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Heart and Neck Vessels
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Cardiovascular System Heart & Blood Vessels Pulmonary Circulation Systemic Circulation
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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
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Heart Location- Heart extends from the 2 nd to 5 th 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
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Apical Pulse = during contraction, apex beats against the chest wall. Usually palpable in the Lt., 5 th ICS, MCL
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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
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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
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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
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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
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Valves – separate the 4 chambers –Prevent backflow –Unidirectional –Open & close passively in response to pressure gradients in the moving bld.
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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
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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)
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Cardiac Cycle 2 Phases –Diastole – ventricles relaxed, tricuspid & mitral valves open The ventricles fill, the AV valves close= S 1 (lub) or the 1 st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient)
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Cardiac cycle –Systole- ventricles are full, heart contracts, bld is pumped to lungs & body
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Heart Sounds S1 – 1 st heart sound S2 – 2 nd heart sound Extra Sounds –3 rd heart sound – S3 – Ventricular Gallop –4 th heart sound – S4 – Atrial Gallop
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Heart Murmurs What are they? What causes a heart murmur?
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Heart Automaticity Conduction SA node – pacemaker AV node ECG Electrical impulse slightly precedes mechanical events.
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Pumping Ability 4-6 liters blood/min. –Cardiac output –Stroke volume
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Neck Vessels Carotid Artery Jugular Veins –Internal –External Jugular Venous Pressure –Measurement –Angle of Louis –Normal JVP = 2cm or <
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Peripheral Vascular System Blood and Lymph Transportation Disease of Vascular System causes problems with delivery of nutrients & oxygen to tissues and removal of wastes.
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Arteries Oxygenated blood to all body tissues Strong & tough Elastic fibers Muscle fibers
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Pulses Temporal Carotid Brachial Radial Ulnar Femoral Popliteal
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Pulses Dorsalis pedis Posterior tibial Veins –Greater # –Closer to skin surface
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Lymphatics Separate vessel system Excess fluid from tissue Prevents edema
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Worksheet # 6
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Subjective Data Chest pain Dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia Past Cardiac History Last EKG Family history Personal habits
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Leg pain / cramps Swelling or skin changes Lymph node enlargement Medications
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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
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–Femoral –Popliteal –Dorsalis pedis –Posterior tibial
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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 2 nd ruler horizontal to level of pulsation
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Read level on vertical ruler Normal JVP = 2cm. or < Inspect Precordial Area for Retraction or Bulging pulsation
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Palpate – use palmar aspect of fingers or ulnar surface of hands to search for other pulsations –Sternoclavicular –Epigastric –Aortic – right 2 nd interspace –Pulmonary – lt. 2 nd interspace
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–Right ventricular – lt. Lower sternal border, 5 th interspace –Apical – 5 th interspace left MCL
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Percussion To outline heart’s borders Limited benefit with lg. Breasts, obese, muscular chest wall Readily available
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Percuss for Cardiac Enlargement Lt. Anterior axillary line 5 th intercostal space & toward the sternal border Resonance over lung – dull over heart Normal – lt. Border of cardiac dullness 5 th interspace MCL: @ 2 nd interspace dullnes coincides with the lt. Sternal border 2 nd interspace to 5 th MCL
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Auscultate Inch stethoscope in a Z pattern from base of heart, across & down to Apex Aortic – 2 nd rt. Interspace Pulmonary – 2 nd lt. Interspace Erb’s Point – 3 rd lt. Interspace Tricuspid – 5 th interspace lt. Lower sternal border Apical – 5 th interspace lt. MCL APE To Man
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Note during auscultation Rate Rhythm S1- Apex S2 – Base Other sounds? Murmurs
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Auscultate –Left side lying –Sitting leaning forward Observe skin, mucus membranes, nails and chest
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Carotid Arteries –Bruits –Neck in neutral position –Bell over carotid @ 3levels Angle of jaw Midcervical area Base of neck
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Peripheral Vascular System Arms –Inspect Skin color, nail beds Temperature Texture & turgor Lesions, edema, clubbing (160 degree angle base = Normal) Capillary refill <2sec. symmetry
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Palpate Rate, rhythm, elasticity, force Grade force as : 1 - 4 0 = absent 4 = bounding Brachial, radial, ulnar Edema
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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
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Legs Inspect –Symmetry –Color –Hair distribution –Venous pattern –Measure calf circumference
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Palpate Legs Femoral Popliteal Dorsalis pedis Posterior tibial Inguinal lymph nodes
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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)
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