CMA ELECTROCARDIOGRAPHY Lesson 6

True or false: The SA node is the primary pace maker which can cause the heart to beat 60-100 BPM

TRUE

CT

computed tomography

An ekg is a recording _____ of the Elecric activity (_____). generated by the cells of the heart(_______)muscles that reaches the body surface using ELECRODES.

"gram" Elecro" Cardio"

REASON FOR USING an EKG

* Problems with breathing * Fatigue and weakness * Presence of any unusual heart sounds noticed during an auscultation or 1. Detect myocordial ischemia. 2. estimate damage to the myocardium cause by the myocardial infarction. 3. detect and evaluate cardiac arrhythmia 4. assess effects of cardiac medication on the heart. 5. determine if electrolyteimbalance is present

kinds of cardiac cells

*Electrical Cardiac cells *Myocardial cells

Types of Electrocardiographs

1. Single-Channel Electrocardiograph 2. Multichannel Electrocardiograph 3. Automatic Electrocardiograph Machines 4. Electrocardiograph Telephone Transmissions 5. Facsimile Electrocardiograph 6. Interpretive Electrocardiograph

2 basic Electrical properties? Elecrical Conduction of the heart

1. Depolorization 2. Repolarization

The most commonly used multi- channel machine is one that can record three channels simultaneously. It records the leads in the ff order.________________

1. I,II,III 2. aVR, aVL, aVF 3. V1, V2, V3 4. V4, V5, V6

1.__________ records electrical activity between the right arm (RA) and left arm (LA) 2._________ records electrical activity between the right arm (RA) and left leg (LL); 3._______ records activity between the left arm (LA) and left leg (LL 4.Lead II is used as a __________ because it portrays the heart's rhythm better than the other leads,The rhythm strip is usually a separate longer recording approx- imately 6 to 12 inches.

1. Lead I 2. Lead II 3. Lead II 4. rhythm strip

1. the sensors that place on the chest is _______ 2 .the sensors that place on the limbs is _______

1. Precordial Leads 2. Augmented leads

1. ________ Chest Leads or Precordial Leads 2.________These leads re- cord the heart's electrical impulse from a central point within the heart to one of six predesignated positions on the chest wall where an electrode is attached.

1. V1, V2, V3, V4, V5, V6 2. precordial leads

ECG equipment 1. ECG paper can be either black or dark blue and is wax- or plastic-coated with a white or pink back- ground and color lines. 2.Because the skin is a poor conductor of electricity,e impulses are transmit- ted to the electrocardiograph by metal tips on the patient lead wires or cables that are attached to the sensors. 3.The sensors detect the electrical impulses on the body surface and relay them through cables, or lead, wires to the ECG machine 4. Once the self-adhesive sensors are placed, a series of lead wires coming from the machine will be con- nected to them. Small clips, sometimes referred to as alligator clips, will grasp the tabs on the sensors 5. Because the electrical activity that comes from the body is small, it is made larger, or amplified, by the amplifier of the electrocardiograph machine. The voltage is changed into a mechanical motion by the galvanometer and recorded on the paper by the heated stylus.

1.Electrocardiograph Paper 2.Electrolyte 3.Sensors or Electrodes 4.Lead Wires 5.Electrocardiograph Machine

1.______ are Augmented leads 2._____ stands for augmented volt- age; 3._____ R, L, and F stand for right, left, and foot (or leg). These are_______

1.aVR, aVL, aVF 2.aV 3.Unipolar leads

Premature Atrial Contraction, or PACS, are characterized by a cycle that occurs before the next cycle is due. PACs can be noticed in healthy individuals, especially in patients who smoke tobacco or use stimulants such as caffeine. The P-wave looks different from that seen in normal cycle.

Atrial Arrythmias

occurs when the normal rhythmic contractions of the atria are replaced by rapid irregular twitching of the muscular heart wall.contraction at an extremely fast pace (400-500bpm) which result in the ventricles contracting at much slower rate. On EKG this condition has no distinguishable P-waves.This reading can be seen in both healthy and cardiac patients.In younger patients this reading indicates a congenital heart condition or damage to the mitral valve. Older patients cause by hypertension,mitral valve prolapse or coronary heart disease.

Atrial Fibrillation

Is located between the left ventricle and the largest artery, in the body. It is where the oxygenated blood enters the aorta and is passed to the rest of the body.

Aortic valve

the lead length and switching of leads are done automatically by the electrocardiograph and there is

Automatic Electrocardiograph Machine

an electrocardiograph the leads are switch automatically, saving time and paper. there s an option to use the machine in manual mode if there is a need for longer tracing.

