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Heart and Neck Vessels

Chapter 19

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 19: Heart and Neck Vessels

Structure and Function

Subjective DataHealth History Questions

Objective DataThe Physical Exam

Abnormal Findings

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-2

Chapter 19: Heart and Neck Vessels

Structure and Function

Position and surface landmarks

Apex and base of heart


Right and left cardiac borders

Great vessels

Precordium
Mediastinum

Heart wall

Pericardium
Myocardium

Endocardium

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-3

Chapter 19: Heart and Neck Vessels

Precordium, Apex and Base

Pat Thomas, 2006.


Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-4

Chapter 19: Heart and Neck Vessels

Structure and Function


(cont.)

Chambers

Atriaright and left

Ventriclesright and left

Valves

Atrioventricular
Tricuspid
Mitral

Semilunar
Pulmonic
Aortic
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-5

Chapter 19: Heart and Neck Vessels

Chambers and Valves

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-6

Chapter 19: Heart and Neck Vessels

Structure and Function

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

(cont.)

QuickTime and a
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Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-7

Chapter 19: Heart and Neck Vessels

Structure and Function


(cont.)

Extra heart sounds

Murmurs
Characteristics of sound

Third heart sound


Fourth heart sound

Frequency (pitch)
Intensity (loudness)
Duration
Timing

Conduction
Pumping ability

Cardiac output
Preload
Afterload

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-8

Chapter 19: Heart and Neck Vessels

Structure and Function


(cont.)

Neck vessels

Carotid artery

Jugular veins
Internal
External
Venous pulse and pressure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-9

Chapter 19: Heart and Neck Vessels

Neck Vessels

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-10

Chapter 19: Heart and Neck Vessels

Subjective Data
Health History Questions

Chest pain

Dyspnea

Orthopnea

Cough

Fatigue

Cyanosis or pallor

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-11

Chapter 19: Heart and Neck Vessels

Health History Questions


(cont.)

Edema

Nocturia

Cardiac history

Family cardiac history

Personal habits (cardiac risk factors)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-12

Chapter 19: Heart and Neck Vessels

Objective DataThe 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
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-13

Chapter 19: Heart and Neck Vessels

Objective DataThe 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


Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-14

Chapter 19: Heart and Neck Vessels

Objective DataThe Physical Exam


(cont.)

Precordium

Inspect the anterior chest

Palpate the apical impulse

Palpate across the precordium

Percuss to outline the cardiac borders

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-15

Chapter 19: Heart and Neck Vessels

Objective DataThe Physical Exam


(cont.)

Auscultate the heart sounds


Identify auscultatory areas

Note the rate and rhythm


Sinus arrhythmia
Pulse deficit
Identify S1 and S2
S1 is louder than S2 at the apex
S1 coincides with carotid artery pulse
S1 coincides with R wave on electrocardiogram
Listen to S1 and S2 separately
Listen for extra heart sounds
Listen for murmurs
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-16

Chapter 19: Heart and Neck Vessels

Auscultatory Areas

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-17

Chapter 19: Heart and Neck Vessels

Objective DataThe Physical Exam


(cont.)

Characteristics of normal heart sounds

Extra heart sounds

First heart sound


Second heart sound
Splitting of second heart sound
Midsystolic click
Third heart sound
Fourth heart sound

Murmurs

Timing
Loudness
Pitch
Pattern

Quality
Location
Radiation
Posture
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-18

Chapter 19: Heart and Neck Vessels

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-19

Chapter 19: Heart and Neck Vessels

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-20

Chapter 19: Heart and Neck Vessels

Abnormal Findings

Systolic Extra Sounds

Ejection click

Aortic prosthetic valve sounds

Midsystolic click

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-21

Chapter 19: Heart and Neck Vessels

Abnormal Findings

Diastolic Extra Sounds

Opening snap

Mitral prosthetic valve sound

Third heart sound

Fourth heart sound

Summation sound

Pericardial friction rub

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-22

Chapter 19: Heart and Neck Vessels

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

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-23

Chapter 19: Heart and Neck Vessels

Abnormal Findings

Congenital Heart Defects

Patent ductus arteriosus

Atrial septal defect

Ventricular septal defect

Tetralogy of Fallot

Coarctation of the aorta

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-24

Chapter 19: Heart and Neck Vessels

Abnormal Findings

Murmurs Caused by Valvular Defects

Midsystolic ejection
murmurs

Diastolic rumbles of
atrioventricular valves

Aortic stenosis

Mitral stenosis

Pulmonic stenosis

Tricuspid stenosis

Pansystolic regurgitant
murmurs

Early diastolic
murmurs

Mitral regurgitation

Aortic regurgitation

Tricuspid regurgitation

Pulmonic regurgitation

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 19-25