CARDIOVASCULAR ASSESSMENT

LEARNING OBJECTIVES
 Perform a cardiovascular assessment, including heart sounds; apical and
peripheral pulses for rate, rhythm, and amplitude; and skin perfusion (color,
temperature, sensation, and capillary refill time)
 Identify S1 and S2 heart sounds
 Differentiate between normal and abnormal heart sounds
 Modify assessment techniques to reflect variations across the life span
 Document actions and observations
 Recognize and report significant deviations from norms
The evaluation of the cardiovascular system includes a thorough medical history
and a detailed examination of the heart and peripheral vascular system. Nurses
must incorporate subjective statements and objective findings to elicit clues of
potential signs of dysfunction. Symptoms like fatigue, indigestion, and leg swelling
may be benign or may indicate something more ominous. As a result, nurses must
be vigilant when collecting comprehensive information to utilize their best clinical
judgment when providing care for the patient.
BASIC CONCEPTS
While the cardiovascular assessment most often focuses on the function of the
heart, it is important for nurses to have an understanding of the underlying
structures of the cardiovascular system to best understand the meaning of their
assessment findings.

CARDIOVASCULAR ASSESSMENT
A thorough assessment of the heart provides valuable information about the
function of a patient’s cardiovascular system. Understanding how to properly
assess the cardiovascular system and identifying both normal and abnormal
assessment findings will allow the nurse to provide quality, safe care to the patient.
Before assessing a patient’s cardiovascular system, it is important to understand
the various functions of the cardiovascular system. In addition to the information
provided in the “Review of Cardiac Basics” section, the following images provide
an overview of the cardiovascular system. ( Figure 1) provides an overview of the
structure of the heart. Note the main cardiac structures are the atria, ventricles, and
heart valves. Figure 2demonstrates blood flow through the heart. Notice the flow
of deoxygenated blood from the posterior and superior vena cava into the right
atria and ventricle during diastole (indicated by blue coloring of these structures).
The right ventricle then pumps deoxygenated blood to the lungs via the pulmonary
artery during systole. At the same time, oxygenated blood from the lungs returns to
the left atria and ventricle via the pulmonary veins during diastole (indicated by red
coloring of these structures) and then is pumped out to the body via the aorta
during systole. . Figure 3 illustrates the arteries of the circulatory system,
and Figure 4 depicts the veins of the circulatory system. The purpose of these
figures is to facilitate understanding of the electrical and mechanical function of
the heart within the cardiovascular system.
Figure 2
Figure 3
Figure 4
Assessing the cardiovascular system includes performing several subjective and
objective assessments. At times, assessment findings are modified according to life
span considerations.

SUBJECTIVE ASSESSMENT
The subjective assessment of the cardiovascular and peripheral vascular system is
vital for uncovering signs of potential dysfunction. To complete the subjective
cardiovascular assessment, the nurse begins with a focused interview. The focused
interview explores past medical and family history, medications, cardiac risk
factors, and reported symptoms. Symptoms related to the cardiovascular system
include chest pain, peripheral edema, unexplained sudden weight gain, shortness of
breath (dyspnea), irregular pulse rate or rhythm, dizziness, or poor peripheral
circulation. Any new or worsening symptoms should be documented and reported
to the health care provider.
Table 1.3a outlines questions used to assess symptoms related to the cardiovascular
and peripheral vascular systems. Table 1.3b outlines questions used to assess
medical history, medications, and risk factors related to the cardiovascular system.
Information obtained from the interview process is used to tailor future patient
education by the nurse.

Table 1.3a
Interview Questions for Cardiovascular and Peripheral Vascular Systems.

Symptom Question Follow-Up

Safety Note: If findings indicate current
severe symptoms suggestive of myocardial
infarction or another critical condition,
suspend the remaining cardiovascular
assessment and obtain immediate assistance
according to agency policy or call 911.

