Heart and Neck Vessels (Cardiovascular System)
Direction of Blood Flow in Heart
Return via the Pulmonic Veins
Cardiac Cycle: Rhythmic movement of blood through the heart p.497
Phases:
o Diastole – ventricles relax and fill with blood , 2/3rd of the cardiac cycle
o Systole – heart’s contraction, blood pumped from the ventricles and fills the
pulmonary and systemic arteries, 1/3rd of the cardiac cycle
Heart Sounds
First heart sounds (S1) – closure of the AV valves(mitral and tricuspid valve close),
beginning of systole,
Second Heart sounds (S2) – closure of the SL valves (aortic and pulmonic valve), end of
systole
, Extra Heart Sounds:
3rd Heart Sound – ventricles resistant to filling during the early rapid filling phase , occurs
after S2
4th heart sound – occurs at the end of diastole, when the ventricle is resistant to filling at
presystole
Characteristics of sound
Frequency (pitch) – high pitched or low pitched
Intensity – loud or soft
Duration – very short for heart sounds, silent periods are longer
Timing – systole or diastole
Palpation
Carotid arteries (p.511)
Assess for strength, symmetry, and grade of pulses
o Normal finding = 2+ equal bilaterally
o Abnormal Finding = bruit indicates turbulence with a local vascular cause such as
atherosclerotic narrowing
Carotids should be assessed one at a time
Inspection
Clients’ anterior chest for skin color, scars, deformities (p.494 and 512)
Observe for pulsation at the apical impulse (located in the heart apex at the 4th or 5th ICS
at the left MCL
o Normal Finding = present or absent in apical impulse with no heaves or lifts
present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole
Palpation (p.512-513)
Palpate across the precordium (the chest wall)
Including the aortic, pulmonic, Erb’s point, the tricuspid and the mitral areas (the same as
the auscultations sites)
Palpate for anomalies such as other pulsations and thrills)
o Normal findings = no pulsations except the apical impulse which is palpable in
about half of adults. There should be no heaves or thrills present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole
Presence of a palpable thrill may indicate a murmur is present
Cardiac enlargement – left ventricular dilation displaces impulse down
and to the left and increases size more than one costal vertebral space
(from 5th to 6th ICS) occurs with heart failure and cardiomyopathy
Left ventricular hypertrophy – sustained impulse with increased force and
duration but no change in location
Direction of Blood Flow in Heart
Return via the Pulmonic Veins
Cardiac Cycle: Rhythmic movement of blood through the heart p.497
Phases:
o Diastole – ventricles relax and fill with blood , 2/3rd of the cardiac cycle
o Systole – heart’s contraction, blood pumped from the ventricles and fills the
pulmonary and systemic arteries, 1/3rd of the cardiac cycle
Heart Sounds
First heart sounds (S1) – closure of the AV valves(mitral and tricuspid valve close),
beginning of systole,
Second Heart sounds (S2) – closure of the SL valves (aortic and pulmonic valve), end of
systole
, Extra Heart Sounds:
3rd Heart Sound – ventricles resistant to filling during the early rapid filling phase , occurs
after S2
4th heart sound – occurs at the end of diastole, when the ventricle is resistant to filling at
presystole
Characteristics of sound
Frequency (pitch) – high pitched or low pitched
Intensity – loud or soft
Duration – very short for heart sounds, silent periods are longer
Timing – systole or diastole
Palpation
Carotid arteries (p.511)
Assess for strength, symmetry, and grade of pulses
o Normal finding = 2+ equal bilaterally
o Abnormal Finding = bruit indicates turbulence with a local vascular cause such as
atherosclerotic narrowing
Carotids should be assessed one at a time
Inspection
Clients’ anterior chest for skin color, scars, deformities (p.494 and 512)
Observe for pulsation at the apical impulse (located in the heart apex at the 4th or 5th ICS
at the left MCL
o Normal Finding = present or absent in apical impulse with no heaves or lifts
present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole
Palpation (p.512-513)
Palpate across the precordium (the chest wall)
Including the aortic, pulmonic, Erb’s point, the tricuspid and the mitral areas (the same as
the auscultations sites)
Palpate for anomalies such as other pulsations and thrills)
o Normal findings = no pulsations except the apical impulse which is palpable in
about half of adults. There should be no heaves or thrills present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole
Presence of a palpable thrill may indicate a murmur is present
Cardiac enlargement – left ventricular dilation displaces impulse down
and to the left and increases size more than one costal vertebral space
(from 5th to 6th ICS) occurs with heart failure and cardiomyopathy
Left ventricular hypertrophy – sustained impulse with increased force and
duration but no change in location