Automatic Electrocardiographs

Standard Limb or Bipolar Leads ; The first three leads that are recorded on a standard ECG are called leads I, II, and III (Figure 37-8A). These are known as___________

Bipolar leads

Represents the one complete cycle of depolarization (contruction) and Repolarization (Recovery). the myocardial cells. This complete cycle is one heartbeat. The EKG cycle is the graphical representation of complete cardiac cycle.

Cardiac cycle

True or false: The electrical impulse pauses briefly at the Atrioventricular node( AV node), delaying ventricular depolarization, which allows blood to fill from the atria into the ventricles.

TRUE

The spread of electrical current through the heart muscle, producing the P-wave from the atria and the QRS complex from the ventricles. This represents the "contraction of the cardiac cells."\\\\\\

DEPOLORIZATION

Blood enters the right atrium from the superior and inferior vena cavaea and passes through the tricuspid valve into the right ventricle.

Deoxygenated blood

Contraction of the heart depends on electrical stimulation of the myocardium. It controls the contractions of the heart through an electrical impulse that travels from one end of the heart to the other.

Electrical Activity of the Heart

Is a graph paper with horizontal and vertical lines at 1-mm intervals. A heavy line appears every 5mm. records duration standard of 25mm/second. this means that that a tracing extending 25 small squares (or 5 large squares) is equal to 1 second of time.

EKG Paper

A machine that checks for problems with the electrical activity of the heart.

EKG machine

EKG equipment vary in size, some can be hand held, transmit wirelessly to a computer monitor, be integrated into laptop or exercise treadmill, or a stand alone device

EKG machine

is used as one of the tools to diagnose cardiac conditions, since it is a graphical representation of the electrical activity of the heart.

EKG/ECG

A test used to assess cardiac function meausure the amount of electrical activity produced by the hear

ELECTROCARDIOGRAPHY

is a noninvasive, diagnostic tool to evaluate cardiac health. This procedure uses sound waves to capture images of the internal structures of the heart. This include anatomy and functioning of the valves and heart chambers.

Echocardiography/Ultrasonography

True or false; Positive Deflection are recording above the baseline and negative deflections are recording below the baseline.

TRUE

can be transmitted via a telephone line to an ECG interpretation site when using an electrocardiograph with such capabilities. A recording printout and interpretation (many times interpretation is done by a cardiologist or by a computer) are transmitted automatically on the electrocardiograph. Results of the ECG can be transmitted verbally as we

Electrocardiograph Telephone Transmissions

The provider may need a rapid, expert ECG interpretation from an off-site diagnostician. Direct ECG fax transmits from the electrocardiograph to a fax machine, and a high-quality facsimile is produced and sent to a diagnostician, who calls back with a reading. This saves time by eliminating the step of copying the report and sending it via the traditional fax machine

Facsimile Electrocardiograph

True or false: EKG record the Muscular Activity of the heart.

False: EKG records the electrical activity of the heart.

Muscular organ that pumps blood forward to the body organs and tissues. it is positioned in the MEDIASTINUM , between both lung(pleural) cavities.. One third of the heart sits to the right and two thirds sit to the LEFT of the STERNUM.

HEART

portable ECG monitor worn by patient for period of few hours to few days to assess heart and pulse activity as person goes through activities of daily living; used to assess patient who experiences chest pain and unusual heart activity during exercise and normal activities

HOLTER MONITOR

Special dispos- able electrodes, which are round plastic and have a strong adhesive backing, are available for the Holter monitor. These disposable electrodes con- tain an electrolyte gel

Holter Monitor Electrode Placement

has a built-in computer program that interprets the ECG tracing while it is being recorded, allowing for faster diag- nosis and treatment.

Interpretive Electrocardiograph

EKG equipment A series of wires connecting to the sensors to the EKG machine transmit the electrical impulses to the machine and displaying reading

Lead wires

Bipolar leads

Leads I, II, and III

It receives oxygenated blood from the left atrium and send it to the rest of the body through aorta. posterolateral with only one fourth of its total mass visible on the anterior view . The Muscular wall of the left Ventricle is larger than the right because of the force needed to pump to the blood to the rest of the body.

Left Ventricle

where is the inventricular septum located?

Located between the right and left Ventricles

Another type of ambulatory electrocardiography,It uses only two electrodes. It records a few minutes of the ECG at a time on a computer chip. It constantly records new informa- tion and discards the oldest information.