Chest Pain Have you had any Review how to assess a patient’s chief
pain or pressure in complaint using the PQRSTU method in the
your chest, neck, or “Health History” chapter.
arm? “P-provocation or palliation—What brings
 on the pain? What relieves the pain?
Q-Quality or quantity—Characteristics,
duration
R-Region or Radiation—Where is the pain?
Does it radiate anywhere?
S- Severity—How would you rate the pain
on a scale of 0-10?
T-Timing—When did the pain start? How
long does the pain last? Anything relieve
the pain?
U-Understanding—What do you think is
causing the pain?”

Shortness of Do you ever feel What level of activity elicits shortness of

Breath short of breath with breath?
(Dyspnea) activity? How long does it take you to recover?
Do you ever feel Have you ever woken up from sleeping
short of breath while feeling suddenly short of breath
sleeping? (paroxysmal nocturnal dyspnea)?
Do you feel short of How many pillows do you need to sleep, or
breath when lying do you sleep in a chair (orthopnea)? Has
flat? this recently changed?

Edema Have you noticed Has this feeling of swelling or restriction

swelling of your feet gotten worse?
or ankles? Is there anything that makes the swelling
Have you noticed better (e.g., sitting with your feet elevated)?
your rings, shoes, or How much weight have you gained? Over
clothing feel tight at what time period have you gained this
the end of the day? weight?
Have you noticed
any unexplained,
sudden weight gain?
 Have you noticed
any new abdominal
fullness?

Palpitations Have you ever Are you currently experiencing

noticed your heart palpitations?
feels as if it is racing When did palpitations start?
or “fluttering” in Have you previously been treated for
your chest? palpitations? If so, what treatment did you
Have you ever felt as receive?
if your heart “skips”
a beat?

Dizziness Do you ever feel Can you describe what happened?

(Syncope) light-headed? Did you have any warning signs?
Do you ever feel Did this occur with position change?
dizzy?
Have you ever
fainted?

Do your hands or What, if anything, brings on these

feet ever feel cold or symptoms?
Poor look pale or bluish? How much activity is needed to cause this
Peripheral Do you have pain in pain?
Circulation your feet or lower Is there anything, such as rest, that makes
legs when the pain better?
exercising?

Calf Pain Do you currently Can you point to the area of pain with one
have any constant finger?
pain in your lower
 legs?

Table 1.3b
Interview Questions Exploring Cardiovascular Medical History, Medications, and
Cardiac Risk Factors

Topic Questions

Have you ever been diagnosed with any heart or circulation

conditions, such as high blood pressure, coronary artery disease,
peripheral vascular disease, high cholesterol, heart failure, or
Medical
valve problems?
History
Have you had any procedures done to improve your heart
function, such as ablation or stent placement?
Have you ever had a heart attack or stroke?

Do you take any heart-related medications, herbs, or supplements

Medications to treat blood pressure, chest pain, high cholesterol, cardiac
rhythm, fluid retention, or the prevention of clots?

Cardiac Risk Have your parents or siblings been diagnosed with any heart
Factors conditions?

 If yes, who has what conditions?

Do you smoke or vape?
 If yes, how many do you smoke/vape daily?
 For how many years have you smoked/vaped?
If you do not currently smoke, have you smoked in the past?
Topic Questions

 If yes, what did you smoke?

 For how many years did you smoke?
Are you physically active during the week?
 How many times per week do you exercise and for how
many minutes?
 What type of exercise do you usually do?
What does a typical day look like in your diet?
2. How many fruits and vegetables do you normally eat in a day?
3. Do you monitor the amount of saturated fats you eat?
4. How many times a week do you eat a meal prepared by a
restaurant?
5. Do you pay attention to salt in your diet? Do you add salt to
your foods before tasting it?
6. Do you have caffeine during the day? If so, how much?
Do you drink alcoholic drinks?
 How many alcoholic drinks do you have on average per
day? Per week?
 Do you drink while at work?
Would you say you experience stress in your life?
 How would you rate the amount of stress in your life from
0-10?
 How do you cope with the stress in your life?
How many hours of sleep do you normally get each day?
 Do you have difficulty falling asleep?
 Do you have difficulty staying asleep?
OBJECTIVE ASSESSMENT
The physical examination of the cardiovascular system involves the interpretation
of vital signs, inspection, palpation, and auscultation of heart sounds as the nurse
evaluates for sufficient perfusion and cardiac output.
Equipment needed for a cardiovascular assessment includes a stethoscope,
penlight, centimeter ruler or tape measure, and sphygmomanometer.

