NurseReview.Org - Heart & Neck Vessels

Heart and Neck Vessels

Cardiovascular System
Heart & Blood Vessels
Pulmonary Circulation
Systemic Circulation

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

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

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

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

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

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

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

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

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

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)

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)

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

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

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

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

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

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

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

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

Pulses
Temporal
Carotid
Brachial
Radial
Ulnar
Femoral
Popliteal

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

Lymphatics
Separate vessel system
Excess fluid from tissue
Prevents edema

Worksheet # 6

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

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

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

Femoral
Popliteal
Dorsalis pedis
Posterior tibial

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

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

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

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

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

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

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

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

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

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

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

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

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

Legs
Inspect
Symmetry
Color
Hair distribution
Venous pattern
Measure calf circumference

Palpate Legs
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
Inguinal lymph nodes

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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