OBJECTIVE

CONTENT
1. ANATOMY AND PHYSIOLOGY OF THE HEART
CARDIO- Heart: Pumps the blood
VASCULAR- Vessels: Carries the blood (VEIN AND ARTERY)

Cool Facts
1. Blood Volume= 5L/6-5qrts/1.5 gal.
2. 1 heart beat pumps=60-80 ml/ 1/3 cup)
3. Heart pumps 2,000 gallons a day (4-6 liters/min)
A. LOCATION

B. PARTS

Precordium: Area on anterior chest

Mediastinum: Between lungs and in the middle
third of the thoracic cage (mediastinum)
2nd to the 5th intercostal space
Base- Right border of sternum
Bottom- Left mid clavicular line
OF THE HEART

METHODOLO
GY

TIME
FRAM
E

RESOURCE
S

PERSON
RESPONSI
BLE

4
CHAMBERS(PUMPS)

4 HEART
VALVES(OPENIN
G/CLOSING)

1. RA
2. LA
3. RV
4. LV

1. AV
2. PV
3. TV
4. MV/BCV

C. CARDIAC CYCLE (BLOOD FLOW)

(SHOW THE VIDEO)

LAB (S1)-systole

DUB(S2)-diastole
2. NORMAL HEART SOUNDS
S1: AV valves close--first Heart sound
(systole)
a. M1: Mitral closes
b. T1: Tricuspid closes
c. S1 is loudest at Apex
S2: semilunar valves close (diastole)
a. A2: Aortic closes
b. P2: Pulmonic closes
c. S2 is loudest at Base
3. ADVENTITIOUS SOUNDS: Bell is best
3. S3: in Diastole
i. Ventricles resistant to filling
(volume too much, backing
up and developing Heart
Failure or Valve
regurgitation)
ii. Lub dub da
4. S4: in Diastole
iii. Later resistant sound
(ventricle too full, still wall,
heart damage Myocardial
infarction (MI))
iv. Lub Dub Da see
Murmurs: Tubulent blood flow
a. Gentle, blowing, wishing sound
b. MURMURS documented
i. Pitch or Frequency (high,
low)

ii. Loudness -- Graded 1-6

loud or soft (intensity)
iii. Timing (systolic or
diastolic)
iv. Pattern (grows louder,
tapers, peaks)
v. Quality (rumbling, musical,
blowing harsh)
c. Conditions that cause Murmurs
Example
Exercise, thyrotoxicosis
Anemia
A stenotic or narrowed valve, an
incompetent or regurgitant valve,
dilated chamber, septal defect

Murmur
Velocity of blood increases
Viscosity fo blood decreases
Structural defects in the valves (a
stenotic or narrowed valve, an
incompetent or regurgitant valve), or
unusual openings occure in the
chambers (dilated chamber, septal
defect)
4. SURFACE LANDMARKS OF HEART SOUNDS

1)
2)
3)
4)
5)

Aortic (Right sternal border, 2nd ICS)

Pulmonic (Left sternal border, 2nd ICS)
Erbs (Left sternal border, 3rd ICS)
Tricuspid (Left sternal border, 4th ICS)
Mitral (Left midclavicular line, 5th ICS)

POINT OF MAXIMAL IMPULSE

Apical Pulse at the Apex

(landmarks: midclavicular line, fifth intercostal space).

5. HEALTH ASSESSMENT
A. Subjective Data
Chest Pain: COLDSPA
a. Angina: Chest Pain Important cardiac
symptom, occurs when hearts own blood supply
cannot keep up with metabolic demand
i. Chest Pain Origin my be found in different
areas: (pg. 493)
1. Pulmonary
2. Musculoskeletal
3. Gastrointestinal
ii. Universal sign of chest pain: Clenched fist
to the chest
1. Men: classic
2. Women: differ (jaw pain, back pain,
etc.)

