Limited cutaneous systemic sclerosis (Scleroderma, CREST syndrome)

How To Conduct A Cardiovascular Assessment In Advanced Practice

Read this article to learn how to conduct an advanced cardiovascular assessment to reveal heart abnormalities and associated symptoms and risk factors

Abstract

Cardiovascular disease remains one of the leading causes of death in developed countries, accounting for a quarter of UK deaths and morbidity. A cardiovascular assessment can reveal cardiac abnormalities and give an understanding of associated symptoms and risk factors to aid early diagnosis. This article, the sixth in a series on assessment and interpretation for advanced clinical practitioners, shows how to take an accurate history and complete a structured physical examination. This includes inspection, palpation and auscultation of the heart, arteries and veins.

Citation: Coaten J, North Z (2024) How to conduct a cardiovascular assessment in advanced practice. Nursing Times [online]; 120: 7.

Authors: Josey-Marie Coaten is programme leader MSc advanced clinical practice and Zach North is MSc head of school: paramedical, peri-operative and advanced practice (interim); both at the University of Hull.

This article has been double-blind peer reviewed

Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Click here to see other articles in this series

Introduction

The cardiovascular system comprises the heart and a network of blood vessels (Waugh and Grant 2022). Its function is to distribute oxygen to the cells of the body and remove waste products such as carbon dioxide (Martini et al, 2018).

The heart is hollow with four chambers and four valves (Fig 1) and sits in the thoracic cavity between the lungs and mediastinum. Deoxygenated blood from the right side of the heart is pumped to the lungs where gas exchange takes place. Carbon dioxide diffuses into the alveoli and is subsequently exhaled as a waste product; the blood also collects and transports oxygen to oxygenate cells in the body (Waugh and Grant, 2022).

In the cardiovascular system, veins carry blood to the heart and arteries carry it away, with capillaries being the gas exchange point for oxygen and carbon dioxide (Waugh and Grant, 2022). Blood enters the right atrium of the heart via the superior and inferior vena cava, before moving into the right ventricle via the tricuspid valve. It is then pumped through the pulmonary valve into the pulmonary artery and then the lungs for gas exchange. Blood from the lungs travels into the left atrium then goes through the mitral valve into the left ventricle, where it passes through the aortic valve and is pumped to the rest of the body via the aorta (Martini et al, 2018).

The heart wall is made up of three layers:

Pericardium – outer layer, consisting of the parietal (outer) and visceral layers (inner), with the pericardial cavity containing pericardial fluid lying between;

Myocardium – muscular middle layer where contraction occurs;

Endocardium – innermost layer.

A specialist group of cells emit impulses that ensure atrial and ventricular contraction, allowing blood to be pumped through the heart and around the body (Innes et al, 2023).

History taking

Cardiovascular disease remains one of the leading causes of death in developed countries, accounting for a quarter of UK deaths and morbidity (National Institute for Health and Care Excellence (NICE), 2023). Taking a comprehensive history is essential to explore the patient's symptoms and risk factors, and determine their likely cause and whether it the problem originates within the heart or cardiovascular system (Kumar and Clark, 2020).

Introduction

For every patient encounter, first introduce yourself and your role, and anyone else present. Confident and appropriate introductions can help build the much-needed rapport between practitioner and patient (Peart, 2022).

Start by using open questioning (for example, "How can I help today?") to allow patients to give their version of their complaint; this can also help patients feel valued and listened to (Peart, 2022). Closed questions are often only used for clarification (for example, "So the pain is in the centre of your chest?").

Presenting complaint

As cardiovascular conditions can be life-threatening, ensure you fully explore each presenting symptom (NICE, 2023). Using a mnemonic such as SOCRATES, adapting it for the specific presentation, gives a framework to the practitioner and allows a systematic approach (Simon et al, 2020) (see article in this series on history taking).

Past medical history

Building a picture of the patient and their past medical history will help determine any specific risk factors; for example, hypertension, high cholesterol or type 2 diabetes increase the risk of cardiovascular disease (Innes et al, 2023). Some connective tissue diseases also have specific links and risk factors; for example, Marfan syndrome carries an increased risk of aortic dissection.

