CARDIOVASCULAR SYSTEM

• Pericardium has two layers: Fibrous and Serous
• FIBROUS - Strong, limits unnecessary movement of the heart; Fuses above with walls of great blood vessels (ascending aorta, pulmonary trunk and veins, superior and inferior vena cava); Firmly attached to central tendon
• SEROUS - Outer layer is parietal pericardium; Inner layer is visceral pericardium or epicardium; Visceral pericardium covers surface of heart except at openings of large vessels; Parietal pericardium lines fibrous pericardium; Space between these two layers forms serous pericardial cavity
• Serous has two layers: Parietal and Visceral
• Parietal - lines fibrous pericardium; reflected around roots of the great vessels; continuous with visceral layer
• Visceral - layer of serous that covers the heart
• Pericardial cavity - pericardial fluid, Hollow, muscular organ within the pericardium; Pyramidal in shape; Has three surfaces
• The pericardial cavity is divided by a vertical septum into four (4) chamber: Right Atrium, Right Ventricle, Left Atrium, Left Ventricle
• Heart makes two (2) sounds: Lub;Dub
• LUB - produced by contraction of ventricles and closure of both atrioventricular valves: tricuspid and mitral (bicuspid)
• DUB - shorter, produced by sharp closure of aortic and pulmonary valves
• Tricuspid Valve - Best heard over right half of lower end of body of sternum
• PULMONARY VALVE - Best heard of medial end of the 2nd left intercostal space
• MITRAL VALVE: Best heard over apex beat (level of 5th left intercostal space, [3.5 inches/9 cm from midline]
• AORTIC VALVE: Best heard of medial end of 2nd right intercostal space
• Blood vessels with 3 coats: Tunica Intima, Tunica Media, and Tunic Adventitia
• Tunica Media- smooth muscle cells and elastic fibers
• TUNICA INTIMA – endothelium that lines the lumen of all vessels
• TUNICA ADVENTITIA – collagen fibers
• Arteries - Carry oxygenated blood away from left portion of the heart and unoxygenated blood to lungs via pulmonary arteries
• Veins - Carry unoxygenated blood back to the right portion of the heart, except for pulmonary veins w/c carry oxygenated blood from lungs to left heart
• CAPILLARIES - Connect arterial and venous system for exchange of gases, fluids, nutrients, and wastes.
• CAPILLARIES - Single layer of microscopic endothelial cells
• THE PROCEDURE • Explain to the client • Wash hands • Provide privacy • Inquire client’s family & Health history • Simultaneously inspect and palpate the precordium • Ensure the patient is in a supine position at an angle of 45 degrees
• 1. Inspect: PRECORDIUM • The aortic & pulmonic area • Tricuspid area for pulsations, heaves or lifts. Apical area for pulsation • apical pulse located on right side of precordium indicates dextrocardia, congenital heart disease
• HEAVES → lifting of chest wall secondary to right ventricular hypertrophy
• Apical pulsation displaced toward axillary line indicates LEFT VENTRICULAR HYPERTROPHY
• Epigastric area at the base of the sternum for ABDOMINAL AORTIC PULSATION
• Pulsations to right of sternum or at epigastric area or sternoclavicular area = AORTIC ANEURYSM
• 2. Palpate: PRECORDIUM: Aortic, Pulmonic, Erb's Point, Tricuspid, and Mitral
• AORTIC - 2nd ICS right sternal border
• ERB’S POINT - 3rd ICS left sternal border
• PULMONIC - 2nd ICS left sternal border
• MITRAL - 5th ICS @ mid clavicular line, PMI
• Erb's point - the auscultation location for heart sounds and heart murmurs
• TRICUSPID - 5th ICS lower left sternal border
• turbulent flow in the heart is referred to as MURMUR
• whole turbulent flow outside of the heart is a BRUIT
• when using diaphragm → use firm pressure
• when using bell → use light pressure