Ch 20. Heart/Neck Flashcards
Heart wall - 3 layers
Pericardium
Myocardium
Endocardium
Direction of blood flow:
superior vena cava/inferior vena cava/coronary sinus –> right atrium –> [tricuspid valve] –> right ventricle –> [pulmonary semilunar valve] –> pulmonary trunk –> right/left pulmonary artery –> lungs –> R/L pulmonary veins –> left atrium –> [bicuspid valve] –> left ventricle –> [aortic semilunar valve] –> ascending aorta –>aortic arch –> rest of body
Abnormally high pressure in the Left V. Right side of heart
Abnormally high pressure in the left side of the heart is manifested by pulmonary congestion or heart failure – what will you see?
Abnormally high pressure in the right side of the heart is manifested by bulging neck veins and abdominal distension.
How much blood does heart pump per min
Heart pumps 4-6L of blood per min
Developmental Considerations: Pregnant women
Increase in blood volume
Increase in stroke volume and cardiac output
Changes in BP (varies with position)
Heart sound changes from increased blood volume and workload
Mammary souffle
Developmental Considerations: Older adult
Influence of lifestyle
Increase in systolic blood pressure
Decreased ability of heart to augment CO with exercise
Increase in supraventricular and ventricular arrhythmias
Decreased tolerance for tachyarrhythmias
Changes in conductions system on ECG
Increase in systolic blood pressure: stiffing of large arteries
Extra beats with age: ectopic beats
Orthostatic hypotension
Avoid pressure on carotid artery
Premature ectopic beats more common
Cultural and Social Considerations
Increase incidence of CVD in Canada for men and women Influence of socioeconomic factors >High blood pressure >Smoking >Serum cholesterol >Obesity >Diabetes
Subjective
Chest pain (angina)– describe it! (crushing, burning, viselike). Do you take any medications such as Nitro? Is it relieved by resting.
Dyspnea – SOB – nocturnal dyspnea occurs wit heart failure.
Orthopnea – the need to assume an upright position
Cough – duration, frequency, what do you cough up?
Fatigue – fatigue from decreased cardiac output is worse in the evenings.
Cyanosis or pallor – occurs with decrease tissue perfusion
Edema – with heart failure it gets worse throughout the day but is better in the morning, cardiac edema is usually bilateral.
Nocturia – occurs with heart failure
Past cardiac history
Family cardiac history
Personal habits (cardiac risk factors)
Pregnant women Hypertension Hypotension Older adults Disease Medication Environment
Heart Attack Symptoms
SOB, L arm up neck to jaw, palpations, diaphoresis, nausea, vomiting,
Women and Heart Attack
- Gi systems often minimize the symptoms, not “typical symptoms”
- Symptoms easily attributed to something else
- Often ignored
- Women minimize significance of symptoms
- Heart disease is leading cause of death in women > 55 years
- Ovaries decrease production of estrogen = increased LDL, BP, and body fat above the waist, decreased HDL, metabolism of sugar affected
If someone can take a big breath with ____, it’s likely:
No pain
Pain
arm movement pain
- no pain: maybe cardiac
- pain: maybe respiratory
- With arm movement: maybe muscle pain
Physical Exam: Carotid arteries
Auscultate the carotid artery --> use bell, in holding head in neutral position, listen to bruit 3 different levels -Angle of the jaw -Midcervical -Base of the neck
Palpate carotid: very genetly, look for contour and amplitude. Normally 2+ and same bilaterally
Physical Exam: Jugular veins
if they looked distended there;s a possibility of heart failure, notice in r side
Inspect the jugular venous pulse
Estimate the jugular venous pressure
Palpate for hepatojugular reflux
Physical Exam: The Precordium (Inspect/Palpate/Percuss)
Inspect: Change with light, abnormal pulsations, may see apical impulse (~4-5 intercostal space)
Palpate apical pulse: One finger pad, get them to exhale, person in supine positon (about 1-2cm)
- Using one finger pad. Ask Pt. to “exhale and then hold it”
- The apical impulse is palpable in 25-40% of adults in supine position and 50-73% of adults in the left lateral position.
Palpate across the precordium: palmer aspects of fingers palpate everywhere start at apex left sternal boarder, base
Percuss to outline the cardiac borders: Can hear chest boarders by the change in sound during percussion. (we don’t really use this since chest CT is better)
Auscultate the heart sounds
Note the Rate and Rhythm
Need to know where the 4 traditional valve areas are. Sound radiates in the direction of blood blow
- Aortic area: 2nd right intercostal space
- Pulmonic area: 2nd left intecostal space
- Tricuspid area: 4th intercostal space, L. lower sternal boarder
- Mitral area: 5th intercostal space, L. midclavicular valve region
Note rate and rhythum regular
Lubb = S1, apex
Dubb = S2, base
Note where you hear the whoosh/murmur
- Blowing, swooshing sound
- Turbulent blood flow
