Circulation + Composition of Blood + Vertebrate Heart + Invertebrate Heart + Blood Vessels
Heart and Neck Vessels. Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic...
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Transcript of Heart and Neck Vessels. Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic...
• 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 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
• Apical Pulse = during contraction, apex beats against the chest wall. Usually palpable in the Lt., 5th 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= S1 (lub) or
the 1st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient)
Heart Sounds
• S1 – 1st heart sound
• S2 – 2nd heart sound
• Extra Sounds– 3rd heart sound – S3 – Ventricular Gallop– 4th heart sound – S4 – Atrial Gallop
Heart Automaticity
• Conduction
• SA node – pacemaker
• AV node
• ECG
• Electrical impulse slightly precedes mechanical events.
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.
Subjective Data
• Chest pain
• Dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia
• Past Cardiac History
• Last EKG
• Family history
• Personal habits
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
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
Read level on vertical rulerNormal JVP = 2cm. or <
Inspect Precordial Area for Retraction or Bulgingpulsation
• 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
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 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
Auscultate
• Inch stethoscope in a Z pattern from base of heart, across & down to ApexAortic – 2nd rt. InterspacePulmonary – 2nd lt. InterspaceErb’s Point – 3rd lt. InterspaceTricuspid – 5th interspace lt. Lower sternal
borderApical – 5th interspace lt. MCL APE To Man
• 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, forceGrade force as : 1 - 4
0 = absent4 = bounding
Brachial, radial, ulnarEdema
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