Cardiac Examination: Anatomic Landmarks, Chief Complaints, and Health History

1. Chapter 16 Heart

2. Competencies • Identify the anatomic landmarks of the chest. • Describe the characteristics of the most common cardiac chief complaints. (continues)

3. Competencies • Elicit a health history from a patient with cardiac pathology. • Perform a cardiac examination on a healthy adult. (continues)

4. Competencies • Perform a cardiac examination on a patient with cardiovascular pathology. • Provide a scientific rationale for abnormal cardiac examination findings.

5. Anatomy and Physiologyof the Heart • The primary function of the heart is to pump blood to all parts of the body. • A healthy adult heart • Contracts 60–100 times per minute • Pumps 4–5 liters of blood per minute (continues)

6. Anatomy and Physiologyof the Heart • Base • Apex • Pericardium • Parietal layer • Visceral layer (continues)

7. Anatomy and Physiologyof the Heart • Chambers of the heart • Right and left atria • Right and left ventricles • Septa (continues)

8. Anatomy and Physiologyof the Heart • Heart valves • Atrioventricular (AV) valves • Tricuspid • Mitral (bicuspid) • Semilunar valves • Pulmonic • Aortic

9. Coronary Circulation • Left main coronary artery • Left circumflex artery • Left anterior descending artery • Right coronary artery

10. Cardiac Cycle • Systole • Isovolumic contraction • Early systole • Late systole • Diastole • Isovolumic relaxation phase • Early and mid-diastolic filling periods • Atrial systole (atrial kick)

11. P Q R Electrocardiogram (EKG) • S • T • Isoelectric line

12. Conduction System of the Heart • Sinoatrial (S-A) node • Atrioventricular (A-V) node • Bundle of His • Right and left bundle branches • Purkinje fibers

13. Health History • Age • Childhood onset: rheumatic fever • Adult onset: CAD, MI, CVA • Gender • Female • Male (continues)

14. Health History • Race • May predispose to higher risk for CVA, CAD

15. Common Chief Complaints • Chest pain • Syncope • Palpitations

16. Characteristics of Chief Complaints • Quality • Associated manifestations • Aggravating factors (continues)

17. Characteristics of Chief Complaints • Alleviating factors • Setting • Timing

18. Past Health History • Medical history • Cardiac specific: angina, cardiogenic shock, cardiomyopathy, CHF, chest trauma • Non-cardiac specific • Surgical history • Previous cardiovascular procedures (continues)

19. Past Health History • Allergies • Aspirin • IVP dye • Seafood • Medications • Cardiac specific (continues)

20. Past Health History • Communicable diseases • Rheumatic fever • Untreated syphilis • Viral myocarditis • Injuries and accidents • Childhood illnesses

21. Family Health History • Assess for • CVA • CAD • MI or sudden cardiac death • MVP

22. Social History • Alcohol use • Excessive alcohol intake • Increases risk for cardiomegaly, cardiomyopathy, angina, CAD, HTN, dysrhythmias, stroke • Moderate alcohol intake (up to 2 oz per day) • Decreases risk for CAD (continues)

23. Social History • Tobacco use • May cause tachycardia, HTN • Increased risk for developing CAD, angina, atherosclerosis (continues)

24. Social History • Drug use • Intravenous drug use • Increases risk for endocarditis • Amphetamines, cocaine, heroin • May cause tachycardia, HTN, hypotension, coronary vasospasm, MI, dysrhythmias, stroke, cardiomyopathy (continues)

25. Social History • Sexual practice • Travel history • Work and home environment • Hobbies and leisure activities • Stress

26. Health Maintenance Activities • Sleep • Diet • Vitamin K intake • Sodium and caffeine intake (continues)

27. Health Maintenance Activities • Exercise • Stress management • Use of safety devices • Health checkups

28. Risk Factors for Cardiovascular Disease • Fixed • Age, gender, race, family history • Modifiable • HTN, hyperlipidemia, tobacco use, glucose intolerance, physical inactivity, diet, stress, sedentary lifestyle, obesity

29. Examination • Equipment • Stethoscope • Sphygmomanometer • Watch with second hand

30. General Approach to Heart Examination • Explain the assessment to the patient • Ensure a warm, quiet, well-lit environment (continues)

31. General Approach to Heart Examination • Limit exposure of the patient’s chest • Place the patient in a supine or sitting position

32. Aortic Pulmonic Midprecordial Inspection • Tricuspid • Mitral (continues)

33. Inspection • Normal findings • No visible pulsations except for the PMI in the mitral area

34. Palpation • Assess for pulsations, thrills, heaves • Assess the following areas: aortic, pulmonic, midprecordial, tricuspid, and mitral (continues)

35. Palpation • Normal findings • No pulsations, thrills, or heaves palpated, except in the mitral area, where the apical impulse may be palpated

36. Auscultation • How • Patient position • Use diaphragm and bell of stethoscope • Where • Aortic, pulmonic, midprecordial, tricuspid, mitral

37. 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 (continues)

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

39. Auscultation: Abnormal Findings • Murmurs • Classified as innocent, functional, or pathological • Possible causes • Use stethoscope diaphragm over aortic, pulmonic, mitral, and tricuspid areas • Use stethoscope bell over mitral and tricuspid areas (continues)

40. Auscultation: Abnormal Findings • Murmurs (cont’d) • Characteristics: location, radiation, timing, intensity, quality, pitch, configuration (continues)

41. Auscultation: Abnormal Findings • Pericardial friction rub • Patient position • Characteristics: location, radiation, timing, quality, pitch • Abnormal finding • Possible cause