Heart and Neck Vessels: Ch 19 Flashcards
Precordium
Is the areas on the anterior chest directly overlaying the heart and great vessels
Mediastinum
Middle third of the thoracic cage, ❤️ and great vessels are located here
“Point of maximum impulse”, mitral- is located where?
4th or 5th intercostal space
What are the great vessels?
Superior and inferior vena cava Pulmonary artery Pulmonary vein Aorta Jugular veins Carotid arteries
Heart wall
3 layers
1- pericardium: tough-double walled sac that surrounds and protects the heart
2- myocardium: muscular wall of the heart, does the pumping
3- endocardium: thin layer of endothelial tissue that lines the inner surface of the ❤️ chambers and valves
Heart chambers
Atria- right and left (top)
Ventricles- right and left (bottom)
Base of the heart is located where?
Top right side
Where is the apex of the heart located?
Bottom left of the heart where it forms a V
Atrioventricular Valves
(AV)
Separate the atria and the ventricles
- tricuspid: right side, 3 flaps
- mitral/bicuspid: left side, 2 flaps
Types of heart valves
Atrioventricular (AV)
Semilunar (SL)
Semilunar valves (SL) Blood travels thru these valves from the ventricles to "leave" the body
Pulmonic: left side-blood leaves right ventricle thru valve to pulmonary artery
Aortic: right side, blood leaves left ventricle thru valve to aorta- to systemic circulation
Cardiac cycle
Diastole- the ventricles relax and fill with blood (2/3 of cycle)
Systole- the heart contracts/ejects the blood from ventricles to pulmonary and aortic artery (1/3 of cycle)
Diastole- AV valves are open
Systole- AV valves close- aortic valve open
Diastole- AV valves open
Which heart sound signals the end of diastole and the beginning of systole?
S1
Which heart sound signals the end of systole, start of diastole/and the beginning of the cycle again?
S2
S1
First heart sound, occurs with the closure of the AV valves and shanks the end of diastole and the beginning of systole
** heard loudest at Apex
S2
Second heart sound, occurs with the closure of the pulmonary and aortic (SL) valves and the end of systole/beginning of cycle again
**heard loudest at the base (top right)
Extra heart sounds “diastolic filling sounds”
S3: occurs after s2, during. Diastolic filling
-usually hear w/ MI, CHF, CAD, 80% of pregnant women
S4: occurs at the end of distill and presystole when the ventricle is reactance to filling
-can be normal in athlete and elderly people
Aortic cyanosis- HTN, CAD
Neck vessels
Carotid arteries: palpate pulse and grade (0-3+)
Jugular veins- no palpate, observe for pulsation by suprasternal notch
- internal: can’t hear, used to give IV
- external: right JVD is direct reflection of the heart, assess for CHF, men may stick out, WT lifters
When/how is JVD best assessed?
When the person is lying down
The engorged vein will run across the SCM muscle
-if the vein remains enlarged when the pt sits up the patient is + for JVD
Carotid artery is located..
In the groove between the trachea and the SCM muscle
JVD
CHF, edema in extremities: check for JVD
More visible on the right
Yes- vein will remain enlarged when sitting up
No- vein will flatten when sitting up
❤️ anatomy
The heart extends from the 2nd-5th intercostal and from the right border of the sternum to the left midclavicular line.
Subjective data: health history
Chest pain: MI, angina?* start intervention early
*dyspnea: sob, labored breathing, PND at night
*orthopnea: trouble breathing lying down
Cough, fatigue, cyanosis
Cardiac history: HTN, ⬆️ LDL= high risk for MI
Personal habits
*cultural considerations
Heart disease and stroke is higher among which population?
Black adults versus any population
What will occur with CHF?
Edema
Nocturia
Objective data: the physical exam
Carotid arteries: palpate 1 at a time, auscultate for bruit with bell
Jugular veins- inspect, check for JVD
Precordium- inspect, palpate the apical pulse, palpate across precordium, outline of cardiac borders
Instructions for patient when listening for a bruit?
Take a deep breath in
Blow it out and hold it
The first heart sound is produced by…?
The closure of the AV valves
When auscultating heart sounds the appropriate position for the patient is…?
Recumbent position
-Layin down
A bruit is caused by?
Turbulent blow flow thru the carotid artery
Auscultation 👂🏻of the heart sounds
Aortic area: 2nd intercostal space-R
Pulmonic area: 2nd intercostal space-L
Erbs point: 3rd intercostal space-L
Tricuspid area: 5th intercostal space-L but more midline
Mitral area: 4th or 5th (usually 5th, mid claviciular line)-L
Apical pulse: “PMI”, mitral/apical=apical pulse
-4th or 5th intercostal space
Note the rate and rhythm
-sinus arrhythmia: most common and easiest treated (Afib)
Pulse deficit
Listen to the apical pulse and palpate the radial pulse at the same time!
Apical-130
Radial-115
PD-15
Peripheral pulse may/may not be a reliable area
Have patient lay on what side to listen to apex?
Left- it brings the heart closer to the chest wall
If a patient has a fistula in the right arm and you need their BP what do you do?
Take it in the left arm
-never do BP in an arm with a fistula
Abnormal findings-diastolic extra sounds
- 3rd heart sound
- 4th heart sound
- precordial friction rub- inflammation of the pericardium, high pitched sound, “sand paper”
