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Heart and Neck Vessels

Cardiovascular System. Heart

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Heart and Neck Vessels

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    1. Heart and Neck Vessels

    2. Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic Circulation

    3. Precordium – area of chest overlying heart and great vessels. Arteries & veins connected to the heart Heart & Great vessels are b/t lungs in the middle 1/3 of the thoracic cage = Mediastinum

    4. Heart Location- Heart extends from the 2nd to 5th ICS & from the Rt. Sternal border to the Lt. MCL Base broader – upside down ? Apex – points down & to the Lt. Rt. Side anterior Lt. Side posterior 4 Chambers

    5. Apical Pulse = during contraction, apex beats against the chest wall. Usually palpable in the Lt., 5th ICS, MCL

    6. Great Vessels Above Base of the heart Superior & Inferior Vena Cava return unoxygenated venous bld. to the Rt atrium Pulmonary Artery leaves the Rt. Ventricle, bifurcates & goes to the lungs Pulmonary Veins return oxygenated bld. to the Lt. Atrium Aorta carries the bld. to the body

    7. The aorta ascends from the Lt. Ventricle arches back @ the sternal angle and descends behind the heart Remember arteries always away from the heart; veins always toward the heart Pulmonary artery to lungs, pulmonary veins to heart

    8. Heart Wall Pericardium – tough, fibrous, double-walled sac, surrounds & protects the heart Has 2 layers containing pericardial fld. Adherent to great vessels, esophagus, sternum, & pleurae & is anchored to the diaphragm Myocardium- muscular wall of the heart. It doesw the pumping. Endocardium – thin layer of endothelial tissue , lines the inner surface of the heart chamber & valves

    9. Chambers of the Heart Right side – pumps blood to the lungs Left side – pumps blood to the body Septum- impermeable wall 2 Atria- holding chambers 2 Ventricles- muscular pumping chambers RA; RV; LA; LV

    10. Valves – separate the 4 chambers Prevent backflow Unidirectional Open & close passively in response to pressure gradients in the moving bld.

    11. Heart Valves There are 4 heart valves 2 Atrioventricular – AV valves- separate the atria & ventricles Rt. AV. = tricuspid Lt. AV. = mitral (bicuspid) Diastole = the heart’s filling phase; AV valves open, ventricles fill with bld. Systole = pumping phase, AV valves close to prevent backup

    12. Semilunar valves – b/t ventricles & arteries The SL valves are: Pulmonic valve- rt. Side of the heart Aortic valve – lt. Side of the heart These valves open in systole (during pumping)

    13. Cardiac Cycle 2 Phases Diastole – ventricles relaxed, tricuspid & mitral valves open The ventricles fill, the AV valves close= S1 (lub) or the 1st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient)

    14. Cardiac cycle Systole- ventricles are full, heart contracts, bld is pumped to lungs & body

    15. Heart Sounds S1 – 1st heart sound S2 – 2nd heart sound Extra Sounds 3rd heart sound – S3 – Ventricular Gallop 4th heart sound – S4 – Atrial Gallop

    16. Heart Murmurs What are they? What causes a heart murmur?

    17. Heart Automaticity Conduction SA node – pacemaker AV node ECG Electrical impulse slightly precedes mechanical events.

    18. Pumping Ability 4-6 liters blood/min. Cardiac output Stroke volume

    19. Neck Vessels Carotid Artery Jugular Veins Internal External Jugular Venous Pressure Measurement Angle of Louis Normal JVP = 2cm or <

    20. Peripheral Vascular System Blood and Lymph Transportation Disease of Vascular System causes problems with delivery of nutrients & oxygen to tissues and removal of wastes.

    21. Arteries Oxygenated blood to all body tissues Strong & tough Elastic fibers Muscle fibers

    22. Pulses Temporal Carotid Brachial Radial Ulnar Femoral Popliteal

    23. Pulses Dorsalis pedis Posterior tibial Veins Greater # Closer to skin surface

    24. Lymphatics Separate vessel system Excess fluid from tissue Prevents edema

    25. Worksheet # 6

    26. Subjective Data Chest pain Dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia Past Cardiac History Last EKG Family history Personal habits

    27. Leg pain / cramps Swelling or skin changes Lymph node enlargement Medications

    28. Objective Data Measure B/P in both arms – lying, sitting, standing Palpate pulses bilaterally Temporal Carotid * important to only palpate one side at a time * Brachial Radial ulnar

    29. Femoral Popliteal Dorsalis pedis Posterior tibial

    30. Jugular Venous Pressure JVP Supine- HOB 30-45 degrees, remove pillow Turn head away from examiner, shine light across neck to highlight pulsation Locate Angle of Louis & position a vertical ruler on reference point 2nd ruler horizontal to level of pulsation

    31. Read level on vertical ruler Normal JVP = 2cm. or < Inspect Precordial Area for Retraction or Bulging pulsation

    32. Palpate – use palmar aspect of fingers or ulnar surface of hands to search for other pulsations Sternoclavicular Epigastric Aortic – right 2nd interspace Pulmonary – lt. 2nd interspace

    33. Right ventricular – lt. Lower sternal border, 5th interspace Apical – 5th interspace left MCL

    34. Percussion To outline heart’s borders Limited benefit with lg. Breasts, obese, muscular chest wall Readily available

    35. Percuss for Cardiac Enlargement Lt. Anterior axillary line 5th intercostal space & toward the sternal border Resonance over lung – dull over heart Normal – lt. Border of cardiac dullness 5th interspace MCL: @ 2nd interspace dullnes coincides with the lt. Sternal border 2nd interspace to 5th MCL

    36. Auscultate Inch stethoscope in a Z pattern from base of heart, across & down to Apex Aortic – 2nd rt. Interspace Pulmonary – 2nd lt. Interspace Erb’s Point – 3rd lt. Interspace Tricuspid – 5th interspace lt. Lower sternal border Apical – 5th interspace lt. MCL APE To Man

    37. Note during auscultation Rate Rhythm S1- Apex S2 – Base Other sounds? Murmurs

    38. Auscultate Left side lying Sitting leaning forward Observe skin, mucus membranes, nails and chest

    39. Carotid Arteries Bruits Neck in neutral position Bell over carotid @ 3levels Angle of jaw Midcervical area Base of neck

    40. Peripheral Vascular System Arms Inspect Skin color, nail beds Temperature Texture & turgor Lesions, edema, clubbing (160 degree angle base = Normal) Capillary refill <2sec. symmetry

    41. Palpate Rate, rhythm, elasticity, force Grade force as : 1 - 4 0 = absent 4 = bounding Brachial, radial, ulnar Edema

    42. Allen Test Used to determine the patency of the ulnar & radial artery Hands on knees, palms up Compress both radial arteries Instruct to open & close fists several times Open hands. Results = pink color – ulnar artery patent Repeat occluding ulnar artery

    43. Legs Inspect Symmetry Color Hair distribution Venous pattern Measure calf circumference

    44. Palpate Legs Femoral Popliteal Dorsalis pedis Posterior tibial Inguinal lymph nodes

    45. Edema Grade scale 1+ to 4+ 1+ slight indentation = 1cm. 2+ moderate = 2cm 3+ deep = 3cm. 4+ very deep = 4cm ( more accurate to classify by depth)

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