EVALUATE VITAL SIGNS AND LEVEL OF CONSCIOUSNESS

Interpret the blood pressure and pulse readings to verify the patient is stable before
proceeding with the physical exam. Assess the level of consciousness; the patient
should be alert and cooperative.

INSPECTION
 Skin color to assess perfusion. Inspect the face, lips, and fingertips
for cyanosis or pallor. Cyanosis is a bluish discoloration of the skin, lips, and
nail beds and indicates decreased perfusion and oxygenation. Pallor is the loss
of color, or paleness of the skin or mucous membranes, as a result of reduced
blood flow, oxygenation, or decreased number of red blood cells. Patients with
light skin tones should be pink in color. For those with darker skin tones, assess
for pallor on the palms, conjunctiva, or inner aspect of the lower lip.
 Jugular Vein Distension (JVD). Inspect the neck for JVD that occurs when the
increased pressure of the superior vena cava causes the jugular vein to bulge,
making it most visible on the right side of a person’s neck. JVD should not be
present in the upright position or when the head of bed is at 30-45 degrees.
 Precordium for abnormalities. Inspect the chest area over the heart (also
called precordium) for deformities, scars, or any abnormal pulsations the
underlying cardiac chambers and great vessels may produce.
 Extremities:
o Upper Extremities: Inspect the fingers, arms, and hands bilaterally noting
Color, Warmth, Movement, Sensation (CWMS). Alterations or bilateral
inconsistency in CWMS may indicate underlying conditions or injury. Assess
capillary refill by compressing the nail bed until it blanches and record the
time taken for the color to return to the nail bed. Normal capillary refill is less
than 3 seconds.
o Lower Extremities: Inspect the toes, feet, and legs bilaterally, noting
CWMS, capillary refill, and the presence of peripheral edema, superficial
 distended veins, and hair distribution. Document the location and size of any
skin ulcers.
 Edema: Note any presence of edema. Peripheral edema is swelling that
can be caused by infection, thrombosis, or venous insufficiency due to an
accumulation of fluid in the tissues. (See Figure 5 )for an image of pedal
edema.)
 Deep Vein Thrombosis (DVT): A deep vein thrombosis (DVT) is a
blood clot that forms in a vein deep in the body. DVT requires
emergency notification of the health care provider and immediate follow-
up because of the risk of developing a life-threatening pulmonary
embolism. Inspect the lower extremities bilaterally. Assess for size,
color, temperature, and for presence of pain in the calves. Unilateral
warmth, redness, tenderness, swelling in the calf, or sudden onset of
intense, sharp muscle pain that increases with dorsiflexion of the foot is
an indication of a deep vein thrombosis (DVT). See Figure 6 for an image
of a DVT in the patient’s right leg, indicated by unilateral redness and
edema.

Figure 5
Figure 6
AUSCULTATION

HEART SOUNDS
Auscultation is routinely performed over five specific areas of the heart to listen
for corresponding valvular sounds. These auscultation sites are often referred to by
the mnemonic “APE To Man,” referring to Aortic, Pulmonic, Erb’s point,
Tricuspid, and Mitral areas (see Figure 7 for an illustration of cardiac auscultation
areas). The aortic area is the second intercostal space to the right of the sternum.
The pulmonary area is the second intercostal space to the left of the sternum. Erb’s
point is directly below the aortic area and located at the third intercostal space to
the left of the sternum. The tricuspid (or parasternal) area is at the fourth intercostal
space to the left of the sternum. The mitral (also called apical or left ventricular
area) is the fifth intercostal space at the midclavicular line.
Figure 7

