Assessment of the heart lecture

• The heart contracts 60-100 times per minute
• the heart pumps 4-5 liters of blood per minute
• base- the uppermost portion which includes left and right atria as well as the aorta, pulmonary arteries and superior vena cava and inferior vena cava
• Apex – lower portion which extends into the left thoracic cavity covering the heart to appear as if it is lying on the right ventricle.
• Pericardium – heart and roots of the great vessels lie within a sac which is composed of fibrous and serous layers.
• Parietal – lies close to the fibrous tissue
• Visceral – lies against the actual heart muscle; epicardium.
• Pericardial fluid – a small space that contains approximately 20 – 50 ml of pericardial fluid; serves to facilitate the movement of the heart muscle and protect it via its lubricant effect.
• Right and Left atria – interatrial septum
• Right and Left ventricle – interventricular septum
• Right atria – is the collection point for the blood returning from the systematic circulation for reoxygenation in the lungs.
• Left atria – receives freshly oxygenated blood via the 4 pulmonary veins which are the only veins in the blood that carry oxygenated blood 
• Atrioventricular valve (AV valves) – prevent it from prematurely entering the ventricles
• Tricuspid valve – named from its 3 flaps/cusps; AV valve between the RA and RV.
• Bicuspid/mitral valve – named from its 2 flaps or cusps; AV valve between LA and LV.
• Semilunar valves/outflow valves because blood exists the heart through them.
• SA Node – normal pacemaker of the heart and located about 1 mm below the right atrial epicardium.
• AV Node – the intranodal atrial pathways conduct the impulse initiated in the SA node to AV node via the myocardium of the RA
• AV node – also known as AV junction which delays the impulse received from the atria before transmitting it to the ventricle.
• Aortic area - Second Intercostal space to the right of the sternum
• Pulmonic area - Second intercostals space to the left of the sternum
• Erb’s Point or Midprecordial area - Third intercostals space to the left of the sternum
• Tricuspid area or septal area- Fifth intercostals space to the left of the sternum
• Mitral area or Apical area- Fifth intercostals space at the left midclavicular line                         
• mitral area correlates anatomically with the apex of the heart. 
• aortic and pulmonic area correlates anatomically with the base of the heart.
• Pulsations – Using the finger pads, locate the cardiac landmark and palpate the area for pulsations.
• Thrills – Using the palmar surface of the hand at the base of the fingers or ball of the hand locate the cardiac landmark and palpate the area for thrills
• Heaves – Using the palmar surface of the hand at the base of the fingers or ball of the hand locate the cardiac landmarks and palpate for the heaves.
• Auscultation of the mitral and tricuspid areas is repeated for low – pitched sounds specifically for S3 or ventricular systolic gallop or extra heart sound. 
• MURMURS - are distinguished from heart sounds by their longer duration. 
• Innocent – which are always systolic and are associated with any other abnormalities
• Functional – which are associated with high-output states
• Pathological – which are related to structural abnormalities.
• Location – area where the murmur is heard the loudest (e.g. mitral, pulmonic, etc.)
• Radiation – transmission of sounds from the specific valves to other adjacent anatomic areas. E.g.:

  Mitral murmurs can often radiate to the axilla.
• Timing – phase of the cardiac cycle in which the murmur is heard
• Murmurs can be further be characterized as pansystolic or holosystolic meaning that the murmur is heard throughout all of systolic. 
• Intensity – Loudness or intensity. The murmur is recorded with the grade over the roman numeral “VI” to show the scale being used.
• Quality – harsh, rumbling, blowing or musical.