Chapter 12: Cardiac and Vascular Assessment

Comprehensive cardiac and vascular assessment integrates patient history, physical examination findings, laboratory values, and diagnostic imaging to establish accurate clinical diagnoses and guide treatment decisions. The subjective component begins with careful symptom analysis, where clinicians systematically evaluate the quality, severity, location, timing, and associated factors of reported symptoms to distinguish primary cardiac or vascular concerns from incidental findings. Cardinal cardiac symptoms include chest discomfort, dyspnea with positional variations, palpitations, syncope, and fatigue, while vascular presentations may manifest as transient visual loss, claudication pain with exercise relief, Raynaud's phenomenon, or characteristic skin changes and ulceration patterns. The objective examination employs a structured approach incorporating vital sign measurement, bilateral pulse assessment using standardized grading scales, and detection of abnormal findings such as auscultatory gaps, orthostatic changes, or pulse deficits. Regional examination focuses on carotid assessment for bruits, jugular venous pressure evaluation as a proxy for cardiac filling pressures, systematic precordial auscultation to identify normal and abnormal heart sounds including extra systoles and murmurs, and peripheral vascular inspection to differentiate venous from arterial insufficiency based on skin appearance, ulcer morphology, and pulse characteristics. Laboratory assessment relies on cardiac biomarkers like troponins for myocardial injury detection, coagulation parameters for anticoagulation monitoring, lipid panels for atherosclerosis risk stratification, and B-type natriuretic peptide for heart failure evaluation. Noninvasive imaging modalities range from chest radiography for structural overview to echocardiography for chamber assessment and ejection fraction calculation, electrocardiography for dysrhythmia and ischemic change detection, and advanced imaging including computed tomography for coronary calcification quantification and magnetic resonance for soft tissue characterization. Invasive procedures such as cardiac catheterization serve as the definitive diagnostic standard for coronary stenosis visualization and hemodynamic measurement, while electrophysiology studies enable dysrhythmia localization and ablation therapy. Understanding sensitivity and specificity principles ensures appropriate test interpretation and clinical decision making throughout the assessment process.