1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Heart and Neck Vessels Chapter 19

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—The Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-3 Structure and Function  Position and surface landmarks  Precordium  Mediastinum  Apex and base of heart  Right and left cardiac borders  Great vessels  Heart wall  Pericardium  Myocardium  Endocardium

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-4 Precordium, Apex and Base © Pat Thomas, 2006.

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-5 Structure and Function (cont.)  Chambers  Atria—right and left  Ventricles—right and left  Valves  Atrioventricular Tricuspid Tricuspid Mitral Mitral  Semilunar Pulmonic Pulmonic Aortic Aortic

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-6 Chambers and Valves © Pat Thomas, 2006.

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-7 Structure and Function (cont.)  Direction of blood flow  Cardiac cycle  Diastole  Systole  Events in the right and left sides  Heart sounds  First heart sound  Second heart sound  Effect of respiration

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-8 Structure and Function (cont.)  Extra heart sounds  Third heart sound  Fourth heart sound  Murmurs  Characteristics of sound  Frequency (pitch)  Intensity (loudness)  Duration  Timing  Conduction  Pumping ability  Cardiac output  Preload  Afterload

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-9 Structure and Function (cont.)  Neck vessels  Carotid artery  Jugular veins Internal Internal External External Venous pulse and pressure Venous pulse and pressure

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-10 Neck Vessels

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-11 Subjective Data— Health History Questions  Chest pain  Dyspnea  Orthopnea  Cough  Fatigue  Cyanosis or pallor

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-12 Health History Questions (cont.)  Edema  Nocturia  Cardiac history  Family cardiac history  Personal habits (cardiac risk factors)

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-13 Objective Data—The Physical Exam  Preparation  Position and draping  Room preparation  Order of examination  Equipment needed  Marking pen  Small centimeter ruler  Stethoscope with diaphragm and bell endpieces  Alcohol swab

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-14 Objective Data—The Physical Exam (cont.)  Carotid arteries  Palpate  Auscultate for bruit  Jugular veins  Inspect the jugular venous pulse  Estimate the jugular venous pressure  Palpate for hepatojugular reflux

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-15 Objective Data—The Physical Exam (cont.) Precordium  Inspect the anterior chest  Palpate the apical impulse  Palpate across the precordium  Percuss to outline the cardiac borders

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-16 Objective Data—The Physical Exam (cont.)  Auscultate the heart sounds  Identify auscultatory areas  Note the rate and rhythm Sinus arrhythmia Sinus arrhythmia Pulse deficit Pulse deficit  Identify S 1 and S 2 S 1 is louder than S 2 at the apex S 1 is louder than S 2 at the apex S 1 coincides with carotid artery pulse S 1 coincides with carotid artery pulse S 1 coincides with R wave on electrocardiogram S 1 coincides with R wave on electrocardiogram  Listen to S 1 and S 2 separately  Listen for extra heart sounds  Listen for murmurs

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-17 Auscultatory Areas

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-18  Characteristics of normal heart sounds  First heart sound  Second heart sound  Splitting of second heart sound  Extra heart sounds  Midsystolic click  Third heart sound  Fourth heart sound  Murmurs  Timing  Loudness  Pitch  Pattern  Quality  Location  Radiation  Posture Objective Data—The Physical Exam (cont.)

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-19 Sample Charting

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-20 Sample Charting (cont.)

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-21 Abnormal Findings Systolic Extra Sounds  Ejection click  Aortic prosthetic valve sounds  Midsystolic click

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-22 Abnormal Findings Diastolic Extra Sounds  Opening snap  Mitral prosthetic valve sound  Third heart sound  Fourth heart sound  Summation sound  Pericardial friction rub

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-23 Abnormal Findings Abnormal Pulsations on the Precordium  Thrill at the base  Lift (heave) at the sternal border  Volume overload at the apex  Pressure overload at the apex

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-24 Abnormal Findings Congenital Heart Defects  Patent ductus arteriosus  Atrial septal defect  Ventricular septal defect  Tetralogy of Fallot  Coarctation of the aorta

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 19: Chapter 19: Heart and Neck Vessels Slide 19-25 Abnormal Findings Murmurs Caused by Valvular Defects  Midsystolic ejection murmurs  Aortic stenosis  Pulmonic stenosis  Pulmonic stenosis  Pansystolic regurgitant murmurs  Mitral regurgitation  Tricuspid regurgitation  Diastolic rumbles of atrioventricular valves  Mitral stenosis  Tricuspid stenosis  Tricuspid stenosis  Early diastolic murmurs  Aortic regurgitation  Pulmonic regurgitation