Assessment of the Cardiovascular System
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Inspect, auscultate & palpate neck vessels
Inspect & palpate across precordium (anterior chest), apical impulse
Auscultate precordium starting at the base using Z pattern:
• Aortic
• Pulmonic
• Tricuspid
• Mtiral (apex and PMI or point of maximal impulse, apical pulse)
Heart sounds
• Identify rate, rhythm
• Assess S1 & S2
• Listen for murmurs
Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
When performing a regional cardiovascular assessment, use this order:
1. Pulse and blood pressure
2. Extremities
3. Neck vessels
4. Precordium
The logic of this order is that you will begin observations peripherally and move in toward the heart.
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NURS1068 PN2 Health Assessment
Areas for Landmarking and Auscultation
Aortic Valve Area = Second Right Intercostal Space
Pulmonic Valve Area = Second Left Intercostal Space
Tricuspid Valve Area = Fourth and Fifth Intercostal Space along the Left
Lower Sternal Border
Mitral Valve Area = Fifth Intercostal Space at Around Left Midclavicular
Line
Erb’s Point = Third Intercostal Border at Left Sternal Border
Note: Erb’s Point best place to hear S2 and is where the superimposing sounds of the
aortic and pulmonic can be heard during expiration and split during inspiration can be
heard.
Precordium, Apex, and Base
Copyright © 2019
Elsevier, Inc.
NURS1068 PN2 Health Assessment
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CARDIAC ASSESSMENT FINDINGS
Auscultate the heart in all four
anatomic sites:
1. Aortic
2. Pulmonic
3. Tricuspid
4. Apical
Palm Placement to Assess Apical
Impulse
Normal Adult Heart Rate = 60 – 100 BPM
Begin with the diaphragm end piece
• S1: Usually heard at all sites.
Usually louder at the apical and
tricuspid areas.
• Sound = LUB
• Coincides with the carotid artery
pulse.
• Occurs at the beginning of systole.
Local Apical Impulse:
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Localize the apical impulse precisely
using one finger pad.
Apical pulsation occupies only one
interspace (the fourth and fifth)
medial to the midclavicular line.
Thrills:
• Palpable vibration.
• Feels like the throat of a purring cat.
• Signifies turbulent blood flow = Murmur.
Heaves or Lifts:
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• S2: Usually heard at all sites.
Usually louder at base of the heart
and aortic and pulmonic areas.
Erb’s Point refers to the third
intercostal space on the left sternal
border where S2 is best auscultated.
• Sound = DUB
Occurs at the end of systole.
Sustained forceful thrusting of the
ventricle during systole.
Signifies ventricular hypertrophy
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NURS1068 PN2 Health Assessment