Assessment of the
Cardiovascular System
Health Assessment Across the
Lifespan
NRS 102
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 19: Heart and Neck Vessels

Structure and Function

Subjective Data—Health History Questions

Objective Data—The Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-2
Chapter 19: Heart and Neck Vessels
Structure and Function
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Position and surface landmarks
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Precordium
Mediastinum
Apex and base of heart
Right and left cardiac borders
Great vessels
Heart wall
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Pericardium
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Myocardium
Endocardium
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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-3
Chapter 19: Heart and Neck Vessels
Precordium, Apex and Base
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-4
Chapter 19: Heart and Neck Vessels
Structure and Function
(cont.)
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Chambers
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Atria—right and left
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Ventricles—right and left
Valves
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Atrioventricular
• Tricuspid
• Mitral
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Semilunar
• Pulmonic
• Aortic
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-5
Chapter 19: Heart and Neck Vessels
Chambers and Valves
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-6
Chapter 19: Heart and Neck Vessels
Structure and Function
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Direction of blood
flow
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Cardiac cycle
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Diastole
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Systole
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Events in the right
and left sides
(cont.)
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
Heart sounds
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First heart sound
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Second heart sound
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Effect of respiration
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-7
Chapter 19: Heart and Neck Vessels
Structure and Function
(cont.)
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Extra heart sounds
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Third heart sound
 Fourth heart sound
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Murmurs
Characteristics of sound
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Frequency (pitch)
Intensity (loudness)
Duration
Timing
Conduction
Pumping ability
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Cardiac output
 Preload
 Afterload
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-8
Chapter 19: Heart and Neck Vessels
Structure and Function
(cont.)

Neck vessels
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Carotid artery
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Jugular veins
• Internal
• External
• Venous pulse and pressure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-9
Chapter 19: Heart and Neck Vessels
Neck Vessels
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-10
Chapter 19: Heart and Neck Vessels
Subjective Data—
Health History Questions
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Chest pain
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Dyspnea
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Orthopnea
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Cough
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Fatigue
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Cyanosis or pallor
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-11
Chapter 19: Heart and Neck Vessels
Health History Questions
(cont.)
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Edema
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Nocturia
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Cardiac history
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Family cardiac history

Personal habits (cardiac risk factors)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-12
Chapter 19: Heart and Neck Vessels
Objective Data—The Physical Exam
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Preparation
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Position and draping
Room preparation
Order of examination
Equipment needed
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Marking pen
Small centimeter ruler
Stethoscope with diaphragm and bell endpieces
Alcohol swab
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-13
Chapter 19: Heart and Neck Vessels
Objective Data—The Physical Exam
(cont.)
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Carotid arteries
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Palpate
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Auscultate for bruit
Jugular veins
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Inspect the jugular venous pulse
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Estimate the jugular venous pressure
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Palpate for hepatojugular reflux
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-14
Chapter 19: Heart and Neck Vessels
Objective Data—The Physical Exam
(cont.)
Precordium

Inspect the anterior chest
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Palpate the apical impulse
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Palpate across the precordium

Percuss to outline the cardiac borders
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-15
Chapter 19: Heart and Neck Vessels
Objective Data—The Physical Exam
(cont.)


Auscultate the heart sounds
Identify auscultatory areas
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Note the rate and rhythm
• Sinus arrhythmia
• Pulse deficit
Identify S1 and S2
• S1 is louder than S2 at the apex
• S1 coincides with carotid artery pulse
• S1 coincides with R wave on electrocardiogram
Listen to S1 and S2 separately
Listen for extra heart sounds
Listen for murmurs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-16
Chapter 19: Heart and Neck Vessels
Auscultatory Areas
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-17
Chapter 19: Heart and Neck Vessels
Objective Data—The Physical Exam
(cont.)

Characteristics of normal heart sounds
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Extra heart sounds
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First heart sound
Second heart sound
Splitting of second heart sound
Midsystolic click
Third heart sound
Fourth heart sound
Murmurs
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Timing
Loudness
Pitch
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Pattern
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Quality
Location
Radiation
Posture
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-18
Chapter 19: Heart and Neck Vessels
Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-19
Chapter 19: Heart and Neck Vessels
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-20
Chapter 19: Heart and Neck Vessels
Abnormal Findings
Diastolic Extra Sounds
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Mitral prosthetic valve sound
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Third heart sound

Fourth heart sound

Summation sound

Pericardial friction rub
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-21
Chapter 19: Heart and Neck Vessels
Abnormal Findings
Congenital Heart Defects
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Patent ductus arteriosus
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Atrial septal defect

Ventricular septal defect

Tetralogy of Fallot

Coarctation of the aorta
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-22
Chapter 19: Heart and Neck Vessels
Abnormal Findings
Murmurs Caused by Valvular Defects
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Midsystolic ejection
murmurs
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Diastolic rumbles of
atrioventricular valves
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Aortic stenosis

Mitral stenosis

Pulmonic stenosis

Tricuspid stenosis
Pansystolic regurgitant
murmurs

Early diastolic
murmurs

Mitral regurgitation

Aortic regurgitation

Tricuspid regurgitation

Pulmonic regurgitation
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 19-23