Heart and Neck Vessel Assessment

Carotid Assessment

• Positioning: Sitting up with head midline.

• Auscultation:

  • Listen in three areas:
    • Angle of the jaw
    • Mid cervical
    • Base of the neck
  • Procedure:
    • Instruct the patient to take a deep breath, exhale, and hold while moving between spots.
    • Use the bell of the stethoscope.
  • Findings: No bruit present.

• Palpation of Carotid Artery:

  • Palpate one area bilaterally.
  • Start at mid cervical by the base of the neck.
  • Note four findings:
    • Rapid upstroke
    • Slower down stroke
    • Smooth contour
    • Equal bilateral with a +2 force

Jugular Vein Assessment

• Positioning: Patient in bed at a 45-degree angle without a pillow.
• Inspection:
  • Turn patient's head to the side.
  • Use tangential lighting.
  • Identify:
    • External jugular over the sternomastoid muscle.
    • Internal jugular at the sternal notch or base of the neck.
  • Findings:
    • Two visible waves per cycle
    • Undulant and diffuse
    • Varies with respiration
    • Disappears with position changes or gentle pressure

Precordium Inspection

• Identification:
  • Area from right sternal border to left midclavicular line.
  • Look for sternal border and apex of the heart.
• Findings:
  • No heaves or lifts.
  • No apical pulse present.

Precordium Palpation

• Technique:
  • Use palmar or ulnar aspect of fingers.
  • Feel from the base of the precordium to the apex.
• Findings:
  • No thrills felt.
  • No apical pulse felt.

Apical Pulse Palpation

• Landmarking:
  • Second intercostal space at angle of Louis.
  • Fifth intercostal space, 7-9 cm over midclavicular line.
• Palpation:
  • Use one finger.
  • Turn patient to left side if not felt initially.
• Findings:
  • Short gentle tap felt in a 1-2 cm area.
  • Not felt in about 50% of population.

Apical Pulse Auscultation

• Technique:
  • Use diaphragm of stethoscope.
  • Landmark fifth intercostal space, left sternal border.
  • Listen for a full minute, note rate and rhythm.
• Findings:
  • Rate: 68
  • Rhythm: Regular

Valve Auscultation

• Landmarking:
  • Aortic Valve: Second intercostal space, right sternal border.
  • Pulmonic Valve: Second intercostal space, left sternal border.
  • Tricuspid Valve: Fourth or fifth intercostal space, left sternal border.
  • Mitral Valve: Fifth intercostal space, left midclavicular line.
• Procedure:
  • Use diaphragm then switch to bell.
  • Listen for one full cardiac cycle.
• Findings:
  • S1 and S2 present.
  • No abnormal or split sounds heard.
  • No murmurs heard.
  • S1 louder at the apex, S2 louder at the base.

Conclusion

• End of assessment.
• Open for questions.