Untitled

• Cardiovascular system


  • Delivers oxygenated blood
  • Removes waste products
  • ANS (Autonomic Nervous System) controls heart pumps
  • Vascular network: arteries, veins, capillaries carry blood throughout the body, keeps heart filled with blood and maintains blood pressure
• Heart

  • Heart and major blood vessels lie centrally in the chest behind the protective sternum
  • Cone-shaped (inverted)
  • A double pump about the size of a clenched fist (12 cm long and 9 cm wide)
  • 250–390 g (8.8 13.8 oz) in adult males
  • 200–275 g (7.0–9.7 oz) in adult females
  • Pumps blood throughout circulatory system

  
• Right Atrium


  Receives DEOXYGENTAED blood from the body via superior and inferior vena cava
• Right Ventricle


  Receives blood from the right atrium and pumps it to the lungs via the pulmonary artery
• Left Atrium


  Receives OXYGENATED blood from the lungs via four pulmonary veins
• Left Ventricle


  Receives OXYGENATED blood from the lungs via the left atrium pumps blood into the systemic circulation via the aorta – the largest and most muscular chamber
• Tricuspid Valve


  Right side of the heart, has three leaflets and prevents backflow of blood from the right ventricle to the right atrium

  
• Bicuspid (Mitral) Valve


  Left side of the heart, has two leaflets, and prevents backflow of blood from left ventricle to the left atrium
• Pulmonic Valve


  Between the right ventricle and the pulmonary artery and prevents backflow of blood from pulmonary trunk to the right ventricle

  
• Aortic Valve


  Between the left ventricle and the Aorta prevents backflow of blood from the aorta into the left ventricle
• S1 "lub"


  First heart sound, result of closure of the AV valves, correlates with the beginning of SYSTOLE, heard at the base & apex of the heart (softer at base, louder at apex)

  
• S2 "dub"


  Second heart sound, results from closure of the SA valves, correlates with the beginning of DIASTOLE, best heard at base of the heart
• S3


  Ventricular gallop, can be heard early in diastole, after S2, when the mitral valve opens

  
• S4


  Atrial gallop, results from ventricular vibrations secondary to ventricular resistance during atrial contraction, can be heard late in diastole, just before S1
• Murmurs


  Blood NORMALLY flows silently through the heart, in conditions of an audible and prolonged sounds, murmurs are auscultated over the precordium, a swooshing or blowing sound resulting from turbulence created within the vascular system

  
• Conditions that contribute to turbulent blood flow

  • Increased blood velocity
  • Structural valve defects
  • Valve malfunction
  • Abnormal chamber opening (septal defect)

  
• Aortic Area


  2nd ICS at the right sternal border, base of the heart
• Pulmonic Area


  2nd or 3rd ICS at the left sternal border, base of the heart
• Erb's Point


  3rd to 5th ICS at the left sternal border
• Mitral (Apical)


  5th ICS near the left MCL, apex of the heart
• Tricuspid Area


  4th or 5th ICS at the left lower sternal border
• 4 valve areas do not reflect the anatomical position of the valves
• Sounds ALWAYS travel in the direction of the blood flow
• The areas described in the traditional auscultation overlaps extensively and sounds produced by the valves can be heard all over the precordium
• Korotkoff's Sounds


  • Phase I: A faint, clear, rhythmic tapping noise that gradually increases in intensity
  • Phase II: A swishing sound that is heard as the vessel distends with blood
  • Phase III: Sounds become more intense, vessel is open in systole but not in diastole
  • Phase IV: Sounds begin to muffle, and pressure is closest to diastolic arterial pressure
  • Phase V: Sounds disappear because vessel remains open

  
• Assessment Proper


  1. I P P A

  2. Perform the assessment in 3 positions: sitting, supine, and left lateral

  3. Semi Fowler's position (30° - 45°)

  4. High Fowler's position (90°)
• Normal Carotids


  • Visible pulsation
  • Palpable pulsation
  • Not affected by respiration
  • Not affected by position

  
• Normal Jugulars


  • Undulated wave
  • Obliterated
  • Affected by respiration
  • Normally only visible when client is supine

  
• Deviations from normal in Neck


  • Large, bounding visible pulsation in neck of suprasternal notch: HTN, aortic stenosis, aneurysm
  • Abnormal venous waveforms: Giant A waves (Tricuspid stenosis, right ventricular hypertrophy, Cor pulmonale)
  • Absent A wave (Atrial fibrillation)

  
• Normal Precordium


  • Positive pulsation at apex
  • Slight pulsations over base in thin adults and children

  
• Deviations from normal in Precordium

  • Pulsation may occur: Right sternum, Epigastric area, Sternoclavicular areas (Aortic aneurysm)
  • Apical pulsation displaced toward axillary line (Left ventricular hypertrophy)

  
• Palpating Jugular Veins


  3 ways: Assessing Jugular Flow, Checking Jugular Fill, Testing Abdominojugular (Hepatojugular) Reflux

  
• Deviations from normal in Cardiac Rate

  • Cardiac rate > 100 bpm: Sinus tachycardia, Supraventricular tachycardia (SVT), Paroxysmal tachycardia (PAT), Uncontrolled atrial fibrillation, Ventricular tachycardia (causes include CHF drugs, HYPERCALCEMIA)
  • Cardiac rate < 60 bpm: Sinus bradycardia, heart block

  
• Checking Jugular Fill


  1. Compress jugular above clavicle

  2. Jugular distends and jugular wave disappears

  
• Testing Abdominojugular (Hepatojugular) Reflux

  1. Position patient at 45-degree angle, place hands over the midabdominal area and apply 20 to 30 mm Hg of pressure for about 15 to 30 sec

  2. Estimate the pressure by placing a partially inflated BP cuff on the abdomen under your hand

  3. Look at the jugular veins while applying pressure, note increase vein distension, return to normal upon release of pressure

  
• Deviations from normal cardiac rate

  • Cardiac rate > 100 bpm: Sinus tachycardia, Supraventricular tachycardia (SVT), Paroxysmal tachycardia (PAT), Uncontrolled atrial fibrillation, Ventricular tachycardia
  • Cardiac rate < 60 bpm: Sinus bradycardia heart block

  
• Causes of deviations from normal cardiac rate

  • Cardiac rate > 100 bpm: CHF drugs (atropine, nitrates, epinephrine, isoproterenol), nicotine, caffeine, HYPERCALCEMIA
  • Cardiac rate < 60 bpm: MI drugs (digoxin, quinidine, procainamide, beta-adrenergic inhibitors), HYPERKALEMIA
• Deviations from normal rhythm

  • Irregular rhythm: Arrythmia (abnormal pulses, unequal pulses), Obstruction or occlusion (stiff, cordlike arteries), Right-sided CHF, tricuspid regurgitation, tricuspid stenosis, constrictive pericarditis, cardiac tamponade, inferior vena cava obstruction, HYPERVOLEMIA
• Apex (left ventricular area)


  • PMI is 1-2 cm, Negative thrills, Amplitude may normally be increased in high-output states, Apical pulsation may not always be palpable, Left lateral displacement of PMI may occur during the last trimester of pregnancy

  
• LLSB (tricuspid area)


  • May not be palpable, although small, no sustained, systolic impulse may be palpated, especially in thin patients, Negative thrills