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Cardio vascular system. Assessment of cardiovascular system. General assessment Skin colour - cyanosis, pallor Skin temperature Oedema Dyspnoea Monitoring of Pulse Blood pressure. Pulse. Each beat of the heart ejects blood from the left ventricle into the aorta

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Cardio vascular system

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Cardio vascular system

Cardio vascular system

Assessment of cardiovascular system

Assessment of cardiovascular system

  • General assessment

  • Skin colour - cyanosis, pallor

  • Skin temperature

  • Oedema

  • Dyspnoea

  • Monitoring of

  • Pulse

  • Blood pressure



  • Each beat of the heart ejects blood from the left ventricle into the aorta

  • This creates a wave of expansion and recoil within the arteries as the heart beats

  • This wave of expansion can be felt when a superficial artery is compressed with a finger against a bone or firm tissue

  • In most people , the pulse is an accurate measure of heart rate.

Pulse principles of assessment

Pulse – Principles of assessment

  • Pulse can be felt at any point where an artery crosses a bone

  • Can usually be observed visually in the neck

  • Normally synonymous with the HR

  • Gives information about the rate & rhythm of the heart, state of the circulation and condition of the arteries

  • DO NOT USE THUMB – may feel own pulse!

  • Normal range – 60-88 BPM at rest (adult)

  • Records over time are more accurate than one isolated reading

  • Use apical beat if radial pulse not available or client has heart disease



  • Problems detecting pulse may indicate –

    • Heart contraction is not strong enough to generate a pulse wave

    • Heart contractions are too rapid

    • There is an occlusion in a peripheral artery (eg. In peripheral disease in diabetes or heart disease)



  • Under some circumstances, including arrhythmias, some of the heat beats are ineffective and the aorta is not stretched enough to create a palpable pressure wave.

  • The pulse is irregular and the heart rate can be (much) higher that the pulse rate.

  • In this case, the heart rate should be determined by auscultation of the heart apex, in which case it is not the pulse.

  • The pulse deficit (difference between heart beats and pulsations at the periphery) should be determined by simultaneous palpation of the radial artery and auscultation at the heart apex

  • .

Common pulse points

Common pulse points

  • Radial pulse

  • Brachial pulse

Common pulse points1

Common pulse points

  • Temporal pulse

Common pulse points2

Common pulse points

  • Carotid pulse

  • Located in the neck (carotid artery)

  • The carotid artery should be palpated gently.

  • Stimulating its barorecptors with vigorous palpation can provoke server bradycardia or even stop the heart in some sensitive persons.

  • Also a person’s two carotid arteries should not palpated at the same time , to avoid a risk of fainting or brain ischemia.

Common pulse points3

Common pulse points

  • Brachial pulse- located between the biceps and triceps, on the medial side of the elbow (brachial artery).

  • Frequently used in place of carotid pulse in infants.

Common pulse points4

Common pulse points

  • Femoral pulse – located in the thigh (femoral artery).

Popliteal pulse

Popliteal pulse

  • located behind the knee in the Popliteal fossa, found by holding the knee bent.

  • The patient bends the knee of approximately 120 degrees and the nurse holds it in both hands to find the Popliteal artery in the pit behind the knee.

Common pulse points5

Common pulse points

  • Dorsalis pedis pulse- located on top of the foot (Dorsalis pedis artery).

Posterior tibial artery

posterior tibial artery

  • – located in the back of the ankle behind the medial malleolus)

Factors that affect the pulse

Factors that affect the pulse

  • Age

  • Sex

  • Body build

  • Level of physical activity

  • Emotions

  • Disease states-arterial disease thyrotoxicosis, febrile conditions, altered electrolytes (esp K, Ca, Mg)

Characteristics of pulse

Characteristics of pulse

  • Rate

  • Tachycardia- abnormally fast heart rate, over 100 bpm in an adult.

  • Causes haemorrhage, fever, thyrotoxicosis,

    Bradycardia - a heart rate slower than 60 bpm

  • Causes – fitness, heart block , cerebral haemorrhage, digoxin toxicity.

Characteristics of pulse1

Characteristics of pulse

  • Rhythm – should be regular

  • Arrhythmia or dysrhythmia may be due to electrolyte imbalance or cardiac tissue disease.

  • Ectopic beats are premature beats

  • Coupled beats (bigeminal beats)- two beats occur in close succession followed by a pause.

  • Atrial fibrillation- random , rapid contraction of the atria cause irregular pulse.

Normal ecg

Normal ECG

  • Normal

Cardio vascular system


  • Undulating baseline, irregular beat.

Cardio vascular system


  • Conduction pathways

Atrial flutter

Atrial flutter

  • Flutter – regular beat, with undulating baseline.

Sinus tachycardia

Sinus Tachycardia

  • Regular, rapid beat > 100 BPM.

Sinus bradycardia

Sinus Bradycardia

  • Regular, slow beat < 60 BPM.

Ectopic beats

Ectopic Beats

  • Irregular beat, noted at odd intervals.

Characteristics of pulse2

Characteristics of pulse

  • Volume – is the feel of the strength of the beat. How full or how much the artery fills with blood. It is usually strong and easily felt.

  • Full and bounding – strenuous exercise, strong emotion, thyrotoxicosis

  • Weak and thready –hemorrhage, shock, cardiac failure.

Regular monitoring of pulse

Regular monitoring of pulse

  • Post operatively

  • Critically ill patients

  • Patient receiving a blood transfusion

  • Patient with a local or systemic infection or inflammatory reactions

  • Patient has a cardiac condition

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