Heart and Neck Vessels

Question 1

What are normal heart sounds? And where are they heard the loudest?

Answer 1

Normal Heart sounds are S1 and S2 heart sounds, with S1 being heard the loudest at the apex of the heart (4th or 5th intercostal space) and S2 being heard loudest at the base of the heart (either the left (pulmonic) or right (Aortic) second intercostal space).

Question 2

Are S3 and S4 sounds considered normal or abnormal heart sounds? Where and how can you hear these sounds?

Answer 2

S3 and S4 sounds can be either normal OR abnormal.
S3 is a “rolling thunder” vibration heard a the apex of the heart (same as S1), and it should be noted that S3 can be heard while patient is lying down, and frequently in young children.
But if the S3 heart sound is heard while an adult patient is sitting up that is an indicator of heart failure.
S4 can be heard at the lower left sternal border and is also noted as a low vibration.

Question 3

What are signs and symptoms of heart failure?

Answer 3

A clinical portriat of Heart Failure often involves;
Dilated pupils
Pale/gray/cyanotic skin coloring
Dyspnea
Orthopnea (cannot breath unless sitting up)
Decreased blood pressure
N and V
Ascites (fluid in the abdominal cavity)
Pitting Edema in the sacrum and legs
Anxiety
Falling O2 Sat.
Confusion
Jugular vain distention
infarct
Fatigue
S3 which is galloping (or tachycardia)
Enlarged spleen or liver
Decreased urine output
Weak pulse with cool/wet skin

Question 4

What 2 mechanisms most commonly lead to heart failure?

Answer 4

1) the hearts inability to pump enough blood
2) Abnormal retention of sodium nd water in the kidneys which happen due to decreased heart output. creating increased venous return which creates more congestion

Question 5

What are the AV Valves of the Heart? What are the semilunar valves of the heart?

Answer 5

AV Valves= The Tricupsid and Mitral Valves
Semilunar Valves= Aortic and Pulmonary valves

Question 6

What differentiates AV and Semilunar valves?

Answer 6

AV valves seperate act to seperate atria from the arteries.
Whereas SL valves seperate ventricles from their name sake great arteries.

Question 7

What are abnormal heart sounds? Describe them.

Answer 7

Abnormal Heart Sounds include;
S3 upon sitting up (Ventrical Gallop)- this is a “rumbling thunder” vibration heard at the apex of the heart.
S4 (Atrial Gallop)-
Bruit- A noisy blowing sound located in a large vascular structur (i.e. artery)
Murmur- a graded system of heart sound that often is described as a blowing or whoosing sound in the apex of the heart that radiate to the axilla.

Question 8

How do you auscultate the heart?

Answer 8

Our textbook often encourages auscultating the heart in a z formation across the pericardium, making sure to assess major heart sound locations, such as S1 at the apex and S2 at the base.

Question 9

What are pulses associated with heart and neck vessels? Where are they located?

Answer 9

The two primary pulses in the Heart and Neck vessels are that of the;
Carotid Pulse; Which is found in the groove of the sternomastaoid muscle and trachea,
Jugular Pulse: and is noted to lie lateral to the sternalmastoid muscle above the clavicle.

Question 10

Define the apical impluse as well as it’s normal location, size and duration.

Answer 10

The apical impulse is a palpable cardiac impulse that is furthest away from the heart.
This typically lies at the 4th or 5th intercostal space, is about 1-2 cm in size and is described as a short gentle tap.