticules HF

S 4 l Before S 1 l Position on L side l Mitral area l Bell l Low pitched l “Tennessee” l Abnormal flow l Elderly, MI, HTN

Murmur l l l Turbulence of blood flow Increased blood flow Incomplete valve closure l Stenosis l Regurgitation Blood flow through: l a dilated chamber l abnormal opening between chambers Anywhere in the cycle Pathology l Benign l Abnormal

Classification of Murmurs l Location l Intensity l Pitch l Quality l Timing l Position (I-VI)

Other Abnormal Heart Sounds l Pericardial Friction Rub l a scratching high pitched sound caused by friction between the pericardial and epicardial surfaces (pericarditis)

Cardiac Assessment Auscultation l l l Quiet environment Consistent /Systematic Method– with bell and diaphragm Listen for 1 full minute Listen with stethoscope and feel for radial Louder sounding valves at different locations Positioning l Sitting up and leaning forward l Left lateral recumbent l Supine

Auscultation Tips l Diaphragm l l Bell l l high-pitched sounds such as S 1, S 2, murmurs, pericardial friction rubs. low-pitched sounds such as S 3, S 4, and murmurs. S 3 and S 4 best position is the Left lateral using the bell