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ASSESSMENT
HEART
▪ 2nd to 5th ICS; aligns with the right border of
sternum to the left midclavicular line
CHAMBERS
▪ 2 Atria
▪ 2 Ventricles
VALVES
▪ Atrioventricular Valves (Tricuspid & Mitral)
▪ Semilunar Valves (Pulmonic & Aortic)
CARDIAC CYCLE
▪ Systole – heart contracts and sends out blood
▪ Diastole – heart relaxes and is filled with blood
Diastole parts:
▪ Ventricular Filling – 70% of blood from the atria to
ventricles (by gravity)
▪ Atrial Contraction (Atrial Kick) – 30% of blood into the
ventricles
S1 – LUB
▪ Ventricular contraction (mitral valve & tricuspid valve
snap is closed)
S2 – DUB
▪ Atrial valve & pulmonic valve shut (the atria is filled with
blood for the next period of diastolic filling)
ARTERIES
▪ away from the heart; carries oxygenated blood
VEINS
▪ towards the heart; carries unoxygenated blood
ARTERIAL PULSES
▪ pressure waves of blood generated by the
pumping action of the heart.
GERIATRIC CONSIDERATIONS:
✓ Slight decrease in heart size
✓ Loss of cardiac contractile strength & efficiency
✓ Decrease cardiac output
✓ Thickening of heart valve
✓ Increase in left ventricular wall thickness
✓ Increase aortic rigidity
✓ Decrease ability to respond to physical &
emotional stress
✓ Diminish peripheral pulses
HEALTH HISTORY
✓ Chest / jaw pain/ pain on the extremities
✓ Irregular heart beat/ palpitation
✓ SOB on exertion or at rest, lying down
✓ Cough
✓ Cyanosis/ pallor
✓ Weakness, fatigue, unexplained weight loss
✓ Swelling on the extremities
✓ Dizziness, H/A, BP changes
✓ Family history
✓ Stress
✓ Habits – smoking, alcohol, caffeine
Equipment:
✓ Stethoscope
✓ BP cuff
✓ Ruler
✓ Penlight
⦿ No bulges on chest
⦿ Apical impulse may or may not be
observable
⦿ No other pulsations over the chest, aside
from apical impulse
PALPATION
▪ Use the ball of hands to detect vibrations, or
thrills, which may be caused by murmurs
▪ Use fingertips or palmar surface to detect for
pulsations
❑ Aortic Area – 2nd R ICS, close to sternum
❑ Pulmonic Area – 2nd L ICS, close to sternum
❑ Tricuspid Area – use palm to detect any heaving or
thrusting of precordium; 5th R ICS, next to sternum
❑ Mitral Area – 5th ICS, left, midclavicular area
NORMAL FINDINGS:
- scratchy, rubbing
quality
- audible medical sign of
pericarditis.
HEART MURMURS
▪ Turbulent blood flow caused by structural
defects in chambers & valves
▪ GRADE SYSTEM:
o I – barely audible murmur
o II – audible but quiet & soft
o III – moderately loud without thrust or thrill
o IV – loud with a thrill
o V – very loud, with thrust or thrill
o VI – loud enough to be heard before stethoscope
comes in contact
ADVENTITIOUS HEART SOUNDS
➢ S1 (“lub”) – systole; ventricular contraction; AV
valves closed; blood to lungs & system