Heart and Neck Vessel Assessment

Summary

In the script, a medical professional named Nancy conducts a comprehensive assessment of a patient's cardiovascular health. She begins by inquiring about the patient's history of heart disease and any past heart-related procedures. The examination includes observing the neck veins for signs of pressure, palpating the carotid pulse for strength and rhythm, and listening for any abnormal sounds in the carotid arteries. Further assessment involves checking the chest for pulsations and palpating the point of maximal impulse. The use of a stethoscope is detailed, with attention to auscultation of heart sounds across different areas of the chest, concluding with no detected abnormalities.

Takeaways

• 👨‍⚕️ The script is a medical transcript involving a nurse named Nancy who is conducting an assessment of a patient's heart and neck vessels.
• 📝 Nancy asks the patient, Mr. Hoffman, about his medical history, specifically inquiring about heart disease, heart attacks, stent procedures, and heart failure.
• 🚫 The patient denies having a history of heart disease but confirms having had a heart attack and a stent procedure.
• 🔍 Nancy checks for chest pain, which the patient does not report experiencing.
• 🛏️ The patient is instructed to lie down at a 45-degree angle in a supine position for the examination of the veins in the neck.
• 🔎 The normalcy of the neck vein is assessed by its flatness; a large or bulging vein may indicate increased pressure.
• 🤲 Nancy palpates the carotid pulse to determine the strength and smoothness of the upstroke, which are within normal limits for the patient.
• 👂 She listens for a bruit, a swishing sound in the carotid arteries, using the bell of the stethoscope, but finds none.
• 🧐 The procore diem, the chest area over the heart, is checked for pulsations, with only normal respiratory movements observed.
• 📍 The point of maximal impulse is palpated at the midclavicular line and fifth intercostal space.
• 🎧 The heart sounds are auscultated at different areas of the chest, including the aortic, pulmonic, tricuspid, and mitral areas, with no abnormal sounds detected.

Q & A

What is the purpose of the assessment being conducted by Nancy?

The purpose of the assessment is to evaluate the heart and the vessels in the neck of Mr. Hoffman.

What is the first question Nancy asks Mr. Hoffman regarding his medical history?

Nancy asks if Mr. Hoffman has any history of heart disease.

What does Nancy inquire about after asking about heart disease history?

She then asks if Mr. Hoffman has ever had a heart attack or a procedure where a stent was placed.

How does Nancy define a normal vein in the neck during the assessment?

A normal vein in the neck should be flat, and its presence should be noticeable without being large or bulging, which would indicate increased pressure.

What position does Nancy ask Mr. Hoffman to assume for the neck vein assessment?

Nancy asks Mr. Hoffman to lay down at a 45-degree angle in a supine position, which means flat, and to turn his head slightly to the left.

What is the normal strength of the carotid pulse that Nancy is feeling for?

A normal strength of the carotid pulse is rated as 2+ on a medical scale.

What is a bruit and why is Nancy listening for it in the carotid arteries?

A bruit is a swishing sound heard in the arteries, and Nancy is listening for it to detect any abnormal blood flow which could indicate a problem.

What does Nancy look for when she observes the precordium, the area of the chest over the heart?

Nancy looks for any abnormal pulsations or movements in the precordium, which should only show normal respiratory movement.

What is the point of maximal impulse and where is it located?

The point of maximal impulse is the location where the heart's beat is strongest and is located at the midclavicular line and the fifth intercostal space.

What heart sounds is Nancy listening for when she uses the stethoscope on different areas of the chest?

Nancy is listening for the first and second heart sounds (S1 and S2), as well as any clicks, extra sounds, or murmurs that might indicate a cardiac issue.

What does the absence of clicks, extra sounds, or murmurs during the heart assessment suggest?

The absence of clicks, extra sounds, or murmurs suggests that there are no detected abnormalities in the heart sounds, which is a normal finding.

Outlines

00:00

👨‍⚕️ Cardiac Assessment and Vein Examination

This paragraph describes a medical professional, Nancy, conducting a cardiac assessment on a patient named Mr. Hoffman. The assessment includes a preliminary interview about the patient's history of heart disease, heart attacks, or stent procedures, and questions about chest pain. The professional then proceeds to examine the veins in the patient's neck for signs of increased pressure, which would be abnormal. The patient is asked to lay down at a 45-degree angle and turn their head to facilitate the examination. The paragraph also details the palpation of the carotid pulse to check for normal strength and a smooth upstroke, followed by auscultation for a bruit, which is a swishing sound indicating abnormal blood flow. The patient is then asked to sit up for further examination.

