1. Heart Conduction System

2. Standards
Analyze the P,Q,R,S,T complex and its correlation to the cardiac cycle. Chart a mock representation of these waves on an electrocardiogram. Analyze rhythm strips and/or 12 lead EKGs and differentiate between critical and non-critical cardiac rhythms using student created algorithms.

3. Bell work
Define: Depolarization Repolarization What is an EKG/ECG? (look at diagnostic research in binder)

4. The Heart: Conduction System
The heart pumps blood through the body
This is accomplished by contraction and relaxation of the cardiac muscle tissue in the myocardium layer.

5. Conduction System Continued….
Cardiac conduction system: The electrical conduction system controls the heart rate
This system creates the electrical impulses and sends them throughout the heart. These impulses make the heart contract and pump blood.

6. CARDIAC CYCLE Creates Heart sounds Heard through stethoscope
“LUB-DUB” sound
1st sound, AKA S1 – longest and loudest (closure of atrioventricular (AV) valves)
Atrioventricular is Tricuspid and Mitral
What would Right AV valve be?
What would Left AV valve be?

7. 2nd sound – closure of aortic and pulmonary valves (AKA Semilunar Valves)
If valves do not close properly – you will hear an extra sound called a heart murmur

8. THE CARDIAC CYCLE
SYSTOLE – CARDIAC CONTRACTION THE BLOOD IS FORCED OUT OF THE HEART TO THE LUNGS FOR OXYGENATION AND TO THE BODY FOR CIRCULATION (CONTRACTION)
DIASTOLE – CARDIAC RELAXATION THE BLOOD IS RETURNED TO THE HEART FROM THE LUNGS AND THE BODY (RELAXATION)
What is this measuring?

9. Septum

10. Components of the Conduction System
Sinoatrial Node (Part I):
located in back wall of the right atrium near the entrance of vena cava
initiates impulses times per minute without any nerve stimulation from brain
establishes basic rhythm of the heartbeat
called the pacemaker of the heart
impulses move through atria causing the two atria to contract.
at the same time, impulses reach the second part of the conduction system

11. Components of the Conduction System Continued ….
Atrioventricular Node (Part II):
located in the bottom of the right atrium near the septum
cells in the AV node conduct impulses more slowly, so there is a delay as impulses travel through the node
this allows time for atria to finish contraction before ventricles begin contracting

12. Atrioventricular Bundle
A.K.A. “Bundle of His”
From the AV node, impulses travel through to the right and left bundle branches
These branches extend to the right and left sides of the septum and bottom of the heart.

13. Atrioventricular Bundle Continued….
These branch a lot to form the Purkinje fibers that transmit the impulses to the myocardium (muscle tissue)
The bundle of His, bundle branches and Purkinje fibers transmit quickly and cause both ventricles to contract at the same time
Like a “phone tree”

14. Atrioventricular Bundle Continued….
As the ventricles contract, blood is forced out through the semilunar valves into the pulmonary trunk and the aorta.
After the ventricles complete their contraction phase, they relax and the SA node initiates another impulse to start another cardiac cycle.

16. 1 - Sinoatrial node (SA node)
2 - Atrioventricular node (AV node)
3 – Bundle of His
4 - Right & Left Bundle Branches
which lead to Purkinje Fibers

17. THE CONDUCTION SYSTEM SINO-ATRIAL (SA) NODE ATRIAL IMPULSES
ATRIO-VENTRICULAR (AV) NODE
BUNDLE OF HIS
BUNDLE BRANCHES
PURKINJE FIBERS

19. USES OF AN EKG
TO DIAGNOSE
FOR MONITORING
IN DEFIBRILLATORS

20. INDICATIONS FOR AN EKG FUNCTION OF HEART
ELECTRICAL PROBLEMS
CHANGES IN THE HEART
ROUTINE PRE-OP
PART OF A COMPLETE Physical exam AFTER AGE 40
EVALUATION OF CARDIAC CONDITIONS
STAT – USUALLY IN AN EMERGENCY

21. EKG PREPARATION PHYSICIAN’S ORDER PATIENT’S WEIGHT AND HEIGHT
PATIENT’S DATA
LOCATION, DATE, AND TIME
PATIENT’S AGE, SEX AND CARDIAC MEDS
PATIENT’S WEIGHT AND HEIGHT
ANY SPECIAL CONDITION OR POSITION OF PATIENT DURING PROCEDURE

22. WHAT THE EKG WILL SHOW HEART RATE RHYTHM SIGNS OF CARDIAC ENLARGEMENT
HEART DISEASE
MYOCARDITIS
SIGNS OF HEART INJURY (MI)
ELECTROLYTE ABNORMALITY
PULMONARY EMBOLISM
DRUG TOXICITY

23. EKG BASICS
ELECTRODES – SENSORS PLACED ON THE PATIENT TO PICK UP ELECTRICAL ACTIVITY
LCD DISPLAY – LIQUID CRYSTAL DIODE AREA FOR PATIENT DATA ENTRY
ECG/EKG – RECORDING OF ELECTRICAL ACTIVITY ONTO GRID PAPER
LEADS – WIRES ATTACHED TO ELECTRODES

