Chapter 19ConceptsReview of A & PReview: Structure and Function Position and Surface LandmarksSlide 5Review: Structure and Function Internal Position and Landmarks of the HeartHeart: Middle and Front SectionsResults of Coronary Flow ImpedimentElectrical Impulse CirculationStructure and Function (cont.)Review: Structure and Function Blood Flow, Cardiac Cycle and Heart SoundsSlide 12Slide 13PQRST and the Cardiac CycleOther TerminologyPumping Ability of HeartNeck VesselsSubjective Data: Health History QuestionsP Q R S TObjective Data: The Physical ExamSequence of ExamInspectionInspection: Carotid Arteries and Jugular VeinsMeasure for Jugular Vein DistensionInternal Jugular VeinEstimating Jugular Venous PressureJVD ReadingsSlide 28Inspect ChestInspect the PrecordiumPalpationPalpate the PrecordiumApical Impulse or PMIInspection and Palpation: Normal v. Abnormal“Noises” of the Heart and their CausesAuscultationPositioning the Patient for AuscultationAuscultation LocationsSlide 39Slide 40Slide 41S1 & S2Auscultating S1 and S2S3 and S4 SoundsSlide 45Listen for MurmursAuscultation of MurmursSlide 48Listen to MurmursAuscultation of Carotid ArteryAuscultation: Normal v. AbnormalCommon Abnormalities: Congestive Heart FailureClinical Portrait of Heart FailureCongestive Heart Failure cont’d.Other Degenerative Cardiovascular DisordersSlide 56Cardiac TamponadeValve DiseaseSlide 59Risk Factors for CADCultural ConsiderationsEnvironmental FactorsAge ConsiderationsAge Considerations cont’dDocumentation Example: NormalSummary of Cardiac AssessmentChapter 19Chapter 19Heart and Neck VesselsHeart and Neck VesselsConceptsConceptsReview of cardiac Review of cardiac A&PA&PMeasurement of JVDMeasurement of JVDInspectionInspectionThrillsThrillsHeavesHeavesPalpationPalpationAusculation of HeartAusculation of HeartSequenceSequenceMurmursMurmursExtra heart soundsExtra heart soundsPathologyPathologyReview of A & PReview of A & PVideo: Heart and circulatory system — HoVideo: Heart and circulatory system — How they work - MayoClinic.comw they work - MayoClinic.comReview: Structure and FunctionReview: Structure and FunctionPosition and Surface LandmarksPosition and Surface LandmarksPrecordiumPrecordiumMediastinumMediastinumPericaridumPericaridumApex and base of heartApex and base of heartR and L cardiac bordersR and L cardiac bordersGreat vesselsGreat vesselsReview: Structure and Function Review: Structure and Function Internal Position and Landmarks of the HeartInternal Position and Landmarks of the HeartChambersChambersAtria: R and LAtria: R and LVentricles: R and LVentricles: R and LValvesValvesAtrioventricularAtrioventricularTricuspidTricuspidMitralMitralSemilunarSemilunarPulmonicPulmonicAorticAorticHeart: Middle and Front SectionsHeart: Middle and Front SectionsResults of Coronary Flow Results of Coronary Flow ImpedimentImpedimentIschemiaIschemiaInjuryInjuryInfarctionInfarctionElectrical Impulse CirculationElectrical Impulse CirculationStructure and FunctionStructure and Function (cont.)(cont.)Cardiac cycleCardiac cycleRhythmic flow of blood through heart is Rhythmic flow of blood through heart is cardiac cyclecardiac cycle•Has two phases, diastole and systoleHas two phases, diastole and systole•Diastole:Diastole:•Systole:Systole:Slide 19-Slide 19-1010Review: Structure and FunctionReview: Structure and FunctionBlood Flow, Cardiac Cycle and Heart SoundsBlood Flow, Cardiac Cycle and Heart Sounds**Direction of blood flowDirection of blood flow**Cardiac cycle:Cardiac cycle: **Heart Sounds:Heart Sounds:SystoleSystole 1st heart sound (S1): Closure of 1st heart sound (S1): Closure of the the A-V valves (mitral & tricuspid)A-V valves (mitral & tricuspid)DiastoleDiastole 2nd heart sound (S2): Closure of 2nd heart sound (S2): Closure of the semi-lunar valves (aortic the semi-lunar valves (aortic and pulmonic valuesand pulmonic values 3rd & 4th heart sounds (S3 and S4)3rd & 4th heart sounds (S3 and S4)PQRST and the Cardiac CyclePQRST and the Cardiac CycleECG SegmentECG SegmentCorrelating Component of cardiac cycleCorrelating Component of cardiac cycleP waveP waveImpulse spreads through atria – atrial systoleImpulse spreads through atria – atrial systole(atrial depolarization)(atrial depolarization)PR intervalPR intervalPassage of impulse from SA node through atria Passage of impulse from SA node through atria to AV node: time form initial stimulation of atria to AV node: time form initial stimulation of atria to initial stimulation of ventriclesto initial stimulation of ventriclesQRS complexQRS complexSpread of impulse through ventricles – Spread of impulse through ventricles – ventricular systole (ventricle depolarization)ventricular systole (ventricle depolarization)ST segment and T ST segment and T wavewaveVentricular muscle returns to resting state Ventricular muscle returns to resting state (ventricular repolarization)(ventricular repolarization)QT intervalQT intervalPeriod from beginning of ventricular Period from beginning of ventricular depolarization to moment of repolarization: depolarization to moment of repolarization: ventricular contractionventricular contractionOther TerminologyOther TerminologyStroke volumeStroke volumeAmount of blood ejected every heartbeatAmount of blood ejected every heartbeatCardiac outputCardiac outputAmount of blood ejected from L ventricle over Amount of blood ejected from L ventricle over 1 minute1 minutePumping Ability of HeartPumping Ability of HeartCardiac output: Cardiac output: CO = Stroke Volume X HR for 1 minuteCO = Stroke Volume X HR for 1 minutePreloadPreloadAfterloadAfterloadNeck VesselsNeck VesselsCarotid arteriesCarotid arteriesJugular veinsJugular veinsSubjective Data: Subjective Data: Health History QuestionsHealth History QuestionsChest painChest painDyspneaDyspneaOrthopneaOrthopneaSyncopeSyncopePalpitationsPalpitationsCoughCoughFatigueFatigueCyanosis or pallorCyanosis or pallorEdemaEdemaNocturiaNocturiaPast cardiac historyPast cardiac historyPast illnesses (r.f.?)Past illnesses (r.f.?)Family cardiac historyFamily cardiac historyChest injuries/traumaChest injuries/traumaPersonal habits (diet, Personal habits (diet, exercise, sleep, smoking, exercise, sleep, smoking, alcohol and drug use, alcohol and drug use, stress management)stress management)P Q R S TP