Chapter 2
Cardiovascular Assessment

This chapter introduces the reader to the key components of assessment related to the cardiovascular system, the techniques involved and the significance of assessment for patient care. Cardiovascular assessment requires a methodological approach to help identify any abnormalities.

Developing essential clinical assessment skills can help provide safe and effective care to patients. One critical aspect of patient assessment is the evaluation of the cardiovascular system. A thorough understanding of cardiovascular assessment is vital as cardiovascular diseases remain a leading cause of morbidity and mortality worldwide.

The Importance of Cardiovascular Assessment

Any dysfunction within this system can have severe consequences for a patient's health and well-being. Therefore, assessing the cardiovascular system is a crucial aspect of patient care, as it aids in the identification of actual and potential issues, monitors disease progression and evaluates the effectiveness of interventions. See Table 2.1 for an overview of where cardiovascular assessment is indicated.

Table 2.1 Areas where cardiovascular assessment is indicated

Sphere of assessment Implications Early detection of cardiovascular diseases Conditions such as hypertension, coronary artery disease, heart failure and arrhythmias often develop silently, progressing slowly. Regular cardiovascular assessments help early identification of risk factors and abnormalities, allowing for timely interventions and preventing complications. Risk assessment Cardiovascular assessments are used to evaluate a patient's risk of developing heart-related conditions. By considering factors such as family history, lifestyle choices and physical examination findings, needs are tailored and preventive measures are instigated accordingly. Treatment planning Assessment provides crucial information for designing individualised treatment plans. Accurate blood pressure measurements, for example, help determine the choice and dosage of antihypertensive medications, cardiac auscultation findings guide decisions about referrals to cardiologists and the need for further diagnostic tests. Monitoring chronic conditions Patients with established cardiovascular diseases require ongoing monitoring to assess the progression of their conditions and the effectiveness of treatment. Regular assessments help make necessary adjustments to medication regimens or lifestyle recommendations. Pre-operative evaluation Before surgery, cardiovascular assessments are performed to assess a patient's fitness for the procedure. This can minimise perioperative complications, ensuring a safe surgical experience. Emergency situations In emergency settings, there is a need to quickly assess a patient's cardiovascular status. For instance, in cases of chest pain or arrhythmias, rapid evaluation can be lifesaving. The assessment guides immediate interventions and treatment decisions. Medication management Cardiovascular assessments are essential for patients taking cardiac medications. Regular check-ups ensure medications are working effectively and help identify potential adverse effects or drug interactions. Patient education Findings from assessments can assist in offering patients information about their condition, risk factors and the importance of adherence to treatment plans. Patient education allows individuals to take an active role in managing their cardiovascular health. Prevention and health promotion Assessment is not only about identifying existing issues but also about promoting heart health and preventing future problems. Those who offer care and support can provide guidance on lifestyle modifications, such as diet, exercise, smoking cessation and stress management to reduce cardiovascular risk. Holistic patient care Comprehensive healthcare involves looking beyond immediate issues and considering a patient's overall well-being. Cardiovascular assessment is a fundamental part of a holistic approach as it helps to understand how a patient's heart health intersects with their overall health.

Assessing Needs

A careful and detailed clinical assessment is vital when assessing the probable cause and severity of symptoms, to request appropriate investigations and referrals, to avoid unnecessary investigations and to assess a person's risk of cardiac disease. The way in which the history is taken and information gathered in different healthcare settings varies and depends on, for example, the patient's presenting symptoms, patient concerns and past medical, psychological and social history. The general framework for history taking (see Box 2.1) may need to be amended depending on the care setting (general practice, an acute care setting, a care home or an emergency department) and the nature of the patient encounter (emergency situation or a pre-planned consultation). Many healthcare providers have protocols and procedures for taking a patient history, local policy and procedure must be followed.

Box 2.1 Systematic Approach to History Taking

• Presenting complaint
• History of presenting complaint
• Past medical history
• Drug history
• Family history
• Social history
• Systems enquiry

Source: Adapted from Bickley (2024); Fairhurst, Innes, and Dover (2023).

The history provides subjective information concerning presenting symptoms, previous patterns of health and illness and the patient's ability to perform the activities of living. A family history, along with risk factor identification and social and psychological background, enriches the history-gathering activity. An in-depth physical examination provides additional objective data.

Explaining to the patient how the history taking will progress, what it entails and how long it may take helps develop rapport and even alleviate anxiety (see Figure 2.1, the usual sequence of events in an examination). Cardiovascular assessment could be considered one of the most important aspects of patient assessment. Throughout the whole assessment process, always be observant of even a slight deviation from the norm. If something is abnormal and uncovered, this warrants further investigation; any findings or concerns must be acted upon and reported.

Figure 2.1 Usual sequence of events

When meeting the patient, in their own home, a cubicle, in an ambulance, behind screens or in the consultation room, introduce yourself and explain that you will be carrying out an interview and a physical examination. Try to make the patient (and family) relax; the patient may be very anxious, and the provision of a chaperone may be required. Do not rush the patient, give them time as rushing can make them more anxious. Provide time for them to answer questions, do not interrupt when the patient is trying to answer and let them finish before asking the next question.

During the assessment phase, the key is to be as objective as possible; when unsure, further investigation is needed. The use of validated tools along with inspection, palpation, percussion and auscultation provides more credibility for findings and subsequent care delivery. Act on and report findings as clearly as possible. Adhering to local policy and procedure and clearly documenting and communicating findings are essential for the treatment of the patient and the care they receive.

Chief Complaint and History of Present Condition

Before performing the assessment, access and read any relevant patient-related data that has already been recorded about the patient, such as notes from any previous admissions. This helps set the screen and contextualise.

The chief complaint and history of the present condition is the story of the illness. Establishing what contributed to the patient coming to the health provider (hospital, general practitioner [GP] practice, walk-in clinic) provides information about the history of the present illness. Seek information regarding present symptoms along with other recent symptoms applicable to this present illness. Obtain the following information specifically associated with the cardiac system:

• Chest and jaw pain
• Pain in the extremities (pain radiating to arms, leg pain or cramps)
• Irregular heart rate or palpitations
• Shortness of breath on exertion when lying down (orthopnoea) or at night (paroxysmal nocturnal dyspnoea)
• Cough
• Cyanosis
• Pallor
• Weakness
• Fatigue
• Unexplained weight changes
• Peripheral oedema
• Dizziness
• Headaches
• Hypo- or hypertension

Family History

Ask the patient about family history. Ask about the age of any living relatives, including relationships and health of immediate relatives. Ask about hypertension, coronary heart disease, stroke, diabetes, hyperlipidaemia, congenital heart disease and any early deaths in the family before the age of 60 years. A family history can identify those who may have or may be at risk of...