Loop ECG

valve between the left atrium and the left ventricle; also called bicuspid valve because of 2 skin flaps

Mitral valve

___ is a n Electrocardiograph that is more efficient , because it can record more than one lead at a time.

Multi-Channel Electrocardiograph

The ECG cycle is the recording or the graphic representation of the cardiac cycle. These electrical impulses can be recorded on special ECG paper or displayed on a ___________________

OSCILLOSCOPE

on a normal EKG reperesents the electrical activity of one cardiac cycle. *3 eletrical waves of an electriclam impulse through the heart

One P-QRS-T

Represents atrial depolarization and is recorded as positive deflection.

P-wave

is the time when from the beginning of the P-wave to the beginning of the QRS complex,it is used to estimate the pause at the AV node prior to ventricular depolarization. delay of AV node to allow filling of ventricles

PR Intervals

is a procedure that widens a narrowed or blocked coronary artery. One type of PTCA is bal- loon angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA

It carries deoxygenated blood to the lungs. this is the only times an artery carries deoxygenated blood. located between the pulmonary valve and the lungs.

Pulmonary Artery

Located underneath the aortic valve, between the right ventricle and pulmonary artery. It is where deoxygenated blood goes to the lungs to received the Oxygen.

Pulmonary Valve

It carries freshly oxygenated blood from the lungs to the left atrium. This is the only times a vein carries oxygenated blood. Located between the lungs and left atrium

Pulmonary Vein

represents ventricular depolarization

QRS complex

Is the time between the beginning of the QRS and the end of T-wave. It represents the total Duration of ventricular depolarization and repolarization

QT Interval

The return of the stimulated muscle to its resting state, producing the ST segments, T- waves and U-waves

REPOLARIZATION

True or False; AV node can control the heartbeat if the SA node fails, but at a slower rate of 40 to 60 beats per minute (bpm).

TRUE

Path of electrical conduction of the heart

SA Node, Av node, bundle of his/her right and left bundle branches, purkinje fibers.

Is a stretch of baseline and interval includes at least one wave

SEGMENT

the segment between the end of the QRS complex and beginning of the T-wave. It is the pause between ventricular depolarization and repolarization.

ST Segment

ekg equipment receive the electrical impulses from the body surface and transmit the m to the EKG machine through lead wires or cables. it is made of metal or other material that is conductive

Sensors

Divides the right and left chambers of the heart. It separates the right and left atrium, The interventricular ____ separates the right and left Ventricle.

Septum

True or False; An EKG can be used to detect ARRHYTHMIAS, THE EFFECT OF MEDICATIONS ON THE HEART, CONDITION OF THE MYOCARDIUM IN THE CASE OF MYOCARDIAL INFARCTION, and to EVALUATE OVERALL CARDIAC FUNCTIONING.

TRUE

True or False; if both SA and AV nodes fail, the ventricles will attempt to "pace' the heart at 20 to 40bpm.This defense mechanism attempts to allow to continued beating of the ventricles to sustain life. However,clinically heartbeats of 20 to 40 bpm will require other life support measures.

TRUE

_______a 12 lead Electrocardiograph can be use either the manual or automatic mode. only one lead recorded at a time. when on manual mode the lead selector will have to be manually turn on and off between leads.

Single -channel Electrocardiograph

A conventional 12-lead single-channel electrocardiograph can be used in either manual mode or automatic mode. When using automatic mode, the 12-lead ECG tracing is complete in less than 40 seconds. With a single-channel machine, only one lead can be recorded at a time. If not automatic, the single-channel ECG requires manually turning the lead selector on and off between each of the 12 leads. It may also require the leads to be coded so that they can be identified later and properly mounted.

Single-Channel Electrocardiograph

represents ventricular repolarization. Atrial repolarization occur during ventricular depolarization.It is obscured by the QRS complex and is not seen on EKG

T wave

True of false: The electrical activity of the AV node,bundle of his, and Purkinje fibers is not recorded on the EKG.what is recorded is the actual depolarization of myocardial fibers.

TRUE

True of false; From the AV node the impulse spreads into the interventricular septum through the bundle of his, then to the right and left bundle branches, and finally the PURKINJE fibers, which trigger Ventricular muscle cell called: DEPOLARIZATION

TRUE

is similar to a treadmill stress test in that the patient has an ECG tracing while exercising on the treadmill after having been given an injection of a radioactive substance such as thallium. The test shows how well blood flows to the heart muscle. test followed scanning the patient in the imaging department.

Thallium stress test

This test a patient is instructed to exercise on treadmill at prescribed speed. sensor is attached to his chest to record cardiac activity during exercise.The patient's blood pressure is also measured during the test. this test usually done to evaluate cardiac function, cause patients chest pain or as away to assess the patient after surgery. test is a noninvasive ECG tracing taken under controlled conditions while the patient is closely monitored by the medical assistant and the provider.

