Cardiovascular Video Assessment

1. Greeting
Hello, Mr./Mrs. ______. Im ____, your family nurse practitioner student. Its
nice to meet you.
Tell me what brings you into the clinic today.
2. Health History:
History of Present Illness:
o When did it begin? Was it sudden or gradual?
o Where is it?
o How long are the episodes? Has it been constant or intermittent?
o Describe a typical attack. What does it feel like? How severe is it from
0-10?
o Does anything make it worse?
o Does anything make it better? What have you done to treat it? Have
you taken any medications for it?
o Do you have any associated symptoms?
Past Medical History: Now we are going to review your past medical
history.
o Have you ever had cardiac surgery?
o Have you ever been hospitalized for a cardiac disorder?
o Do you have a history of congenital heart disease? A rhythm
disorder? Acute rheumatic fever? Kawasaki disease?
o Have you ever been diagnosed with any chronic illnesses such as:
- Hypertension? Bleeding disorders? Clotting disorders?
Hyperlipidemia? Diabetes? Thyroid dysfunction? Coronary
Artery Disease? Obesity? Anemia?
o Have you ever had an MI or heart attack?
Family History:
o Has anyone in your family been diagnosed with:
- Long QT syndrome? Marfan syndrome? Diabetes? Heart
disease? Dyslipidemia? Hypertension? Obesity? Congenital
heart disease?
o Have there been any sudden cardiac deaths in your family?
Personal/Social History:
o What type of job do you do? Is it physically demanding? Are you
exposed to environmental hazards?
o Do you smoke or use tobacco?
o Do you drink alcohol?
o Do you use any illicit drugs such as cocaine or injection drugs?
o Do you exercise? How often? For how long?
3. Review of Systems: Identify the presence or absence of health-related
issues in the pertinent body system(s).
General:
o Have you had any fever? Chills? Malaise? Fatigue? Night sweats?
Weight changes?

Cardiac: Have you had any.

o Chest pain/distress? (causes, duration, timing, relieving factors)
o Palpitations?
o Dyspnea?
o Orthopnea? How many pillows do you sleep on?
o Edema?
o Exercise intolerance?
o Cyanosis?
o Cough?
o Loss of consciousness?
Vascular:
o Do you have any pain in your legs when walking? (frequency,
severity)
o Do you have a tendency to bruise/bleed?

4. General Survey:
Alertness & Orientation/Mental Status: Based on our interaction and his
responses thus far, the patient is alert and oriented x 4. He also follows
commands and answers questions appropriately.
Appearance: Patient appears calm, well-groomed and in no apparent
distress.
Heart Rate: palpate radial pulse for 30 sec & multiply by 2
o Regular rhythm with HR of __ beats per minute.
Respirations: count number of breaths for 30 sec & multiply by 2
immediately after counting pulse
o Respirations are regular and even with a rate of __ breaths per
minute.
Pain:
o Are you having any pain now? OLDCARTS
5. Estimation of Jugular Venous Pressure: I am now going to assess your jugular
venous pressure. Would you mind lying down for me?
Have patient supine at 30
Find point of pulsation in right jugular vein
Extend index card at right angle from meniscus point of pulsation to the
ruler, which should be placed vertically on the sternal angle (AKA Angle of
Louis; continuous with 2nd rib)
Read where card crosses the ruler & round to nearest centimeters of water
(should be < 9 cm)
6. Assessment of Carotid Pulses: I am now going to assess your carotid pulses.
I am inspecting your right and left carotid arteries and comparing sides.
I am now palpating each side to feel for thrills.
o Place index & middle finger on carotid artery in lower 3rd of neck &
press just inside the medial border of a well-relaxed
sternocleidomastoid muscle.
o Increase pressure until you feel a maximal pulsation.
o Decrease pressure to detect arterial wave & contour.

o Assess amplitude of pulse.

I am now auscultating your carotid arteries to listen for bruits. Can you hold
your breath for just a moment?
o Use diaphragm

7. Inspection of Chest: I am now inspecting your chest for lifts or heaves. Normally,
I would inspect a bare chest.
Rate, Rhythm, Depth, & Effort of Breathing
o Rate of respirations determined earlier. Regular rhythm and depth.
No increased effort of breathing. No lifts or heaves noted.
8. Palpation of Chest: I am now palpating your chest for heaves, lifts, & thrills.
Normally, I would palpate a bare chest.
Heaves, Lifts, Thrills
o Use finger pads to palpate for heaves & lifts at right & left 2nd
intercostal spaces, along the left sternal border, & in the apical area.
o Use ball of hand to palpate for thrills in the same locations.
Apical Impulse
o Palpate with finger pads & describe location, diameter, & amplitude.
o If cant feel it, ask pt to roll into left lateral decubitus position.
9. Auscultation of Chest: I am going to listen to your heart over various areas of
your chest. Normally, I would place my stethoscope on a bare chest.
Heart Rate/Rhythm in Key Locations:
o Listen for S1 & S2 at all 6 sites:
- Aortic area: Right 2nd intercostal space; sternal border
Use
- Pulmonic area: Left 2nd intercostal space; sternal border
diaphragm
- Erbs Point: Left 3rd intercostal space; sternal border
- Tricuspid Area: Left 4th & 5th intercostal spaces; sternal border
Use bell
- Mitral/Apex Area: Left 5th intercostal space; midclavicular line
o Will you please roll on your left side while I listen to your apical
impulse?
- Use bell to listen at apical impulse area
Lung Sounds: Will you please sit up so that I may listen to your lungs?
o Use diaphragm; have patient breathe slowly & deeply through the
mouth
o Comparing sides, start at top and work down
- 8 sites on front
- 10 sites on back