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Tuesday, May 6, 2008

Heart & Neck Vessels

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Heart & Neck Vessels Slide Transcript
Slide 1: Heart and Neck Vessels

Slide 2: Cardiovascular System • Heart & Blood Vessels • Pulmonary Circulation • Systemic Circulation

Slide 3: • 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

Slide 4: Heart • Location- Heart extends from the 2nd to 5th 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

Slide 5: • Apical Pulse = during contraction, apex beats against the chest wall. Usually palpable in the Lt., 5th ICS, MCL

Slide 6: 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

Slide 7: • 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

Slide 8: 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

Slide 9: 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

Slide 10: • Valves – separate the 4 chambers – Prevent backflow – Unidirectional – Open & close passively in response to pressure gradients in the moving bld.

Slide 11: 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

Slide 12: • 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)

Slide 13: Cardiac Cycle • 2 Phases – Diastole – ventricles relaxed, tricuspid & mitral valves open • The ventricles fill, the AV valves close= S1 (lub) or the 1st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient)

Slide 14: Cardiac cycle – Systole- ventricles are full, heart contracts, bld is pumped to lungs & body

Slide 15: Heart Sounds • S1 – 1st heart sound • S2 – 2nd heart sound • Extra Sounds – 3rd heart sound – S3 – Ventricular Gallop – 4th heart sound – S4 – Atrial Gallop

Slide 16: Heart Murmurs • What are they? • What causes a heart murmur?

Slide 17: Heart Automaticity • Conduction • SA node – pacemaker • AV node • ECG • Electrical impulse slightly precedes mechanical events.

Slide 18: Pumping Ability • 4-6 liters blood/min. – Cardiac output – Stroke volume

Slide 19: Neck Vessels • Carotid Artery • Jugular Veins – Internal – External • Jugular Venous Pressure – Measurement – Angle of Louis – Normal JVP = 2cm or <

Slide 20: Peripheral Vascular System • Blood and Lymph Transportation • Disease of Vascular System causes problems with delivery of nutrients & oxygen to tissues and removal of wastes.

Slide 21: Arteries • Oxygenated blood to all body tissues • Strong & tough • Elastic fibers • Muscle fibers

Slide 22: Pulses • Temporal • Carotid • Brachial • Radial • Ulnar • Femoral • Popliteal

Slide 23: Pulses • Dorsalis pedis • Posterior tibial • Veins – Greater # – Closer to skin surface

Slide 24: Lymphatics • Separate vessel system • Excess fluid from tissue • Prevents edema

Slide 25: Worksheet # 6

Slide 26: Subjective Data • Chest pain • Dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia • Past Cardiac History • Last EKG • Family history • Personal habits

Slide 27: • Leg pain / cramps • Swelling or skin changes • Lymph node enlargement • Medications

Slide 28: 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

Slide 29: – Femoral – Popliteal – Dorsalis pedis – Posterior tibial

Slide 30: 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 2nd ruler horizontal to level of pulsation

Slide 31: Read level on vertical ruler Normal JVP = 2cm. or <  Inspect Precordial Area for Retraction or Bulging pulsation

Slide 32: • Palpate – use palmar aspect of fingers or ulnar surface of hands to search for other pulsations – Sternoclavicular – Epigastric – Aortic – right 2nd interspace – Pulmonary – lt. 2nd interspace

Slide 33: – Right ventricular – lt. Lower sternal border, 5th interspace – Apical – 5th interspace left MCL

Slide 34: Percussion • To outline heart’s borders • Limited benefit with lg. Breasts, obese, muscular chest wall • Readily available

Slide 35: Percuss for Cardiac Enlargement • Lt. Anterior axillary line 5th intercostal space & toward the sternal border • Resonance over lung – dull over heart • Normal – lt. Border of cardiac dullness 5th interspace MCL: @ 2nd interspace dullnes coincides with the lt. Sternal border • 2nd interspace to 5th MCL

Slide 36: Auscultate • Inch stethoscope in a Z pattern from base of heart, across & down to Apex Aortic – 2nd rt. Interspace Pulmonary – 2nd lt. Interspace Erb’s Point – 3rd lt. Interspace Tricuspid – 5th interspace lt. Lower sternal border Apical – 5th interspace lt. MCL APE To Man

Slide 37: Note during auscultation • Rate • Rhythm • S1- Apex S2 – Base • Other sounds? • Murmurs

Slide 38: • Auscultate – Left side lying – Sitting leaning forward • Observe skin, mucus membranes, nails and chest

Slide 39: • Carotid Arteries – Bruits – Neck in neutral position – Bell over carotid @ 3levels • Angle of jaw • Midcervical area • Base of neck

Slide 40: Peripheral Vascular System • Arms – Inspect • Skin color, nail beds • Temperature • Texture & turgor • Lesions, edema, clubbing (160 degree angle base = Normal) • Capillary refill <2sec. • symmetry

Slide 41: Palpate • Rate, rhythm, elasticity, force Grade force as : 1 - 4 0 = absent 4 = bounding Brachial, radial, ulnar Edema

Slide 42: 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

Slide 43: Legs • Inspect – Symmetry – Color – Hair distribution – Venous pattern – Measure calf circumference

Slide 44: Palpate Legs • Femoral • Popliteal • Dorsalis pedis • Posterior tibial • Inguinal lymph nodes

Slide 45: • 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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