Heart and Neck Vessels
Cardiovascular System
• Heart & Blood Vessels
• Pulmonary Circulation
• Systemic Circulation
• Precordium – area of chest overlying heart
and great vessels.
– Arteries & veins connected to the heart
– Heart & Great vessels are b/t lungs in the
middle 1/3 of the thoracic cage = Mediastinum
Heart
• Location- Heart extends from the 2nd to 5th
ICS & from the Rt. Sternal border to the
Lt. MCL
• Base broader – upside down 
• Apex – points down & to the Lt.
• Rt. Side anterior
• Lt. Side posterior
• 4 Chambers
• Apical Pulse = during contraction, apex
beats against the chest wall. Usually
palpable in the Lt., 5th ICS, MCL
Great Vessels
• Above Base of the heart
• Superior & Inferior Vena Cava return
unoxygenated venous bld. to the Rt atrium
• Pulmonary Artery leaves the Rt. Ventricle,
bifurcates & goes to the lungs
• Pulmonary Veins return oxygenated bld. to
the Lt. Atrium
• Aorta carries the bld. to the body
• The aorta ascends from the Lt. Ventricle
arches back @ the sternal angle and
descends behind the heart
• Remember arteries always away from the
heart; veins always toward the heart
– Pulmonary artery to lungs, pulmonary veins to
heart
Heart Wall
• Pericardium – tough, fibrous, double-walled sac,
surrounds & protects the heart
– Has 2 layers containing pericardial fld.
– Adherent to great vessels, esophagus, sternum, &
pleurae & is anchored to the diaphragm
• Myocardium- muscular wall of the heart. It doesw
the pumping.
• Endocardium – thin layer of endothelial tissue ,
lines the inner surface of the heart chamber &
valves
Chambers of the Heart
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Right side – pumps blood to the lungs
Left side – pumps blood to the body
Septum- impermeable wall
2 Atria- holding chambers
2 Ventricles- muscular pumping chambers
– RA; RV; LA; LV
• Valves – separate the 4 chambers
– Prevent backflow
– Unidirectional
– Open & close passively in response to pressure
gradients in the moving bld.
Heart Valves
There are 4 heart valves
• 2 Atrioventricular – AV valves- separate the atria
& ventricles
• Rt. AV. = tricuspid
• Lt. AV. = mitral (bicuspid)
• Diastole = the heart’s filling phase; AV valves
open, ventricles fill with bld.
• Systole = pumping phase, AV valves close to
prevent backup
• Semilunar valves – b/t ventricles & arteries
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The SL valves are:
Pulmonic valve- rt. Side of the heart
Aortic valve – lt. Side of the heart
These valves open in systole (during pumping)
Cardiac Cycle
• 2 Phases
– Diastole – ventricles relaxed, tricuspid & mitral
valves open
• The ventricles fill, the AV valves close= S1 (lub) or
the 1st heart sound (remember the atria are filled,
the ventricles are empty creating the pressure
gradient)
Cardiac cycle
– Systole- ventricles are full, heart contracts, bld
is pumped to lungs & body
Heart Sounds
• S1 – 1st heart sound
• S2 – 2nd heart sound
• Extra Sounds
– 3rd heart sound – S3 – Ventricular Gallop
– 4th heart sound – S4 – Atrial Gallop
Heart Murmurs
• What are they?
• What causes a heart murmur?
Heart Automaticity
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Conduction
SA node – pacemaker
AV node
ECG
• Electrical impulse slightly precedes
mechanical events.
Pumping Ability
• 4-6 liters blood/min.
– Cardiac output
– Stroke volume
Neck Vessels
• Carotid Artery
• Jugular Veins
– Internal
– External
• Jugular Venous Pressure
– Measurement
– Angle of Louis
– Normal JVP = 2cm or <
Peripheral Vascular System
• Blood and Lymph Transportation
• Disease of Vascular System causes
problems with delivery of nutrients &
oxygen to tissues and removal of wastes.
