5 Emergency Cardiovascular Assessment

Recognize immediate threats

Begin by checking scene safety, the patient’s responsiveness and appearance, and whether they are breathing normally. Gasping does not count as normal breathing. If the patient is unresponsive and not breathing normally, activate emergency response, begin CPR, and use an AED as soon as one is available. Treat possible cardiac arrest as an immediate emergency, not as a routine assessment.

For suspected heart attack, cardiac arrest, or sudden severe deterioration in the United States, call 911. For a responsive but unwell patient, use ABCDE to identify and address life-threatening problems as they appear, call for appropriate help early, and reassess after each intervention. Do not delay activating emergency help to complete a full history.

Gather a focused history

Ask the patient, a witness, or a caregiver for information while assessment and monitoring continue. Record when symptoms began, whether they started suddenly or gradually, and how they have changed.

Use OPQRST to explore pain or discomfort. Ask what the patient was doing when it began; what makes it worse or better, including exertion, breathing, position, or rest; and whether it feels like pressure, tightness, squeezing, burning, heaviness, or something else. Ask where it is and whether it spreads to the arm, shoulder, back, neck, jaw, or upper abdomen. Establish its severity, for example using a scale from zero to ten, and whether it is constant, recurrent, changing, or associated with episodes of a particular duration.

Ask about shortness of breath, sweating, nausea or vomiting, dizziness, fainting, palpitations, weakness, confusion, and unusual fatigue. Heart attack symptoms are not always prominent chest pain: discomfort may occur elsewhere in the upper body or alongside breathing difficulty, nausea, sweating, or lightheadedness.

Use SAMPLE to organize additional history, including signs and symptoms; allergies; medications, recent doses, and blood thinners; past history such as heart disease, prior heart attack, heart failure, arrhythmia, diabetes, or vascular disease; last oral intake when relevant; and events leading up to the symptoms. When time allows, also ask about prior similar episodes, recent illness, and relevant family history. A concise history supports assessment but cannot, by itself, confirm or rule out a heart attack.

Examine circulation and perfusion

Observe for distress, pallor, sweating, cyanosis, unusual restlessness, or reduced alertness. Note whether the patient can speak comfortably and whether breathing looks labored.

With appropriate training and within your role, assess circulation by checking pulse rate and regularity, pulse strength, skin color and temperature, capillary refill, and visible bleeding. Compare central and peripheral pulses when indicated. If trained to assess them, look for possible fluid or congestion clues such as ankle swelling, raised neck veins, or crackles on lung examination.

Check alertness and note new confusion, fainting, or weakness, which may indicate impaired perfusion or another emergency. A normal blood pressure does not by itself exclude shock. Consider mental status, skin temperature and color, pulse, and how these findings change over time.

Measure and investigate

Obtain and document measurements appropriate to the setting and the patient’s condition: heart rate and rhythm, blood pressure, respiratory rate and work of breathing, oxygen saturation (SpO₂), temperature, level of consciousness, and pain score. Clinical teams caring for critically ill patients should apply monitoring promptly and follow local protocols.

Record the time and method of each measurement. Track trends rather than relying only on isolated readings.

When acute coronary syndrome is suspected, a 12-lead ECG is an important early test, and emergency-care guidance emphasizes obtaining and interpreting it promptly. A concerning ECG or an unstable patient requires urgent escalation. One ECG without signs of ischemia does not necessarily end the assessment: clinicians may repeat ECGs and use blood tests such as cardiac troponin as part of a structured evaluation.

Reassess and communicate

Repeat the ABCDE assessment regularly, after an intervention, when symptoms change, and after any deterioration. Recheck symptoms, mental status, pulse, blood pressure, breathing, oxygen saturation, skin perfusion, and relevant monitor findings. Compare each set of findings with earlier results, documenting the time, changes, actions, and response. If the patient worsens, escalate immediately rather than waiting for the next scheduled observation.

Use SBAR for a concise handover: state what is happening now, provide relevant history and symptom onset, summarize current symptoms, examination, vital signs, and trends, and specify what help or action is needed.

For example: “Patient developed central chest pressure 20 minutes ago, spreading to the left arm, with nausea. They are pale and sweaty. Pulse is fast; blood pressure and oxygen saturation are recorded here. Symptoms are worsening. Possible acute coronary syndrome—urgent assessment and ECG needed.”