Ch. 20 Heart and Neck Vessels

Atrium

Thin-walled reservoir for holding blood

Ventricle

Thick-walled, muscular pumping chamber

Atrioventricular (AV) Valves

Tricuspid and Mitral; open during heart's filling phase (diastole) and close during pumping phase (systole)

Semilunar (SL) Valves

Aortic and Pulmonic; open during pumping (systole) to allow blood to be ejected from heart

Blood Through the Heart

Superior/Inferior Vena Cava -> Right atrium -> Tricuspid valve -> Right Ventricle -> Pulmonary Valve -> Pulmonary Arteries -> Lungs -> Pulmonary Veins -> Left Atrium -> Mitral Valve -> Left Ventricle -> Aortic Valve -> Aorta -> Body

S1

Loudest at the apex caused by the closure of the AV valves (mitral and tricuspid) (Systole).

S2

Auscultated best at the base. Associated with the closure of the semilunar valves (aortic and pulmonic) (Diastole).

S3

Best heard at the apex (left ventricle) in the left lateral position; or left lower sternal border (right ventricle) when supine. May be normal or associated with decreased compliance of the ventricles as in heart failure.

S4

Very soft sound of low pitch best heard at the apex with the person in the left lateral position. Represents a ventricular filling sound, may be normal or due to decreased compliance of the ventricles.

Murmurs

Described in terms of intensity from I to IV. Grade I is barely audible with a stethoscope to grade VI very loud, heard with the stethoscope lifted off the chest. Described in terms such as harsh, blowing, musical, or rumbling.

Cardiac Output

Heart normally pumps between 4 and 6 L of blood per minute throughout the body. CO = HR x SV

Carotid Artery

Timing coincides with ventricular systole.

Jugular Venous Pulse

Empties unoxygenated blood directly into the superior vena cava. Gives information about activity on the right side of the heart.

Thrill

At the base, a vibratory sensation felt on the skin overlying an area of turbulence and indicates a loud heart murmur usually caused by an incompetent heart valve.

Lift (Heave)

At the left sternal border, you would feel the heel of your hand being lifted with each systole.

Major Risks of Heart Disease

Diabetes, hypertension, obesity, and smoking

General Risks of Heart Disease

Family history, personality type, and stress

Signs and Symptoms of Heart Failure

Paroxysmal Nocturnal Dyspnea

Orthopnea

JVD

Pulmonary Edema

Nocturia

Pitting Pedal Edema

Decrease in Cardiac Output

Weight Gain

Arterial Ischemic Ulcers

Occur at the toes, metatarsal heads, heels, and lateral ankle and are characterized by a pale ischemic base, well-defined edges, and no bleeding.

Venous (Stasis) Ulcers

Occur at the medial malleolus (not the great toe) and are characterized by bleeding and uneven edges.

Deep Vein Thrombosis

The development of a thrombus, or clot, in a deep vein, most commonly in the legs, that may present with swelling, pain, redness, and warmth. Pain is not relieved with positioning or elevation. Causes include prolonged bedrest, history of varicose veins, trauma, infection, obesity, immobility.

Varicosities or Varicose Veins

Caused by incompetent distant valves in the veins which produce dilated, tortuous veins.