05:02

🔍 Comprehensive Heart and Vessel Auscultation

In this paragraph, the medical professional continues the cardiac assessment by auscultating the carotid arteries using the bell of the stethoscope to listen for any abnormal sounds like a bruit. After confirming the absence of such sounds, the examination moves to the chest area, specifically the precordium, to observe for any abnormal pulsations. The point of maximal impulse is palpated to assess the heartbeat. The professional then moves on to oscillate the heart by listening at various points across the chest, including the aortic, pulmonic, tricuspid, and mitral areas, to identify the first and second heart sounds (S1 and S2) and to check for any clicks, extra sounds, or murmurs, which could indicate heart abnormalities. The assessment concludes with no abnormal sounds detected, indicating a normal cardiac examination result.

Keywords

💡Assessment

Assessment in this context refers to the process of evaluating a patient's health condition through a series of medical tests and observations. It is central to the video's theme as it outlines the steps taken to examine the heart and neck vessels. The script mentions an 'assessment of your heart and the vessels in your neck,' indicating the primary purpose of the interaction.

💡Heart Disease

Heart disease encompasses a range of conditions affecting the heart, including coronary artery diseases, heart failure, and arrhythmias. The script inquires about the patient's history with heart disease, specifically asking if they have had a heart attack or a stent procedure, which are common heart-related conditions.

💡Stent

A stent is a small, expandable tube that is inserted into a narrowed artery to help keep it open. The script refers to a 'procedure where they put in a stent,' highlighting a common treatment for heart disease where blood flow is restored to the heart muscle.

💡Chest Pain

Chest pain is a common symptom that can indicate various health issues, including heart problems. In the script, the medical professional asks if the patient 'ever experience[s] any chest pain,' which is a critical symptom check in cardiovascular assessments.

💡Veins

Veins are blood vessels that return blood to the heart. The script describes examining the veins in the neck to check for signs of normal pressure or bulging, which could indicate abnormal pressure changes, thus relating to the overall cardiovascular health assessment.

💡Supine Position

The supine position is when a person lies flat on their back. The script instructs the patient to lay down in a 'supine position' for the examination of the neck veins, demonstrating the importance of positioning in medical assessments.

💡Carotid Pulse

The carotid pulse is the pulsation felt in the neck, which is a result of blood flowing through the carotid arteries. The script mentions 'palpate your carotid pulse,' which is a standard procedure to check the strength and rhythm of the pulse, indicative of the heart's function.

💡Bruit

A bruit is an abnormal sound heard in blood vessels, often caused by turbulent blood flow. The script describes listening for a 'bruit,' which is a swishing sound that could indicate arterial narrowing or blockage, a critical part of the vascular assessment.

💡Point of Maximal Impulse (PMI)

The PMI is the point on the chest wall where the heartbeat is strongest and can be felt with the greatest intensity. The script refers to palpating the 'point of maximal impulse,' which is a standard procedure to locate the heart's apex beat and assess its position.

💡Oscillation

In medical terms, oscillation refers to the movement of the heart as it beats. The script mentions 'oscillating the heart,' which involves listening to the heart sounds in different areas to detect any abnormal sounds or rhythms, a key part of a cardiac assessment.

💡Heart Sounds

Heart sounds are the noises produced by the heart as it contracts and relaxes. The script discusses listening for 's1 and the s2,' which are the first and second heart sounds, respectively. These sounds are crucial for diagnosing various heart conditions and are a fundamental aspect of the cardiac assessment.

💡Murmurs

Murmurs are abnormal heart sounds that are caused by turbulent blood flow through the heart. The script mentions not hearing any 'murmurs,' which is an important finding as the absence of murmurs can indicate the absence of certain heart conditions during the assessment.

