Assessment of Heart and
Great Vessels
Christine M. Wilson
Viterbo University
Objectives
Landmarks
 Structures
 Cardiac cycle
 Developmental/transcultural
 Risk factors
 Subjective data
 Objective data

Position in the Chest
 Beneath
precordium—area on
anterior chest overlying the heart
and great vessels
 Located in mediastinum—middle
third of chest—between the lungs
 Heart
is an
upside down
triangle in the
chest
 Top of heart is
Base, bottom is
Apex
 Extends
from
2nd to 5th ICS
and from Rt
sternal border to
Lt MCL
 Great vessels
above base of
heart
Blood Flow
Inferior vena cava
 Right atrium
 Right ventricle
 Pulmonary artery
 Pulmonary vein
 Left atrium
 Left ventricle
 Aorta

Valves of the Heart
 Tricuspid
valve:
right AV
 It is the closure
of the heart
 Mitral valve: left
AV
valves that we
 Pulmonic Valve:
hear as heart
right
sounds.
 Aortic Valve: left
Cardiac Cycle
Diastole
 Tricuspid/mitral valves
open
 Ventricles relax and
fill with blood
 Ventricular pressures
increases
 Tricuspid/mitral valves
close causing first
heart sound S1
 LUB dub
Systole
 Ventricular
contraction increases
pressure
 Pulmonic/aortic valves
open; blood ejects
 Ventricular pressure
drops
 Pulmonic/aortic valves
close causing second
heart sound S2
 lub DUB
More heart sounds

Events of right heart occur slightly later
– S1 Mitral valve closes then tricuspid
– S2 Aortic valve closes then pulmonic

Sound radiates with direction of blood flow
– S1 heard loudest at apex
– S2 heard loudest at base

Murmurs—turbulent flow through
chambers and valves
– Swooshing, blowing sound
Pumping ability
Right side pumps blood to lungs
 Left side pumps blood to body
 Cardiac output—volume of blood pumped
per minute

– dependent upon volume ejected per stroke
and heart rate (CO=SV x rate)
– Normal cardiac output 4-6 L per minute
Great Vessels—Neck

Carotid arteries
– Central arteries
branching from
aorta

Jugular veins
– Internal and
external
– Empty into
superior vena
cava
Developmental Considerations
Fetal
Fetal heart begins to beat at 3 weeks
 Oxygenation takes place through the
placenta
 Blood returned to the Right side of the
heart and bypasses lungs

– Foramen ovale-opening between atrium
– Ductus arteriosus-opening b/tw PA and Aorta
Fetal Circulation
Changes take place at birth!
 Blood
is oxygenated through lungs
 Foramen ovale closes in one hour
 Ductus Arteriosus closes in
10-15 hours
 Left ventricle pumps blood to entire
body; by one year, left ventricle twice
as large as the right
Pregnant Female
 Blood
volume increases by 30-40%,
mostly during the 2nd trimester
 Increases Stroke Volume and CO
 Rate increases by 10-15 BPM
Aging Adult
 Cardiac
aging depends on
lifestyle factors
 Stiffening of large arteries due to
calcification of vessel walls causes
increased workload for heart
–BP increases by 25-30%
–LV wall thickness increases by
25%
Aging Adult (con’t)
Arrhymias increase with age
 Conduction changes are common
 50% of deaths in elderly due to
cardiovascular disease
 Hypertension increases with age

– Systolic greater than 140 and Diastolic
greater than 90

Heart failure common
Transcultural Considerations
Heart Disease and Stroke
 1/3 of deaths from culturally diverse
backgrounds
 Prevalence higher in blacks, followed by
whites, then Mexican Americans
 Native Americans (<35) CAD 2X greater
than other groups
 Black males 2X more likely to die from
stroke as white males
Transcultural Considerations
Heart Disease and Stroke (con’t)
 Blacks 20-40 years
– Increased # of deaths from CVD
compared to whites
– Increased mortality in black females
over black males
 Black and Mexican American females
higher CVD risk factors
Risk Factors for Heart Disease,
Stroke, and Hypertension
 Smoking
 Increased
cholesterol levels (LDL)
 Obesity
 Diabetes
 Oral
contraceptives
 Post-menopause
Subjective Data
Chest Pain
 Dyspnea
 Orthopnea
 Cough
 Fatigue
 Cyanosis or pallor

Edema
 Nocturia
 Past cardiac history
 Family cardiac
history
 Cardiac risk factors

Objective Assessment
Order of the exam
 Pulse and blood pressure
 Extremities:Peripheral Vascular System
 Neck Vessels
 Precordium
The Neck Vessels
Carotid arteries
 Palpate
–Individually, with gentle touch
 Auscultate
–Angle of jaw, mid-cervical, base of
neck
–Patient to exhale and hold breath
The Precordium
 Inspect
for pulsations
 Palpate the apical pulse
–5th ICS MCL
–“Bump” of the left ventricle
against chest wall during systole
 Palpate apex, Lt sternal border,
base
 Percussion not usually done
Auscultation
Areas to listen
 Aortic valve area: 2nd Rt. intercostal space
 Pulmonic area: 2nd Lt. intercostal space
 Erb’s Point: 3rd Lt. intercostal space
 Tricuspid area: 5th Lt. intercostal space
 Mitral area: 5th intercostal space at MCL
Heart Ascultation Areas
Ascultation tips
Concentrate
 Inch diaphragm in Z pattern, base to apex

– Aortic—pulmonic—Erb’s—tricuspid—mitral

Listen to one sound at a time
– Rate
– Rhythm
– Identify and assess S1 and S2 separately

Listen for extra sounds
REMEMBER
S1 is louder than
S2 at Apex.
 S2 is louder than
S1 at Base.
 S1 coincides with
the Carotid artery
pulse

 Visualize
what’s
under the skin