THE CARDIOVASCULAR

SYSTEM
The Heart and Great Vessels: Anatomy
Remember Your Surface Landmarks

Identify your ...

Count •
•
Midsternal line
Midclavicular line
interspaces • Anterior axillary line
• Midaxillary line
 Visualize the Chambers of the Heart and
Important Great Vessels
• Superior and inferior vena
Visualize cavas
the • Right atrium and the right
ventricle
circulation • Pulmonary arteries
through • Left atrium and left ventricle
the: • Aorta and the aortic arch
Cardiac chambers, valves and circulation
 The Heart as a Pump:
The Cardiac Cycle of Systole and Diastole
Systole: the ventricles contract
• The right ventricle pumps blood into the pulmonary arteries (pulmonic
valve is open)
• The left ventricle pumps blood into the aorta
(aortic valve is open)
Diastole: the ventricles relax
• Blood flows from the right atrium → right ventricle (tricuspid valve is
open)
• Blood flows from the left atrium → left ventricle (mitral valve is open)
The Heart as a Pump: Important Concepts
Preload
volume overload

Blood pressure:
cardiac output x Contractility:
systemic vascular ventricles contract
resistance during systole

Cardiac output: Afterload

stroke volume x pressure
heart rate overload
 Jugular Venous Pressure (JVP)
and Pulsations

Recall that jugular veins reflect right atrial

pressure

Steps for examination

• Raise the head of the bed or examining table to 30°

• Turn the patient’s head gently to the left
• Identify the topmost point of the flickering venous pulsations
• Place a centimeter ruler upright on the sternal angle
• Place a card or tongue blade horizontally from the top of the
JVP to the ruler, making a right angle
• Measure the distance above the sternal angle in centimeters:
a 3- to 4-centimeter elevation is normal
JVP and pulsations
Assessing the Carotid Pulse

Place your index The upstroke may

and middle fingers be:
Never palpate right • Brisk – normal
Keep the patient’s on the right then Listen with the
and left carotid • Delayed – suggests
head elevated to the left carotid stethoscope for
arteries aortic stenosis
30° arteries, and any bruits
simultaneously • Bounding – suggests
palpate the carotid aortic insufficiency
upstroke
Palpating the Chest Wall
Using the finger pads,
palpate for heaves or lifts
from abnormal ventricular
movements

Using the ball of the hand,

• Palpate the chest
palpate for thrills, or wall in the aortic,
turbulence transmitted to pulmonic, left
the chest wall surface by parasternal, and
a damaged heart valve
apical areas
 Assessing the Point of Maximal Impulse
Inspect the left anterior chest for a visible PMI(PMI)

Using your finger pads, palpate at the apex for the PMI

The PMI may be:

• Tapping — normal
• Sustained — suggests LV hypertrophy from hypertension or aortic stenosis
• Diffuse — suggests a dilated ventricle from congestive heart failure or cardiomyopathy
Locate the PMI by interspace and distance in centimeters from the midsternal line

Assess location, amplitude, duration, and diameter

Listening to the Heart — Auscultation
Listen in all 6 listening areas for S1 and S2
using the diaphragm of the stethoscope

Then listen at the apex with the bell

The diaphragm and the bell ...

• The diaphragm is best for detecting high-pitched sounds

like S1, S2, and also S4 and most murmurs
• The bell is best for detecting low-pitched sounds like S3
and the rumble of mitral stenosis
Listening to the Heart — Auscultation
Recording your Findings
“ The Jugular venous pulse is 3 cm above
the sternal angle with the head of the bed
elevated to 30°. Carotid upstrokes are
brisk, without bruits. The point of
maximal impulse is tapping, 7 cms lateral
to the midsternal line in the 5th intercostal
space. Crisp S1 and S2. At the base S2 is
greater than S1 and physiologically split,
with A2 > P2. At the apex S1 is greater
than S2 and constant. No murmurs or
extrasounds.”