Treadmill stress test / Exercise Tolerance ECG

valve between the right atrium and the right ventricle, it is called Tricuspid because it has 3 skin flaps.

Tricuspid Valve

True or false: a Healthy SA nodes 'fires' at a rate of 60 to 70 times a minute in resting heart.

True

while not always seen and poorly understood, Represents ventricular after potentials

U-wave

Characterize by a total disorganization of ventricular impulses means that the ventricles are not contacting. this seen in patient experiencing myocardial infarction or someone who has cardiac disease.it can be fatal, has no distinguishing P-, QRS-, or T-waves

Ventricular Fibrillation

a very rapid heartbeat that begins within the ventricles. is seen on patients who have chronic or acute cardiac disease. On an EKG, ther is no P-wave, the QRS complex is distorted an T-wave has different shape. Myocardial infraction can result in a __________. an EKG reveal reveal a sustained run of PVC at rate of 150-250bpm that can lead to fibrillation and cardiac arrest.

Ventricular tachycardia

Lead ______records electrical activity from the midpoint between the right arm added to the left arm, directed to the left leg. Because these three leads produce such small electrical impulses, the electrocardiograph ma- chine augments, or increases, their size to record

aVF

Lead ______ records electrical activity from the midpoint between the right arm added to the left leg, directed to the left arm.

aVL

Lead______records electrical activity from the midpoint between the left arm added to the left leg, directed to the right arm

aVR

Made larger or louder

amplified

The tip of the heart is called and it is formed by the tip of the left VENTRICLE and rests on the DIAPHRAGM. The heart is titled FORWARD, DOWNWARD, and To the LEFT.

apex

is an irregular heartbeat. It could be caused by the atrium or the ventricles misfiring.

arrhythmia

two categories of arrhythmias,

atrial and ventricular arrhythmias.

AED

automated external defibrillator

Top of the heart is called

base

line is the flat line that separates the various waves. It is present when there is no current flowing in the heart. The waves are either deflecting upward, known as positive de- flection, or deflecting downward, known as nega- tive deflection from the baseline.

baseline isoelectric

EKG known as ECG

electrocardiogram

READ- The electrocardiograph records the electrical activity that causes the contraction (systole) and the relaxation (diastole) of the atria and ventricles.

fact

a device that uses an electromagnet to measure electric current

galvanometer

ICD

implantable cardioverter-defibrillator

receives oxygenated blood from the lungs. it is entirely posterior and lies in front of the esophagus, aorta and spinal column.

left atrium

is useful in identifying the location and thickness of cardiac muscle scars due to damage.

magnetic resonance imaging (MRI

An electrocardiograph that can simultaneously record several different leads is known as

multichannel electrocardiograph

heart attack

myocardial infarction

The anatomic positions for placement of the chest or precordial leads are: ______1. fourth intercostal space at right margin of sternum. _____2. fourth intercostal space at left margin of sternum _____3.midway between V2 and V4 (Note: This is correct order, V3 after V4.) _____4. fifth intercostal space on left midclavicular line _____5. horizontal to V4 at left anterior axillary line _____6.: horizontal to V4 at left midaxillary line

note: (Vsub 1-6) 1. V1 2. V2 3 V3 4. V4 5. V5 6. V6

is characterized by a sudden increase in heart rate to 160-250 bpm and then abruptly returns to normal. In this condition the P-wave looks like a saw tooth pattern. This condition can be seen in healthy individuals and those who have a cardiac disease.

paroxysmal atrial tachycardia (PAT) -symptoms include shortness of breath, fluttering in the chest and ocasionally dizziness.

sonographer

person who performs sonography

PVC

premature ventricular contraction

characterized by beat that occurs early in the cycle, then a pause then a normal cycle. it can be seen in healthy individuals and those having cardiac disease or lung disease. In healthy individuals this arrhythmia can be cause by alcohol and tobacco use, anxiety or use of certain medications.

premature ventricular contraction PVC

Is above and behind the right ventricle (superior and exterior)Receives deoxygenated blood from the body ( from the SUPERIOR and INFERIOR Vena cava.

right atrium

the most anterior structure of the heart. it is received the deoxygenated blood form the right atrium and send it to the lungs to received Oxygen.

right ventricle

'pacemaker of the heart' The electrical impulse that starts the conduction system is found in the upper wall of the right atrium and is called __________.

sinoatrial node

used to copy or trace lines, obtain a sharp, clear recording

tracing

The chambers of the heart are the

ventricles (Lower/Upper) and atria (Lower/Upper)

XRA

x-ray angiography