Drug history

Many prescribed, herbal or over-the-counter medications can cause or aggravate cardiovascular symptoms (Kumar and Clark, 2017). For example, amlodipine used to treat hypertension may cause ankle oedema, beta blockers for asthma may cause breathlessness and thyroxine may cause arrythmias, so ensure you explore medications the patient is taking and their potential side-effects (Innes et al, 2023).

Family history

he risk of cardiovascular disease is higher in patients with a family history (NHS, 2022). For example, cardiomyopathies (diseases of the heart wall) are often genetic; note that a family history of cardiovascular disease or sudden unexplained deaths may increase the risk of cardiomyopathies or arrythmias in younger people (<55 years) (Kumar and Clark, 2020). Another risk factor for cardiovascular disease is a history of familial hypercholesterolemia (high cholesterol) (Innes, et al, 2023). Make sure you consider ethnicity, as people from South Asian, Black African or African Carribean backgrounds are more likely to develop hypertension or type 2 diabetes, already noted as risk factors (NHS, 2022).

Social history

Taking a social history includes lifestyle and environmental factors. Table 1 highlights elements to consider.

Systems review

As well as presenting symptoms, you will also need to review other bodily systems for associated symptoms the patient may not have mentioned. This can also help identify any red flags that need to be dealt with urgently.

For cardiovascular symptoms, ask about oedema and shortness of breath, as this could indicate heart failure (Kumar and Clark, 2020). Dizziness and vasovagal episodes (faints) could suggest aortic stenosis, while hypotension, postural hypotension or calf pain when walking could indicate peripheral vascular disease (Kumar and Clark, 2020). Table 2 gives a general overview of cardiovascular symptoms.

Cardiovascular examination

The next step is to examine the patient. Before you start:

Explain the procedure and steps involved. Always use patient-facing language (for example, instead of "auscultation", say "listen to the heart with a stethoscope");

Tell the patient you will need to expose their chest/abdomen and may require any trousers to be rolled up or removed. Assure them that their dignity will be maintained and they can ask you to stop if they experience any discomfort;

Offer a chaperone in case the patient would like one;

Obtain the patient's verbal consent;

Wash your hands.

The clinical examination should be structured and follow an inspect, palpate and auscultate format (Bickley, 2020).

Initial inspection

Start by gaining an overall impression of the health of the patient. Measure and assess the patient's vital signs – blood pressure, heart rate, oxygen saturation, respiratory rate and overall level of consciousness – as this will provide vital information and enable you to assess the urgency of the patient's presentation (Penman et al, 2023). Check for signs of visible pain, distress or confusion, cyanosis (blue hue around the mouth or extremities), pallor (lighter skin complexion than is usual), shortness of breath, sweating or oedema.

For the acutely deteriorating patient, you will need to take a more urgent approach, such as the ABCDE (airway, breathing, circulation, disability, exposure) approach for assessing and treating critically ill patients (RCUK, 2021).

This article describes the approach to take for a non-deteriorating patient.

Inspect the hands

Assess the patient's hands, correlating any clinical signs with others in your examination and the patient's history. Certain abnormalities can suggest cardiovascular disease but may also be found in other disease processes.

Temperature and colourCompare the temperature of both hands. Cold hands might suggest peripheral vasoconstriction (narrowing of the blood vessels) as in patients with hypertension.

Cyanosis (bluish tint to the skin) can suggest poor circulation or deoxygenated blood, which can be due to heart failure or congenital heart diseases.

Capillary refill timeAssess peripheral perfusion and cardiac output by pressing down on a fingernail until it turns white for approximately 5 seconds, then releasing. The pink colour should return in less than 2 seconds. A prolonged capillary refill time could suggest poor perfusion or hypoxia, which can be due to heart failure or shock.

Finger clubbingA bulbous enlargement of the distal phalanges of the fingers and toes, while often associated with lung diseases, can be seen in certain cardiovascular conditions like infective endocarditis, heart failure and atrial myxoma.

