Chapter 19: Heart and Neck Vessels Flashcards
Heart is located
between 2nd and 5th intercostal space, R border of sternum to L midclavicular line
Precordium
area on anterior chest overlying the heart and great vessels
Great vessels lie where?
bunched above the base of the heart
Pericardium
tough, fibrous, double walled sac that surrounds and protects the heart
Myocardium
muscular wall of the heart, does the pumping
Endocardium
thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
During diastole, AV valves
open during the hearts filling phase
During systole, AV valves
close to prevent regurgitation of blood back up into the atria
S1
occurs with the closure of AV valves and thus signals the beginning of systole.
S2
occurs with closure of the semilunar valves and signals the end of systole.
Where can you hear S1 heart sounds?
usually loudest at the apex, but heard throughout the precordium
Where can you hear S2 heart sounds?
loudest at the base, but heard throughout the pericordium
Extra heart sounds include
S3, S4, Murmurs
S3
some conditions create vibrations during ventricular filling, the vibrations are S3
S4
atria contract and push blood into a noncompliant ventricle which creates vibration that are heard as S4
Murmurs
- turbulent blood flow and collision currents against cardiac chambers and/or valves.
- gentle, blowing, swooshing sound that can be auscultated on the chest wall.
Cardiac output
equals the volume of blood in each systole (SV) times the number of beats per minute (rate)
Preload
blood filling in the ventricles
Afterload
push against force to contract
Neck Vessels include
carotid artery and external jugular
carotid artery
located between the trachea and sternomastoid muscle
jugular veins
internal and external jugular
internal jugular
lies deep and medial to the sternomastoid muscle
external jugular
superficial, lateral to the sternomastoid muscle, above the clavicle
Cultural and Genetic Considerations for Heart disease
increased incidence in African American population
Cultural and Genetic Considerations for HTN
African Americans highest incidence, also they develop HTN earlier in life and their average B/P’s are much higher.
Cultural and Genetic Considerations for Smoking
nicotine increases the risk of myocardial infarction and stroke by increasing the oxygen demand, but having a decrease in oxygen supply, changing lipid profiles and activating platelets and fibrinogen which are clot forming agents.
Cultural and Genetic Considerations for Cholesterol
whites, mexican americans and african americans - both male and female - highest groups of elevated LDLs which gradually contributes to thrombus formation in arteries and leads to MI’s and strokes
Cultural and Genetic Considerations for Obesity
epidemic in US, highest incidence in Whites, African Americans, and Mexican Americans.
Cultural and Genetic Considerations for Diabetes (Type 2)
risk of cardiovascular disease is 2x greater among people with diabetes
Cultural and Genetic Considerations for Males/Females
heart disease is a leading cause of death for both males and females; however, presenting symptoms vary greatly.
Cardiovascular History (Subjective)
A. Chest pain/chest tightness B. Dyspnea, SOB C. Orthopnea D. Cough E. Fatigue F. Cyanosis or pallor G. Edema H. Nocturia I. Past Cardiac Hx J. Family Cardiac Hx K. Self-Care/Personal Habits
Orthopnea
difficulty breathing during sleep or lying down
Edema
any swelling in the lower extremities
Nocturia
awaken at night with an urgent need to urinate
Past Cardiac Hx
HTN, elevated blood cholesterol, elevated triglycerides, heart murmur, congenital heart disease, rheumatic fever
Family Cardiac Hx
HTN, obesity, diabetes, coronary artery disease, sudden death
Self-Care/Personal Habits
- Nutrition/Diet - (in regards to fat, cholesterol & salt intake)
- Smoking
- Alcohol
- Exercise
- Medications (prescribed, OTC, street drugs)
Physical Exam/Assessment (Objective)
- Palpitation
- Auscultation
- Inspection
Cardiac Palpitation
- Palpate carotid artery bilaterally
- Palpate the apical impulse
- Palpate precordium - note any other pulsations or thrills, normally none
Cardiac Inspection
- Inspect for jugular venous distension.
2. Inspect the anterior chest.
Cardiac Auscultation
- Auscultate the carotid artery
- Auscultation of anterior chest.
- Auscultation of apical heart rate
Inspect jugular venous distension
- position pt supine w/ head/neck elevated approx. 30-45 degree angle.
- instruct pt to turn head away from examiner and observe for distension.
Inspect anterior chest
you may or may not see the apical impulse.
note other pulsations, heaves or lifts.
Heaves or lifts
forceful thrusting
Auscultate the carotid artery
for the presence of a bruit with the bell of the stethoscope (a bruit is abnormal)
Auscultate the anterior chest
- Z pattern or 5 traditional valve areas.
- Identify S1 and S2
- Listen for possible S3 and/or S4.
- Listen for murmurs
5 Traditional Valve Areas:
- Aortic (R 2nd interspace)
- Pulmonic (L 2nd interspace)
- Erb’s Point (L 3rd interspace)
- Tricuspid (L lower sternal border, 4-5 interspace)
- Mitral (5th interspace, L midclavicular line)
If a murmur is auscultated describe intensity in terms of the following:
- Grade I/VI
- Grade II/VI
- Grade III/VI
- Grade IV/VI
- Grade V/VI
- Grade VI/VI
Grade I/VI
barely audible, heard with difficulty
Grade II/VI
clearly audible, but faint
Grade III/VI
moderately loud, easy to hear
Grade IV/VI
loud, associated with a thrill palpable on the chest wall
Grade V/VI
loud, heard with 1 corner of the stethoscope lifted off the chest wall, palpable thrill
Grade VI/VI
very loud, still heard with entire stethoscope lifted off the chest wall, palpable thrill
Auscultate apical heart rate
note rate and rhythm
Common Cardiac Abnormalities
A. Patent Ductus Arteriosus (PDA) B. Atrial Septal Defect (ASD) C. Ventricular Septal Defect (VSD) D. Tetralogy of Fallot E. Coarctation of the Aorta F. Mitral Regurgitation G. Murmurs H. Congestive Heart Failure (CHF)
Patent Ductus Arteriosus (PDA)
normal in fetus, spontaneously closes within hours of birth
Atrial Septal Defect (ASD)
Abnormal opening of the atrial septum resulting usually in L to R shunt and causing large increase in pulmonary blood flow
Ventricular Septal Defect (VSD)
Abnormal opening in septum between ventricles (usually sub aortic area)
Tetralogy of Fallot
4 components: shunts a lot of venous blood directly into aorta away from pulmonary system so blood never gets oxygenated
4 Components of Tetralogy of Fallot
- R ventricular outflow stenosis
- VSD
- R ventricular hypertrophy
- Overriding aorta
Coarctation of the Aorta
severe narrowing of descending aorta, increased workload on L ventricle
Mitral Regurgitation
- stream of blood regurgitates back into L atria during systole through incompetent mitral valve
- in diastole, blood passes back into L ventricle again along with new flow
When assessing murmurs
determine grade, differentiate systolic vs. diastolic, note location
Congestive Heart Failure (CHF)
- the heart’s inability to pump enough blood to meet the metabolic demands of the body.
- the kidney’s compensatory mechanisms of abnormal retention of Na and H2O to compensate for the decreased CO2
S3
(ventricular gallop) occurs with heart failure and volume overload
S4
(atrial gallop) occurs with CAD
fixed split
unaffected by respiration; the split is always there
paradoxical split
opposite of what you would expect; the sounds fuse on inspiration and split on expiration
the murmur of mitral stenosis is
low
the murmur of aortic stenosis is
harsh
