Chapter 19

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Heart and Neck VesselsHeart and Neck Vessels

Chapter 19Chapter 19


Chapter 19: Chapter 19: Heart and Neck Vessels

Slide 19-2

Structure and FunctionStructure and Function Subjective Data—Health History QuestionsSubjective Data—Health History Questions Objective Data—The Physical ExamObjective Data—The Physical Exam Abnormal FindingsAbnormal Findings



Slide 19-3

Structure and FunctionStructure and Function

Position and surface landmarksPosition and surface landmarks PrecordiumPrecordium MediastinumMediastinum Apex and base of heartApex and base of heart Right and left cardiac bordersRight and left cardiac borders Great vesselsGreat vessels

Heart wallHeart wall PericardiumPericardium MyocardiumMyocardium EndocardiumEndocardium



Slide 19-4

Precordium, Apex and BasePrecordium, Apex and Base

© Pat Thomas, 2006.



Slide 19-5

Structure and Function Structure and Function (cont.)(cont.)

ChambersChambers Atria—right and leftAtria—right and left Ventricles—right and leftVentricles—right and left

ValvesValves AtrioventricularAtrioventricular

• TricuspidTricuspid

• MitralMitral

SemilunarSemilunar• PulmonicPulmonic

• AorticAortic



Slide 19-6

Chambers and ValvesChambers and Valves

© Pat Thomas, 2006.



Slide 19-7

Structure and Function Structure and Function (cont.)(cont.) Direction of blood flowDirection of blood flow

Cardiac cycleCardiac cycle DiastoleDiastole SystoleSystole Events in the right and left Events in the right and left

sidessides Heart soundsHeart sounds

First heart soundFirst heart sound Second heart soundSecond heart sound Effect of respirationEffect of respiration

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Slide 19-8

Structure and Function Structure and Function (cont.)(cont.)

Extra heart soundsExtra heart sounds Third heart soundThird heart sound Fourth heart soundFourth heart sound

MurmursMurmurs Characteristics of soundCharacteristics of sound

Frequency (pitch)Frequency (pitch) Intensity (loudness)Intensity (loudness) DurationDuration TimingTiming

ConductionConduction Pumping abilityPumping ability

Cardiac outputCardiac output PreloadPreload AfterloadAfterload



Slide 19-9

Structure and FunctionStructure and Function (cont.)(cont.)

Neck vesselsNeck vessels Carotid arteryCarotid artery Jugular veinsJugular veins

• InternalInternal

• ExternalExternal

• Venous pulse and pressureVenous pulse and pressure



Slide 19-10

Neck VesselsNeck Vessels



Slide 19-11

Subjective Data—Subjective Data—Health History QuestionsHealth History Questions

Chest painChest pain DyspneaDyspnea OrthopneaOrthopnea CoughCough FatigueFatigue Cyanosis or pallorCyanosis or pallor



Slide 19-12

Health History Questions Health History Questions (cont.)(cont.)

EdemaEdema NocturiaNocturia Cardiac historyCardiac history Family cardiac historyFamily cardiac history Personal habits (cardiac risk factors)Personal habits (cardiac risk factors)



Slide 19-13

Objective Data—The Physical ExamObjective Data—The Physical Exam

PreparationPreparation Position and drapingPosition and draping Room preparationRoom preparation Order of examinationOrder of examination

Equipment neededEquipment needed Marking penMarking pen Small centimeter rulerSmall centimeter ruler Stethoscope with diaphragm and bell endpiecesStethoscope with diaphragm and bell endpieces Alcohol swabAlcohol swab



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Objective Data—The Physical Exam Objective Data—The Physical Exam (cont.)(cont.)