b. Dyspnea: shortness of breath

i. Dyspnea on exertion (DOE) Quantify
exactly (i.e. after walking two blocks)
Paroxymal, Constant or intermittent,
Recumbent
ii. Paroxymal nocturnal dyspnea (PND):
occurs with Heart failure, supine increases
volume of intrathoracic blood, weakened
heart cannot accommodate
1. Typically, After 2 hours of sleep,
person awakens with the need for
fresh air
c. Cough: Any sputum
i. Productive cough, mucoid or purulent.
ii. Hemoptysis: coughing up blood
1. Often pulmonary disorder
2. Does occur with mitral stenosis
d. Fatigue: tiring easily
i. Unusual fatique is a top prodromal MI
symptom for women
ii. Decrease cardiac output is worse in the
evening
iii. Anxiety or depression occurs all day, or
worse in morning
e. Edema: Swelling
i. Edema: Dependent when caused by heart
failure
ii. Cardiac edema: worse in evening
1. Better in morning (elevated legs all
night)
2. Bilateral; unilateral swelling has local
vein cause
f. Cyanosis or Pallor: Both occurs with MI or low
cardiac output decreased tissue perfussion
g. Nocturia: waking up at night to urinate
i. Recumbency at night promotes fluid
resorption and excretion; this occurs with
heart failure in the person who is
ambulatory during the day
B. Past Health History
C. Family Cardiac History

D. Lifestyle & Health Habits

ii. Nutrition, Smoking, Exercise, MEDS, stress,
weight, cholesterol, checkup?
E. Preparation for auscultating the heart: Should be
review
Wash hands
Clean Steth
Warm and quiet room
Privacy
Access to chest gown
Watch with second hand
Stethoscope
Patient sitting upright
F. Objective Data Inspection anterior
PT in upright sitting position
Note skin color
Ease of Respirations
Not visible pulsations in neck or chest
Neck Vessel Distention (JVD
6. PHYSICAL EXAM
Inspection: Anterior Chest Precordium
i. Pulsation: May be able to see apical impulse
(left ventricle rotating against the chest wall
during systole).
4th or 5th intercostal space at or inside
midclavicular line
Easier to see in children
Abnormal: Heave or lift: sustained
forceful thrusting of ventricle during
systole
a. Ventricle hypertrophy (increased
workload)
b. Right Ventricular Heave: seen at
sternal border
c. Left Ventricular Heave: seen at
apex
Palpation: Precordium
i. Apical Impulse (can be palpated in 25-40%

adults 50-73% in left lateral position)

palpate with one finger.
Ask Patint to exhale and hold
ii. Palpation across the Precordium: using
palmar aspects
plapate the apex, left sternal borde, and
the base (searching for any other
pulsations)
ABNORMAL FINDINGS:

1) Cardiac enlargement
2) Left ventricular dilation (volume overload) displaces impulse
down and to left and increases size more than one space
(Diameter 4cm or greater = dilated)
a. Occurs in Heart failure
b. Occurs in Cardiomyopathy
3) Sustained Impulse: increased force and duration but no
change in location occurs in left ventricular hypertrophy and no
dilation (pressure overload)

Percussion: Not on the heart

Ausculatation
Auscultory Areas

7. Heart Failure: Signs and Symptoms

Shortness of Breath
Adventitious Sounds
Dissiness

Tiredness (fatigue) & weakness

Rapid or irregular HR, S3
Swelling in ankles, legs and abdomen and weight
gain
Other: Nausea, palpitations, Chest pain, waking
suddenly at night unable to breath (PND), changes
in sleep patterns
Suggest aspirin

8. Developmental Considerations:

Infants and Children

i. Listen whenever you can (sleeping, quiet)
ii. Functional (innocent) murmurs common
Usually change or disappear with
position change
REFER ALL MURMURS
iii. Check heart and femoral pulse simultaneously
in infant for delay (coarctation)
iv. Significant History Findings in Infants and
Children:
Mothers health in pregnancy
Cyanosis
Growht Chart (delays)
Activity
Joint pain fever
Frequent respiratory infection
Family history

9. Elderly: Considerations
i. Slow position changes in elderly: Risk
orthostatic hypotension (sudden drop in
BP)
ii. BP gradual systolic rise with age
iii. Carefully listen for S3 and S4
iv. Occasional irregular beats common
v. Known cardiac/Respiratory history?
vi. Medications
vii. Environment

10. Accurately document findings to determine your

patient's cardiovascular status.