Cardiac

anatomy

  • base (top) between the second and third intercostal spaces

  • apex (bottom) in the fifth intercostal space at the mid-clavicular line

  • Point of maximum impulse: area where the force of blood flow is the strongest; fifth intercostal space at the mid-clavicular line (Where apical pulse is taken)


  • Heart chambers

    • atrioventricular valves: tricuspid and bicuspid valves

    • semilunar valves: pulmonary and aortic valves


function

  • Diastole:

    • the filling / relaxing phase of the heart

  • systole:

    • the ejection phase where ventricles are contracted

Heart sounds

S1- Lub

  • what creates it: closure of the AV (mitral and tricuspid) valves at the beginning of systole (heart is contracting)

  • It is low-pitched and longer

  • is best heard at the apex

S2- Dub

  • Closure of the semilunar valves (aortic and pulmonic) at the end of the systole/beginning of diastole

  • the heart is relaxed and filling up

  • sounds like high pitched and shorter

  • best heard at the base

Murmurs

  • sustained swishing or blowing sounds

  • can be asymptomatic or a sign of heart disease

  • could be a sign of valve damage

subjective assessment

  • smoking

  • alcohol

  • caffeine

  • medication (prescription OTC or supplements)

  • drugs

  • exercise

  • diet

  • medical history

  • episodes of feeling lightheaded

  • swelling in extremities

  • leg pain or cramping

  • chest pain

  • shortness of breath

Techniques of assessment

  • inspection

    • skin (even distributed color)

    • nails (clubbing is chronic problem with oxygenation and perfusion)

      • rounded on the nail

    • mucus membranes

    • extremities (look at color, edema, if a patient just cannot grow hair in a certain area)

  • palpation

    • capillary refill (how fast the color changes when pressure is applied, do to top and bottom, left and right)

    • check both radial and pedal

      • bilaterally at the same time; rate on a scale of

        • 0- absent

        • 1+-weak/decreased

        • 2+-normal

        • 3+-bounding

    • sensation

    • edema (pitting stays for a bit)

      • 1+ = 2 mm

      • 2+ = 4 mm

      • 3+ = 6 mm

      • 4+ = 8 mm


  • auscultation



  • Cardiac telemtry

    • assess if its on

    • if on; call telemetry if the telemetry is going through and if rate and rhythm right