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An Overview of the Cardiovascular System
Figure 20.1
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Anatomy of the Heart
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Heart in mediastinum
Figure 20.2a, b
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The Superficial Anatomy of theHeart
Figure 20.3a
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The Superficial Anatomy of theHeart
Figure 20.3b, c
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Chambers :Atria and ventricles
Septum : Inter atrial and inter ventricular
Valves : Av and SL valves
Chordae tendineae
Papillary muscle and trabeculae carneae
Internal Anatomy
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The Sectional Anatomy of the Heart
Figure 20.6c
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Heart Chambers Atria
right and left
less muscular
Ventricles
right and left
more muscular
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Heart Chambers
Septum
interatrial
intraventricular
both: connective tissue and muscle
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Cardiovascular Anatomy
Blood Flow
From theBody
RightAtrium
To the Lungs Right
Ventricle
From theLungs
Left Atrium
To the Body Left
Ventricle
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Blood flow through Heart
Figure 20.6a, b
Animation: Diagrammatic Frontal Section through the Heart
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Basic Heart ExaminationBasic Heart Examination
InspectionInspection
PalpationPalpation
PerdussionPerdussion
AuscultationAuscultation
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Inspection of the Heart
Precordium
Normal apical impulse
Abnormal apical impulse
Precordial abnormal impulse
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P
recordium - Inspection
Scars
Median sternotomy
CABG
Valve replacement
Lateral thoracotomy
Infraclavicular(pacemaker)
Pectus excavatum
Pacemaker box
Apex beat
Sternotomy scar
Pectus
excavatum
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Precordium Precordial bulge
Features: bony bulge
Clinical importance: Congenital heart
disease with ventricular enlargement
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N
ormal Apical Impulse
Location0.5 ~ 1 cm to
the left midclavicular lineat the 5th ICS outside LSB.
Range:2~2.5cm
Direction: outward whenventricular systole begins
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Abnormal Apical Impulse
Abnormal location
Physical: posture, pregnancy, etc.
Heart diseases
L.V enlargement: inferior left
R.V enlargement: left
B.V enlargement: inferior left
Chest and abdominal diseases
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Abnormal Apical Impulse
Abnormal range or intensity
Increased intensity: LV hypertrophy,hyperthyroidism, fever, anemia, etc.
Decreasedmyocardial diseases, pericardialeffusion, pleural effusion of left thorax or left-sidepneumothorax, emphysema.
Abnormal direction Inward impulseadhesive pericarditis.
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Precordial Abnormal Impulse
2nd ICS, LSBPulmonary hypertension,
youth
2nd ICS, RSBAneurysm of ascending
aorta
3rd, 4th ICS, LSBR.V hypertrophy
xiphoid processR.V hypertrophy,
abdominal aneurysm
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Palpation
Contents
Apical impulse
Thrill
Pericardial friction rub
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Precordium - Palpation
Apex beat
Location
Character
Heaving
Thrusting
Double
Tapping
Paradoxical
Left parasternal heave
Thrills (palpable murmurs)
Systolic
Diastolic
Palpable P2 (pulmonaryhypertension)
Pacemaker box
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Apical Impulse
Clinical significance: signifying the start of thesystolic phase
Location and range: same as in inspection
Increased (heave):
Causeleft ventricular pressure overload and
consequent hypertrophyCharacterforceful and sustained
Clinical significanceleft ventricular hypertrophy
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Decreased
Causes: decreased contractibility of the
myocardium
Clinical significance: heart failure,
pericardial effusion, myocarditis
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Pericardial Friction Fremitus
Mechanism: inflammation or irritation of the
pericardium
Typical site: 4th ICS, LSB
Features: It is best palpated with the person
sitting up and leaning forward, and with the
breath held in expiration
Clinical significance: pericarditis
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Thrill
Mechanism: formation of bloodflow
vortices caused by valve stenosis or
abnormal pathway.
Types: systole, diastole, continuous
Clinical significance: reliable signs of
organic heart diseases
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Thrill in Systole
2nd ICS, LSB: Pulmonic stenosis
2nd ICS, RSB: Aortic stenosis
3rd, 4th ICS, LSB: Interventricular septal defect
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Thrill in Diastole
Apex: mitral stenosis
2nd ICS, LSB Patent ductusarteriosus
Continuous thrill
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Percussion of the Heart Border
Technique
Force: light percussion for the relative dullness
border of the heart
Position Supine
Sitting
Steps
From left to right, lower to upper, outward to inward Left border: 2~3cm from the apical impulse
Right border: ICS next to the upper border of the liver
Measure: the distance from dullness border to anteriormidline
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Normal Relative Dullness
Border of the HeartDistance between dullness border and anterior midline
Right
(cm)
ICS Left
(cm)2-3 2-3
2-3 3.5-4.5
3-4 5-6
7-9
(the distance between left midclavicular line and anterior midline is 9 cm)
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Abnormal Dullness Heart Border
Boot-shaped heart: L.V enlargement
Pear-shaped heart: L.A enlargement
General enlarged heart: B.V enlargement
Flask-shaped heart: pericardial effusion
Shrinked dullness border: emphysema
Dullness border undetectable: pleural effusion
or lung consolidation
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Boot-shaped Heart
Mechanism: L.V enlargement
Features: the left border extends tothe inferior left, waist of the heart isdeepened.
Causes:
Aortic insufficiency
hypertensive heart disease
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Pear-shaped Heart
Mechanism: L.A enlargement and
distension of pulmonary artery
Features: dullness heart border in the
2nd, 3rd ICS on the LSB extends
outside, waist of the heart bulges out
Causes: mitral stenosis
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General Enlarged Heart
Mechanism: both left and rightventricle are enlarged
Features: the dullness border extendsto both sides, the left border extendsto inferior left
Causes: cardiomyopathy, myocarditis,whole heart failure
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Flask-shaped Heart
Mechanism: pericardial effusion
Features:
Sitting position: triangular dullness
border
Supine: widened dullness border of the
base
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Auscultation of the heart
Areas for auscultation and sequence to auscultate
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Content of Heart Auscultation
Heart rate: 60~100/min normally
Rhythm: regular or sinus arrhythmia
Heart sounds: normal, abnormal,
Heart murmurs
Pericardial friction rub
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Next timeNext time
AulscultationAulscultation
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