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Chapter 17 Text

Chapter 17 Text. Heart and Neck Vessels. MENU. F. Chapter 17. Heart and Neck Vessels. Slide 17-1:. Slide 17-2:. Slide 17-3:. Slide 17-4:. Slide 17-5:. Slide 17-6:. B. MENU. F. To Graphic Slides. Chapter 17. Heart and Neck Vessels. Slide 17-7:. Slide 17-8:. Slide 17-9:.

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Chapter 17 Text

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  1. Chapter 17 Text Heart and Neck Vessels MENU F

  2. Chapter 17 Heart and Neck Vessels Slide 17-1: Slide 17-2: Slide 17-3: Slide 17-4: Slide 17-5: Slide 17-6: B MENU F To Graphic Slides

  3. Chapter 17 Heart and Neck Vessels Slide 17-7: Slide 17-8: Slide 17-9: Slide 17-10: Slide 17-11: Slide 17-12: B MENU F To Graphic Slides

  4. Chapter 17 Heart and Neck Vessels Slide 17-13: Slide 17-14: Slide 17-15: B MENU F To Graphic Slides

  5. Chapter 17 Heart and Neck Vessels STRUCTURE AND FUNCTION • Position and Surface Landmarks • Precordium • Mediastinum • Apex and base of heart • Right and left cardiac borders • Great vessels • Heart wall • Pericardium • Myocardium • Endocardium B MENU F Slide 17-2

  6. Chapter 17 Heart and Neck Vessels STRUCTURE AND FUNCTION, cont. • Chambers • Atria – right and left • Ventricles – right and left • Valves • Atrioventricular • Tricuspid • Mitral • Semilunar • Pulmonic • Aortic B MENU F Slide 17-3

  7. Chapter 17 Heart and Neck Vessels STRUCTURE AND FUNCTION, cont. • Direction of Blood Flow • Cardiac Cycle • Diastole • Systole • Events in the right and left sides • Heart Sounds • First Heart sound • Second Heart sound • Effect of Respiration • Pumping Ability • Cardiac Output • Preload • Afterload B MENU F Slide 17-4

  8. Chapter 17 Heart and Neck Vessels STRUCTURE AND FUNCTION • The Carotid Artery pulse is a pressure wave generated by each systole pumping blood into the aorta, carotid located between the trachea & sternomastoid muscle, a smooth rapid upstroke, rounded & downstroke that is more gradual & dicrotic notch caused by closure of aortic valve. B MENU F Slide 17-5

  9. Jugular Veins • jugular vein empty unoxygenated blood directly into SVC, since no valves there jugular gives information about Rt side of heart, specifically reflect filling pressure & volume changes volume& pressure increase when Rt side fails to pump effeciantly the jugular veins expose this. 2 jugular veins the larger internal jugular lies deep & medial to sternomastoid muscle .

  10. not visible but pulse can be seen in sternal notch, external jugular superficial lateral to sternomastoid muscle, pulse result from a backwash, a waveform moving backward.Waves are: • A wave: atrial contraction • C wave: ventricular contraction • X descent: atrial relaxation • V wave: passive atrial filling • Y descent: passive ventricular filling.

  11. Chapter 17 Heart and Neck Vessels SUBJECTIVE DATA – HEALTH HISTORY QUESTIONS 7. Edema 8. Nocturia 9. Past cardiac history 10. Family cardiac history 11. Personal habits (cardiac risk factors) 1. Chest pain 2. Dyspnea 3. Orthopnea 4. Cough 5. Fatigue 6. Cyanosis or pallor B MENU F Slide 17-6

  12. Chapter 17 Heart and Neck Vessels OBJECTIVE DATA – THE PHYSICAL EXAM • Preparation • Position and draping • Room preparation • Order of examination • Equipment needed • Marking pen • Small centimeter ruler • Stethoscope with diaphragm and bell endpieces • Alcohol swab B MENU F Slide 17-7

  13. Chapter 17 Heart and Neck Vessels OBJECTIVE DATA – THE PHYSICAL EXAM, cont. • The Carotid Arteries ·Palpate gently, one artery at a time ·The contour & amplitude of pulse: smooth, with upper upstroke & slower down stroke, +2 or moderate strength & symmetric bilaterally ·Avoid excessive pressure → vagal stimulation→ ↓ HR B MENU F Slide 17-8

  14. Carotid pulse • Auscultate for bruit • ·Used mainly for elderly & CAD. • ·No presence of Bruit (a blowing, swishing sound indicates vascular narrowing) • ·Use bell at 3 levels: 1- angle of jaw 2- midcervical area 3- base of neck. • ·Ask person to breath, exhale & hold it so tracheal breath sounds don’t mask bruit.