Splinter haemorrhagesTiny blood clots running vertically under the nails can be seen in infective endocarditis and can be caused by trauma to the nail bed.

Janeway lesionsNon-tender and small, red nodular lesions on the palms or soles of the feet are indicative of infective endocarditis.

Osler nodesTender nodules found on the fingertips or toes are associated with infective endocarditis.

Palmar erythemaReddening of the palms can be a sign of liver disease, which can affect the heart or be a consequence of right heart failure.

XanthomasYellow, fatty deposits often found on the elbows, knees, or palms might suggest hyperlipidemia (high cholesterol or triglycerides), which is a risk factor for atherosclerotic cardiovascular disease.

Inspect the face

Carefully inspect the face, including eyes, mouth and lips:

Colour

Pallor – reduced redness of the face, especially the cheeks or lips, can suggest anaemia or poor perfusion;

Cyanosis – a blue-purple hue to the skin, around the lips or the mouth can indicate reduced oxygen levels in the blood;

Malar flush – redness or flushing over the cheeks can be seen in mitral stenosis, a condition where the mitral valve is narrowed.

Eyes

Conjunctival pallor – carefully lower the bottom eyelid and assess the colour of the conjunctiva, which if pale can indicate anaemia;

Corneal arcus – in younger individuals a pale, gray or white ring around the outside of the cornea can suggest hyperlipidemia (high cholesterol or triglycerides), although it can be a normal sign of aging in older adults;

Xanthelasma – pale yellow cholesterol deposits around or on the eyelids can be a sign of hyperlipidemia, a significant risk factor for cardiovascular disease.

Mouth and lips

Central cyanosis – blue-purple discoloration of the lips can signal reduced oxygen saturation due to pulmonary or cardiac origins;

Dental hygiene – poor dental hygiene can be a risk factor for bacterial endocarditis, where oral pathogens enter the bloodstream and settle on damaged heart valves.

Jugular venous pressure (JVP)

The JVP can give a visual representation of the pressures in the right atrium. This can be used to understand the function of the right side of the heart, fluid status (such as overload or hypovolemia) and pathologies such as tricuspid valve disease, cardiac tamponade (fluid build-up in the sac around the heart) and superior vena cava obstruction. To check the patient's JVP:

First locate the internal jugular vein, lying beneath the sternocleidomastoid muscle in the neck (Innes et al, 2023);

Position the patient at a 45-degree angle as this gives the most reliable measurement;

To identify the JVP, look for a 'double waveform pulsation' in the internal jugular vein caused by atrial contraction ('a' wave) and venous filling ('v' wave);

Locate the highest point of the pulsation then measure with a ruler vertically from the sternal angle to this highest point to give the JVP. A reading of ≤4cm is considered normal (Innes et al, 2023) (Fig 2).

Interpretating the JVP can be challenging, so seek advice from a senior colleague if need be. A raised JVP (>4cm) can be seen in conditions where the right side of the heart is not pumping blood efficiently into the pulmonary circulation, such as right heart failure, tricuspid valve disease, pulmonary hypertension or cardiac tamponade (Kumar and Clark, 2020).

Assessing the pulses

Pulses are palpable wave forms in the arteries as a result of systole, where the beating heart forces blood from the left ventricle through the aortic valve into the aorta and onwards to the rest of the body (Agur and Dalley, 2023). Assessing the pulses allows assessment of the rate (beats/min), rhythm (regular or irregular) and volume/character (strength and quality) of the pulse (Innes et al, 2023). There are three general principles to consider when assessing the pulses:

Ensure the environment is warm as a cold environment can cause vasoconstriction and alter a pulse's character;

Use firm pressure with the index and middle finger, but not too much or you may collapse the pulse and will not be able to feel it or change its character;

Compare both sides of the pulse (for example, the radial pulse on the left and right) to check they are the same.

