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• upper portion of the heart is the base
• lower portion of the heart is the apex
• horizontally the heart extends from the right of the sternum to the left middavicular line
• vertically the heart extends from left 2nd intercostal to left 5th intercostal
• aortic- 2nd right ICS - base of heart and is the second s2 heart sound
• pulmonic- 2nd L ICS is also part of the S2 heart sound
• Erb's Point (2nd Pulmonic Area) 3rd to 5th L ICS
• Mitral - 5th L ICS Midclavicular at the apex of the heart and is part of S1 heart sounds
• A pulse deficit indicates a weak contraction of the ventricles, and occurs with atrial fibrillation, premature beats, and congestive heart failure
• Unilateral distention or fully distended external jugular veins when client’s head is elevated at or above 45 degree is abnormal
• Jugular Vein Distention (JVD) Indicates increased central venous pressure that may be the result of right ventricular failure, pulmonary hypertension, pulmonary emboli, or cardiac tamponade
• A Thrill is a palpable vibration that signifies Turbulent blood flow
• A bruit, which is a blowing or swishing sound caused by turbulent blood through a narrowed vessel, is indicative of occlusive artery disease
• However, if the artery is more than two-thirds occluded, a bruit may not be heard
• The apical pulse may or may not be visible, if apparent, it will be seen in the mitral area
• apical pulse is Sometimes called maximal impulse or PMI
• palpating apical pulse –  Remain on client’s rt. side and ask client to lay supine

  –  Use one finger pad to palpate the apical pulse at the 4th or 5th ICS, MCL

  –  If pulsation cannot be palpated, have client roll midway to the left to bring the heart closer to the chest wall

  –  The apical impulse palpated in the mitral area should be size of a nickel

  –  Amplitude is usually small-like a gentle tap

  –  The duration is brief, lasting through the first two-thirds of systole and often less
• –  In obese clients, the apical impulse may not be palpable
• –  An apical impulse larger than 1-2cm, displaced, more forceful, or longer in duration may indicate cardiac enlargement
• apical pulse related: Specifically, a displaced impulse down and to the left and one that occupies more than one ICS indicates left ventricular enlargement or volume overload

  –  Increased force and duration but no change in location occurs with left ventricular hypertrophy
• –  S1 corresponds with each carotid pulsation and is loudest at the apex of the heart
• –  S2 immediately follows after S1 and is loudest at the base of the heart
• –  An irregular heartbeat is an arrhythmia (also called dysrhythmia).
• „Right ventricle pumps blood to the lungs to collect oxygen
• „Left ventricle pumps blood to the rest of the bodies extremities
• perfusion is The Flow of Blood through arteries and capillaries delivering nutrients and oxygen to cells
• There are two sets of jugular veins: internal and external
• The internal jugular veins lie deep and medial to the sternocleidomastoid muscle
• The external jugular veins are more superficial, they lie lateral to the sternocleidomastoid muscle above the clavicle
• –A Murmur is a swishing sound caused by turbulent blood flow through the heart valves or great vessels
• –Innocent Murmur- not associated with any physiologic abnormality, they occur when the ejection of blood into the aorta is turbulent, very common in children and young adults
• –Physiologic Murmur-caused by temporary increase in blood flow.  Can occur with anemia, pregnancy, fever, and hyperthyroidism
• „Pericardial friction rub is caused by inflammation of the pericardial sac„Best heard using diaphragm over the third intercostal space (ICS) to the left of the sternum (ERBS point area)„It is a high pitched, scratchy, scraping sound„For best results, have patient sit up, lean forward, exhale,

       and hold breath

  Commonly heard during the first week after a myocardial infarction
• –It is normal to see pulsations when the client is lying flat or at 30

   degrees. The jugular venous pulse is not normally visible with the

  client is elevated to 45 degrees
• –Palpate each carotid artery alternately by placing pads of the index and middle fingers medial to the sternocleidomastoid muscle on the neck–Note amplitude and contour of the pulse, elasticity of the artery, and any thrills–Pulses should be equally strong:2+ with no variation in strength, arteries are elastic and no thrills noted
• –Auscultate carotid arteries if client is middle-aged or older