Heart and Neck Vessels. Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic...

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Heart and Neck Vessels

Transcript of Heart and Neck Vessels. Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic...

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 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)

Cardiac cycle

– Systole- ventricles are full, heart contracts, bld is pumped to lungs & body

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 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 = 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.

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

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

– Right ventricular – lt. Lower sternal border, 5th interspace

– Apical – 5th 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 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

Note during auscultation

• Rate

• Rhythm

• S1- Apex S2 – 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 @ 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

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 = 1cm.

• 2+ moderate = 2cm

• 3+ deep = 3cm.

• 4+ very deep = 4cm

• ( more accurate to classify by depth)