First palpate the radial pulses - the six pulses in the arms, legs and feet. Start by assessing rate, followed by rhythm and finally volume/character, comparing right and left extremities (Innes et al, 2023). Table 3 describes radial pulse locations and reasons for assessment.

Next assess the carotid pulse. There are two carotid arteries on either side of the neck but these should never be palpated simultaneously as this could restrict blood flow to the brain.

Prior to palpating, first auscultate each artery. Use the diaphragm of your stethoscope to listen to high frequency sounds and the bell to listen to low frequency sounds (Innes et al, 2020). If the patient's carotid arteries are normal, you may not hear anything. In this case it is fine to palpate the carotid artery. Conversely, an audible sound on auscultation due to turbulent blood flow may indicate a bruit (Penman et al, 2023). This can be caused by plaques in the artery or aortic stenosis (narrowing of the artery), which can lead to stroke (Penman et al, 2023). If a bruit is detected do not palpate as there may be a risk of loosening a plaque and causing a stroke.

Auscultation and palpation of the heart

Palpation gives information about the position, size and activity of the heart (Innes et al, 2020). From this, it is also possible to assess any abnormal masses or pain from trauma.

The heart has four valves (aortic, pulmonary, tricuspid and mitral). Placement of the hands or stethoscope to assess a particular valve is not where the valve is located anatomically but is in the direction of blood flow to or from the valve (Kumar and Clark, 2020).

AuscultationTo auscultate the heart valves, use both the diaphragm (high frequency sounds) and the bell (low frequency sounds) of the stethoscope, as this will give a more accurate assessment. Assessment points are as follows:

Aortic valve (second intercostal space, right sternal edge);

Pulmonic valve (second intercostal space, left sternal edge);

Tricuspid valve (fourth/fifth intercostal space, left sternal edge);

Mitral valve (fifth intercostal space, medial to the midclavicular line, around the apex) (Fig 3).

Be systematic and take your time. It helps to have a quiet environment, as sometimes heart sounds can be quite difficult to distinguish. If you are struggling to hear over the patient's breathing, consider asking them to hold their breath for a few seconds (Talley and O'Connor, 2022).

The terms S1 and S2 are often used in relation to heart auscultation. These refer to the sound the heart makes ('lub, dub, lub, dub') when the valves snap shut (Kumar et al, 2020). S1 is the 'lub' sound produced by the closure of the mitral and tricuspid valve, and S2 is the 'dub' sound generated by the closure of the aortic and pulmonary valve.

While you auscultate, try to identify S1 and then S2. Then look out for added sounds, which may signify abnormalities. These are commonly called S3 and S4 and are explained below:

S3 – a low-pitched sound that occurs shortly after S2. This can be normal in young adults, but may indicate heart failure in older adults;

S4 – a low-pitched sound occurring just before S1. This can suggest a stiff (non-compliant) left ventricle due to hypertension, aortic stenosis or ischaemic heart disease (Innes et al, 2022).

You may also hear a murmur. Murmurs are due to turbulent blood flow, which causes a sound that is audible with a stethoscope (or in severe cases, without one). There are three main causes of murmurs:

Valvular abnormalities – these can include stenosis (narrowing of a valve, causing resistance to blood flow) and regurgitation or insufficiency (incomplete closure of a valve, leading to blood flowing backwards);

Holes in the heart walls – for example, septal defects, which allow blood to flow between the chambers;

Other conditions – cardiac tumours, hyperthyroidism, anaemia, fevers, and pregnancy can increase the blood flow and cause murmurs even in structurally normal hearts.

Once you have heard a murmur, if you or a colleague are experienced enough, you should try to classify it (Talley and O'Connor, 2022) (Box 1).

