3.2 Cardiac Assessment

Question 1

Heart Anatomy (Wall)

Answer 1

Pericardium - Fibrous double walled sac that protects the heart.
Myocardium - Muscular wall of heart that pumps
Endocardium - Thin layer of endothelial tissue that lines inner surface of heart chamber and valves

Question 2

Heart Anatomy (Pump Systems)

Answer 2

2 Pump systems, one on the right, one on the left. Each pump has 2 chambers (total 4 in heart)

Atrium - Thin walled reservoir for holding blood
Ventricle - Thick walled muscular pumping chamber.

Question 3

Heart Anatomy (Valves)

Answer 3

• Each chamber of the heart is separated by valves to prevent backflow of blood. They only open one way and open based on pressure gradients.

Total of 4 valves in heart (2 atrioventricular and 2 semilunar valves) (2AV and 2SL)

Question 4

Atrioventricular Valves

Answer 4

Separates Atria and Ventricles.

• Tricuspid Valve (Right Side of Heart)
• Bicuspid or Mitral Valve (Left Side of Heart)

AV Valves thin leaflets are anchored by collagen fiber (chordae tendineae) to papillary muscles embedded on ventricle floor.
- Open during heart filling phase (diastole). Close during pumping phase (systole) to prevent backflow back into Atria.

Question 5

Semilunar Valves

Answer 5

• Between ventricles and arteries. Each have 3 cusps that look like half moons.
  Pulmonic Valve - Right side of heart
  Aortic Valve - Left side of heart

SL valves open during pumping (systole) to allow blood to travel out of the heart.

• No valves between vena cava and right atrium, or between pulmonary veins and left atrium.

Question 6

Path of blood

Answer 6

• Unoxygenated blood from top of body go into Superior Vena Cava. Liver blood goes into inferior Vena Cava into Right Atrium
• From RA blood goes through tricuspid valve to Right Ventricle (RV). RV goes through pulmonic valve to pulmonary artery and gets sent to lungs.
• Lungs oxygenate blood and send back to heart from pulmonic veins to Left Atrium (LA). From LA goes through mitral valve to LV and ejected into aortic valve than aorta. Aorta delivers oxygenated blood to body.

Question 7

Review of Systems (Heart)

Answer 7

History of
- Palpations
- Dizziness
- Chest Pain
- Dyspnea while going up stairs. 
(Any EKG Tests)
Any Medications that slow or speed heartrate
Smoking/Alcohol
Exercise Habits

Question 8

Inspection of Cardiac System

Answer 8

• Look at chest for any lumps/lesions.
  (Small vessels over the chest may indicate high pressure)
• Color changes (cyanosis or pallor). Can indicate hypoxemia (low oxygen in blood)
• Assess jugular vein distension
  (Patient lie back in 45 degrees - Fowlers and turn head to side)
• Shine light at their neck, take paper ruler and measure height of jugular vein from surface of neck.
  (Normal - does not protrude enough to measure)
  (JVD - indicates hypervolemia due to congestive heart failure)

Question 9

Palpation

Answer 9

• Palpate and compare all pulse sites from head to toe
• Palpate for “thrill” by placing hand over chest wall.
• If thrill is present you will feel slight vibration on palm
• May indicate high pressure in vessels.

Question 10

Auscultation of Heart

Answer 10

• Heart apex is on bottom and base is on top
• S1 “lub” sound is heard loudest at apex
• S2 “dub” sound is heard loudest at base
• S3 “third heart sound” low pitched sound that occurs after diastole. (Harmless in young athletes or pregnant women. Usually harmless in older adults but may indicate heart disease).
• S4 “Gallop” extra sound after S1 systole. Abnormal and commonly heard with heart failure.

Question 11

How to Preform Auscultation of Heart

Answer 11

Aortic Valve - Right side of heart in second intercostal space. (S2 is loudest here)
Pulmonic Valve - Left side of heart in second intercostal space. (S2 is loudest here) .
Erb’s Point - Located left of sternum in 4th-5th intercostal space. (S1 and S2 Equal)
Tricuspid Valve - Left side of sternum in 4th-5th intercostal space (S1 loudest here)
Mitral Valve - Over midclavicular line in 5th-6th intercostal space. (S1 loudest here) - This is also where apical pulse is felt (point of maximum impulse (PMI)).

Question 12

Cardiac Assessment Order

Answer 12

• Look for bumps/lesions/vessels
• Look for pulsations in jugular vein
• Look at heartbeat (beating out of chest)
• Palpate all pulse sites and chest wall.
• Palpate Bruits with palm and rest under clavicles
  (Turbulent Flow)
• Patient tilt head back and to the right and look for jugular vein distension. (Measure with ruler if they have)
• Auscultate Carotid with bell stethoscope
• Auscultate Heart Valves “Lub Dub”
  Aortic, Pulmonic, Herbs Point, Tricuspid, Mitral Valve