  15. The Jugular Veins • Inspect the jugular venous pulse • ·To assess the CVP & heart’s efficiency as a pump: equal or less than 2 cm above sternal angle. • ·Page 502 table 19-1 • ·Internal Jugular vein (Rt) attached more to SVC so more reliable for assessment, you don’t see the vein just the pulse. • ·Position supine, 30-45 degree angle, remove pillow. Turn his head slightly away, direct light on pulse, pulsation in suprastrenal notch or around origin of sternomastoid muscle.

  16. Estimate the jugular venous pressure • Hold a vertical ruler on the sternal angle; adjust level of horizontal straight edge to level of pulsation. Level of intersection on a vertical ruler. Normal 2 cm or less. • If cant find internal J.V, use external & note point where it collapsed.

  17. Palpate for hepatojugular reflux • If venous pressure is elevated (HF), supine, take breath, hold your Rt hand on RUQ of abdomen below rib cage, watch jugular pulse as you push in with your hand for 30 seconds → JV distended for a few seconds then back (if HF stay elevated as long as you push).

  18. Chapter 17 Heart and Neck Vessels OBJECTIVE DATA – THE PHYSICAL EXAM, cont. The Precordium • Inspect the anterior chest • Palpate the apical impulse • Palpate across the precordium • Percuss to outline the cardiac borders B MENU F Slide 17-9

  19. I) INSPECT THE ANTERIOR CHEST: • Pulsation (apical impulse): pulsation created as LV rotates against chest wall during systole, it observable at 4th or 5th ICS MCL. • II) PALPATE THE APICAL IMPULSE (PMI): • Palpable in half adult. • Location: 5th ICS MCL • Size: 1 X 2 cm • Amplitude: short, gentle tap • Duration: short • Not palpable in obese person or thick chest wall

  20. Using one finger pad, ask him to exhale then hold it may roll to Lt, increased with increase of COP (anxiety, fever, hyperthyroidism) III) Palpate across the pericardium: • No other pulsation • Using palmar of fingers, palpate apex, Lt sternal border & base.

  21. IV) PERCUSSION: • Used to outline heart borders, but with limited usefulness (replaced by CXR or Echo) • Normally: dullness over 5th ICS MCL & disappear upward over the 2nd ICS of sternal border.

  22. Chapter 17 Heart and Neck Vessels OBJECTIVE DATA – THE PHYSICAL EXAM, cont. • Auscultate the heart sounds ·Valves areas: • 1-Rt 2 ICS → aortic V. area • 2-Lt 2 ICS → Pulmonary valve area • 3-Lt lower sternal border → tricuspid .V. area • 4-Lt MCL 5th ICS → Mitral .V. area • Sounds of valves may heard all over precordium • Use stethoscope in a Z pattern B MENU F Slide 17-10

  23. Identify auscultatory areas 1. Note the rate and rhythm • Sinus arrhythmia • Pulse deficit 2. Identify S1 and S2 • S1 is louder than S2 at the apex • S1 coincides with carotid artery pulse • S1 coincides with R wave on ECG 3. Assess S1and S2 separately 4. Listen for extra heart sounds 5. Listen for murmurs

  24. ** S1& S2: • Listen to S1 & S2 separately: by diaphragm • S1: caused by closure of AV valves, signals the beginning of systole, hear over the entire precordium, loudest at apex, hear equally well in inspiration & expiration. • Split S1 is normal but rarely; it means hearing the Mitral & tricuspid separately, audible in tricuspid valve area (lt sternal border), and its rapid 0.03-second apart.

  25. - S2: • closure of semi lunar valves, hear with diaphragm over entire precordium, loudest at base. • Splitting S2: normal, occurs at the end of inspiration, recall that closure of aortic & pulmonic valves is nearly synchronous, because the effect of respiration, inspiration separates timing of two valve’s closure 0.06 second apart, instead of hearing one DUP, you hear a split sound__ T-DUP.

  26. During expiration synchrony returns & aortic and pulmonic fuse together, split S2 heard in pulmonic valve area (2Lt ICS). • Don’t tell patient to hold breathing that will equalize ejection times in RT& LT sides and split goes away. Instead concentrate on split while chest rise up & down with breathing, occurs every fourth heartbeat

  27. S3: ventricular fillings creates vibrations that can be heard over chest, these vibrations are S3 ;occurs when ventricles are resistant to filling during early rapid filling phase after S2. S4:occurs at the end of diastole , atria contract & push blood into a noncompliant ventricles, create vibrations heard as S4(occur before S1).

  28. Listen for any extra heart sounds with diaphragm then bell, midsystolic click associated with Mitral valve prolapsed is most common extra sound. • S3 & S4 occurs in diastole may normal or abnormal.

  29. Listen for murmurs: a blowing swooshing sound occurs with turbulent blood flow in heart or great vessels, its abnormal due to congenital defects & acquired valvular defects.

  30. Change position: after auscultating in supine roll person to Lt, listen with bell at apex (S3, S4), ask him to sit up, lean forward slightly & exhale listen with diaphragm at base, Rt &Lt sides, check for soft high pitched murmurs of aortic or pulmonic regurgitation.

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