Recognising Cardiovascular Deterioration for Student Nurses
Learn how to recognise changes in circulation, connect abnormal observations with clinical signs and identify when cardiovascular deterioration requires prompt assessment and escalation.
What can cardiovascular deterioration look like?
Changes in circulation may appear through vital signs, symptoms, skin changes, altered consciousness or reduced organ perfusion.
Rate or rhythm changes
A pulse that is substantially faster, slower or different from the patient's baseline may require further assessment.
A meaningful change
Consider the blood pressure alongside symptoms, previous readings and the patient's overall clinical presentation.
Cool or poorly perfused peripheries
Skin temperature, colour and peripheral perfusion can provide useful clues about circulation.
New confusion or drowsiness
Altered cerebral perfusion or wider physiological deterioration may present as a change in mental state.
Reduced output
Reduced urine output may occur when renal perfusion is impaired and should be interpreted within the wider clinical picture.
How does the patient feel?
Chest discomfort, breathlessness, dizziness, weakness or feeling faint can accompany cardiovascular deterioration.
Look beyond the monitor
Equipment provides important measurements, but clinical assessment also involves observing and speaking to the patient.
Colour and temperature
Look for pallor, mottling, cool skin or other changes from the patient's usual appearance.
Assess perfusion
Assess peripheral perfusion according to local practice and interpret the result alongside the wider assessment.
More than beats per minute
When appropriate, consider the character and regularity of the pulse as well as its rate.
Compare with baseline
A value that is unusual for this patient can matter even when viewed differently in another patient.
Has behaviour changed?
New confusion, restlessness or reduced responsiveness may accompany physiological deterioration.
Can the patient tolerate activity?
New weakness, dizziness or collapse when moving may indicate that further assessment is needed.
Assess cardiovascular deterioration within ABCDE
Airway
Confirm airway patency and identify any immediate threat before progressing through the assessment.
Breathing
Assess respiratory rate, oxygen saturation, work of breathing and other relevant respiratory findings.
Circulation
Assess pulse, blood pressure, peripheral perfusion, skin, bleeding and other relevant circulatory findings.
Disability
Assess consciousness and check blood glucose when clinically appropriate.
Exposure
Look for bleeding, swelling, infection or other relevant findings while maintaining dignity.
Escalate
Significant cardiovascular or wider physiological deterioration should be escalated according to local emergency procedures.
Interpret heart rate in context
Heart rate can change for many reasons. The important task is to decide whether the change forms part of a deteriorating clinical picture.
Tachycardia
A faster pulse may occur with pain, fever, dehydration, bleeding, physiological stress or cardiac problems, among other causes.
Bradycardia
A slow pulse may be normal for some individuals but concerning when new or associated with symptoms or deterioration.
Rhythm change
A newly irregular pulse or significant change from baseline should be communicated and assessed appropriately.
Ask whether the patient's circulation is changing
Compare with earlier readings
A falling or rising trend can provide more information than one isolated measurement.
Know what is usual
Patients differ considerably, so previous readings can help you recognise clinically important change.
Connect the number with the patient
Dizziness, faintness, chest symptoms, weakness or confusion may make a blood pressure change more concerning.
Recognise signs that tissues may not be receiving adequate blood flow
- New cool or clammy skin.
- Pallor or mottling.
- Changes in peripheral perfusion.
- New dizziness, weakness or collapse.
- New confusion or reduced responsiveness.
- Reduced urine output.
- Worsening pulse or blood pressure trend.
- Increasing respiratory rate or breathlessness.
When cardiovascular deterioration needs prompt escalation
- New cardiovascular abnormalities with altered consciousness.
- Significant deterioration in blood pressure compared with baseline.
- New pulse abnormality accompanied by chest pain, breathlessness or collapse.
- Evidence of poor peripheral perfusion with worsening observations.
- Suspected significant bleeding with circulatory deterioration.
- New severe chest discomfort with physiological deterioration.
- Syncope or near-syncope with concerning cardiovascular findings.
- Rapidly deteriorating NEWS2 or ABCDE findings.
- Reduced urine output alongside signs of wider deterioration.
- Any patient who appears seriously unwell or is deteriorating rapidly.
A patient becomes pale, dizzy and tachycardic
Example
A patient who was previously comfortable tells you they suddenly feel weak and light-headed.
They appear pale and clammy. Their pulse is considerably faster than earlier and their blood pressure has fallen compared with the previous observation.
You recognise that these findings should not be considered separately: symptoms + skin changes + pulse change + falling blood pressure indicate a deteriorating circulatory picture.
You begin an ABCDE assessment, obtain appropriate observations and escalate promptly according to local procedures.
Describe the cardiovascular trend clearly
Example escalation
“I'm concerned about Mrs Patel. She has suddenly become pale, clammy and dizzy. Her pulse is significantly faster than earlier and her blood pressure has fallen from her previous reading. I'm currently completing an ABCDE assessment and would like her reviewed urgently.”
This communicates the new symptoms, objective changes, trend and level of concern.
Cardiovascular assessment errors to avoid
- Focusing on blood pressure while ignoring the patient's appearance.
- Recording heart rate without considering rhythm or symptoms.
- Ignoring trends because individual readings appear acceptable.
- Failing to compare findings with baseline.
- Considering circulatory findings separately from breathing and consciousness.
- Assuming dizziness or collapse has a harmless cause before assessment.
- Waiting for severe hypotension before escalating deterioration.
- Trying to diagnose the exact cardiovascular problem before seeking help.
Recognise → assess → connect → escalate
Notice the change
Identify new symptoms, abnormal observations and differences from the patient's baseline.
Build the circulation picture
Connect pulse, blood pressure, perfusion, symptoms, urine output and consciousness within an ABCDE assessment.
State why you are concerned
Describe the findings and trend clearly and follow the appropriate local escalation pathway.
Build confidence in cardiovascular assessment
Cardiovascular deterioration is recognised by connecting observations with the patient's symptoms, perfusion, baseline and overall clinical condition — not by relying on one number.
Explore Clinical Confidence →