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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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