Free Simple Cardiac Assessment Checklist Template

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Free Simple Cardiac Assessment Checklist Template

Simple Cardiac Assessment Checklist

Prepared by: [YOUR NAME]


I. PATIENT INFORMATION

#

Task

Status

1

Record the patient's full name and age.

2

Document presenting symptoms.

3

Note the patient's medical history.

4

Gather family history of cardiac issues.

5

List current medications and allergies.


II. VITAL SIGNS

#

Task

Status

1

Measure and record heart rate.

2

Measure and record blood pressure (both arms).

3

Record respiratory rate and pattern.

4

Assess and record oxygen saturation levels.

5

Take and note temperature if relevant.


III. PHYSICAL EXAMINATION

#

Task

Status

1

Perform chest auscultation to detect heart sounds.

2

Assess peripheral pulses for strength and rhythm.

3

Check for signs of edema in extremities.

4

Observe for cyanosis in lips, nail beds, or skin.

5

Inspect the jugular vein for distension.


IV. DIAGNOSTIC TESTS

#

Task

Status

1

Conduct an Electrocardiogram (ECG/EKG).

2

Schedule and perform an echocardiogram.

3

Collect and analyze lab tests (e.g., troponin, cholesterol).

4

Obtain imaging studies if necessary (e.g., chest X-ray, CT scan).

5

Review results with the patient or team.


V. RISK FACTOR ASSESSMENT

#

Task

Status

1

Evaluate for smoking or tobacco use.

2

Check for a history of diabetes or hyperglycemia.

3

Measure and record Body Mass Index (BMI).

4

Assess for hypertension and its management.

5

Discuss lifestyle factors, including diet and exercise.


VI. CLINICAL NOTES AND RECOMMENDATIONS

#

Task

Status

1

Summarize key findings from the assessment.

2

Provide initial treatment recommendations.

3

Determine if a specialist referral is needed.

4

Document patient education provided.

5

Schedule follow-up or additional diagnostic tests.


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