NR 302 EXAM 3 HEALTH ASSESSMENT: HEART AND NECK VESSELS COMPLETE
SOLUTION
Heart and Neck Vessels
Position and Surface Landmarks
o Precordium: area on anterior chest overlying heart and great vessels
o During contraction, apex beats against chest wall, producing an apical impulse
o Heart has four chambers: atria and ventricles
o Great vessels lie bunched above base of heart
o Pulmonary veins return freshly oxygenated blood to left side of heart, and aorta carries
it out to body
Heart Wall, Chambers, and Valves
o Heart wall has numerous layers
Pericardium: tough, fibrous, double-walled sac that surrounds and protects
heart
Myocardium: muscular wall of heart; it does pumping
Endocardium: thin layer of endothelial tissue that lines inner surface of heart
chambers and valves
o Heart has two pump systems
o Each side of the heart has an atrium and ventricle
Atrium: thin-walled reservoir for holding blood
Ventricle: thick-walled, muscular pumping chamber
Heart Chambers and Valves
o Four chambers separated by valves, whose main purpose is to prevent backflow of
blood
Valves are unidirectional: can only open one way
Valves open and close passively in response to pressure gradients in moving
blood
o Four valves in heart
Two atrioventricular (AV) valves
Two semilunar (SL) valves
AV Valves
o Two AV valves separate atria and ventricles
Tricuspid valve: right AV valve
Bicuspid, or mitral valve: left AV valve
• Valves’ thin leaflets are anchored by collagenous fibers (chordae
tendineae) to papillary muscles embedded in ventricle floor
, AV valves open during heart’s filling phase, or diastole, to allow ventricles to fill
with blood
During pumping phase, or systole, AV valves close to prevent regurgitation of
blood back up into atria
SL Valves
o SL valves are set between ventricles and arteries
Each valve has three cusps that look like half moons
Pulmonic valve: SL valve in right side of heart
Aortic valve: SL valve in left side of heart
• Open during pumping, or systole, to allow blood to be ejected from
heart
No valves are present between vena cava and right atrium, or between
pulmonary veins and left atrium, for this reason
• Abnormally high pressure in left side of heart gives a person symptoms
of pulmonary congestion
• Abnormally high pressure in right side of heart shows in neck veins and
abdomen
• Chambers and Valves
Direction of Blood Flow I
Unoxygenated red blood drains into vena cava, follows route of venous blood
o From liver to right atrium (RA) through inferior vena cava
Superior vena cava drains venous blood from the head and upper extremities
From RA, venous blood travels through tricuspid valve to right ventricle (RV)
o From RV, venous blood flows through pulmonic valve to pulmonary artery
Pulmonary artery delivers unoxygenated blood to lungs
Direction of Blood Flow II
Lungs oxygenate blood
• Pulmonary veins return fresh blood to LA
From LA, arterial blood travels through mitral valve to LV
• LV ejects blood through aortic valve into aorta
Aorta delivers oxygenated blood to body
o Circulation is continuous loop; blood is kept moving by continually shifting pressure
gradients
Blood flows from area of higher pressure to area of lower pressure
Cardiac Cycle
o Rhythmic flow of blood through heart is cardiac cycle
Has two phases, diastole and systole
Diastole: ventricles relax and fill with blood; this takes up two thirds of cardiac
cycle
Systole: heart’s contraction, blood pumped from ventricles fills pulmonary and
systemic arteries; this is one third of cardiac cycle
, Cardiac Cycle: Diastole
Ventricles relaxed, and AV valves, tricuspid and mitral, are open; opening of
normal valve is silent
Pressure in atria higher than that in ventricles, so blood pours rapidly into
ventricles
• This first passive filling phase called protodiastolic filling
Toward end of diastole, atria contract and push last amount of blood into
ventricles
• This active filling phase called presystole, or atrial systole
o Note that atrial systole occurs during ventricular diastole, a confusing but important
point
Cardiac Cycle: Systole
o Ventricular pressure becomes higher than that in atria, so mitral and tricuspid valves
close
o Closure of AV valves contributes to first heart sound (S1) and signals beginning of systole
AV valves close to prevent any regurgitation of blood back up into atria during
contraction
o For a very brief moment, all four valves are closed and ventricular walls contract
Isometric contraction: this contraction against closed system works to build high
level pressure in ventricles
Events in Right and Left Side of Heart I
Systole
o Consider left side of heart
o When pressure in ventricle finally exceeds pressure in aorta, aortic valve opens and
blood is ejected rapidly
After ventricle’s contents are ejected, its pressure falls
o When pressure falls below pressure in aorta, some blood flows backward toward
ventricle, causing aortic valve to close
o This closure of semilunar valves causes second heart sound (S2) and signals end of
systole
Events in Right and Left Side of Heart II
o Diastole again
Now all four valves are closed and ventricles relax
• Isometric or isovolumic relaxation
Atria have been filling with blood delivered from lungs
Atrial pressure now higher than relaxed ventricular pressure
Mitral valve opens and diastolic filling begins again
