Assessing Cardiac Function

1. Assessing Cardiac Function Lesson 2 How to detect Coronary Artery Disease?

2. Initial questions to take into consideration. • What do you want to know about the Chief Complaint? -Is the patient short of breath, what’s the location, intensity of the pain? -What precipitates or relieves the pain? • What do you want to know about client history? -Past surgeries, hospitalizations? • What do you want to know about present occurrences or related cardiac symptoms? -Does the patient have Hypertension (HTN), Diabetes, Angina (chest pain), Heart Attack (MI), congestive heart failure(CHF), fatigue, dizziness, fainting, or blood clots? • What do you want to know about personal habits and nutritional history? -Does the patient smoke, consume excessive alcohol or caffeine intake? What is the patients cholesterol intake, or potassium and sodium intake?

3. History and Cardiac Symptoms • History Chief Complaint- Is the patient experiencing shortness of breath, chest pain, or palpitations? • Quantity of Pain • Quality of Pain • Location of Pain • Onset of Pain • Precipitating Factors • Aggravating Factors • Associated Symptoms • Cardiac Symptoms -Chest Pain/Pressure -Shortness of Breath -Fatigue -Palpitations -Edema -Abdominal Pain -Cyanosis -Fainting (syncope) -Dizziness -Cough

4. Monitor Risk Factors • Age • Gender • Smoking • Family History • Diabetes • Obesity http://www.abc-of-yoga.com/images/pics/yoga-for-obesity-and-diabetes.jpg

5. Auscultate the Heart • Aortic- Second intercostal space, right sternal border • Pulmonic- Second intercostal space, left sternal border • Tricuspid- Fifth intercostal space, left sternal boarder • Mitral (apical)- Fifth intercostal space, medial to midclavicular line.

6. Inspection, Palpation, Auscultation • Inspect the patients apical, retractions, pulsations, heaves or lifts, or a palpable thrill. • Palpate each area of the heart. • Note any thrills. • Note location and size of apical pulse. Should only be one intercostal space usually fourth or fifth. • Begin with the diaphragm, note the rate and rhythm. • Identify S1 which is closure of the AV valves at the onset of contraction (systole) produces the first heart sound. • Identify S2 which is closure of the semilunar valves at the onset of relaxation (diastole) produces the second heart sound.

7. Auscultation Continued • Identify any extra heart beats. • Listen for heart murmurs, usually a whooshing sound. • Use theses Resources to help with the different heart sounds. • The Auscultation Assistant- http://www.med.ucla.edu/wilkes/inex.htm • Cardiac Examination/ Heart Sounds- http://www.blaufuss.org/tutonline.html#

8. Carotid Artery/ Peripheral Pulses • Palpate the carotid artery, one at a time. • Auscultate the carotid artery if shows signs of cardiac disease. • Auscultate for bruit (blowing sound) with the bell of the stethoscope. Check bilaterally. • Check heart rate and rhythm. • Listen to apical pulse while at the same time examining the radial pulse. • Palpate all pulses, compare from side to side. • Assess capillary refill- color should return in less than three seconds if normal.

9. Assessment Continued • Inspect skin color for cyanosis. Clubbing which indicates decreased oxygen supply. • Monitor blood pressure. Cuff pressures along with postural changes made by the patient. http://www.sunsetvideo.org/blood-pressure-devices.html