Chapter 20-Heart and Neck Vessels Flashcards
position and surface landmarks
-precordium
-mediastinum
-apex & base of heart
-right and left cardiac borders
-great vessels
heart layers
-pericardium (sac)
-myocardium (muscle)
-endocardium (valves & chambers)
chambers
-atria: right and left
-ventricles: right and left
valves
atrioventricular
-tricuspid
-mitral (bicuspid valve)
semilunar
-pulmonic
-aortic
cardiac cycle
-systole (s1 & s2)
-diastole (blood fills; don’t usually hear sounds)
-events in the right and left sides
direction of blood flow
heart sounds
-second heart sounds
-second heart sound
-effect of respiration
heart sounds review
first heart sound (s1)
-occurs with closure of av valves (mitral/tricuspid): signals beginning of systole (heard best near apex)
second heart sound (s2)
-occurs with closure of semilunar valves (aortic/pulmonic) signals end of systole (s2 loudest at base)
effect of respiration
-volume of right and left ventricular systole is just about equal but can be affected by respiration
-consider phrase: more to the right heart; less to the left
electrocardiograph (ecg)
-ECG waves arbitrarily labeled PQRST, which stand for
-P wave: depolarization of atria
-P-R interval: from beginning of P wave to beginning of
-QRS complex (time necessary for atrial depolarization plus time for impulse to travel through AV node to ventricles)
-QRS complex: depolarization of ventricles
-electrical events slightly precede mechanical events in heart
extra heart sounds
-third heart sound (s3): during diastole; heard after s2; usually signifies HF; ventricle gallop
-fourth heart sound (s4): very soft; end of diastole; hear just before s1
murmurs
usually a valve problem (stenosis vs regurgitation)
characteristics of sound
-frequency (pitch)
-intensity (loudness)
-duration
-timing
conduction
-sa, av, bundle, pernicke fibers
pumping ability
-cardiac output (how much blood)
-preload (before systole)
-afterload (after systole)
neck vessels
-carotid artery (look for bruits; carotid artery stenosis; atherosclerosis)
-jugular veins
-internal (much deeper)
-external
-venous pulse and pressure (if distended usually right sided heart failure)
subjective data: health history questions
-chest pain (does it get worse with deep breath? y=lungs n=heart)
-dyspnea
-orthopnea
-cough
-fatigue (related to decreased cardiac output)
-cyanosis (can be normal in dark skin) or pallor
health history questions
-edema
-nocturia (urination at night)
-cardiac history
-family cardiac history
-personal habits (cardiac risk factors): smoking, exercise, diet
objective data: the physical exam
preparation
-position and draping
-room preparation
-order of examination
equipment needed
-marking pen
-small centimeter ruler
-stethoscope with diaphragm and bell endpieces
-alcohol swab
carotid arteries
no percussion
bell, hold breath
-palpate (palpate separate, don’t massage)
-auscultate for bruit (could be carotid artery stenosis-obstruction)
jugular veins
-inspect the jugular venous pulse (bulging; pulsation) (30-45 degrees have bed)
-estimate the jugular venous pressure
-palpate for hepatojugular reflux
objective data
precordium
-inspect the anterior chest
-palpate the apical impulse
-palpate across the precordium (lumps/masses; tenderness) (subcutaneous air crepitus)
-percuss to outline the cardiac borders
objective data: auscultation
-auscultate the heart sounds
-identify auscultatory areas
-note the rate and rhythm
-sinus arrhythmia
-pulse deficit
-identify s1 and s2
-s1 is louder than s2 at the apex
-s1 coincides with carotid artery pulse
-s1 coincides with r wave on electrocardiogram
-listen to s1 and s2 separately
-listen for extra heart sounds (s3 & s4)
-listen for murmurs
characteristics of normal heart sounds
-first heart sound
-second heart sound
-splitting of second heart sound
extra heart sounds
-mid systolic click (metal valve=click)
-third heart sound
-fourth heart sound
^^3rd & 4th tilt pt. to left lateral position
murmurs
-timing
-loudness
-pitch
-pattern
-quality
-location
-radiation
-posture
abnormal findings systolic extra sounds
-ejection click
-aortic prosthetic valve sounds
-midsystolic click
abnormal findings diastolic extra sounds
-opening snap
-mitral prosthetic valve sound
-third heart sound
-fourth heart sound
-summation sound
-pericardial friction rub (infection is precursor)
abnormal findings abnormal pulsations on the precordium
-thrill at the base
-lift (heave) at the sternal border
-volume overload at the apex
-pressure overload at the apex
abnormal findings congenital heart defects
-patent ductus arteriosus
-atrial septal defect
-ventricular septal defect
-tetralogy of fallof
-coarctation of the aorta
Abnormal findings murmurs caused by valvular defects
-midsystolic ejection
-diastolic rumbles of atrioventricular valves
-pansystolic regurgitant murmurs
-early diastolic murmurs
mid systolic ejection (what you would hear)
-aortic stenosis
-pulmonic stenosis
diastolic rumbles of atrioventricular valves
-mitral stenosis
-tricuspid stenosis
pan systolic regurgitant murmurs
-mitral regurgitation
-tricuspid regurgitation
early diastolic murmurs
-aortic regurgitation
-pulmonic regurgitation
summary checklist: heart and neck vessels examination
-neck
-precordium
summary checklist: neck
-carotid pulse: observe and palpate
-observe jugular venous pulse
-estimate jugular venous pressure
summary checklist: precordium
inspection & palpation
-describe location of apical pulse
-note any heave (lift) or thrill
auscultation
-identify anatomic areas noting rate and rhythm
-listen in systole and diastole for murmurs
-repeat with bell
-listen at apex with person in left lateral position
-listen at base with person in sitting position
