Heart and Neck Vessels Cardiovascular System Heart Blood

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 • S 1 – 1 st heart sound • S 2 – 2 nd heart sound • Extra Sounds – 3 rd heart sound – S 3 – Ventricular Gallop – 4 th heart sound – S 4 – 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 = 2 cm 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 = 2 cm. or < Ø Inspect Precordial Area for ØRetraction or Bulging Øpulsation

• 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 S 1 - Apex S 2 – 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 @ 3 levels • 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 <2 sec. • symmetry

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

Allen Test • Used to determine the patency of the ulnar & radial artery YHands on knees, palms up YCompress both radial arteries YInstruct to open & close fists several times YOpen hands. YResults = pink color – ulnar artery patent YRepeat 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 = 1 cm. 2+ moderate = 2 cm 3+ deep = 3 cm. 4+ very deep = 4 cm ( more accurate to classify by depth)