Box 1. Classification of heart murmurs

Timing in the cardiac cycle

Systolic murmurs – between the first heart sound (S1) and the second heart sound (S2). They can either be early (crescendo), mid (plateau) or late (decrescendo) systolic

Diastolic murmurs – between S2 and the next S1. They can be early (decrescendo), mid (crescendo-decrescendo), or late (crescendo) diastolic

Intensity (grade 1-6)

Grade 1 – very faint and heard only in quiet conditions after listener has 'tuned in'

Grade 2 – quiet but clearly audible

Grade 3 – moderately loud

Grade 4 – loud and associated with a 'thrill' palpable on the chest

Grade 5 – very loud and audible with a stethoscope barely touching the chest, with a thrill often palpable

Grade 6 – very loud and audible with a stethoscope entirely off the chest, with a thrill palpable

Quality

Descriptions such as 'blowing', 'harsh', 'rumbling', or 'musical' can be used

Location

The best place on the chest to hear the loudest component

Source: Innes et al (2023)

PalpationEnsure the patient is supine and at a 45-degree angle; this helps palpation by bringing the heart closer to the chest wall (Penman et al, 2023). Palpate the following:

Apex beat (point of maximal impulse) – this is typically located in the fifth intercostal rib space, just medial to the midclavicular line. Use the flat of your palm to palpate. Note its position, size, amplitude, and duration. A displaced apex beat can suggest cardiac enlargement and left ventricular hypertrophy;

Heaves – using the flat of your hand, palpate the chest to feel for any abnormal lifts, which can indicate ventricular hypertrophy. Feeling a heave at the left sternal edge can indicate right ventricular enlargement;

Thrills – use the flats of your finger tips to palpate across each valve assessment point. A thrill feels like a cat purring and indicates turbulent blood flow (a murmur) often due to abnormalities, such as stenosis or regurgitation of a heart valve.

Lung auscultation

Auscultation of the lung fields are important in the assessment of the cardiovascular system. The technique of auscultation of the respiratory system has been covered already in this series. However, in the context of the cardiovascular system we are looking for crackles. These are short, high-pitched sounds heard more commonly on inspiration (Bickley, 2020). In the context of cardiovascular disease, they often indicate fluid overload or heart failure, especially when heard at the lung bases (Bickley, 2020).

Wheezing, although common in respiratory conditions such as asthma, can also be present in heart failure where there is significant pulmonary oedema (Bickley, 2020).

Assessment of oedema

Peripheral oedema is swelling of the ankles, feet, legs and sacrum caused by a build-up of fluid. Causes can range from standing or sitting in the same position for too long, to renal or liver disease and malnutrition (Kumar and Clark, 2020). Bilateral oedema is often a sign of systemic fluid overload and is seen in right-sided heart failure (Kumar and Clark, 2020).

If oedema is apparent on inspection, palpate by pressing gently but firmly with your thumb on the bony area and holding for a couple of seconds. This will determine if the oedema is pitting (pressure leaves a lasting indentation or pit) or non-pitting (pressure leaves no lasting indentation) as pitting oedema is more likely to be a sign of liver, heart or kidney problems.

Investigations

Following on from the history and clinical examination, advanced nurse practitioners may choose a watch and wait approach or consider investigating further to confirm a diagnosis.

Table 4 details common investigations of cardiac disease.

Conclusion

As heart disease is highly prevalent and a leading cause of morbidity and mortality, advanced nurse practitioners need to be competent in conducting cardiovascular assessments. Taking a thorough history is important and the clinical examination should be structured and follow an inspect, palpate and auscultate format. If in doubt, refer to a specialist.

Advanced practitioners

This series is aimed at nurses and midwives working at, or towards, advanced practice. Advanced practitioners are educated at master's level and are assessed as competent to make autonomous decisions in assessing, diagnosing and treating patients. Advanced assessment and interpretation is based on a medical model, and the role of advanced practitioners is to integrate this into a holistic package of care.

Professional responsibilities

This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.

References

Agur AMR, Dalley AF (2023) Moore's Essential Clinical Anatomy. Wolters Kluwer.

Armstrong GP (2022) Infective endocarditis, msdmanuals.Com, July (accessed 2 May 2024)

Bickley LS (2020) Bates' Guide to Physical Examination and History Taking. Wolters Kluwer Health.

Epomedicine (2018) Jugular Venous Pulse and Pressure (JVP) Examination. Epomedicine.Com , 14 July (accessed 4 June 2024).

