Heart & Neck Vessels

Question 0

What are the components of the examination of the pericardium?

Answer 0

Inspection

• anterior chest
• locate apical impulse
• note any heave(lift) or thrill

Palpation
-of pericardium

Percussion
-cardiac borders

Auscultation
-identify each anatomic area where you listen
-note rate and rhythm of heart beat
-identify s1 and s2, note any variation…state expected
-listen in systole and diastole for any extra heart sounds
- listen in systole and diastole for any murmurs
-repeat sequence with bell
-listen at apex with person in left lateral position
-listen at base with person in sitting position
-check for pulse deficit
-

Question 1

What are the components of the neck examination?

Answer 1

Auscultate carotid artery

Carotid pulse - observe and Palpate

Observe jugular venous pulse

Estimate jugular venous pressure

*do not perform hepatojugular reflux

Question 2

How are the carotid arteries assessed?

Answer 2

Auscultation first

• landmarked beside sternomastoid
• check at angle of jaw, mid cervical area and base of neck
• have patient exhale and suspend breath out while you listen

Palpation
-check one side at a time, compare rates

Question 3

How are the jugular veins examined

Answer 3

• shine light tangentially
• look for external jugular venous pulse, usually visible over sternomastoid muscle while pt turns head away from you
• internal jugular venous pulse, visible in notch
• jugular pulsations have two upstrokes per cycle

Estimate jugular venous pressure

• patient should be 30 - 45 degrees position
• land mark angle of Louis
• place ruler vertical at that point
• Use second ruler or straight edge to measure height of internal jugular venous pressure by placing perpendicular
• expected 2 cm or less. Record angle of patient as well as measurement

Question 4

Where should apical pulse be found/landmarked and what should be noted about it?

Answer 4

• at mid clavicular line in fourth or fifth intercostal space
• location should be noted
• size should be 1x 2 cm
• amplitude should be a gentle tap
• duration short

Question 5

How is the precordium palpated?

Answer 5

Palpate for apical impulse
Palpate apex of heart
Next feel near left sternal border, then base (top part) of the heart feeling for extra pulsations/thrills

Question 6

How do you percuss precordium ?

Answer 6

22

Question 7

How do you auscultation precordium

Answer 7

Note rate and rhythm using diaphragm

Identify s1 and s2 - s1 first, the lub, corresponds with carotid artery pulse, and is loudest at apex

Assess s1 and s2

Listen for murmurs during systole and diastole, which are normally quiet

Switch to bell to look for s3