Events in Right and Left Side of Heart III
SOLUTION
Heart and Neck Vessels
Position and Surface Landmarks
o Precordium: area on anterior chest overlying heart and great vessels
o During contraction, apex beats against chest wall, producing an apical impulse
o Heart has four chambers: atria and ventricles
o Great vessels lie bunched above base of heart
o Pulmonary veins return freshly oxygenated blood to left side of heart, and aorta carries
it out to body
Heart Wall, Chambers, and Valves
o Heart wall has numerous layers
Pericardium: tough, fibrous, double-walled sac that surrounds and protects
heart
Myocardium: muscular wall of heart; it does pumping
Endocardium: thin layer of endothelial tissue that lines inner surface of heart
chambers and valves
o Heart has two pump systems
o Each side of the heart has an atrium and ventricle
Atrium: thin-walled reservoir for holding blood
Ventricle: thick-walled, muscular pumping chamber
Heart Chambers and Valves
o Four chambers separated by valves, whose main purpose is to prevent backflow of
blood
Valves are unidirectional: can only open one way
Valves open and close passively in response to pressure gradients in moving
blood
o Four valves in heart
Two atrioventricular (AV) valves
Two semilunar (SL) valves
AV Valves
o Two AV valves separate atria and ventricles
Tricuspid valve: right AV valve
Bicuspid, or mitral valve: left AV valve
• Valves’ thin leaflets are anchored by collagenous fibers (chordae
tendineae) to papillary muscles embedded in ventricle floor
, AV valves open during heart’s filling phase, or diastole, to allow ventricles to fill
with blood
During pumping phase, or systole, AV valves close to prevent regurgitation of
blood back up into atria
SL Valves
o SL valves are set between ventricles and arteries
Each valve has three cusps that look like half moons
Pulmonic valve: SL valve in right side of heart
Aortic valve: SL valve in left side of heart
• Open during pumping, or systole, to allow blood to be ejected from
heart
No valves are present between vena cava and right atrium, or between
pulmonary veins and left atrium, for this reason
• Abnormally high pressure in left side of heart gives a person symptoms
of pulmonary congestion
• Abnormally high pressure in right side of heart shows in neck veins and
abdomen
• Chambers and Valves
Direction of Blood Flow I
Unoxygenated red blood drains into vena cava, follows route of venous blood
o From liver to right atrium (RA) through inferior vena cava
Superior vena cava drains venous blood from the head and upper extremities
From RA, venous blood travels through tricuspid valve to right ventricle (RV)
o From RV, venous blood flows through pulmonic valve to pulmonary artery
Pulmonary artery delivers unoxygenated blood to lungs
Direction of Blood Flow II
Lungs oxygenate blood
• Pulmonary veins return fresh blood to LA
From LA, arterial blood travels through mitral valve to LV
• LV ejects blood through aortic valve into aorta
Aorta delivers oxygenated blood to body
o Circulation is continuous loop; blood is kept moving by continually shifting pressure
gradients
Blood flows from area of higher pressure to area of lower pressure
Cardiac Cycle
o Rhythmic flow of blood through heart is cardiac cycle
Has two phases, diastole and systole
Diastole: ventricles relax and fill with blood; this takes up two thirds of cardiac
cycle
Systole: heart’s contraction, blood pumped from ventricles fills pulmonary and
systemic arteries; this is one third of cardiac cycle
, Cardiac Cycle: Diastole
Ventricles relaxed, and AV valves, tricuspid and mitral, are open; opening of
normal valve is silent
Pressure in atria higher than that in ventricles, so blood pours rapidly into
ventricles
• This first passive filling phase called protodiastolic filling
Toward end of diastole, atria contract and push last amount of blood into
ventricles
• This active filling phase called presystole, or atrial systole
o Note that atrial systole occurs during ventricular diastole, a confusing but important
point
Cardiac Cycle: Systole
o Ventricular pressure becomes higher than that in atria, so mitral and tricuspid valves
close
o Closure of AV valves contributes to first heart sound (S1) and signals beginning of systole
AV valves close to prevent any regurgitation of blood back up into atria during
contraction
o For a very brief moment, all four valves are closed and ventricular walls contract
Isometric contraction: this contraction against closed system works to build high
level pressure in ventricles
Events in Right and Left Side of Heart I
Systole
o Consider left side of heart
o When pressure in ventricle finally exceeds pressure in aorta, aortic valve opens and
blood is ejected rapidly
After ventricle’s contents are ejected, its pressure falls
o When pressure falls below pressure in aorta, some blood flows backward toward
ventricle, causing aortic valve to close
o This closure of semilunar valves causes second heart sound (S2) and signals end of
systole
Events in Right and Left Side of Heart II
o Diastole again
Now all four valves are closed and ventricles relax
• Isometric or isovolumic relaxation
Atria have been filling with blood delivered from lungs
Atrial pressure now higher than relaxed ventricular pressure
Mitral valve opens and diastolic filling begins again
Events in Right and Left Side of Heart III