Kumar PJ, Clark ML (2020) Kumar and Clark's Clinical Medicine. Elsevier.

Innes JA et al (2023) Macleod's Clinical Examination. Elsevier.

Martini FH et al (2018) Fundamentals of Anatomy and Physiology. Pearson Education Ltd.

NHS (2022) Cardiovascular disease, nhs.Uk, 22 April (accessed 2 May 2024).

National Institute for Health and Care Excellence (2023) What is the impact of CVD? Cks.Nice.Org.Uk, May (accessed 2 May, 2024).

Peart P (2022) Clinical history taking. Clinics in Integrated Care; 10, 100088.

Penman ID et al (2023) Davidson's Principles and Practice of Medicine. Elsevier.Resuscitation Council UK (2021) The ABCDE approach, resus.Org.Uk (accessed 2 May 2024).

Resuscitation Council UK (2021) The ABCDE approach, resus.Org.Uk (accessed 2 May 2024).

Simon C et al (2020) Oxford Handbook of General Practice. Oxford University Press.

Talley NJ, O'Connor S (2022) Talley and O'Connor's Clinical Examination: A Systematic Guide to Physical Diagnosis. Elsevier.

Waugh A, Grant A (2022) Ross and Wilson: Anatomy and Physiology. Elsevier.

 

Help Nursing Times improve

Help us better understand how you use our clinical articles, what you think about them and how you would improve them. Please complete our short survey.

What Is Postpartum Hypertension, And Is It Serious?

Postpartum hypertension is when a person experiences high blood pressure after giving birth. It can have serious complications, but it is treatable.

The postpartum period begins when a person gives birth and lasts 6 to 8 weeks.

Hypertension is high blood pressure, a condition that increases someone's risk of health complications.

This article discusses the causes of postpartum hypertension, its symptoms, diagnosis, and treatment. It also discusses the risk factors, complications, prevention, outlook, and when to consult a doctor.

When the heart pumps blood, the force it exerts against blood vessel walls is known as blood pressure.

Doctors measure blood pressure in millimeters of mercury (mm Hg) using two numbers:

Systolic: This is the upper number and represents the force against blood vessel walls during each heartbeat.

Diastolic: This is the lower number and represents the force against blood vessel walls between heartbeats when the heart is relaxed.

In postpartum, doctors classify blood pressure in the following ways:

The American Heart Association (AHA) recommends seeking immediate medical treatment if a person experiences a hypertensive crisis, which is a sudden rise in blood pressure.

Blood pressure naturally fluctuates in response to factors such as stress or physical activity. So, one elevated reading is not enough to diagnose hypertension.

For a doctor to diagnose hypertension, a person must have high readings at a minimum of two separate appointments.

To assess the effects of postpartum hypertension, doctors may also conduct a physical exam and order more tests, such as:

If a person has no symptoms and their blood pressure is 150/100 or higher, they can take oral medication as an outpatient.

Medications include:

A 2023 study found that:

People using nifedipine had a 65% lower risk of hospital readmission for hypertensive complications than those who went without treatment.

Those who used nifedipine with labetalol had a 56% reduction in their risk of hospital readmission.

Whether a person chooses to breastfeed their newborn can affect postpartum hypertension treatment. Some medications are safe for use during breastfeeding. However, some are unsuitable, such as angiotensin-2 receptor blockers.

A doctor will recommend hospital treatment if a person has postpartum preeclampsia with severe features, which may include signs of impaired liver function and shortness of breath. Management may include blood pressure monitoring, regular blood tests, and giving the person magnesium.

A person experiencing postpartum hypertension may be at risk of complications, including:

A healthy lifestyle that includes regular exercise may help reduce a person's risk of developing postpartum hypertension. A person can ask a doctor to recommend exercises suitable for pregnancy.

If someone experiences preeclampsia or has a history of high blood pressure, avoiding NSAIDs for pain control may reduce their risk of postpartum hypertension.