Highlights

Introduction to the assessment of heart and neck vessels

Confirmation of no history of heart disease

Disclosure of past heart failure and stent procedure

Inquiry about chest pain with a negative response

Instruction to lay down at a 45-degree angle for neck vein assessment

Observation that the neck vein should be flat under normal conditions

Identification of bulging veins as a sign of increased pressure

Palpation of the carotid pulse to assess strength and upstroke

Normal carotid pulse strength and upstroke noted

Listening for a bruit in the carotid arteries with a stethoscope

Absence of any swishing sound indicating no bruit

Observation of the precordium for pulsations or movement

Palpation of the point of maximal impulse at the midclavicular line

Oscillation of the heart to listen for S1 and S2 sounds

No clicks or extra heart sounds detected

Use of the stethoscope bell to listen for low-pitched heart sounds

No murmurs or extra heart sounds detected with the bell

Conclusion of the assessment with normal findings

Transcripts

all right back back washing my hands

Oh mr. Hoffman are you today

going well thank you my name is Nancy

I'm going to be doing an assessment of

your heart and the vessels in your neck

today so I'm going to start out by

asking two questions do you have any

history of heart disease I do not have

you ever had a heart attack or a

procedure where they put in a stent oh

yeah um heart failure um okay do you

ever experience any chest pain I do not

okay good good all right so we're going

to start out by looking at the veins in

your neck and for that I need you to lay

down at a 45 degree angle in a supine

position which means flat and I'm going

to ask you to turn your head a little

bit to the left and I'm looking at the

vein right here in your neck and it

should be flat that would be normal

some people you can see the vein

especially if the skin tone is very

light other people you cannot see it at

all but there should be a notice of it

that it's plan if you see the vein

itself is large or bulging that'd be an

indication of an increase in pressure

there which would be abnormal alright

that's good I'm going to have you sit

back up and I'm going to palpate your

carotid pulse so I'm putting my fingers

right next to the trachea at about

midway up the neck and what I am feeling

for is the strength of the pulse a

normal strength would be to plus I'm

also feeling for the upstroke it should

be nice and smooth and strong and then

I'm going to awesome do the same thing

on the other side

and then I feel that this pulse is two

plus and the upstroke is smooth and

strong then I'm going to listen to the

carotid arteries I'm listening for a

bruit which is a swishing sound and I'm

going to listen with the bell of my

stethoscope which is the part of the

stethoscope that will hear a low pitch

tone so I place my stethoscope about

halfway up the neck can you take a big

breath in and out and old

and I should just hear the pulse I

should not hear any swishing and breathe

and take a breath in and out and hold

and I hear the pulse you can breathe but

I don't hear any swishing then I'm going

to move down to the chest I'm looking at

the procore diem the procore diem is the

part of the chest that is over lies the

heart and I'm looking to see if I see

any pulsations or any movement there

which I only see normal respiratory

movement and then I'm going to palpate

the point of maximal impulse which is at

the midclavicular line and the fifth

intercostal space so it's going to be if

you put your fingers right here on the

ribs feel in between the ribs and then

you'll feel that pulse right and then

I'm going to move on to oscillating the

heart so you start by finding the second

intercostal space so you can either

count down from the clavicle okay

they're spaced one and they're spaced

two or you can find the angle of Louie

this is the part of the sternum that is

a protrudes a little bit and right

across from there is the second

intercostal space so I'm going to start

by loosening with the diaphragm so make

sure that you have your stethoscope set

up the right way start in the aortic

area does he have the person breathe

normal

and I'm listening for the s1 and the s2

the loved up and I'm listening for any

clicks or extra sounds or murmurs okay

that's a or tick right across from that

second intercostal space to the left of

the sternum is the pulmonic area

and then as we move down I'm going to

listen to the left at the fifth inter

just right next to the sternal border

and then finally at the midclavicular

line the fifth intercostal space some

mitral area

so I heard s1 s2 the love dub I did not

hear any clicks or extra heart sounds

and I did not hear any murmurs I'm going

to do the same thing with the bell of

the stethoscope so second intercostal

space to the right of the sternum the

aortic area

then to the left of the sternum in the

second intercostal space in the pulmonic

area okay right next to the sternum the

fifth intercostal space the tricuspid

area

and then finally the midclavicular line

fifth intercostal space the mitral area

I heard s1 s2 I did not hear any extra

heart sounds and I did not hear any

murmurs and so that concludes the

assessment of the neck vessels in the

heart