lOMoAR cPSD| 57629747
CARDIAC & VASCULAR
ASSESSMENT Exam 3 Key
Concepts
, lOMoAR cPSD| 57629747
Cardiac
● Assessing Carotid Arteries o Palpation
▪ Patient sits or lies with their head slightly tilted back.
▪ Locate the artery in the groove between the trachea and
sternocleidomastoid muscle.
▪ Palpate one side at a time to avoid reducing cerebral blood flow.
▪ Assess pulse strength, rate, and rhythm with gentle pressure.
▪ Compare both sides for symmetry.
o Auscultation
▪ Position the Patient
▪ Use the Bell of the Stethoscope
▪ Ask the Patient to Hold Their Breath
▪ Listen for Bruits
● Auscultation- aortic, pulmonic, tricuspid, mitral: locations o
Aortic Valve – Right 2nd intercostal space, sternal border
▪ Best heard at the right upper chest.
▪ Detects issues like aortic stenosis or regurgitation.
o Pulmonic Valve – Left 2nd intercostal space, sternal border ▪
Best heard at the left upper chest.
▪ Assesses conditions like pulmonic stenosis or regurgitation.
o Tricuspid Valve – Left 4th or 5th intercostal space, sternal
border ▪ Located over the lower left sternum.
▪ Evaluates tricuspid stenosis or regurgitation. o Mitral Valve
(Apical Area) – Left 5th intercostal space, midclavicular line ▪ Near the apex
of the heart (below the left nipple).
▪ Best for detecting mitral stenosis or regurgitation.
● Murmurs: grading scale o Grade I: Barely audible, requires a
quiet environment and experienced examiner. o Grade II:
Soft but easily heard. o Grade III: Moderately loud, no
thrill. o Grade IV: Loud with a palpable thrill (vibration).
o Grade V: Very loud, heard with the stethoscope barely touching the chest, with a
thrill.
o Grade VI: Extremely loud, heard without a stethoscope touching the chest, with a
thrill.
● Palpating the apical impulse o Position the Patient – Have
them sit upright or lie in a left lateral decubitus position to bring
the heart closer to the chest wall.
o Locate the Apex – Place your fingertips at the 5th intercostal space, midclavicular
line on the left side of the chest.
, lOMoAR cPSD| 57629747
o Use Light Pressure – Palpate with the pads of your fingers to feel for a brief,
localized tap.
o Assess Characteristics – Note the location, size, amplitude, and duration of the
impulse. A displaced or forceful impulse may indicate cardiac enlargement or
pathology.
● Subjective data: chest pain o Onset & Duration – When did the
pain start? Is it sudden or gradual? How long does it last? o
Location & Radiation – Where is the pain? Does it
spread to the jaw, arm, back, or shoulder?
o Quality – Is it sharp, dull, crushing, burning, or pressure-like?
o Severity – Rate the pain on a scale of 0-10.
o Aggravating & Relieving Factors – What makes it worse (activity, stress, deep
breathing)? What helps (rest, medications)?
o Associated Symptoms – Any shortness of breath, dizziness, nausea, sweating, or
palpitations?
o Patient History – History of heart disease, GERD, anxiety, or prior similar
episodes?
● S1 and S2 normal o S1 ("lub"):
▪ Caused by the closure of the mitral and tricuspid valves at the start of
systole (ventricular contraction).
▪ Best heard at the apex of the heart (left midclavicular line, 5th intercostal
space).
▪ Louder in conditions like fever, exercise, or mitral stenosis.
o S2 ("dub"):
▪ Caused by the closure of the aortic and pulmonary valves at the start of
diastole (ventricular relaxation).
▪ Best heard at the base of the heart (right and left upper sternal borders, 2nd
intercostal space).
▪ Can physiologically split during inspiration due to delayed pulmonary
valve closure.
● Inspecting the Anterior Chest normal vs abnormal o Normal
Findings:
▪ Chest Contour – The chest should be symmetrical with no visible
deformities.
▪ No Visible Pulsations – There should be no visible abnormal pulsations or
heaves (lifts) on the chest wall.
▪ Skin Color – The skin should be a normal color, with no signs of cyanosis
(bluish tint) or pallor.
