Cardiovascular system Flashcards
Demonstrate the surface markings of the upper/right/inferior/left borders of the heart
The upper border is formed by connecting two points with a sloping line from left to right: lateral (about 2.5cm) to the left sternal border at the 2nd costal cartilage, and just lateral to right sternal border at the 3rd costal cartilage.
The right border is formed by connecting two points with a line slightly curved to the right: just lateral to right sternal border at the 3rd costal cartilage, and just lateral to the right sternal border at the 6th costal cartilage (at level of xiphisternal joint).
The inferior border is formed by connecting two points with a line passing through the xiphisternal joint: just lateral to the right sternal border at the 6th costal cartilage (at level of xiphisternal joint), and at the position of apex beat, which is normally palpable just medial to the mid-clavicular line in the 5th left intercostal space.
The left border is formed by connecting two points with a line slightly curved to the left: at the position of the apex beat, and lateral (about 2.5cm) to the left sternal border at the 2nd costal cartilage.
Demonstrate where you would auscultate for aortic/pulmonary/mitral/tricuspid valves using a stethoscope
Aortic: right 2nd intercostal space near sternum
Pulmonary: left 2nd (or 3rd) intercostal space near sternum
Mitral: left 5th intercostal space at mid-clavicular line (= apex beat)
Tricuspid: left 5th intercostal space near sternum
Examine the radial/ulnar/brachial (2 sites)/carotid pulse and describe them (rate and rhythm)
Common carotid artery: palpate in the neck, between the lateral side of thyroid cartilage and medial border of sternocleidomastoid
Radial artery (wrist): palpate at the wrist over the distal end of radius (closest to thumb)
Ulnar pulse can be palpated on wrist at little finger side
Brachial artery pulse (in cubital fossa): palpate on the medial side of tendon of biceps on a fully extended elbow
Brachial artery (mid-arm): palpate along middle third of humerus, in the medial bicipital groove behind the medial border of biceps
Palpate the arteries with the pulps of the forefinger and middle finger
Describe the surface marking of the apex beat of the heart and demonstrate palpation
Subject should sit oveer the edge of the couch. Stand facing the subject on the right side.
Palpate with the palm and middle three fingers of the right hand, aligning the middle finger in the left 5th intercostal space and the other two fingers in intercostal spaces above and below.
Start palpating from the lateral side (from near mid-axillary line) and move anteriorly towards mid-clavicular line.
NB: Male nipple is in 4th intercostal space, lateral to mid-clavicular line. In female subjects, hand should be laid beneath the breast along its lower border.
Demonstrate the site of routine venipuncture
Antebrachial vein in cubital fossa
Describe and demonstrate the surface marking of the arch of the aorta
The aortic arch lies within the superior mediastinum behind the manubrium.
Its 3 main branches (brachiocephalic trunk, left common carotid and left subclavian arteries) arise within the superior mediastinum.
The arch begins and ends at the level of the sternal angle.
Beginning of the arch (from ascending aorta) at the level of right 2nd costal cartilage.
End of the arch (becomes thoracic aorta) at the level of left 2nd costal cartilage.
Top of the arch midway between jugular notch and sternal angle.
Describe and demonstrate the surface markings of the internal jugular vein and common carotid artery
The internal jugular vein is just lateral to the common carotid artery for each side and reaches the sternoclavicular joints.
The right common carotid artery ascends into the neck on the right side of trachea under the cover of right sternocleidomastoid muscle. Subject should turn their head to the left side so that the right sternocleidomastoid muscle will become prominent and visible. Right common carotid artery runs in a line from the right sternoclavicular joint to the lobe of the right ear.
The left common carotid artery arises from the arch of aorta slightly posterior and left of the brachiocephalic trunk. The subject should turn their head to the right side. The left common carotid artery runs in a line from the aortic arch towards the left sternoclavicular joint. This line ascends into the neck along the left side of the trachea and continues upwards along the anterior border of left sternocleidomastoid muscle towards the left ear lobe.