Auscultation usually begins at the aortic area (upper right sternal edge). Use the
diaphragm of the stethoscope to carefully identify the S1 and S2 sounds. They will
make a “lub-dub” sound. Note that when listening over the area of the aortic and
pulmonic valves, the “dub” (S2) will sound louder than the “lub” (S1). Move the
stethoscope sequentially to the pulmonic area (upper left sternal edge), Erb’s point
(left third intercostal space at the sternal border), and tricuspid area (fourth
intercostal space. When assessing the mitral area for female patients, it is often
helpful to ask them to lift up their breast tissue so the stethoscope can be placed
directly on the chest wall. Repeat this process with the bell of the stethoscope. The
apical pulse should be counted over a 60-second period. For an adult, the heart rate
should be between 60 and 100 with a regular rhythm to be considered within
normal range. The apical pulse is an important assessment to obtain before the
administration of many cardiac medications.
The first heart sound (S1) identifies the onset of systole, when the atrioventricular
(AV) valves (mitral and tricuspid) close and the ventricles contract and eject the
blood out of the heart. The second heart sound (S2) identifies the end of systole
and the onset of diastole when the semilunar valves close, the AV valves open, and
the ventricles fill with blood. When auscultating, it is important to identify the S1
(“lub”) and S2 (“dub”) sounds, evaluate the rate and rhythm of the heart, and listen
for any extra heart sounds.
AUSCULTATING HEART SOUNDS
 To effectively auscultate heart sounds, patient repositioning may be required.
Ask the patient to lean forward if able, or position them to lie on their left
side.
 It is common to hear lung sounds when auscultating the heart sounds. It may
be helpful to ask the patient to briefly hold their breath if lung sounds impede
adequate heart auscultation. Limit the holding of breath to 10 seconds or as
tolerated by the patient.
 Environmental noise can cause difficulty in auscultating heart sounds.
Removing environmental noise by turning down the television volume or
shutting the door may be required for an accurate assessment.
 Patients may try to talk to you as you are assessing their heart sounds. It is
often helpful to explain the procedure such as, “I am going to take a few
minutes to listen carefully to the sounds of blood flow going through your
heart. Please try not to speak while I am listening, so I can hear the sounds
better.”

EXTRA HEART SOUNDS

Extra heart sounds include clicks, murmurs, S3 and S4 sounds, and pleural friction
rubs. These extra sounds can be difficult for a novice to distinguish, so if you
notice any new or different sounds, consult an advanced practitioner or notify the
provider. A midsystolic click, associated with mitral valve prolapse, may be heard
with the diaphragm at the apex or left lower sternal border.
A click may be followed by a murmur. A murmur is a blowing or whooshing
sound that signifies turbulent blood flow often caused by a valvular defect. New
murmurs not previously recorded should be immediately communicated to the
health care provider. In the aortic area, listen for possible murmurs of aortic
stenosis and aortic regurgitation with the diaphragm of the stethoscope. In the
pulmonic area, listen for potential murmurs of pulmonic stenosis and pulmonary
and aortic regurgitation. In the tricuspid area, at the fourth and fifth intercostal
spaces along the left sternal border, listen for the potential murmurs of tricuspid
regurgitation, tricuspid stenosis, or ventricular septal defect.
S3 and S4 sounds, if present, are often heard best by asking the patient to lie on
their left side and listening over the apex with the bell of the stethoscope. An S3
sound, also called a ventricular gallop, occurs with fluid overload or heart failure
when the ventricles are filling. It occurs after the S2 and sounds like “lub-dub-
dah,” or a sound similar to a horse galloping. The S4 sound, also called atrial
gallop, occurs immediately before the S1 and sounds like “ta-lub-dub.” An S4
sound can occur with decreased ventricular compliance or coronary artery disease.
A pleural friction rub is caused by inflammation of the pericardium and sounds
like sandpaper being rubbed together. It is best heard at the apex or left lower
sternal border with the diaphragm as the patient sits up, leans forward, and holds
their breath.

CAROTID SOUNDS
The carotid artery may be auscultated for bruits. Bruits are a swishing sound due
to turbulence in the blood vessel and may be heard due to atherosclerotic changes.

PALPATION
Palpation is used to evaluate peripheral pulses, capillary refill, and for the presence
of edema. When palpating these areas, also pay attention to the temperature and
moisture of the skin.

