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Cardiovascular System Handout
Blood Group Comparison Chart
Donor
Recipient
Blood
Group
Person 1
Person 1
Person 2
Person 3
Person 4
Person 5
Labelling Diagram
Person 2
Person 3
Person 4
Person 5
N/A
N/A
N/A
N/A
N/A
Blood Flow Through the Heart
………..
Valve
Aorta
Capillaries
………..
Valve
Vena Cava
Lungs
………..
Valve
………...
Valve
Auscultation of the heart
Auscultation is that part of the physical examination involving the act of listening
with a stethoscope to sounds made by the heart, lungs, and blood.
Normal Heart Sounds
Normal heart sounds are produced by closure of the valves of the heart.
Flow through the valves will affect the sound the valve makes. Thus, in
situations of increased flow (exercise for example) the intensity of the heart
sounds will be increased. In situations of low flow (shock for example) the
intensity of the heart sounds will be decreased.
S1: The S1 sound is normally the first heart sound heard. (‘Lub’, in lub-dub). S1
corresponds to closure of the mitral and tricuspid valves. A normal S1 is lowpitched and of longer duration than S2.
S2: The S2 sound is normally the second sound heard. (‘Dub’ in lub-dub) S2
corresponds to closure of the pulmonary and aortic valves. A normal S2 is
higher-pitched and of shorter duration than S1.
The flow from the ventricles is more forceful than the flow from the atria.
Therefore, S2 will normally be the louder sound.
Abnormal heart sounds
Extra heart sounds
The rarer extra heart sounds form gallop rhythms and are heard in both normal
and abnormal situations.
S3 = Rarely, there may be a third heart sound. It occurs just after S2 and is lower
in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is
normal in youth and some trained athletes, but if it re-emerges later in life it may
signal cardiac problems.
S4 = The rare fourth heart sound is sometimes audible in healthy children and
again in trained athletes, but when audible in an adult is called a presystolic
gallop or atrial gallop. This gallop is produced by the sound of blood being forced
into a stiff/hypertrophic ventricle. It is a sign of a pathologic state, usually a failing
left ventricle. The sound occurs just before S1.
Heart murmurs
Heart murmurs are produced as a result of turbulent flow of blood. They are
usually heard as a whooshing sound. They can be caused by regurgitation
through a valve, narrowing of a heart valve, or abnormal openings between the
left ventricle and right heart.
Clicks and rubs
Clicks: These are short, high-pitched sounds. They are common in patients with
a valve stenosis or prolapse.
The atrioventricular valves of patients with mitral stenosis may open with an
opening snap on the beginning of diastole.
Patients with mitral valve prolapse may have a mid-systolic click along with a
murmur.
Aortic and pulmonary stenosis may cause an ejection click immediately after S1.
Rubs: Patients with pericarditis, an inflammation of the sac surrounding the heart
(pericardium), may have an audible pericardial friction rub. This is a characteristic
scratching, creaking, high-pitched sound emanating from the rubbing of both
layers of inflammated pericardium. It is very dependent on body position and
breathing, and changes from hour to hour.
Where to listen
There are four major functional areas of auscultation of the heart. They are
named for the valve that they best assess.
The bell of the stethoscope is best for listening to low pitched sounds such as
murmurs
The diaphragm filters out low pitched sounds, so it is best for high pitched
sounds such as the second heart sounds S2
Area
Aortic
Location
2nd Intercostal
space
Abnormality
Aortic Stenosis
R sternal border
Pulmonic
2nd Iintercostal
space
Pulmonary stenosis or
regurgitation
L sternal border
Tricuspid
L lower sternal
border
Tricuspid stenosis
Mitral
5th Iintercostal
space
Mitral stenosis or
regurgitation
Partner work
Working with a partner, listen to each other’s heart beat at the four locations in
the table.
Experiment using both the bell and diaphragm of the stethoscope
Can you hear both S1 and S2?
Where is S1 loudest?
Where is S2 loudest?
Are there any extra heart sounds present?
If so what kind of sounds is it and how loud is it?
How to Take Blood Pressure
Blood pressure is the pressure exerted on the wall of the artery or vein as blood
is pumped through the body. Blood does not flow readily, it surges along with
each beat of the heart.
Systolic and Diastolic pressure
As blood is pumped through the body it exerts pressure on the veins and
arteries. The systolic pressure is the pressure as the heart contracts and pumps
the blood.
The diastolic pressure is the pressure in the vessels when the heart is at rest
between beats.
Blood pressure is recorded as a fraction such as 110/70. The systolic pressure is
the top number and the diastolic number is the bottom number.
Influencing Factors
Factors that can influence blood pressure readings include proper cuff size for
the size of the arm, activity, emotions, posture, medications, alcohol
consumption, temperature and diet.
How to take blood pressure
To take a blood pressure, the person should be sitting comfortably and relaxed.
Sleeves are pushed up or the shirt removed to reveal a naked arm as clothing
can interfere with the pressure of the inflated cuff as well as hearing the correct
sounds.
The cuff of the sphygmomanometer is placed on the upper arm. It is centred over
the brachial artery which is located in the crook of the elbow. The gauge should
be placed so it can be easily read. There is usually a place on the cuff to clip it
on. Once the cuff is secured, raise the arm to heart level, place your arm
underneath it to support it and ask the person to relax their arm.
Palpate (feel for) the brachial pulse and place the diaphragm of the stethoscope
over this spot. Place the ear pieces on the stethoscope into your ears. Listen to
the brachial pulse.
Close the valve on the bladder of the cuff and begin to squeeze the bulb.
Continue squeezing until the needle on the gauge reads at least 180 or until it is
10mmHg above where you last heard the as pulse as you inflated the cuff. Some
people cannot hear this and so it is usually pumped up to 180-200mmHg on the
gauge.
As the blood is pumped through the vessels a turbulence is heard. These sounds
are created by turbulence as the blood begins to flow through the arteries after
the blood pressure cuff has temporarily stopped the flow by the pressure exerted
as it was inflated. When the sound is first heard, this is the systolic pressure; and
when the sound ceases as the turbulence ends, the diastolic pressure is
determined. We call these sounds Karotkoff sounds
Open the valve slowly and allow the cuff to deflate by 5mmHg/second while you
listen to the artery. When you first hear the Karotkoff sound this is the systolic
pressure. Continue deflating the cuff until you no longer hear the Karotkoff
sound. This is the diastolic pressure.
At this point you can open the valve completely to allow the cuff to deflate rapidly.
If you did not hear clearly, wait at least one minute before repeating the
procedure.