Assessment of the Cardiac

System
PCU-MJCN
Class 2011
HISTORY
 Past Medical History
 Past Surgical History
 Allergies
 Medications, OTC
 Dietary Habits
 Social History
 Family History
Current Health
Chief Complaint
Onset
Location
Duration
Characteristics
Associated manifetations
Aggravating factors
Relieving factors
Clinical Manifestations
CHEST PAIN
 Pressure Worsened by:
 Burning  Exertion

 Heaviness  Eating

 Constriction  Emotions

 Cold

Relieved by:
 Rest

 Nitroglycerin
CHEST PAIN
 Sharp, fleeting, vague Worsened by
 Sudden onset  Deep breathing

 Lasts hours to days  Position changes

 Coughing

Releived by
 Pain pills

 Spontaneously
PALPITATIONS
 Rapid heart beats Ask about
 thumping  medications

 Pounding  Caffaine intake

 Similar to syncopal  Thyroid disease

episodes -  Frequency/pattern
Vision changes, weakness,  Duration
dizziness, nausea,  Associated
doiaphoresis manifestations
CYANOSIS – bluish discoloration due to
decreased hemoglobin or decreased tissue perfusion
Central cyanosis Peripheral Cyanosis
 Congenital Heart  Occurs with cold
Disease  Anemia
 Pulmonary Disease  Advanced CHF
 Chemical Exposure  New MI
 Prior MI

 Prior CHF

 Anemia
SYNCOPE-loss of consciousness related to
decrease cerebral perfusion
Sudden onset Warning manifestations
 Prodromal aura
 Dysrhythmias
 Palpitations
 seizures  Vision changes
 Dizziness or weakness
 Occurs with
 Micturition
 Defections exertion
 Occurs with fear, smells, sights
 Occurs with position changes
 Alcohol or drug abuse
 Volume depletion
 History of depression
 Residual neuroligic deficit
DYSPNEA
Sudden Chronic
 Occurs with: Occurs with:
 Fever  Anxiety
 Exposure to high altitude  Depression
 Acute pulmonary edema  LVHF
 Pnemothorax  Pulmonary disease
 Pulmonary emboli  Pleural effusion
 Airway obstruction  Asthma
 Obesity
 Poor physical fitness
 Psychosomatic conditions
DYSPNEA
 Exertional Dyspnea - cardiac
 Orthopnea - pulmonary
 Paroxysmal nocturnal dyspnea - LVHF
FATIGUE
 Weariness or exhaustion
 Can accompany complaints of dyspnea
 Other causes
 Anemia
 Anxiety
 Chronic disease
 Depression
 Thyroid dysfunction
EDEMA
Unilateral Bilateral
 Deep vein thrombosis  Initial site
 Cellulitis  progression
 Lymphatic blockage  History of
ASK  CHF
 Recent surgery or bed rest  Nephrotic syndrome
 Injury  Shortness of breath
 Skin color changes  cough
 Fever / redness
 History of cancer
PHYSICAL EXAMINATION
 General Appearance and LOC
 VITAL SIGNS
 Head and Neck
 Neck Vein Assessment – jugular pulses
 Carotid Artery Assessment - bruit
 Thorax
PHYSICAL EXAMINATION
 Abdomen

 Extremities
 Skin color
 Skin turgor
 Temperature
 Clubbing
 Edema
DIAGNOSTIC TESTING
Noninvasive Testing  Echocardiogram
 ECG  Radiographic Cardiac
 Exercise Tests Tests
 Upright Tilt-Table
 Chest X-ray
Tests  CT Angiography
 MRI
 MRA – gadolinium
 PET
DIAGNOSTIC TESTING
Invasive Cardiac Tests
 Transesophageal Echocardiography

 Cardiac catheterization

 Left/Right heart catheterization

Laboratory Tests
 CBC  Serum Lipids
 Cardiac Enzymes  C-Reactive Protein
 Myoglobin  D-Dimer
 Creatinine kinase  Serum electrolytes
 CKMM, CKMB, CKBB
 K
 Troponin
 Ca
 Blood Coagulation Tests  Na
 PT  Ma
 PTT  P
 Serum Lipids  BUN, Creatinine, GFR
 Serum Glucose