PULSES
Compare the rate, rhythm, and quality of arterial pulses bilaterally, including the
carotid, radial, brachial, posterior tibialis, and dorsalis pedis pulses. Review
additional information about obtaining pulses in the “General Survey” chapter.
Bilateral comparison for all pulses (except the carotid) is important for determining
subtle variations in pulse strength. Carotid pulses should be palpated on one side at
a time to avoid decreasing perfusion of the brain. The posterior tibial artery is
located just behind the medial malleolus. It can be palpated by scooping the
patient’s heel in your hand and wrapping your fingers around so that the tips come
to rest on the appropriate area just below the medial malleolus. The dorsalis pedis
artery is located just lateral to the extensor tendon of the big toe and can be
identified by asking the patient to flex their toe while you provide resistance to this
movement. Gently place the tips of your second, third, and fourth fingers adjacent
to the tendon, and try to feel the pulse.
The quality of the pulse is graded on a scale of 0 to 3, with 0 being absent pulses, 1
being decreased pulses, 2 is within normal range, and 3 being increased (also
referred to as “bounding”). If unable to palpate a pulse, additional assessment is
needed. First, determine if this is a new or chronic finding. Second, if available,
use a doppler ultrasound to determine the presence or absence of the pulse. Many
agencies use doppler ultrasound to document if a nonpalpable pulse is present. If
the pulse is not found, this could be a sign of an emergent condition requiring
immediate follow-up and provider notification. See Figure 8 and Figure 9. for
images of assessing pedal pulses.
Figure 8
 Figure 9

CAPILLARY REFILL
The capillary refill test is performed on the nail beds to monitor perfusion, the
amount of blood flow to tissue. Pressure is applied to a fingernail or toenail until it
pales, indicating that the blood has been forced from the tissue under the nail. This
paleness is called blanching. Once the tissue has blanched, pressure is removed.
Capillary refill time is defined as the time it takes for the color to return after
pressure is removed. If there is sufficient blood flow to the area, a pink color
should return within 2 to 3 seconds after the pressure is removed.

EDEMA
Edema occurs when one can visualize visible swelling caused by a buildup of fluid
within the tissues. If edema is present on inspection, palpate the area to determine
if the edema is pitting or nonpitting. Press on the skin to assess for indentation,
ideally over a bony structure, such as the tibia. If no indentation occurs, it is
referred to as nonpitting edema. If indentation occurs, it is referred to as pitting
edema. See Figure 10 for images demonstrating pitting edema.
 Figure10
1010101

Note the depth of the indention and how long it takes for the skin to rebound back
to its original position. The indentation and time required to rebound to the original
position are graded on a scale from 1 to 4. Edema rated at 1+ indicates a barely
detectable depression with immediate rebound, and 4+ indicates a deep depression
with a time lapse of over 20 seconds required to rebound. See Figure 11 for an
illustration of grading edema. Additionally, it is helpful to note edema may be
difficult to observe in larger patients. It is also important to monitor for sudden
changes in weight, which is considered a probable sign of fluid volume overload.

Figure 11
HEAVES OR THRILLS
You may observe advanced practice nurses and other health care providers
palpating the anterior chest wall to detect any abnormal pulsations the underlying
cardiac chambers and great vessels may produce. Precordial movements should be
evaluated at the apex (mitral area). It is best to examine the precordium with the
patient supine because if the patient is turned on the left side, the apical region of
the heart is displaced against the lateral chest wall, distorting the chest movements.
[24]
A heave or lift is a palpable lifting sensation under the sternum and anterior
chest wall to the left of the sternum that suggests severe right ventricular
hypertrophy. A thrill is a vibration felt on the skin of the precordium or over an
area of turbulence, such as an arteriovenous fistula or graft.

LIFE SPAN CONSIDERATIONS

The cardiovascular assessment and expected findings should be modified
according to common variations across the life span.
INFANTS AND CHILDREN
A murmur may be heard in a newborn in the first few days of life until the ductus
arteriosus closes.
When assessing the cardiovascular system in children, it is important to assess the
apical pulse. Parameters for expected findings vary according to age group. After a
child reaches adolescence, a radial pulse may be assessed. Table 12 outlines the
expected apical pulse rate by age.

