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KULIAH SISTEMKARDIOVASKULAR


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THE CARDIOVASCULAR SYSTEM

A. ANATOMY AND PHYSIOLOGY

B. THE HEART

C. THE ARTERIAL PULSE

D. BLOOD PRESSURE


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A. ANATOMY AND

PHYSIOLOGY1. SUFACE PROJECTION OF THE HEART AND

GREAT VESSELS

Right Ventricle :

( + ) the pulmonary artery A Wedgelike structure

behind and to the left f the sternum

Inferior border : below the junctional of the sternumand the Xiphoid Process

Meets The pulmonary artery : 3rdleft costal cartilage

close to the sternum


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Left Ventricle : Lying to the left of and behind to the right ventricle

Forms the left border of the heart and produces the apical

impulse ( 5thinterspace, 7-9 cm from the midsternal )

Right Atrium :

Forms the right border of the heart

Not usually identifiable on physical examination


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Left Atrium :

Mostly posterior and cannot be examined directly

The Aorta :

Curves upward from the left ventricle to the level of thesternal angle arches backward down

The superior Vena Cava :

on the right, empties into the right atrium

The Inferior Vena Cava :

Base :the right and the left 2nd interspace close to thesternum


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2. CARDIAC VALVES

Tricuspid left atrioventricular valvemitral right atrioventricular valve

Aortic and Pulmonic semilunar valve

As the heart valve close normal heart sounds

3. CARDIAC CYCLE

Systole the period of ventricular contraction

Diastole the period of ventricular contraction


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4. HEART SOUND

S1 2 COMPONENTS :

Mitral sound : much louder, can be heard best at thecardiac apex

Tricuspid sound : softer, heard best at the louder left sternalborder

S2 2 OMPONENTS :

The Aortic valve closure ( A2 )

The pulmonic value closure ( p2 )

S3 Rapid ventricular filling as blood flows early indiastole rom left atrim to left ventricle


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S4 ATRIAL CONTRACTION

EARLY SYSTOLIC EJECTION SOUND ( EJ )

Accompanied the opening of the aortic valve

OPENING SNAP ( OS ) The mitral valve opens ( in

mitral stenosis )


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5. HEART MURMURS

LONGER DURTION

ATRIBUTED TO TURBULENT BLOOD FLOW

MAY INDICATE SERIOUS DISEASE THE MEANING OF MURMUR MUST BE ABLE TO

TIME THEM IN THE CARDIAC CYCLE ANDIDENTIFY WHERE THEY CAN BE HEARD BEST

6. RELATION OF AUSCULTATORY FINDINGS TO THECHEST WALL SOUND AND MURMUR THATORINATE IN :

The Mitral valve at and around the cardiac apex

The Tricuspid valve the lower left sternal border

The Pulmonic valve the 2ndand 3rdleft interspace close tothe sternum

The Aortic valve may be heard anywhere from the right2ndinterspace to the apex


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If ( - ) ask patient to exhale fully and stop breathing for

a few second

If ( + ) make finer assessments with fingertips and then

withone finger ( location, diameter, amplitude and duration

)


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THE LEFT STERNAL BORDER IN THE 3RD, 4TH AND

INTERSPACE ( RIGHT VENTRICULAR AREA )

The patient should rest supine at 30o

Place the tips of your curved finger in the 3rd, 4th,and 5th

interspace and try to feel the systolic impuls of the right

ventricle

Improves your observation asking the patient to breath

out and then briefly stop breathing

Location, amplitude and duration


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THE EPIGASTRIC ( SUB XIPHOPID ) AREA

Useful when examine a person with an increased

anteroposterior diameter of the chest

2. PERCUSSION

IN MOST CASES, PALPITATION HAS REPLACEDPERCUSION IN THE ESTIMATION OF THE

CARDIAC SIZE

PERSUS FROM RESONANCE TOWARD CARDIAC

DULLNESS IN THE 3RD

, 4TH

, 5TH

AND POSSIBLY6THINTERSPACES ( THE LEFT ON THE CHEST )


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3.AUSCULTATION

LOCATION : 2ndinterspace close to the sternum ( right aortic, lelt

pulmonic )

Along the left sternal border in each interspace from 2nd

through 5th

interspaces ( tricuspid ) The apex ( mitral ) if the heart is enlargedor displaced, you

should alter your pattern accordinely

SEQUENCE :BASE APEX OR APEX BASE

STETOSCOPE : THE DIAPRAGHM S1 AND S2 ;MURMUR OF AORTIC AND MITRAL REGURTATION

THE BELL S3 AND S4 ; MURMUR OF MITRAL

STENOSIS


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POSITION :

Supine entire precordium

Roll partly ontothe left side the apical impulse ( bell )

Sit up, lean forward, exhale completely and stop breathing

along the left sternal border and at the apex ( diaphraem ).

Pausing periodically so the patient may breath .

WHAT TO LISTEN FOR ?

S1 intensity, spliting ?

S2 intensity, spliting ?

Extra sound in systole ( ejection sound or systole click )

Extra sound in diastole ( S3, S4, or opening snap )

Systolic murmurs

Diastolic murmurs


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C. ARTERIAL PRESSURE

HEART RATE

The Radial Pulse

The pads of your index and middle fingers a maximalpulsation is detected

Rhythm is regular and the rate seems normal 15 seconds

and multiply by 4

The Rate is unusual , fast or slow 60 seconds

The rhythm is irregular the rate should be evaluated by

cardiac auscultation


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D. BLOOD PRESSURE CHOICE OF SPHYGMOMANOMETER

Choose a cuff of appropriate size

The inflatable bladder of the cuff :

- Width about 40 % of limbs circumference

- Length about 80 % of limbs circumference

Aneroid or Mercury Type

An aneroid instrument often becomes inaccurate with

repeated use so it should be recalibrated periodically


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TECHNIQUE

- Avoid smoking or ingesting caffeine for 30 minutes

- Rest for at least 5 minutes

- The room should be quiet and comfortably warm

- The arm selected should be resting and free of

clothing

- Free of : a. Arteriovenous fistules for dyalisis

b. Scarring from Brachia Artery

cutdown

c. Lymphedema


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- The Brachial Artery should at the heart level

( 4th interspace at its junction with the sternum )

- The patients arm so that it is slightly flexed at the

elbow

- The inflatable bladder over The Brachial Artery

- The lower border of the cuff should be about 2,5

cm above The Antecubital Crease


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1. Feel The Radial Artery with the fingers of one hands

rapidly inflate the cuff until the radial pulse disappears

2. Read this pressure on the manometer and add 30

mmHg to it

3. Deflate the cuff promptly and completely and wait 15

30 minutes

4. Place the bell of a stethoscope lightly over The

Brachial Artery

5. Inflate The Cuff rapidly again to the level just determined

and then deflate it slowly at a rate of about 2-3 mmHgg /

seconds


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6. Note the level at which you hear the sounds of at least twoconsecutive beats ( Systolic Pressure )

7. Continue to pressure slowly until the sounds become

muffled and then disappear ( Diastolic Pressure )

8. To confirm the disappearance of sounds, listen as thepresure falls another 10-20 mmHg then deflate the cuff

rapidly

9. Wait 2 or more minutes and repeat and take the

average. If the first two readings differ by more than

5 mmHg, take the additional readings