The Heart
Heart's position
upper half of the upper-arm
after base of sternum
from the sixth intercostal ribs and higher.
This knowledge is essential for properly
CPR applying. see clip
Good graphics
As to the correct level of the heart to the arm follow link
Back to the Correct position of the Tefilin
Shel Yad
must rest very well leveled to the heart, and that is no lower than the mid humerus bone
The mid Humerus bone is at the insertion of the deltoid muscle
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The mammillary line, directly below the nipple, in the intercostal space of the 6th and 7th ribs. |
p. of maximal impulse (PMI) the point on the chest where the impulse of the left ventricle is felt most strongly, normally in the fifth costal interspace inside the left mammillary line
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The apex of the heart is leveled to the Deltoid Tuberosity |
details about where "Level With The Heart" is actually located
Size -Nine (9) inches long x three (3) inches wide.
Located within the mediastinum, bordered laterally by the lungs, posteriorly by the backbone, and anteriorly by the sternum.
Base--attached to several large blood vessels and lies beneath the second rib.
Apex--at the fifth intercostal space
Thorax (ribs and sternum)
12 pair of ribs
7 true (attach directly to sternum)
5 false
3 indirectly attach to sternum
2 are floating (no anterior attachment)
Sternum
Manubrium
jugular notch (superior manubrium - articulation with clavicles)
sternal angle (inferior manubrium - equivalent to 2nd rib)
Body
Xiphoid process
Für die anatomischen Grundlagen beachten Sie bitte unsere Themen Rippe und Brustkorb (Thorax).
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Requirements for auscultationIn order to perform adequate auscultation, the following requirements are ideally present: 1. A quiet, well lit, warm room. [This eliminates extraneous noise and facilitates cardiac inspection.] 2. A properly disrobed patient. [This permits the stethoscope to be placed directly on the chest]. 3. Ability to examine patient supine, sitting, and in left lateral recumbent positions. [Various sounds, especially abnormal sounds, may be elicited in different positions.] 4. Ability to examine from right side. [This decreases the likelihood of producing extraneous sounds from the tubing of the stethoscope hitting objects].
5. A stethoscope with both a bell and diaphragm or capacity to act as a bell and diaphragm. [The bell when held lightly against the chest picks up sounds of low frequency. The diaphragm when firmly pressed so that it leaves an after imprint picks up sounds of high frequency.] 6. *A sequence of auscultation. [Minimally four areas should be auscultated using first the diaphragm and then the bell: a. Left Lateral Sternal Border (LLSB) ‑ the fourth intercostal space to the left of the sternum. Tricuspid and right heart sounds are heard best in this area.
b. Apex ‑ the fifth intercostal space in the midclavicular line. Mitral and left heart sounds are heard best in this area. c. Base Right ‑ second intercostal space to the right of the sternum. Sounds from the aortic valve are best heard here. d. Base Left ‑ second intercostal space to the left of the sternum. Sounds from the pulmonic valve are best heard here. 7. Ability to selectively listen. [One sound at a time is attended to. When listening to sounds in systole, sounds in diastole are initially ignored.] *[The sequence listed above is only one of the many acceptable ones. The important point is that the four areas mentioned be auscultated each time in a consistent manner; and that each area be assessed for sounds of both low and high frequencies.] You are now ready to begin listening to the various heart sounds. When you hear each sound, keep in mind the various characteristics of sound and the fundamental procedures used in listening to the heart.
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