Table 12
Expected Apical Pulse by Age

Age Group Heart Rate

Preterm 120-180

Newborn (0 to 1 month) 100-160

Infant (1 to 12 months) 80-140

Toddler (1 to 3 years) 80-130

Preschool (3 to 5 years) 80-110

School Age (6 to 12 years) 70-100

Adolescents (13 to 18 years) 60-90

OLDER ADULTS
In adults over age 65, irregular heart rhythms and extra sounds are more likely. An
“irregularly irregular” rhythm suggests atrial fibrillation, and further investigation
is required if this is a new finding. See the hyperlink in the box below for more
information about atrial fibrillation.

EXPECTED VERSUS UNEXPECTED FINDINGS

After completing a cardiovascular assessment, it is important for the nurse to use
critical thinking to determine if any findings require follow-up. Depending on the
urgency of the findings, follow-up can range from calling the health care provider
to calling the rapid response team. Table 13 compares examples of expected
findings, meaning those considered within normal limits, to unexpected findings,
which require follow-up. Critical conditions are those that should be reported
immediately and may require notification of a rapid response team.

Table 13
Expected Versus Unexpected Findings on Cardiac Assessment

Unexpected Findings
(Document and notify the
Assessment Expected Findings
provider if this is a new
finding*)

Scars not previously

documented that could indicate
Apical impulse may or prior cardiac surgeries
Inspection
may not be visible Heave or lift observed in the
precordium
Chest anatomy malformations
 Unexpected Findings
(Document and notify the
Assessment Expected Findings
provider if this is a new
finding*)

Apical pulse felt to the left of

the midclavicular fifth
Apical pulse felt over
intercostal space
Palpation midclavicular fifth
Additional movements over
intercostal space
precordium such as a heave,
lift, or thrill

New irregular heart rhythm

S1 and S2 heart sounds
Auscultation Extra heart sounds such as a
in a regular rhythm
murmur, S3, or S4

*CRITICAL Symptomatic tachycardia at

CONDITIONS to rest (HR>100 bpm)
report immediately Symptomatic bradycardia
(HR<60 bpm)
New systolic blood pressure
(<100 mmHg)
Orthostatic blood pressure
changes (see “Blood Pressure”
chapter for more information)
New irregular heart rhythm
New extra heart sounds such as
a murmur, S3, or S4
New abnormal cardiac rhythm
changes
Reported chest pain, calf pain,
or worsening shortness of
 Unexpected Findings
(Document and notify the
Assessment Expected Findings
provider if this is a new
finding*)

breath

See Table 14 for a comparison of expected versus unexpected findings when

assessing the peripheral vascular system.

Table 14
Expected Versus Unexpected Peripheral Vascular Assessment Findings

Unexpected Findings
Assessment Expected Findings (Document or notify provider if
new finding*)

Skin color uniform

Cyanosis or pallor, indicating
and appropriate for
decreased perfusion
race bilaterally
Decreased or unequal hair
Equal hair
distribution
distribution on upper
Presence of jugular vein
and lower
distention (JVD) in an upright
extremities
Inspection position or when head of bed is
Absence of jugular
30-45 degrees
vein distention
New or worsening edema
(JVD)
Rapid and unexplained weight
Absence of edema
gain
Sensation and
Impaired movement or sensation
movement of fingers
of fingers and toes
and toes intact
 Unexpected Findings
Assessment Expected Findings (Document or notify provider if
new finding*)

Skin cool, excessively warm, or

diaphoretic
Absent, weak/thready, or
Skin warm and dry bounding pulses
Pulses present and New irregular pulse
equal bilaterally New or worsening edema
Palpation
Absence of edema Capillary refill greater than 2
Capillary refill less seconds
than 2 seconds Unilateral warmth, redness,
tenderness, or edema, indicating
possible deep vein thrombosis
(DVT)

