Heart and Neck Vessels Flashcards
Cardiac tissue
Layers:
1. Endometrium: innermost layer of the heart; continuous with the endothelial lining of blood vessels
- Myocardium: thickest layer of the heart made of contractile cardiac myocytes
- Epicardium (visceral pericardium): inner layer of the pericardium on the surface of heart
- Pericardial cavity: space between the epicardium and parietal pericardium layers; contains pericardial fluid
- Parietal pericardium: outer layer of the pericardium that is in contact with lungs and the structures in the chest cavity
Heart diseases
- Myocardial ischemia: imbalance of heart’s oxygen supply and demand; S/S: Unstable angina, NSTEMI/STEMI, acute coronary syndromes; varying presentations among women and individuals with DM
- Myocardial contraction/relaxation disorders: decreased pumping ability of the heart, resulting in elevated intravascular pressure upstream d/t failing ventricle
- Obstruction of flow (d/t valvular stenosis); S/S: Chest discomfort
- Cardiac arrhythmia: abnormal rhythm or rate; S/S: Palpitations, dyspnea, hypotension, syncope
- Orthopnea: dyspnea when supine; indicative of LHF
Subjective data assessment
CC/HPI:
1. Angina pectoris: classic exertional pain/pressure/discomfort in chest, shoulder, neck, back, or arms; most common symptom associated with CAD; Atypical descriptor: Cramping/grinding/pricking in teeth or jaw pain
- Palpitation: unpleasant awareness of heartbeat; may occur with (1) arrhythmias or (2) heart’s attempt to increase CO2 byproduct by increasing HR; S/S: Skipping/racing/flutter/pounding heart beat, anxiety
PMHX: Murmurs, heart surgery, HTN, rheumatic fever, rheumatic carditis (d/t exposure to strep.)
FHX: Immediate family members with h/o heart disease/attack, HTN, DM, lipid disorders
Lifestyle and health practices: Smoking, stress, diet, alcohol, activity level, substance use
Physical assessment preparation
Assess after thorax and lungs; WIPE and explain positions changes
Equipment: Stethoscope, small pillow, penlight, watch, cm. ruler
General routine screening:
- Inspect jugular veins, anterior chest pulsation
- Palpate carotid arteries, apical, and abnormal pulsation
- Auscultate carotid artery
- Auscultate S1/S2, extra heart sounds, murmurs
Focused speciality assessment:
- Evaluate jugular venous pressure
- Grade murmur and identify source
- Differentiate between split, rubs, snaps, click sounds
Auscultating precordium
“APE To Man”:
- Aortic area (right of sternum)
- Pulmonic area (left of sternum)
- Erb’s point (below pulmonic area)
- Tricuspid area (below Erb’s point)
- Mitral area (apical)
Hold breath to differentiate a pericardial friction rub from a pleural friction rub
Pulse rate deficit
If irregular rhythm detected, find the difference between auscultating the apical pulse and palpating the radial pulse for a full minute
Indicative of arterial stenosis or arrhythmia (A fib., flutter, PVC, varying degrees of heart block)
Heart sounds
Normal: “lub, dub” (S1, S2) produced by closure of AV and semilunar valves
Extra heart sounds (S3, S4) and murmurs s/t diseased valves
Auscultating heart sounds
S1: closure of AV valves (systole); louder at APEX; palpate carotid artery if difficulty differentiating from S2
S2: closure of SL valves (diastole); louder at BASE
Auscultating extra heart sounds
S3/S4 sounds are heard best at apex, in left lateral position, with the bell of the stethoscope
Ventricular gallop - “Kentucky”
S3: Occurs just after S2, from increased atrial pressure leading to increased flow rates in EARLY diastole; also associated with dilated ventricular cardiomyopathy (SYSTOLIC HF); Normal finding in children, pregnancy, athletes; rarely normal >40 yrs. old (volume overload, high CO, myocardial contractibility, MI, CHF)
Atrial gallop - “Tennessee”
S4: Occurs just before S1, from atrial contraction forcing blood into a stiff ventricle in LATE diastole; Older adults after exercise; rarely a normal finding (DIASTOLIC HF, CAD, HTN, aortic/pulmonic stenosis, acute MI)
Other: Systolic click (floppy mitral valve prolapsing backward in the LA); Murmurs; Rubs
Murmur assessment
Blowing sound of turbulent blood flow within a heart chamber or great vessels due to increased blood flow, structural valve defects/malfunctions, abnormal chamber openings
Assess:
1. Timing: can occur during (1) systole (can be present in a healthy heart) or (2) diastole (always indicates heart disease)
- Intensity (grading)
As well as: Pitch, quality, shape, pattern, location, transmission, ventilation, position
Apical pulse
Assess location and diameter of pulsation
Lateral displacement of pulse towards axillary line d/t HF, cardiomyopathy, ischemic heart disease, thoracic deformities, mediastinal shift (s/t tension pneumothorax), ventricular hypertrophy
Assume left lateral position if unable to palpate supine (displaces heart towards left chest wall)
Abnormal palpable findings
- Lift: cardiac lifting during systole, associated with RV hypertrophy (s/t pulmonic valve disease, pulmonic HTN, chronic lung disease)
- Thrill: a vibratory sensation felt on the skin overlying an area of turbulence, indicating a loud heart murmur usually caused by an incompetent heart valve
Neck vessels: carotid artery and jugular veins
Assess while supine with HOB at 30-deg.
Carotid artery: provides information about cardiac function, aortic valve stenosis, and regurgitation; assess: (1) upstroke, (2) amplitude, (3) contour, (4) absence/presence of thrills or bruits
Jugular veins: reflect RA pressure and RV diastolic filling pressure
Older client consideration
Atherosclerosis may have caused obstruction of blood flow
Difficult to palpate apical pulse d/t increased anteroposterior chest diameter
Fatigue r/t decreased CO (may worsen as day progresses)
CAD
Atherosclerotic narrowing of the coronary arteries that can lead to stable/unstable angina, MI, thromboembolism
Risk factors: Dyslipidemia, tobacco use, HTN, FHX (of CAD, DM, obesity), Native-American descent
Complications can lead to acute coronary syndromes, STEMI/NSTEMI, acute HF, arrhythmias, sudden death
Health promotion: Identify/treat heart attack/stroke risk factors, smoking cessation, diet, exercise, medication, DM education, limit alcohol use, stress practice techniques
