Heart and Neck Vessels

1. Heart and Neck Vessels

2. Cardiovascular System • Heart & Blood Vessels • Pulmonary Circulation • Systemic Circulation

3. 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

4. Heart • Location- Heart extends from the 2nd to 5th 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

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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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)

13. Cardiac Cycle • 2 Phases • Diastole – ventricles relaxed, tricuspid & mitral valves open • The ventricles fill, the AV valves close= S1 (lub) or the 1st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient)

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

15. Heart Sounds • S1 – 1st heart sound • S2 – 2nd heart sound • Extra Sounds • 3rd heart sound – S3 – Ventricular Gallop • 4th heart sound – S4 – Atrial Gallop

16. Heart Murmurs • What are they? • What causes a heart murmur?

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

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

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

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

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

22. Pulses • Temporal • Carotid • Brachial • Radial • Ulnar • Femoral • Popliteal

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

24. Lymphatics • Separate vessel system • Excess fluid from tissue • Prevents edema

25. Worksheet # 6

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

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

28. 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

29. Femoral • Popliteal • Dorsalis pedis • Posterior tibial

30. 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 • 2nd ruler horizontal to level of pulsation

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

32. Palpate – use palmar aspect of fingers or ulnar surface of hands to search for other pulsations • Sternoclavicular • Epigastric • Aortic – right 2nd interspace • Pulmonary – lt. 2nd interspace

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

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

35. Percuss for Cardiac Enlargement • Lt. Anterior axillary line 5th intercostal space & toward the sternal border • Resonance over lung – dull over heart • Normal – lt. Border of cardiac dullness 5th interspace MCL: @ 2nd interspace dullnes coincides with the lt. Sternal border • 2nd interspace to 5th MCL

36. Auscultate • Inch stethoscope in a Z pattern from base of heart, across & down to Apex • Aortic – 2nd rt. Interspace • Pulmonary – 2nd lt. Interspace • Erb’s Point – 3rd lt. Interspace • Tricuspid – 5th interspace lt. Lower sternal border • Apical – 5th interspace lt. MCL APE To Man

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

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

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

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

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

42. 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

43. Legs • Inspect • Symmetry • Color • Hair distribution • Venous pattern • Measure calf circumference

44. Palpate Legs • Femoral • Popliteal • Dorsalis pedis • Posterior tibial • Inguinal lymph nodes

45. 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)