Heart and Neck Vessels

Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic Circulation

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

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

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

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

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

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

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

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.

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

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)

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)

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

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

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?

What are they?

What causes a heart murmur?

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

Conduction

SA node – pacemaker

AV node

ECG

Electrical impulse slightly precedes mechanical events.

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

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 <

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.

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

Oxygenated blood to all body tissues

Strong & tough

Elastic fibers

Muscle fibers

Pulses Temporal Carotid Brachial Radial Ulnar Femoral Popliteal

Temporal

Carotid

Brachial

Radial

Ulnar

Femoral

Popliteal

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

Dorsalis pedis

Posterior tibial

Veins

Greater #

Closer to skin surface

Lymphatics Separate vessel system Excess fluid from tissue Prevents edema

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

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

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

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

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

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

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

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

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

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

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

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

Rate

Rhythm

S1- Apex S2 – Base

Other sounds?

Murmurs

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

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

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

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

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

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

Inspect

Symmetry

Color

Hair distribution

Venous pattern

Measure calf circumference

Palpate Legs Femoral Popliteal Dorsalis pedis Posterior tibial Inguinal lymph nodes

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)

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)