Heart

1
Adventist University of the Philippines

College of Nursing
MNHA 510 – Advanced Health Assessment
Heart
Equipment: marking pencil, centimeter ruler,tape measure, and stethoscope.
Physiological Examination Findings

Inspection of the Precordium
First, observe the precordium. Note the location of the Precordium was observed. Apical
apical impulse. Note any forceful pulsations. impulse was not visibly seen.
Second, inspect the organs that may provide clues

about the cardiac status.
- Asses the skin to detect cyanosis or venous - Skin is warm, with tan color. No
distention. cyanosis noted.
- Inspect the nail beds for cyanosis and capillary - Nails beds are color pink, with 0-1
refill time. capillary refill time.
Palpation of the Precordium
First, with warm hands gently palpate the supine

patient’s precordium while moving systematically
through five areas.
- Palpate to the apex.
- Move to the left sternal border. During the systemic palpation through
the five areas of the patient’s
- Move to the base. precordium, no pulsation noted.
- Go down to the right sternal border.
- Move into the epigastrium or axillae, if

needed.
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Second, feel for the apical impulse and identify its The apical impulse is felt in the 5th
location, distance from the midesternal line, and width. intercostal space.
Describe the point at which the apical impulse is most It was located mid-clavicular point at
readily seen or felt as the point of maximal impulse (or intercostal space 5.
PMI).
If the apical impulse is more vigorous than a gentle, A normal, non-sustained tapping felt.
brief pulsation, describe it as a heave or lift.
Third, feel for a thrill over the base of the heart at the No thrill or vibrations palpated over
right or left second intercostal space. these areas.
Fourth, as you feel the precordium, use your other Yes, the carotid pulse and S1 occur
hand to palpate the carotid artery. The carotid pulse almost simultaneously.
and S1 should occur almost simultaneously.
Auscultation of the Precordium
Using a warm stethoscope in a quiet room,
systematically auscultate the precordium in five areas.
- The aortic valve area, in the second right

intercostal space at the right sternal border.
- The pulmonic valve area, in the second left Had done this auscultation
intercostal space at the left sternal border. systematically. S1 and S2 heard. Apical
pulse 78bpm over 60second. Normal
- The second pulmonic area, in the third left heart rate and rhythm. No extra sounds
intercostal space at the left sternal border. like murmurs, clicks, or friction rubs
heard.
- The tricuspid area, in the fourth intercostal
space along the lower left sternal border.
- The mitral (or apical) area, in the fifth left

intercostal space at the midclavicular line.

Auscultate all five sites with the patient in different
positions as in this suggested four-part sequence.
- Listen with the patient sitting up and leaning - Listened with this position. No
slightly forward. This is best for hearing high- murmurs or friction rubs noted/heard.
pitched murmurs with the diaphragm of the
stethoscope.
- Listen with the patient supine. - Listened with this position. No S3 or

S4 heard.
- Listen with the patient in the left lateral - Listened with this position. No
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recumbent position. This is best for hearing abnormal sound heard like low pitched
low-pitched filling sounds with the bell of the diastolic murmur.
stethoscope.
- Listen with the patient in other positions based - Listened in other positions. S1 and S2
on your findings. For, example, use the right is heard. Not diminished or
lateral recumbent position to asses a right- accentuated.
rotated heart.