Some research suggests that for people with high blood pressure during pregnancy, their risk of postpartum hypertension may decrease if they use diuretics after giving birth. Diuretics help rid the body of excess fluid, which can contribute to high blood pressure.

A person needs to contact a doctor if they experience the following symptoms:

vision changes

persistent headache

dizziness

nausea

vomiting

Immediate help is vital if a person has these symptoms:

chest pain

breathing difficulties

loss of consciousness

Hypertension increases a person's risk of stroke. This is a medical emergency and requires immediate treatment.

Signs of stroke include:

Read more about what a stroke feels like.

Postpartum hypertension is treatable with medication and can resolve without issues.

An estimated 33% of people with elevated blood pressure after the birth of their baby return to having typical levels within 2 days. Others return to nonhypertensive blood pressure levels after a few weeks.

Postpartum hypertension is also potentially serious and, when severe, can lead to life threatening issues, such as organ failure and stroke.

Research has found that people who experience hypertensive disorders during pregnancy have a higher risk of adverse cardiovascular issues later in life. These issues include coronary heart disease and chronic hypertension.

Postpartum hypertension is high blood pressure during the 6 to 8 weeks following childbirth.

Certain factors increase a person's risk of experiencing postpartum hypertension, including previous hypertension and preeclampsia.

Postpartum hypertension can cause serious complications, such as organ damage and stroke. However, it is treatable with medication and often resolves without long-term effects.

Tectonic Bets On GPCR Heart Failure Drug Following Reverse Merger With Avrobio

Tectonic Therapeutic has completed a reverse merger with Avrobio and will begin trading on the Nasdaq global market as Tectonic Therapeutic (ticker symbol 'TECX') on 21 June.

Coinciding with the merger, the new company also completed a private placement of $130.7m with multiple US and European investors. Following the placement, Tectonic reported total cash reserves of $181m, before payment of final transaction-related expenses, which is expected to fund operations until mid-2027.

As part of the merger, Avrobio enacted a 1-for-12 reverse stock split of its common shares, along with an issuance of a non-transferable contingent value right. Under that, shareholders will have the rights to cash payments received by Tectonic, if any, related to Avrobio's pre-transaction legacy assets.

Avrobio's stockholders will own approximately 24.8% of the new company while old Tectonic shareholders, including the investors in the private placement, will hold 75.2% of the combined company's outstanding common stock. The merged company's stock debuted at a share price of $16.80 on the Nasdaq.

The companies first announced the merger back in January, prompted by Avrobio's cash-strapped coffers. The company's money woes started last year when it stopped development work on its gene therapy programmes. Avrobio also sold its investigational haematopoietic stem cell (HSC) gene therapy programme, designed to treat cystinosis, to Novartis in an all-cash deal valued at $87.5m.

Tectonic's lead asset, TX000045 (TX45), is a G protein-coupled receptor (GCPR) targeting the Fc-relaxin fusion molecule. It activates relaxin family peptide receptor 1 (RXFP1) in cardiovascular cells and its overexpression can have a cardioprotective effect. The therapy is being evaluated in a Phase Ia trial in patients with group 2 pulmonary hypertension due to left-sided heart disease, one of the most common forms of pulmonary hypertension.

"We expect to initiate a randomised Phase II clinical trial for our lead program, TX45, in group 2 pulmonary hypertension in the setting of left heart disease with preserved ejection fraction in the second half of this year," said Dr Alise Reicin, president and CEO of Tectonic.

"Results from the ongoing Phase Ia clinical trial in this patient population are expected in mid-2024, to be followed by Phase Ib results expected in 2025 and results from the Phase II clinical trial expected in 2026."

The company's second programme targets hereditary haemorrhagic telangiectasia (HHT), a genetic bleeding disorder that causes vessel enlargement and malformations. Tectonic plans to select a development asset for HHT later this year and start clinical trials in the fourth quarter (Q4) of 2025 or Q1 2026.

Story continues

"Tectonic bets on GPCR heart failure drug following reverse merger with Avrobio" was originally created and published by Clinical Trials Arena, a GlobalData owned brand.

The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site.

View comments

---