Heart and Neck vessels Assessment

Question 1

Health history Questions

Chestpain

• PQRSTU
• Angina
• causes

Resp. related symptom’s

• dyspnea
• orthopnea
• cough

FCENCFC

Answer 1

Chest pain

• PQRSTU + associated symptoms (diaphoresis, pallor, palpitations, SOB, nausea, fatigue)
• Angina- chest pain caused by reduced blood supply to the heart
• Other causes: pulmonary, MSK, gastrointestinal

Respiratory related symptoms:

• Dyspnea- difficulty breathing
• Orthopnea- difficulty breathing when laying flat
• Cough- is it productive (exudate?)

Fatigue
-Do you tire easily?
Cyanosis or pallor
-Blue or pale
Edema- swelling caused by fluid in body tissues
-Notice any swelling?
Nocturia- excessive urination at night

Cardiac history

• Heart disease, heart attack
• HTN, elevated cholesterol
• Murmurs, congenital heart disease, rheumatic fever

Family cardiac history:

• HTN, obesity, diabetes
• Coronary Artery Disease (CAD)
• Sudden death at younger age

Cardiac Risk Factors:
-Smoking, junk food, high blood pressure, lack of exercise, alc, drug use, obesity, stress

Question 2

Women and heart attacks

Women are more likely ton have what

*leading cause of death in women over 55

Answer 2

Women are more likely to present with atypical symptoms of chest pain:

• Nausea
• Sweating
• Indigestion
• Shortness of breath
• Pain in the arm, throat or jaw
• Flu-like symptoms
• Fatigue

Promoting Health: exercise and weight control

Question 3

Perform a regional CV exam in this order

Answer 3

Pulse and BP
Extremities (we will cover this next week)
Neck Vessels*
Precordium*

Question 4

Tips for CVS exam

Answer 4

Patient position:

• Sitting- carotid arteries
• Lying- jugular veins and precordium
• Stand at the RIGHT side of the bed
• Room should be WARM and QUIET
• Ensure PRIVACY
• Keep chest draped
• Gently displace women’s left breast upward, or ask her to hold it out of the way

Question 5

Assess the Neck vessels

3 steps

Answer 5

1.Auscultate for bruit –Apply the BELL of the stethoscope over the carotid artery at 3 levels:
1.angle of the jaw
2.mid-cervical area
3.base of the neck
Tips:
-Keep the neck in neutral position. (gently press, can compromise artery)
-Ask pt to take a breath, exhale & hold it briefly

2. Palpate each carotid artery
   -Location: medial to sternomastoid muscle in the lower neck (avoid carotid sinus)
   -Palpate gently ONE artery at a time
   Note:
   -Contour- smooth with rapid upstroke & slower downstroke
   -Strength- 2+
   -Equality- equal bilaterally
3. Estimate Jugular venous pressure
   - not done
   - Instead inspect for jugular venous distension
   - Indicator of heart failure if present with HOB raised 45° or higher (see a bulge if theyre laying)

Question 6

Assess the precordium

5 steps

Answer 6

1. Inspect the Anterior Chest
   - Pulsations- may see Apical Impulse (apex beating against chest wall)
   - Heave or Lift- a sustained forceful thrusting of the ventricle during systole (indicates ventricular hypertrophy) (NOT NORMAL)
2. Palpate the Apical Impulse
   Location: 4th OR 5th intercostal space, midclavicular line
   Note:
   -Location – occupies only one intercostal space
   -Size – 1x2 cm
   -Amplitude – short, gentle tap
   -Duration – short
3. Palpate across the Precordium
   - Use the palmar aspect of your 4 fingers
   - Palpate over: apex, left sternal border, base
   - Thrill- palpable vibration (signifies turbulent blood flow)

4.Percussion
Not routinely done

5. Auscultation
   Aortic- 2nd right interspace
   Pulmonic- 2nd left interspace
   Erb’s point- 3rd left interspace
   Tricuspid- 5th left interspace
   Mitral- 5th left interspace midclavicular line
   -ALL PEOPLE ENJOY TIMES MAGAZINE/ use both sides of stethoscope
   -Lay them on their side, kind of on left or stand up and lean over
   -S1 loudest at apex
   -S2 loudest at base
   (look for murmurs, extra heart sounds, change in position)

Question 7

Developmental considerations

Infants

Children

Answer 7

Infants 
-Heart is more horizontal 
apical impulse in 4th ICS until age 7
-HR 100-180 bpm
Health history:
-Tiring
-Cyanosis
-Breathing changes
-Failure to thrive

Children
-Heart more horizontal
-HR 80-130 bpm
-Innocent murmurs
Health history:
-Growth
-Activity
-Joint pain & fever

Question 8

Developmental considerations

Pregnant women

Older adults
-Arteriosclerosis

Answer 8

Pregnant Women:
-increased blood volume 30-40%
-increased CO and  HR 10-15 bpm
-Vasodilation of blood vessels
causes lower BP
-Enlarging uterus moves heart up
-Murmurs of pregnancy
Health history:
Hypertension
Hypotension

Older Adults:
-BP increases as a result of stiffer arteries
-Arteriosclerosis= arterial wall calcification
Increased LV wall thickness
-Orthostatic hypotension (standing fast)
-Decreased exercise tolerance
-Presence of arrhythmias 
-ECG changes
Health History:
Pervious heart or lung disease
Medications
CVD risk factors

Question 9

Abnormal findings/ Heart failure

what is it and 2 reasons behind it

Answer 9

Heart Failure- failure of the heart to pump blood efficiently

Two basic mechanisms:

1.The heart’s inability to pump enough blood to meet the demands of the body

2. The kidney’s natural reaction to try to increase cardiac output
   - Retain sodium and water to increase the blood volume (which causes further congestion)

Question 10

Types of heart failure

2

Answer 10

Left sided- causes back of blood in the lungs

• Results in pulmonary edema
• S&S: Dyspnea, orthopnea, cough (frothy pink or white), crackles in lungs, decreased O2 saturation, cyanosis, anxiety, confusion, fatigue, tachycardia

Right sided- causes back of blood in the systemic veins

• Results in peripheral edema
• S&S: Dependent pitting edema, ascites, jugular venous distension, N&V, enlarged liver & spleen, weight gain, fatigue

Often heart failure progresses to affect BOTH sides of the heart