HEART

Chapter 14
Seidel’s Guide to Physical Examination
OBJECTIVES
 To identify layers of heart
 To understand ventricles and atria

 To understand heart murmur

 To explain concept of cardiac output

 To explain cardiac cycle

 To explain ECG rhythms

 To identify 5 points for cardiac auscultation

KEY WORDS
 Pericardium
 Epicardium
 Myocardium
 Endocardium
 Aorta
 Atrioventricular Valves
 Semilunar Valves
 Purkinjie Fibers
 SA node
 AV node
 QRS complex
 Pericarditis
 Systole
 Diastole
 Electrocardiogram
(EKG)
 Cardiac Output
 Atria
 Ventricles
 Heart Murmur
 Cardiac Cycle
 Heart Failure
 Myocardial Infarction
 Bruit
ANATOMY & PHYSIOLOGY: HEART
LOCATION
 In mediastinum
 Left of midline

 Above diaphragm

 Between medial/lower borders of lungs

 Behind sternum & 3rd – 6th intercostal cartilages

 Estimate size by percussion, begin tapping

anterior axillary line

Precordium: Area of chest overlying heart

Base: broader upper portion of heart
Apex: Narrower lower tip of heart
ANATOMY & PHYSIOLOGY: POSITION
VARIANCE
 Body build
 Chest configuration

 Diaphragm level

 Dextrocardia
ANATOMY & PHYSIOLOGY: LAYERS OF
HEART
ANATOMY & PHYSIOLOGY: HEART
 Pericardium
 Tough, double-walled, fibrous sac
 Encases and protects the heart
 Fluid between inner and outer layers of pericardium
 Epicardium
 Thin outermost muscle layer
 Covers surface of heart and extends over great
vessels
 Myocardium
 Thick muscular, middle layer
 Responsible for pumping of heart
 Endocardium
 Inner most layer, covers valves
ANATOMY & PHYSIOLOGY: CHAMBERS
 Left atrium Left Heart
 Left ventricle
 Right atrium
Right Heart
 Right ventricle

 Right/left atria – reservoirs

 Right/left ventricles - pumps

 Interventricular Septum – blood tight partition

dividing the left and right heart
ANATOMY & PHYSIOLOGY: VENTRICLES
 Right & left ventricles primary mass of heart
 Left ventricle mass greater than right ventricle

 Larger because higher pressure in systemic

circulation requires greater contraction force
 Most anterior of heart – right ventricle

 Left ventricle’s contraction & thrust=apical

impulse in 5th intercostal space
 Aorta carries oxygenated blood to the body from
the left ventricle
ANATOMY & PHYSIOLOGY: VALVES
 Tricuspid
Atrioventricular valves
 Mitral

 Pulmonic
Semilunar valves
 Aortic
ANATOMY & PHYSIOLOGY: CARDIAC
CYCLE

 Systole – contraction of ventricles opens

semilunar valves, causing blood to rush into
pulmonary artery and aorta
 Diastole- relaxation of ventricles, valves close,
draw blood into ventricles as atria contract

https://www.youtube.com/watch?v=jLTdgrhpDCg
https://www.youtube.com/watch?v=r32VObKw0gY
ANATOMY & PHYSIOLOGY: CARDIAC CYCLE
 Two sounds produced: Lub (𝑆1 ) and Dub (𝑆2 )
 Lub – ventricles contraction increases pressure
and forces mitral and tricuspid valves closed
 Dub – ventricles empty, pressure decreases,
aortic and pulmonic valves close
 Normal heart sounds heard best over areas
where blood flows after it passes through a valve

Note: Pressures right ventricle, right atrium, and pulmonary artery

lower than left side of heart
ANATOMY & PHYSIOLOGY: ELECTRICAL
CONDUCTION OF THE HEART
ANATOMY & PHYSIOLOGY: ELECTRICAL
CONDUCTION

 Sinoatrial node
 AV node

 AV bundle (Bundle of His)

 Purkinje fibers
ANATOMY & PHYSIOLOGY: ECG WAVES
 Electrocardiogram
 P Wave
 PR interval
 QRS complex
 ST segment
 T wave
 U wave
CARDIAC RHYTHMS
 Normal Sinus Rhythm

 V-Tach

 Atrial Fibrillation (afib) & atrial flutter

HEART MURMURS
 Prolonged extra sounds heard during systole or
diastole
 Cause- disruption blood flow into, through, or out
of heart
 Swooshing or blowing sound heard auscultation
 Similar sound called a “bruit” heard over arteries
 Conditions contribute to heart murmurs
 Increased blood velocity
 Structural valve defects
 Valve malfunction
 Abnormal chamber openings
https://www.youtube.com/watch?v=tGcAidBJCdM
TYPES OF HEART MURMURS
 Midsystolic
 Pansystolic

 Diastolic

 Exam & Findings

 Timing/duration
 Pitch
 Intensity
 Pattern
 Quality
 Location/radiation
CARDIAC HEALTH ASSESSMENT
 Collecting Subjective Data
 History present health concern, chest pain,
 Palpations
 Past health history
 Family history
 Lifestyle and health practices

 Collecting Objective Data

 Inspect pulsations
 Palpate the apical impulse
 Palpate for abnormal pulsations
 Auscultate heart rate and rhythm
 If you detect an irregular rhythm, auscultate for a pulse
rate deficit
EXAMINATION
• Inspect pulsations
• Palpate the apical impulse- most visible
when patient is in the upright position
• Palpate for abnormal pulsations
• Auscultate heart rate and rhythm
• If you detect an irregular rhythm,
auscultate for a pulse rate deficit
5 CARDIAC AUSCULTATION POINTS
 https://www.youtube.com/watch?v=83CBjj9dMRc
CARDIAC ABNORMALITIES
 Angina
 Heart Failure
 Myocardial Infarction (MI)
 Pericarditis
 Common symptom with abnormalities especially in the
older adult is fatigue

 Risk Factors:
 Smoking
 Hypertension
 Obesity
 High Cholesterol Level
SUMMARY
 Anatomy heart
 Chambers

 Electrocardiogram

 Cardiac cycle

 5 cardiac auscultation points

 Cardiac output

 Cardiac abnormalities