1. Chapter 16
Heart

2. Competencies Identify the anatomic landmarks of the chest.
Describe the characteristics of the most common cardiac chief complaints.
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3. Competencies
Elicit a health history from a patient with cardiac pathology.
Perform a cardiac examination on a healthy adult.
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4. Competencies
Perform a cardiac examination on a patient with cardiovascular pathology.
Provide a scientific rationale for abnormal cardiac examination findings.

5. 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
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6. Anatomy and Physiology of the Heart
Base
Apex
Pericardium
Parietal layer
Visceral layer
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7. Anatomy and Physiology of the Heart
Chambers of the heart
Right and left atria
Right and left ventricles
Septa
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8. Anatomy and Physiology of the Heart
Heart valves
Atrioventricular (AV) valves
Tricuspid
Mitral (bicuspid)
Semilunar valves
Pulmonic
Aortic

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

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

11. Electrocardiogram (EKG)P Q R S T
Isoelectric line

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

13. Health History Age Gender Childhood onset: rheumatic fever
Adult onset: CAD, MI, CVA
Gender
Female
Male
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14. Health History
Race
May predispose to higher risk for CVA, CAD

15. Common Chief Complaints
Chest pain
Syncope
Palpitations

16. Characteristics of Chief Complaints
Quality
Associated manifestations
Aggravating factors
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17. Characteristics of Chief Complaints
Alleviating factors
Setting
Timing

18. Past Health History Medical history Surgical history
Cardiac specific: angina, cardiogenic shock, cardiomyopathy, CHF, chest trauma
Non-cardiac specific
Surgical history
Previous cardiovascular procedures
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19. Past Health History Allergies Medications Aspirin IVP dye Seafood
Cardiac specific
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20. Past Health History Communicable diseases Injuries and accidents
Rheumatic fever
Untreated syphilis
Viral myocarditis
Injuries and accidents
Childhood illnesses

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

22. 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
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23. Social History Tobacco use May cause tachycardia, HTN
Increased risk for developing CAD, angina, atherosclerosis
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24. 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
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25. Social History Sexual practice Travel history
Work and home environment
Hobbies and leisure activities
Stress

26. Health Maintenance Activities
Sleep
Diet
Vitamin K intake
Sodium and caffeine intake
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27. Health Maintenance Activities
Exercise
Stress management
Use of safety devices
Health checkups

28. 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

29. Examination Equipment Stethoscope Sphygmomanometer
Watch with second hand

30. General Approach to Heart Examination
Explain the assessment to the patient
Ensure a warm, quiet, well-lit environment
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31. General Approach to Heart Examination
Limit exposure of the patient’s chest
Place the patient in a supine or sitting position

32. Inspection
Aortic
Pulmonic
Midprecordial
Tricuspid
Mitral
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33. Inspection Normal findings
No visible pulsations except for the PMI in the mitral area

34. Palpation Assess for pulsations, thrills, heaves
Assess the following areas: aortic, pulmonic, midprecordial, tricuspid, and mitral
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35. Palpation Normal findings
No pulsations, thrills, or heaves palpated, except in the mitral area, where the apical impulse may be palpated

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

37. 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
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38. Auscultation: Normal Findings
Mitral and tricuspid
S3 (gallop) may be heard in children, young adults, and pregnant women
S4 may indicate cardiac decompensation

39. 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
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40. Auscultation: Abnormal Findings
Murmurs (cont’d)
Characteristics: location, radiation, timing, intensity, quality, pitch, configuration
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41. Auscultation: Abnormal Findings
Pericardial friction rub
Patient position
Characteristics: location, radiation, timing, quality, pitch
Abnormal finding
Possible cause