Heart and Neck Vessels HA Exam #3

chest pain (angina)
dyspnea
orthopnea
cough
fatigue
cyanosis/pallor
edema
nocturia
past cardiac history
risk factors

men -> crushing chest pain, "elephant on my chest"
women -> left shoulder hurts, heartburn
pain radiating into jaw
pain left back of arm

DOE -> dyspnea on exertion
PND -> Paroxysmal nocturnal dyspnea

dyspnea when lying flat

heart causing stress to the body

central cyanosis -> core, torso
peripheral cyanosis -> fingertips, tongue
pallor -> not perfusing blood

bilaterally on all 4 extremities = congestive heart failure
male -> check scrotum for edema

full bladder being emptied = cardiac issues
waking up in the night to go pee

cough up bubbly, frothy, pink sputum

family history (time and treatment) -> mom and dad, aunt and uncle, grandparents and siblings
Hypertension
Activity Level -> what do you like to do for working
NONMODIFIABLE

Nutrition
Smoking
Alcohol
Exercise
Drugs (recreational)
MODIFIABLE

ensure privacy

Pulse and BP
Extremities -> clubbing, temp, cap refill, lesions, edema, compare bilaterally
Neck Vessels
Precordium

Tape measure
Stethoscope
Pen light

listen for murmurs
soft pressure
if press hard turns into diaphragm

firm pressure

Carotid Arteries--sitting position -> brings all blood flow to brain; palpate one at a time
Jugular veins & precordium--supine slightly elevated -> will see distention/pooling if heart not ready
Ensure privacy

Marking pen
Small centimeter ruler
Stethoscope Alcohol Wipe

a mirror or picture of vascular blood flow
can be arterial or venous

waves are active
takes force from cardiac contraction to push blood around

waves are passive

does not matter what's happening in the body you will always see active arterial waves

blood flow is dominant and not affected by breathing

blood flow can be interrupted by respirations

valves closing

medial

avoid excessive pressure on the carotid sinus higher in the. neck
palpate medial to the sternal muscle
one carotid artery at a time
note if any thrills (turbulence)
**Normal Strength 2+**

may be plaque build up

palpable vibration
feels like the throat of a purring cat
signifies turbulent blood flow and usually accompanies loud murmurs
absence of thrill does not necessarily rule out the presence of a murmur

Use bell, light pressure
middle aged or older
or show symptoms or sign of CV disease
presence of bruit -> instead of pulsation sound like liquid moving
listen bilaterally
**Ask pt to take deep breath and hold it**

absence of bruit
normal strength 2+
equal bilaterally

Supine (30-45 degree angle)
turn head to side
direct penlight on the neck

jugular venous distention

right sided heart failure

disappears (drains) when sit up--visible by pulsation only

increased CVP (central venous pressure)--heart failure
pt sits up and vein is still distended

lower, more lateral, under or behind the sternomastoid muscle

higher and medial to this muscle

undulant and diffuse, two visible waves per cycle

brisk and localized, one way per cyycle

varies with respiration; its level descends during inspiration when intrathoracic pressure is decreased

does not vary

No

Yes

light pressure at the base of the neck easily obliterates

no change

level of pulse drops and disappears as the person is brought to a sitting position

Unaffected

Tricuspid (right)
Mitral (left)
allow to go from atria to ventricle
closure makes S1 sound

Pulmonic (right)
Aortic (left)
closure makes S2 sound

pressure gradients

open during filling (diastole)
close during ejection (systole)

open during ejection (systole)
push closed to push blood to lungs and body

ventricles relaxed and filling with blood
2/3 of cycle
takes longer to fill something than squeeze

ventricle contract (ejection)
blood pumped from ventricles fills pulmonary and systemic arteries
1/3 of cycle

left bigger
right smaller

run to back of heart
biggest vessel
comes right from aorta

ribs 1-6 = precordial area

heart attack
muscle-heart-lack of blood flow
caused by blockage like a clot
causes decreased ejection fraction

left main occulsion

pushing forward towards ribcage
is the point of Maximum Impulse (PMI)

Apical impulse (PMI)
4th to 5th ICS, at or inside left MCL (depending on age)
use back of hand to displace breast tissue
PMI easier to see in children and with thinner chest walls

Location: occupy 1 interspace; 5th ICS, at or medial to MCL
Size: 1 cm X 2 cm
Amplitude: Short, gentle tap
Duration: Short, first half of systole

Assess for other pulsations (apex, left sternal border, base)
Palmar aspect of hand
Normal: **No pulsations**

Supine position (30-45 degree angle)
Listen over all areas, first with diaphragm then bell
Listen to one sound at a time
Identify S1 then S2 (happen close enough together sounds the same, any splitting (click noise)
Rate and rhythm, count apical pulse

60 seconds

over all areas
S1-loudest at apex, coincides with carotid artery pulse
S2-loudest at base
Note any splitting--might occur at end of inspiration T-DUP
Any murmurs

APE to Man
Aortic
Pulmonic
Erb's
Tricuspid
Mitral

2nd Right ICS

2nd Left ICS

3rd Left ICS

left lower sternal border (4th-5th ICS)

5th ICS, left MCL (Apex)

Rhythmic flow of blood through the heart is cardiac cycle
two phases: diastole and systole

ventricle relaxed and AV valves (tricuspid and mitral) are open
pressure in atria higher than in ventricles so blood pours rapidly into ventricles
toward end of diastole, atria contract and push last amount of blood into ventricles (Atrial Kick)
Note that atrial systole occurs DURING ventricular diastole

ventricular pressure becomes higher than that in atria, so mitral and tricuspid valves close
closure of AV valves contributes to first heart sound (S1) and signals beginning of systole
for a very brief moment, all four valves are closed and ventricular walls contract -> isometric contraction

less cardiac output
not as much volume getting pumped out with a faster heart rate

ventricular stretch prior to next contraction

amount of resistance ventricles overcome

strength of myocardial muscle fiber

amount of blood pumped through the circulatory system in 1 minute

amount of blood ejected with each contraction

prevent backflow

only open one way

respond to extreme pressures (open/close)

closing of Mitral and Tricuspid valves
heard best at Apex of Heart
marks start of systole

closing of semilunar valves
signals end of systole
heard best at base of Heart

splitting occurs when Aortic valve closes earlier than Pulmonic Valve
Effect of Inspiration
sometimes not pathogenic

use the bell
over all areas
assess for S3 and S4 sounds
roll to left side
any low-pitched murmurs

sudden lack of blood flow and blocked coronary artery(s)
caused by:
plaque
clot
spasm

chest pain
shortness of breath
nausea/vomiting
sweating
fatigue
indigestion
dizziness
restlessness/apprehension

decreased blood flow to the gut causes nausea

4-6 liters