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 2 nd to 5 th 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., 5 th 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= S 1 (lub) or the 1 st 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 – 1 st heart sound S2 – 2 nd heart sound Extra Sounds –3 rd heart sound – S3 – Ventricular Gallop –4 th 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 2 nd 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 2 nd interspace –Pulmonary – lt. 2 nd interspace

33. –Right ventricular – lt. Lower sternal border, 5 th interspace –Apical – 5 th 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 5 th intercostal space & toward the sternal border Resonance over lung – dull over heart Normal – lt. Border of cardiac dullness 5 th interspace MCL: @ 2 nd interspace dullnes coincides with the lt. Sternal border 2 nd interspace to 5 th MCL

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