At each site, pause and listen selectively for each
component of the cardiac cycle. Remember to inch
your stethoscope along and let it follow the sounds
wherever they lead. Listen for those five components.
- Asses the heart rate and rhythm at a site where - Regular heart rate 78bpm, regular
the tones are easily heard. If the cardiac heart rhythm. No deficit noted.
rhythm, compare the beats per minute over the
heart with the beats per minute at radial pulse.
Note any deficit.
- Have the patient breathe normally and then - S1 heard, coinciding with the rise if
hold the breath on expiration. Listen for S1 the carotid pulse. No splitting sound
while you palpate the carotid pulse. S1, which heard.
marks the beginning of systole, should
coincide with the rise of the carotid pulse,
splitting, and the effects of respirations.
- Concentrate on systole, listening for any extra - No extra sounds or murmurs heard or
sounds or murmurs. noted.
- Focus on diastole, which begins with S2 and is - Done this. No extra heart sounds or
longer than systole. Again, note any extra heart murmurs.
sounds or murmurs.
- Have the patients inhale deeply. Then listen - Done this. No splitting of S2 heard.
closely for S2 to become two components
during inspiration. This split S2 is best heard in
the pulmonic site.
Listen for the four basic heart sounds: S1, S2, S3, and - Listened to the four basic heart
S4. S1 and S2 are the most distinct and should be sounds.
characterized separately. S3 and S4 normally may or
may not be present.
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- S1 marks at the beginning of systole and is best - S1 sound heard and is not diminished
heard toward apex, where it is usually louder, nor accentuated. Normal S1 heart
lower, and longer, and longer than S2. sound.
- S2 marks at the end of systole and is best heard - S2 sound heard and is not diminished
in the aortic and pulmonic areas. It is louder nor accentuated. Normal S1 heart
than S1 at the base of the heart. sound. No splitting of S2 heard.
- S3 occurs early in diastole. It also normally is - No S3 heard.

quiet and difficult to hear.
- Splitting of S1 is uncommon, but may be - Splitting of S1 not heard.

heard in the tricuspid area, particularly on deep
inspiration.
- Splitting of S2 is expected and can be divided - Splitting of S2 not heard.

into aortic component (or A2) and the
pulmonic component (or P2).
Identify any extra heart sounds.
- An increased S3 has a galloping rhythm, as in

the word Ken- TUCK-y. it is best heard with
the bell at the apex and with the patient in the
left lateral recumbent position.
- An increased S4 has the rhythm of the word

TEN-nes-see. It is best heard with the bell at
the apex and with the patient in the supine or
left lateral recumbent position.
- No extra heart sounds heard.
- A gallop is beast hard the same way as an
increased S4.
- A mitral valve opening snap is detected with

the diaphragm medial to the apex at the second
left intercostal space with the patients in any
position.
- An injection click is auscultated best with the

diaphragm is a seated or supine patients.
- A pericardial friction rub is widely heard, and

its grating or rubbing sound is clearest toward
apex.
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Stay alert for heart murmurs during systole or diastole.

If you detect a murmur, identify these eight
characteristics.
- First, note its timing and duration. A murmur

any affect as specific part of the cardiac cycle,
such as early systole, or it may be continuous.
- Rate its pitch as high, medium, or low.

No murmur heard during systole or
diastole.
- Rank its intensity from grade one to grade six.
- Determine its pattern as crescendo,

decrescendo, or plateau.
- Describe its quality, such as harsh, raspy,

musical, or blowing.
- Identify its location.
- Note its radiation.
- Assess any respiratory phase variations, such

as changes in intensity, quality, or timing on
inspiration or expiration.

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1

Adventist University of the Philippines

MNHA 510 – Advanced Health Assessment

Physiological Examination Findings

Second, inspect the organs that may provide clues

Palpation of the Precordium

First, with warm hands gently palpate the supine

- Palpate to the apex.

- Go down to the right sternal border.

- Move into the epigastrium or axillae, if

Physiological Examination Findings

- The aortic valve area, in the second right

- The mitral (or apical) area, in the fifth left

Physiological Examination Findings

- Listen with the patient supine. - Listened with this position. No S3 or

Physiological Examination Findings

- S3 occurs early in diastole. It also normally is - No S3 heard.

- Splitting of S1 is uncommon, but may be - Splitting of S1 not heard.

- Splitting of S2 is expected and can be divided - Splitting of S2 not heard.

Identify any extra heart sounds.

- An increased S3 has a galloping rhythm, as in

- An increased S4 has the rhythm of the word

- A mitral valve opening snap is detected with

- An injection click is auscultated best with the

- A pericardial friction rub is widely heard, and

Stay alert for heart murmurs during systole or diastole.

- First, note its timing and duration. A murmur

- Rate its pitch as high, medium, or low.

- Determine its pattern as crescendo,

- Describe its quality, such as harsh, raspy,

- Identify its location.

- Note its radiation.

- Assess any respiratory phase variations, such

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