Arteries
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Oxygenated blood to all body tissues
Strong & tough
Elastic fibers
Muscle fibers
Pulses
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Temporal
Carotid
Brachial
Radial
Ulnar
Femoral
Popliteal
Pulses
• Dorsalis pedis
• Posterior tibial
• Veins
– Greater #
– Closer to skin surface
Lymphatics
• Separate vessel system
• Excess fluid from tissue
• Prevents edema
Worksheet # 6
Subjective Data
• Chest pain
• Dyspnea, orthopnea, cough, fatigue,
cyanosis, pallor, edema, nocturia
• Past Cardiac History
• Last EKG
• Family history
• Personal habits
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Leg pain / cramps
Swelling or skin changes
Lymph node enlargement
Medications
Objective Data
• Measure B/P in both arms – lying, sitting, standing
• Palpate pulses bilaterally
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Temporal
Carotid * important to only palpate one side at a time *
Brachial
Radial
ulnar
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Femoral
Popliteal
Dorsalis pedis
Posterior tibial
Jugular Venous Pressure JVP
Supine- HOB 30-45 degrees, remove
pillow
Turn head away from examiner, shine light
across neck to highlight pulsation
Locate Angle of Louis & position a vertical
ruler on reference point
2nd ruler horizontal to level of pulsation
Read level on vertical ruler
Normal JVP = 2cm. or <
Inspect Precordial Area for
Retraction or Bulging
pulsation
• Palpate – use palmar aspect of fingers or
ulnar surface of hands to search for other
pulsations
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Sternoclavicular
Epigastric
Aortic – right 2nd interspace
Pulmonary – lt. 2nd interspace
– Right ventricular – lt. Lower sternal border, 5th
interspace
– Apical – 5th interspace left MCL
Percussion
• To outline heart’s borders
• Limited benefit with lg. Breasts, obese,
muscular chest wall
• Readily available
Percuss for Cardiac Enlargement
• Lt. Anterior axillary line 5th intercostal
space & toward the sternal border
• Resonance over lung – dull over heart
• Normal – lt. Border of cardiac dullness 5th
interspace MCL: @ 2nd interspace dullnes
coincides with the lt. Sternal border
• 2nd interspace to 5th MCL
Auscultate
• Inch stethoscope in a Z pattern from base of
heart, across & down to Apex
Aortic – 2nd rt. Interspace
Pulmonary – 2nd lt. Interspace
Erb’s Point – 3rd lt. Interspace
Tricuspid – 5th interspace lt. Lower sternal
border
Apical – 5th interspace lt. MCL APE To Man
Note during auscultation
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Rate
Rhythm
S1- Apex S2 – Base
Other sounds?
Murmurs
• Auscultate
– Left side lying
– Sitting leaning forward
• Observe skin, mucus membranes, nails and
chest
• Carotid Arteries
– Bruits
– Neck in neutral position
– Bell over carotid @ 3levels
• Angle of jaw
• Midcervical area
• Base of neck
Peripheral Vascular System
• Arms
– Inspect
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Skin color, nail beds
Temperature
Texture & turgor
Lesions, edema, clubbing (160 degree angle base =
Normal)
• Capillary refill <2sec.
• symmetry
Palpate
• Rate, rhythm, elasticity, force
Grade force as : 1 - 4
0 = absent
4 = bounding
Brachial, radial, ulnar
Edema
Allen Test
• Used to determine the patency of the ulnar
& radial artery
Hands on knees, palms up
Compress both radial arteries
Instruct to open & close fists several times
Open hands.
Results = pink color – ulnar artery patent
Repeat occluding ulnar artery
Legs
• Inspect
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Symmetry
Color
Hair distribution
Venous pattern
Measure calf circumference
Palpate Legs
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Femoral
Popliteal
Dorsalis pedis
Posterior tibial
Inguinal lymph nodes
• Edema
– Grade scale 1+ to 4+
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1+ slight indentation = 1cm.
2+ moderate = 2cm
3+ deep = 3cm.
4+ very deep = 4cm
( more accurate to classify by depth)