Chapter 16 Heart

Competencies Identify the anatomic landmarks of the chest. Describe the characteristics of the most common cardiac chief complaints. (continues)

Competencies Elicit a health history from a patient with cardiac pathology. Perform a cardiac examination on a healthy adult. (continues)

Competencies Perform a cardiac examination on a patient with cardiovascular pathology. Provide a scientific rationale for abnormal cardiac examination findings.

Anatomy and Physiology of the Heart The primary function of the heart is to pump blood to all parts of the body. A healthy adult heart Contracts 60–100 times per minute Pumps 4–5 liters of blood per minute (continues)

Anatomy and Physiology of the Heart Base Apex Pericardium Parietal layer Visceral layer (continues)

Anatomy and Physiology of the Heart Chambers of the heart Right and left atria Right and left ventricles Septa (continues)

Anatomy and Physiology of the Heart Heart valves Atrioventricular (AV) valves Tricuspid Mitral (bicuspid) Semilunar valves Pulmonic Aortic

Coronary Circulation Left main coronary artery Right coronary artery Left circumflex artery Left anterior descending artery Right coronary artery

Cardiac Cycle Systole Diastole Isovolumic contraction Early systole Late systole Diastole Isovolumic relaxation phase Early and mid-diastolic filling periods Atrial systole (atrial kick)

Electrocardiogram (EKG) P Q R S T Isoelectric line

Conduction System of the Heart Sinoatrial (S-A) node Atrioventricular (A-V) node Bundle of His Right and left bundle branches Purkinje fibers

Health History Age Gender Childhood onset: rheumatic fever Adult onset: CAD, MI, CVA Gender Female Male (continues)

Health History Race May predispose to higher risk for CVA, CAD

Common Chief Complaints Chest pain Syncope Palpitations

Characteristics of Chief Complaints Quality Associated manifestations Aggravating factors (continues)

Characteristics of Chief Complaints Alleviating factors Setting Timing

Past Health History Medical history Surgical history Cardiac specific: angina, cardiogenic shock, cardiomyopathy, CHF, chest trauma Non-cardiac specific Surgical history Previous cardiovascular procedures (continues)

Past Health History Allergies Medications Aspirin IVP dye Seafood Cardiac specific (continues)

Past Health History Communicable diseases Injuries and accidents Rheumatic fever Untreated syphilis Viral myocarditis Injuries and accidents Childhood illnesses

Family Health History Assess for CVA CAD MI or sudden cardiac death MVP

Social History Alcohol use Excessive alcohol intake Increases risk for cardiomegaly, cardiomyopathy, angina, CAD, HTN, dysrhythmias, stroke Moderate alcohol intake (up to 2 oz per day) Decreases risk for CAD (continues)

Social History Tobacco use May cause tachycardia, HTN Increased risk for developing CAD, angina, atherosclerosis (continues)

Social History Drug use Intravenous drug use Increases risk for endocarditis Amphetamines, cocaine, heroin May cause tachycardia, HTN, hypotension, coronary vasospasm, MI, dysrhythmias, stroke, cardiomyopathy (continues)

Social History Sexual practice Travel history Work and home environment Hobbies and leisure activities Stress

Health Maintenance Activities Sleep Diet Vitamin K intake Sodium and caffeine intake (continues)

Health Maintenance Activities Exercise Stress management Use of safety devices Health checkups

Risk Factors for Cardiovascular Disease Fixed Age, gender, race, family history Modifiable HTN, hyperlipidemia, tobacco use, glucose intolerance, physical inactivity, diet, stress, sedentary lifestyle, obesity

Examination Equipment Stethoscope Sphygmomanometer Watch with second hand

General Approach to Heart Examination Explain the assessment to the patient Ensure a warm, quiet, well-lit environment (continues)

General Approach to Heart Examination Limit exposure of the patient’s chest Place the patient in a supine or sitting position

Inspection Aortic Pulmonic Midprecordial Tricuspid Mitral (continues)

Inspection Normal findings No visible pulsations except for the PMI in the mitral area

Palpation Assess for pulsations, thrills, heaves Assess the following areas: aortic, pulmonic, midprecordial, tricuspid, and mitral (continues)

Palpation Normal findings No pulsations, thrills, or heaves palpated, except in the mitral area, where the apical impulse may be palpated

Auscultation How Where Patient position Use diaphragm and bell of stethoscope Where Aortic, pulmonic, midprecordial, tricuspid, mitral

Auscultation: Normal Findings Aortic: S2 is louder than S1 Pulmonic: S2 is louder than S1 Tricuspid: S1 is louder than S2 Mitral: S1 is louder than S2 (continues)

Auscultation: Normal Findings Mitral and tricuspid S3 (gallop) may be heard in children, young adults, and pregnant women S4 may indicate cardiac decompensation

Auscultation: Abnormal Findings Murmurs Classified as innocent, functional, or pathological Possible causes Use stethoscope diaphragm over aortic, pulmonic, mitral, and tricuspid areas Use stethoscope bell over mitral and tricuspid areas (continues)

Auscultation: Abnormal Findings Murmurs (cont’d) Characteristics: location, radiation, timing, intensity, quality, pitch, configuration (continues)

Auscultation: Abnormal Findings Pericardial friction rub Patient position Characteristics: location, radiation, timing, quality, pitch Abnormal finding Possible cause