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Objectives

• By the end of the unit, learners will be able to:
• Describe the components of health history that should be elicited during the assessment of cardiovascular system.
• Identify the landmarks of the chest.
• Describe the following:
• Pulse rate, rhythm and pulsation characteristics
• PMI
• Heart sounds
• Discuss systolic and diastolic murmurs
• Assess the cardiovascular system systematically.
• Document findings.

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Describe the components of health history that should be elicited during the assessment of cardiovascular system

Objective 01

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• When assessing the cardiovascular system, obtaining a comprehensive health history is essential to understand the patient's cardiovascular health and identify potential risk factors or issues.
• Here are the 7 key components of a health history that should be elicited during a cardiovascular system assessment;

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• Chief Complaint (CC)
• History of Present Illness
• Past Medical History (PMH)
• Family History (FH)
• Personal/Social History
• Review of Systems (ROS)
• Medications and Allergies

1. Chief Complaint: Start by asking the patient about their main reason for seeking medical evaluation related to their cardiovascular health. E.g. “What brought you to the hospital/clinic today?“ or "Can you describe your chest pain?“

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• History of Present Illness: Inquire about the current symptoms and their duration, such as chest pain, shortness of breath, palpitations, dizziness, fatigue, or edema (swelling). Ask about any precipitating or relieving factors, associated symptoms, and the pattern of occurrence.

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3. Past Medical History (PMH): Discuss the patient's medical history, including any pre-existing cardiovascular conditions, such as Cardiovascular Conditions (Hypertension, MI, heart failure, arrhythmias, CAD, VHD, CHD). Risk Factors (Diabetes, hyperlipidemia, obesity). Surgeries/Procedures (Stent placement, bypass surgery, pacemaker).

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• Family History (FH): Inquire about a family history of cardiovascular diseases, as these can indicate risk factors. E.g. “Has anyone in your family died suddenly from heart problems?"

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5. Personal/ Psychosocial History: Discuss the patient's lifestyle and habits, including, diet, exercise, smoking, alcohol consumption, Stress, anxiety and recreational drug use, as these factors can significantly impact cardiovascular health.

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• Review of Systems (ROS): Conduct a systematic review of other body systems to identify potential associations with cardiovascular issues. This includes questions about respiratory symptoms, neurological symptoms, and signs of peripheral vascular disease.

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• Medications and Allergies: Medication History: Document the patient's current and past use of medications, including antihypertensives, anticoagulants, antiplatelet agents, or other cardiovascular drugs. Allergies: Inquire about any known allergies, especially those related to medications commonly prescribed for cardiovascular conditions.
2. By gathering information on these components, healthcare providers can create a comprehensive cardiovascular health history that aids in the assessment, diagnosis, and development of appropriate management and prevention strategies for cardiovascular diseases.

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Identify the landmarks of the chest

Objective 02

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• Identifying the landmarks of the chest" means recognizing specific points on the chest that guide physical examination such as listening to heart sounds, performing palpation, or locating auscultation points.

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• These landmarks help healthcare providers accurately assess the heart, lungs, and major blood vessels, and determine the correct placement of the stethoscope during cardiovascular examination.

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Landmarks of the Chest for Physical Examination

These help locate findings precisely in clinical documentation:

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Anatomical Landmarks

• Suprasternal Notch: U-shaped dip above the sternum (between clavicles).
• Sternal Angle (Angle of Louis):
• Bony ridge where the sternum meets the 2nd rib.
• Correlates with the 2nd intercostal space (ICS) and the aortic/pulmonic valve auscultation sites.
• Costal Margin: Lower edge of the rib cage.

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Vertical Reference Lines

• Midsternal Line: Down the middle of the sternum.
• Midclavicular Line (MCL): Vertical line from the clavicle’s midpoint.
• Anterior Axillary Line: From the front axillary fold.
• Midaxillary Line: From the apex of the axilla (armpit).
• Posterior Axillary Line: From the back axillary fold.

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Rib and Intercostal Space (ICS) Numbering

• Ribs: Palpate from the sternal angle (2nd rib) and count downward.
• ICS: The space below each rib (e.g., 5th ICS at the left midclavicular line = apex of the heart).

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Key Auscultation Sites for Heart Sounds

• Aortic Valve: 2^nd ICS, right sternal border.
• Pulmonic Valve: 2^nd ICS, left sternal border.
• Tricuspid Valve: 4^th ICS left sternal border.
• Mitral Valve (Apex): 5th ICS, left midclavicular line.

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Quiz Session

Are you ready ?

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Quiz # 01

• Which of the following is a component of MSE?
1. Blood pressure
2. Appearance
3. Hemoglobin level
4. Respiratory rate

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• Answer: b) Appearance

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Reference

• Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. (2021). Bates’ Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer.
• www.pubmed.ncbi.nlm.nih.gov

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If you have any…!

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Questions…?

or

Confusion…?

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Good luck

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