1. Copyright 2002, Delmar, A division of Thomson Learning Chapter 16 Heart and Peripheral Vasculature

2. Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify the anatomic landmarks of the chest and periphery. Describe the characteristics of the most common cardiovascular chief complaints. Elicit a health history from a patient with cardiovascular pathology. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning Competencies Perform a cardiovascular assessment of a healthy adult. Perform a cardiovascular assessment on a patient. Describe the changes that occur in the cardiovascular system in the elderly.

4. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Base Apex Pericardium  Parietal  Visceral (continues)

5. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Chambers of the heart  Right and left atria  Right and left ventricles (continues)

6. Copyright 2002, Delmar, A division of Thomson Learning Cardiac Cycle Systole Diastole  Atrial kick

7. Copyright 2002, Delmar, A division of Thomson Learning Electrical Activity of the Heart Sino-atrial (SA) node Atrioventricular node Bundle of HIS Right and left bundle branches Purkinje fibers

8. Copyright 2002, Delmar, A division of Thomson Learning Peripheral Vasculature Arterial system  Three layers of arterial walls: tunica intima, media, externa  Arteries  Arterioles  Capillaries Venous system  Veins  Venules

9. Copyright 2002, Delmar, A division of Thomson Learning Health History Age  Childhood onset: Rheumatic fever  Adult onset: CAD, HTN, MI, CVA, AAA, CHF Gender  Female  Male Race  May predispose to higher risk for CVA, CAD, HTN, DM

10. Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Chest pain Syncope Palpitations Peripheral edema Claudication

11. Copyright 2002, Delmar, A division of Thomson Learning Characteristics of Chief Complaints Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing

12. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical  Cardiac specific: AAA, angina, CAD, CHF, HTN, MI, PVD, hyperlipidemia  Noncardiac specific Surgical  Prior cardiovascular procedures Presence of risk factors (continues)

13. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Common medications  Antianginals or vasodilators  Antidysrhythmics  Anticoagulants  Antihypertensives  Antilipemics  Diuretics  Inotropics  Thrombolytics (continues)

14. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Communicable diseases Childhood illnesses Allergies  Aspirin  IVP dye  Seafood

15. Copyright 2002, Delmar, A division of Thomson Learning Family Health History Assess for the following diseases  Aneurysm  CAD  CVA  HTN  CHF  MI or sudden cardiac death  MVP  Rheumatic fever

16. Copyright 2002, Delmar, A division of Thomson Learning Social History Alcohol, drug, or tobacco use Sexual practices Travel history Work and home environment Hobbies and leisure Stress

17. Copyright 2002, Delmar, A division of Thomson Learning Health Maintenance Activities Sleep Diet Exercise Stress management Use of safety devices Health checkups

18. Copyright 2002, Delmar, A division of Thomson Learning Patient Education Risk factor modification Heart smart diet Exercise

19. Copyright 2002, Delmar, A division of Thomson Learning Risk Factors Modifiable  HTN, hyperlipidemia, tobacco use, physical inactivity, diet, glucose intolerance, stress, sedentary lifestyle, obesity Nonmodifiable  Age, gender, race, family history

20. Copyright 2002, Delmar, A division of Thomson Learning Heart Smart Diet American Heart Association guidelines Total fat intake < 30%  < 10% from saturated fat  < 10% from polyunsaturated fat  10–15% monounsaturated fat Cholesterol < 300 mg/day Sodium < 2,400 mg/day Carbohydrates should equal 55– 60% of total calories/day

21. Copyright 2002, Delmar, A division of Thomson Learning Exercise and Cardiovascular Health Consult with primary care provider prior to starting an exercise program Avoid strenuous activity in extremes of temperature or after a heavy meal Immediately stop exercise if chest pain, dizziness, faintness, light- headedness occur

22. Copyright 2002, Delmar, A division of Thomson Learning Assessment Equipment  Stethoscope  Sphygmomanometer  Watch with second hand  Tape measure

23. Copyright 2002, Delmar, A division of Thomson Learning Inspection Aortic Pulmonic Midprecordial Tricuspid Mitral Normal findings: no visible pulsations except for the PMI in the mitral area

24. Copyright 2002, Delmar, A division of Thomson Learning Palpation Assess for pulsations, thrills, heaves Assess the following areas: aortic, pulmonic, midprecordial, tricuspid, and mitral Normal findings  No pulsations, thrills, or heaves palpated, except in the mitral area where the apical impulse may be palpated

25. Copyright 2002, Delmar, A division of Thomson Learning Auscultation How?  Patient position  Use diaphragm and bell of stethoscope Where?  Aortic, pulmonic, midprecordial, tricuspid, mitral

26. Copyright 2002, Delmar, A division of Thomson Learning Auscultation: Normal Findings Aortic: S 2 is louder than S 1 Pulmonic: S 2 is louder than S 1 Tricuspid: S 1 is louder than S 2 Mitral: S 1 is louder than S 2 Mitral and tricuspid: S 3 (gallop) may be heard in children, young adults, and pregnant women. S 4 may indicate cardiac decompensation

27. Copyright 2002, Delmar, A division of Thomson Learning Auscultation: Abnormal Findings Murmurs  Possible causes  Characteristics: location, timing, radiation, intensity, quality, pitch, configuration  Use stethoscope diaphragm over aortic, pulmonic, mitral, and tricuspid areas  Use stethoscope bell over mitral and tricuspid areas  Normal findings: no murmurs auscultated (continues)

28. Copyright 2002, Delmar, A division of Thomson Learning Auscultation: Abnormal Findings Pericardial friction rub  Possible cause  Characteristics: location, timing, radiation, quality, pitch  Patient position  Location  Abnormal finding

29. Copyright 2002, Delmar, A division of Thomson Learning Assessment of Arterial Pulses Evaluate temporal, carotid, brachial, femoral, popliteal, posterior tibial, dorsalis pedis How? Patient position Characteristics: rate, rhythm, amplitude, symmetry (continues)

30. Copyright 2002, Delmar, A division of Thomson Learning Assessment of Arterial Pulses Auscultate temporal, carotid, femoral pulses for bruits Normal findings Abnormal findings Pathophysiological indications: obstruction due to atherosclerotic plaques, high output states such as anemia or thyrotoxicosis

31. Copyright 2002, Delmar, A division of Thomson Learning Special Techniques Orthostatic hypotension  How?  Patient position  Normal findings  Abnormal findings  Pathophysiological indications: hypovolemic, neurogenic dysfunction, or side effect from medications (continues)

32. Copyright 2002, Delmar, A division of Thomson Learning Assessment of Peripheral Perfusion Evaluate peripheral pulses, color, clubbing, capillary refill, skin temperature, edema, ulcerations, hair distribution Venous system  Homan’s sign Arterial  Pallor  Allen’s test

33. Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Decreased size of heart muscle Decreased cardiac output Arterial vessels are more rigid, less distensible Calcifications or fibrosis of heart valves