Auscultation Carotid pulse Carotid bruit

Cyanosis
Absent pulse (and not heard using
Doppler device)
*CRITICAL
Capillary refill time greater than 3
CONDITIONS to
seconds
report immediately
Unilateral redness, warmth, and
edema, indicating a possible deep
vein thrombosis (DVT)
SAMPLE FORMAT OF CARDIOVASCULAR ASSESSMENT SHEET

Date S ample
Patient Name Gender
DOB/Age
Cardiovascular History

Review of Systems/Symptoms

Social History

CARDIOVASCULAR RISK FACTORS

Dyslipidemia No#### # Yes ##### Previous RX

Hypertension No ##### Yes ##### BP ____________ Previous RX

_____________________
Diabetes No ##### Yes ##### FBS/HbA1c ____/____ Previous RX
___________________
Smoking Current Previous Never
Cigs/Day ##### Year Quit ##### Previous Cessation Methods
#### #

Fam Hx CAD :No ________ Yes

_________________________________________________
Menstrual Status: Premenopausal Perimenopausal

Postmenopausal _______
Physical Activity - Weight History ___________________
Initial diet - None AHA DASH Vegetarian Other
Alcohol Use-
Thyroid Dis - Stress Source/Mgmt
No _________________________________________
Liver Dis - Yes _________ Cancer No Yes
No ________
Yes _________ Bleeding Dis No Yes
________
LIFESTYLE & PAST MEDICAL HISTORY

Headaches- No Yes ________ Liver Dis No

Yes ________
Renal Dis - No Yes _________ Insomnia No Yes
________
Past Surgeries Other
_____________________________________
Other Family History
_______________________________________________________________
CURRENT MEDICATIONS
__________________________________________________________________
______________
________________________________________ Allergies
________________________________
BASELINE PHYSICAL EXAMINATION
Blood Pressure Heart Rate
_______________________

CARDIOVASCULAR ASSESSMENT SHEET

Chief Complaint/Reason for Evaluation:
HISTORY OF PRESENT ILLNESS Risk Factors For CAD
Fam Hx
Smoking:Pks/Yrs
Quit
Dyslipidemia
DM
HTN
Inactivity
Stress
Weight
Other
Women Only
Pregnant ( ) Yes ( ) No: Planning Pregnancy ( ) Yes ( ) No: G P###
Postmenopause ( ) Yes ( ) No
PAST MEDICAL / SURGICAL HISTORY
Hospitalization or Surgery Current Medications
Reason
Date

Allergies

MEDICAL HISTORY REVIEW OF SYMPTOMS

Cardiovascular ( ) CAD ( ) Cardiomyopathy ( )
( ) CHF Valvular Dz Wt chg
Respiratory ( ) COPD ( ) Arrhythmia ( ) RHD
GI/GU ( ) PUD Dyspnea
Renal/Endo ( ) Renal Failure ( ) Pulm Embolism ( ) Cough Chest
Pain
Periph Vasc( ) Carotid ASO (
( )( ) Prostate Peripheral
Neurological Heme/On. AAA
Hepatitis Edema
( ) CVA/TIA
Abdomen
 ( ) Claudication
Numbness ext
( ) Migraine HA Freq
( ) Anemia ( )
UTI
Thyroid
Mental Health
( ) Seizure
FAMILY Alive/Well Deceased HTN CAD S troke PVD Diabetes
HX ( ) ( ) ( ) ( )( ) ( ) ( ) Age/Cause of
Father ( ) ( ) ( ) ( ) ( ) Death
Mother ( ) ( ) ( ) ( )( ) ( ) ( ) ( )
Siblings ( ) ( ) ( ) ( ) ( ) ( )
( )
( )

CVS EXAMINATION:
INSPECTION
 Colour and texture of skin-
 Any suture marks-
 Any dilated engorged superficial veins-
 Inspected precordium-
 Visible pulsations (Apex beat)-
PALPATION
 Any local rise of temperature and tenderness-
 Locate apex beat-
 Parasternal heave-
 Thrill
PERCUSSION
Borders of heart:
 Right border-
 Left border-
 Upper border-
 Lower border-
AUSCULTATION
Cardiac areas:
 Mitral areas-
 Tricuspid areas-
 Aortic areas-
 Pulmonary area-