Nursing Cardiovascular Physical

Examination Made Ridiculously

Simple
RUBEN M. ASIS, JR., RN

Mariano Marcos State University

College of Health Sciences
Department of Nursing
 WARNING
This short REVIEW is designed to give the
audience a brief overview of the
important details in performing a
cardiovascular assessment.
IT IS NOT meant to supplant the
comprehensive discussion provided by
the standard textbook.
OBJECTIVES
• To review the anatomy and physiology of
the cardiovascular system (CVS)

• To highlight the essential aspects of the

CVS physical exam (PE)

• To provide useful clinical hints from the

PE
ESSENTIAL ANATOMY
ESSENTIAL ANATOMY
ESSENTIAL ANATOMY HINTS
• Know the location of the heart and the
major blood vessels

• Knowing where your organs are located

facilitates the PE

• An abnormal finding at a specific site

helps determine the problem
ESSENTIAL PHYSIOLOGY
• Heart – pumps blood
• Lungs – perform gas
exchange
• Arteries – carry blood
away from heart to
tissues
• Capillaries –distribute
blood in the tissues
• Veins – carry blood back
to the heart
ESSENTIAL PHYSIOLOGY HINTS
• CVS is a“circuit”; if one section breaks down, the system
becomes problematic

• Problems in the CVS will cause changes in the VITAL SIGNS

(VS) – blood pressure, heart rate, respiratory rate

• The effects of a CVS problem will manifest in the PE findings

CVS PE HIGHLIGHTS
• Vital Signs
• Cardiac
• Vascular

…look, listen and feel (LLF)…

CVS PE HIGHLIGHTS
• VITAL SIGNS (BP, HR, RR)
▫ Know the normal range
▫ BP (90-130/60-80 mmHg)
 Hypotension – heart failure, anemia
Hypertension – heart disease, kidney disease
▫ HR (60-100 beats/min)
Bradycardia – heart block, CNS problem
Tachycardia – heart failure, anemia
▫ RR (16-20 breaths/min)
Bradypnea – CNS problem
Tachypnea – congestive heart failure
CVS PE HIGHLIGHTS
• CARDIAC
▫ Look for the APEX
BEAT or the APICAL
IMPULSE
▫ 5th intercostal space, left
midclavicular line
▫ If displaced laterally or
inferiorly, could signify
cardiomegaly
CVS PE HIGHLIGHTS
• CARDIAC
▫ Auscultate for the heart sounds
(usually 2 – S1 and S2) “LUB-DUB”
▫ Are the sounds clear or distant?
 Weak sounds could signify
pericardial effusion or
thickening
▫ Listen for ADDITIONAL SOUNDS
Rumbling or clicking sounds
could be murmurs from valvular
disease
An extra heart sound could be a
“gallop” of heart failure
CVS PE HIGHLIGHTS
• CARDIAC
▫ Is the rhythm regular?
 Irregular rhythms
signify heart disease
▫ Feel for the apical pulse
This is to verify your
visual observation
CVS PE HIGHLIGHTS
• VASCULAR
▫ Observe for skin changes,
wounds, swelling, masses
 Cyanosis means poor blood
flow, brownish discoloration
could be due to venous
insufficiency, erythema
could be infection or
ischemia; ulcers are
associated with vascular
occlusion; masses could be
tumors or aneurysms
▫ Listen for BRUITS
A bruit arises from disturbed
blood flow
CVS PE HIGHLIGHTS
• VASCULAR
▫ Palpate the arterial pulses;
know their locations and
significance
The carotid pulse is always
the reference point in terms
of “grading” – 0 to 2
A weak or absent pulse
means arterial occlusion
proximally
▫ Feel for thrills
This is a palpable BRUIT
▫ Check the temperature of the
skin
Warmth could mean
infection, coldness ischemia
CVS PE HIGHLIGHTS
Create your shortcut after mastering
the main route, not before reaching
your destination, for you will
certainly lose your way…