heart/neck vessels

CV structure/function

function: move oxygenated blood to tissue and remove waste

main components:

• heart →pump

• blood vessels

  • great vessels

  • peripheral vessels

  • arteries

  • veins

heart walls

pericardium

myocardium

endocardium

pericardium

outer protective sac

myocardium

thick muscular layer → contraction

endocardium

inner lining of heart chambers

heart chambers

2 atria → receive blood

2 ventricle → pump blood out, heavy work

av valves

tricuspid right, mitral left

semilunar valves

aortic

pulmonic

blood flow through heart

demonstrate direction of blood flow

right heart → lungs → left heart → body

cardiac cycle: diastole

ventricle relax

av valve open

blood fill ventricle

atrial contraction at end = atrial kick

cardiac cycle: systole

ventricle contract

av valve close → s1

blood ejected through aortic and pulmonic valve

semilunar valve close → s2

normal heart sound: S1

LUB

av valve close

beginning of systole

loudest at apex

coincides with carotid pulse, R wave ECG

normal heart sound: S2

DUB

semilunar valve close

end systole

loudest at base

extra heart sound: S3

Immediately after S2

low-pitches

ventricular create vibration

early sign of heart failure (pathologic)

extra heart sound: S4

before S1

atrial kick against stiff ventricle

low-pitched, soft

seen with CAD or cardiomyopathy (enlarged heart)

extra heart sound: murmurs

turbulent blood flow

causes:

• ↑ blood velocity

• ↓ blood viscosity

• Structural defects

conduction

heart contract due to electrica impulses

SA node = pacemaker

electrical pathway

• SA node

• AV node

• bundle of his

• bundle branches

pumping ability

normal CO: 4-6 L/min

CO = stroke volume x heart rate

preload: blood filling ventricles

afterload: resistance ventricle pump against

neck vessels

focus on carotid arteries and jugular vein

asses:

• cerebral circulation

• cardiac function

• fluid volume status

carotid arteries

carry blood to head

palpate one side at a time

groove between trachea and sternomastoid

bruit: enlargement of neck

jugular vein

return blood from head

internal: deep, medial

external: superficial, visible when supine

dev competence: preg women

blood volume increases 30-50%

pulse rate increases by 10-20 bpm

CV system adapt to provide blood to supply uterus and placenta, ensure baby receive plenty oxygen/nutrient

dev competence: infant/children

heart beat by 3rd week

lung are non functional during pregnancy (womb, fluid filled)

placenta: O2, CO2, nutrient and waste exchange

foramen ovale and ductus arteriosus close after birth

dev competence (aging adult)

• ↑ systolic BP

• Arterial stiffening

• LV wall thickening

• ↓ cardiac output with exercise

• Dysrhythmias more common

• #1 cause of death ≥65: cardiovascular disease

culture and genetics

• Genetics + lifestyle affect CV risk

• Healthy lifestyle ↓ risk by 46%

• Men: crushing chest pain

• Women: atypical symptoms

  • Fatigue

  • Jaw pain

  • SOB

  • Nausea

  • Dizziness

subjective data

patient/caregiver describe symptoms

chest pain

dyspnea

orthopnea (diff breathing when lying down)

fatigue

edema

nocturia (pee at night)

cyanosis

cough

physical exam (objective data): carotid arteries

palpate: gently, one at a time

• rate, rhythm, force

auscultate: middle age or older

bell stethoscope 3 places: angle jaw, mid-cervical area, base neck

bruit: blow swish sound, turbulent blood flow

physical exam (objective data): jugular vein

inspect: jugular vein distension

pt: supine, remove pillow, turn head slightly away

Bilateral JVD at ≥45° = heart failure

inspect anterior chest

apical impulse: left midclavicular line, 4/5th intercostal space

• created as left ventricle rotate against chest wall (Systole)

inspect: lift or heave of chest wall

Lift/heave = ventricular hypertrophy

palpate anterior chest: PMI

apical impulse: point of maximal impulse (PMI)

• Size: 1 × 2 cm

• Short, gentle tap

• Patient may roll left, patient exhale → hold breath → locate apical impulse

• duration: short

• location: 5th ICS at LMCL

palpate anterior chest: precordium

palpate for “thrills” or vibration across precordium

check apex, base, left sternal border

murmur: turbulent blood flow, thrill feel

auscultate heart

stethoscope

• Aortic: 2nd ICS, RSB

• Pulmonic: 2nd ICS, LSB

• Erb’s: 3rd ICS, LSB

• Tricuspid: 4–5th ICS, LSB

• Mitral: 5th ICS, LMCL

listen murmur

• Grade 1–6 (soft → loudest)

• Grade ≥4 = thrill present

• Pathologic murmurs require follow-up testing

signs symptom of heart failure

dilated pupils

skin: pale, gray, cyanotic

orthopnea

crackles, wheeze

cough

↓ BP

nausea/vomiting

ascites

dependent, pitting edema

anxiety

falling O₂ saturation

confuse

jugular vein distention

infarct

fatigue

S₃ gallop, tachycardia

enlarged spleen, liver

↓ urine output

weak pulse, cool, moist skin