Carotid arteriesCarotid arteries PalpatePalpate AuscultateAuscultate for bruit for bruit

Jugular veinsJugular veins InspectInspect the jugular venous pulse the jugular venous pulse Estimate Estimate the jugular venous pressure the jugular venous pressure Palpate Palpate for hepatojugular refluxfor hepatojugular reflux



Slide 19-15


PrecordiumPrecordium InspectInspect the anterior chest the anterior chest PalpatePalpate the apical impulse the apical impulse PalpatePalpate across the precordium across the precordium PercussPercuss to outline the cardiac borders to outline the cardiac borders



Slide 19-16


AuscultateAuscultate the heart sounds the heart sounds Identify auscultatory areasIdentify auscultatory areas

Note the rate and rhythmNote the rate and rhythm• Sinus arrhythmiaSinus arrhythmia• Pulse deficitPulse deficit

Identify SIdentify S11 and S and S22

• SS11 is louder than S is louder than S22 at the apex at the apex• SS11 coincides with carotid artery pulse coincides with carotid artery pulse• SS11 coincides with R wave on electrocardiogram coincides with R wave on electrocardiogram

Listen to SListen to S11 and S and S22 separately separately Listen for extra heart soundsListen for extra heart sounds Listen for murmursListen for murmurs



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Auscultatory AreasAuscultatory Areas



Slide 19-18

Characteristics of normal heart soundsCharacteristics of normal heart sounds First heart soundFirst heart sound Second heart soundSecond heart sound Splitting of second heart soundSplitting of second heart sound

Extra heart soundsExtra heart sounds Midsystolic clickMidsystolic click Third heart soundThird heart sound Fourth heart soundFourth heart sound

MurmursMurmurs TimingTiming LoudnessLoudness PitchPitch PatternPattern

QualityQuality LocationLocation RadiationRadiation PosturePosture




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Sample ChartingSample Charting



Slide 19-20

Sample Charting Sample Charting (cont.)(cont.)



Slide 19-21

Abnormal FindingsAbnormal FindingsSystolic Extra SoundsSystolic Extra Sounds

Ejection clickEjection click Aortic prosthetic valve soundsAortic prosthetic valve sounds Midsystolic clickMidsystolic click



Slide 19-22

Abnormal FindingsAbnormal FindingsDiastolic Extra SoundsDiastolic Extra Sounds

Opening snapOpening snap Mitral prosthetic valve soundMitral prosthetic valve sound Third heart soundThird heart sound Fourth heart soundFourth heart sound Summation soundSummation sound Pericardial friction rubPericardial friction rub



Slide 19-23

Abnormal FindingsAbnormal FindingsAbnormal Pulsations on the PrecordiumAbnormal Pulsations on the Precordium

Thrill at the baseThrill at the base Lift (heave) at the sternal borderLift (heave) at the sternal border Volume overload at the apexVolume overload at the apex Pressure overload at the apex Pressure overload at the apex



Slide 19-24

Abnormal FindingsAbnormal FindingsCongenital Heart DefectsCongenital Heart Defects

Patent ductus arteriosusPatent ductus arteriosus Atrial septal defectAtrial septal defect Ventricular septal defectVentricular septal defect Tetralogy of FallotTetralogy of Fallot Coarctation of the aortaCoarctation of the aorta



Slide 19-25

Abnormal FindingsAbnormal FindingsMurmurs Caused by Valvular DefectsMurmurs Caused by Valvular Defects

Midsystolic ejection Midsystolic ejection murmursmurmurs Aortic stenosisAortic stenosis Pulmonic stenosisPulmonic stenosis

Pansystolic regurgitant Pansystolic regurgitant

murmursmurmurs Mitral regurgitationMitral regurgitation Tricuspid regurgitationTricuspid regurgitation

Diastolic rumbles of Diastolic rumbles of atrioventricular valvesatrioventricular valves Mitral stenosisMitral stenosis Tricuspid stenosisTricuspid stenosis

Early diastolic Early diastolic

murmursmurmurs Aortic regurgitationAortic regurgitation Pulmonic regurgitationPulmonic regurgitation

Chapter 19

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