HEART ASSESSMENT

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HEART ASSESSMENT
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HEART ANATOMY

• RIGHT VENTRICLE
• LEFT VENTRICLE
• RIGHT ATRIUM
• LEFT ATRIUM
• SUPERIOR AND INFERIOR VENA CAVA
• PULMONARY ARTERY
• PULMONARY VEIN
• AORTA

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ANATOMY CONT

• THREE LAYERS
• - pericardium
• - myocardium
• - endocardium
• TWO PUMPS
• Right side pumps blood to lungs
• Left side pumps blood to body
• FOUR VALVES- tricuspid, mitral, pulmonic, aortic

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CARDIAC CYCLE

• DIASTOLE
• - Ventricles are relaxed, AV valves open
• - Blood pours rapidly into ventricles
• - Atria contract to push last amt of blood-
• presystole
• SYSTOLE
• Mitral and tricuspid valves close, S1 beginning
  of systole
• Left ventricular pressure gt aortic pressure ?
  aortic valve opens, blood ejected
• Semilunar valves close ? S2, end of systole

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HEART SOUNDS

• S1- closure of AV, beginning of systole, heard
  best at apex
• S2- closure of semilunar valves, end of systole,
  heard best at base
• Respiration effect- MoRe to the Right Heart, Less
  to the Left
• S3 and S4- ventricular filling sounds
• Murmur- gentle, swooshing sound due
• Described by frequency, intensity, duration,
  timing

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CONDUCTION

• SA node- pacemaker ? AV node ? Bundle of His ?
  Bundle branches ? ventricles
• ECG- measures electrical impulses
• P wave
• PR interval
• QRS complex
• T wave

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PUMPING ABILITY

• Cardiac Output Stroke Volume X Rate
• PRELOAD
• AFTERLOAD

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NECK VESSELS

• CAROTID ARTERY
• JUGULAR VENOUS PULSE AND PRESSURE
• - Internal
• - External
• - Comparison of ECG and Jugular Venous
• Pulse- p. 493

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AGING ADULT

• Systolic BP ? 20 mm Hg between 20-60 yrs.,
• ? another 20 mm Hg between 60-80 yrs.
• Left ventricular wall thickens to adapt to large
  artery stiffening
• ? systolic BP with constant diastolic BP ? ?
  pulse pressure
• No change in CO at rest
• ? ability of heart to adjust CO to ? exercise

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AGING ADULT CONT

• ? ARRHYTHMIAS
• ? CAD
• ? ECG CHANGES
• ? HYPERTENSION
• ? HEART FAILURE

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TRANSCULTURAL

• Heart disease and stroke ? among black adults
• High Blood Pressure- Blacks, Mexican- Americans
  and Native Americans have higher incidence
• Smoking- adult Black and Native American men
  smoke more than white men
• Serum cholesterol- higher in adult White and
  Native American populations
• Obesity
• Diabetes

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SUBJECTIVE DATA

• CHEST PAIN
• DYSPNEA
• ORTHOPNEA
• COUGH
• FATIGUE
• CYANOSIS, PALLOR
• EDEMA
• NOCTURIA
• PAST CARDIAC HISTORY
• FAMILY CARDIAC HISTORY
• PERSONAL HABITS

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OBJECTIVE DATA

• PREPARATION
• ASSESSMENT ORDER
• - Pulse, BP
• - Extremities
• - Neck vessels
• - Precordium

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NECK VESSELS

• Palpate carotid artery- one side at a time
• Auscultate carotid artery- Listen at the
• -
• -
• -
• Jugular Venous Pulse- put pt at 30- 45
• Turn pt head away from side youre observing
• Characteristics of jugular vs carotid, p. 502

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PRECORDIUM

• INSPECTION- apical impulse
• PALPATION- apical impulse, note location, size,
  amplitude, duration
• PERCUSSION
• AUSCULTATION- four areas
• - 2nd right interspace
• - 2nd left interspace
• - left lower sternal border
• - 5th interspace at left midclavic. line

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Auscultation cont

• Note the rate, rhythm
• - pulse deficit
• Identify S1 and S2
• - S1 coincides with the carotid artery pulse
• Assess S1 and S2 separately
• Listen for extra heart sounds- S3 and S4
• Listen for murmurs

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