Cardiovascular system 1: Heart and Neck vessels

Question 1

Auscultate the Carotid Artery

Answer 1

• Auscultate each carotid artery for the presence of a bruit
• Keep the neck in a neutral position and lightly apply the bell of the stethoscope over the carotid artery levels
  
  • (Angle of the jaw, mid-cervical area, and base of the neck)
• Do not compress the artery because this could lead to creating artificial bruit and compromise circulation of the carotid artery.
• Ask pt. to breathe, exhale, and hold still without breathing to listen for the tracheal breath sounds.

Question 2

Palpate the Carotid Artery

Answer 2

• Palpate each carotid artery medial to the sternomastoid muscle
• Avoid excessive pressure on the carotid sinus area (higher area in the neck) excessive vagal simulation slows down the heart rate
• older adults gently palpate to avoid compromising arterial blood flow to the brain. Palpate only one carotid artery at a time.
• Contour should be smooth with a rapid upstroke and slower downstroke with a normal 2+
  
  • Findings should be bilateral.

Question 3

Inspect the Anterior Chest (Precordium)

Answer 3

• Arrange tangential lighting to emphasize any flicker of movement
• Apical pulse is not visible but when it is visible it appears at the level of the fourth or fifth intercostal space
  
  • Easier to see in children or pts with thin chest wall

Question 4

Palpate the Apical Impulse (Precordium)

Answer 4

• Localize the apical impulse by using one finger pad
• Ask the pt to exhale then hold it to locate the pulsation. Might need to roll the pt midway to the left to find it.
• ## Should be palpable in about half of the adults but not in obese people or people with thick chest wall

Note
- Location: apical impulse should occupy only one interspace
- Size: Normally 1x2cm
- Amplitude: Normally, a short, gentle tap
- Duration: Short; normally occupies only the first half of systole

Question 5

Percussion (Precordium)