CARDIAC & VASCULAR
ASSESSMENT Exam 3 Key
Concepts
, lOMoAR cPSD| 57629747
Cardiac
● Assessing Carotid Arteries o Palpation
▪ Patient sits or lies with their head slightly tilted back.
▪ Locate the artery in the groove between the trachea and
sternocleidomastoid muscle.
▪ Palpate one side at a time to avoid reducing cerebral blood flow.
▪ Assess pulse strength, rate, and rhythm with gentle pressure.
▪ Compare both sides for symmetry.
o Auscultation
▪ Position the Patient
▪ Use the Bell of the Stethoscope
▪ Ask the Patient to Hold Their Breath
▪ Listen for Bruits
● Auscultation- aortic, pulmonic, tricuspid, mitral: locations o
Aortic Valve – Right 2nd intercostal space, sternal border
▪ Best heard at the right upper chest.
▪ Detects issues like aortic stenosis or regurgitation.
o Pulmonic Valve – Left 2nd intercostal space, sternal border ▪
Best heard at the left upper chest.
▪ Assesses conditions like pulmonic stenosis or regurgitation.
o Tricuspid Valve – Left 4th or 5th intercostal space, sternal
border ▪ Located over the lower left sternum.
▪ Evaluates tricuspid stenosis or regurgitation. o Mitral Valve
(Apical Area) – Left 5th intercostal space, midclavicular line ▪ Near the apex
of the heart (below the left nipple).
▪ Best for detecting mitral stenosis or regurgitation.
● Murmurs: grading scale o Grade I: Barely audible, requires a
quiet environment and experienced examiner. o Grade II:
Soft but easily heard. o Grade III: Moderately loud, no
thrill. o Grade IV: Loud with a palpable thrill (vibration).
o Grade V: Very loud, heard with the stethoscope barely touching the chest, with a
thrill.
o Grade VI: Extremely loud, heard without a stethoscope touching the chest, with a
thrill.
● Palpating the apical impulse o Position the Patient – Have
them sit upright or lie in a left lateral decubitus position to bring
the heart closer to the chest wall.
o Locate the Apex – Place your fingertips at the 5th intercostal space, midclavicular
line on the left side of the chest.
, lOMoAR cPSD| 57629747
o Use Light Pressure – Palpate with the pads of your fingers to feel for a brief,
localized tap.
o Assess Characteristics – Note the location, size, amplitude, and duration of the
impulse. A displaced or forceful impulse may indicate cardiac enlargement or
pathology.
● Subjective data: chest pain o Onset & Duration – When did the
pain start? Is it sudden or gradual? How long does it last? o
Location & Radiation – Where is the pain? Does it
spread to the jaw, arm, back, or shoulder?
o Quality – Is it sharp, dull, crushing, burning, or pressure-like?
o Severity – Rate the pain on a scale of 0-10.
o Aggravating & Relieving Factors – What makes it worse (activity, stress, deep
breathing)? What helps (rest, medications)?
o Associated Symptoms – Any shortness of breath, dizziness, nausea, sweating, or
palpitations?
o Patient History – History of heart disease, GERD, anxiety, or prior similar
episodes?
● S1 and S2 normal o S1 ("lub"):
▪ Caused by the closure of the mitral and tricuspid valves at the start of
systole (ventricular contraction).
▪ Best heard at the apex of the heart (left midclavicular line, 5th intercostal
space).
▪ Louder in conditions like fever, exercise, or mitral stenosis.
o S2 ("dub"):
▪ Caused by the closure of the aortic and pulmonary valves at the start of
diastole (ventricular relaxation).
▪ Best heard at the base of the heart (right and left upper sternal borders, 2nd
intercostal space).
▪ Can physiologically split during inspiration due to delayed pulmonary
valve closure.
● Inspecting the Anterior Chest normal vs abnormal o Normal
Findings:
▪ Chest Contour – The chest should be symmetrical with no visible
deformities.
▪ No Visible Pulsations – There should be no visible abnormal pulsations or
heaves (lifts) on the chest wall.
▪ Skin Color – The skin should be a normal color, with no signs of cyanosis
(bluish tint) or pallor.
