Assessing Cardiac Function

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

Initial questions to take into consideration.What do you want to know about the Chief Complaint?-Is the patient short of breath, whats 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?

History and Cardiac SymptomsHistoryChief Complaint- Is the patient experiencing shortness of breath, chest pain, or palpitations?Quantity of PainQuality of PainLocation of PainOnset of PainPrecipitating FactorsAggravating FactorsAssociated SymptomsCardiac Symptoms-Chest Pain/Pressure-Shortness of Breath-Fatigue-Palpitations-Edema-Abdominal Pain-Cyanosis-Fainting (syncope)-Dizziness-Cough

Monitor Risk FactorsAge GenderSmokingFamily HistoryDiabetesObesity

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Auscultate the HeartAortic- Second intercostal space, right sternal borderPulmonic- Second intercostal space, left sternal borderTricuspid- Fifth intercostal space, left sternal boarderMitral (apical)- Fifth intercostal space, medial to midclavicular line.

Inspection, Palpation, AuscultationInspect 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.

Auscultation ContinuedIdentify 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#

Carotid Artery/ Peripheral PulsesPalpate 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.

Assessment ContinuedInspect skin color for cyanosis. Clubbing which indicates decreased oxygen supply.Monitor blood pressure. Cuff pressures along with postural changes made by the patient.

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