24. PATIENT PREPARATION REMOVE CLOTHING FROM THE WAIST UP
REMOVE JEWELRY THAT MAY INTERFERE
PROVIDE DRAPE FOR PRIVACY
CLEAN SKIN WITH ALCOHOL
APPLY LEADS TO NON-HAIRY AREA
SHAVE AREA ONLY IF NECESSARY

25. APPLYING ELECTRODES COMPLETE EKG CONSISTS OF 12 LEADS
LIMB LEADS ARE APPLIED TO ARMS AND LEGS
CHEST LEADS ARE APPLIED TO THE CHEST

26. CHEST LEADS 12 Leads V4 – 5TH INTERCOSTAL SPACE AT MID-CLAVICULAR LINE
V5 – SAME LEVEL AS 4 AT LT ANT. AXILLARY LINE
V6 – SAME LEVEL AS 4 AT LT MIDAXILLARY LINE
V1 – 4TH INTERCOSTAL SPACE RT OF STERNUM
V2 – 4TH INTERCOSTAL SPACE LT OF STERNUM
V3 – MIDWAY BETWEEN V2 & V4

27. LIMB LEADS RA - FLESHY OUTER AREA OF UPPER RIGHT ARM
LA – FLESHY OUTER AREA OF UPPER LEFT ARM
RL – FLESHY PART OF LOWER RIGHT LEG
LL – FLESHY PART OF LOWER LEFT LEG

28. THREE LEAD TRACING RA- RIGHT OF STERNUM (white)
LA – LEFT OF STERNUM (black)
LL LEFT LOWER RIB AREA (red)
Can have 5 lead tracing – see all leads

29. Day 2

30. Bell work
1. Define: Depolarization and Repolarization 2. How do you prepare a patient for an EKG? 3. Name three items an EKG could show 4. Put the following terms in order of correct cardiac conduction: Bundle of HIS SA Node Purkinje FibersL/R Bundle Branches AV Node

31. Standards
Analyze the P,Q,R,S,T complex and its correlation to the cardiac cycle. Chart a mock representation of these waves on an electrocardiogram. Analyze rhythm strips and/or 12 lead EKGs and differentiate between critical and non-critical cardiac rhythms using student created algorithms.

32. Objective
Understand Repolarization and Depolarization as it relates to the PQRST wave Identify arrhythmias

33. EKG

35. Polarization
Depolarization and Repolarization 1. Cardiac cells at rest are considered polarized, meaning no electrical activity takes place 2. The cell membrane of the cardiac muscle cell separates different concentrations of ions, such as sodium, potassium, and calcium. This is called the resting potential.

36. Polarization
3.  Electrical impulses are generated by automaticity of specialized cardiac cells
4.  Once an electrical cell generates an electrical impulse, this electrical impulse causes the ions to cross the cell membrane and causes the action potential, also called depolarization
5.  The movement of ions across the cell membrane through sodium, potassium and calcium channels, is the drive that causes contraction of the cardiac cells/muscle

37. Polarization
6.  Depolarization with corresponding contraction of myocardial muscle moves as a wave through the heart
7.  Repolarization is the return of the ions to their previous resting state, which corresponds with relaxation of the myocardial muscle

38. Polarization
8.  Depolarization and repolarization are electrical activities which cause muscular activity
9.  The action potential curve shows the electrical changes in the myocardial cell during the depolarization – repolarization cycle
10.  This electrical activity is what is detected on ECG, not the muscular activity.

39. EKG COMPONENTS
P WAVE – INDICATES ATRIAL DEPOLARIZATION CAUSING ATRIAL CONTRACTION
QRS COMPLEX – INDICATES VENTRICULAR DEPOLARIZATION CAUSING VENTRICULAR CONTRACTION
ST SEGMENT – INDICATES MYOCARDIAL DAMAGE
T WAVE – INDICATES VENTRICULAR REPOLARIZATION CAUSING VENTRICULAR RELAXATION

40. How To Read EKG
EKG paper is a grid where time is measured along the horizontal axis.
Each small square is 1 mm in length and represents 0.04 seconds.
Each larger square is 5 mm in length and represents 0.2 seconds
In order to correctly identify heart rhythms, you will need to print off 6 second strips

41. How to Read EKG Can determine HR from EKG strip
Each strip is 6 seconds
To determine HR:
Count R waves and multiply by 10

42. EKG Analysis – 8 steps Rhythm – Regular or Irregular Heart Rate
Is there a P Wave?
Is there a PR – interval?
Is there a QRS?
Is there a T wave?
Is there a Q-T interval
Is there an ST segment

43. REGULAR HEART RHYTHMS NORMAL SINUS RHYTHM (NSR) SINUS TACHYCARDIA
between 60 – 100 BPM, regular rhythm
SINUS TACHYCARDIA
> 100 BPM, regular rhythm
SINUS BRADYCARDIA
< 60 BPM, regular rhythm

44. Normal Sinus Rhythm
60 – 100 Beats per minute

45. Sinus Tachycardia
 A fast heart rhythm with a rate of more than 100 beats per minute.

46. Sinus Bradycardia
A slow heart rhythm with a rate below 60 beats per minute.

47. Arrhythmias
Abnormal heart rhythms that can be mild to life threatening.
Atrial
Junctional
Ventricular
Heart Blocks

48. Irregular Rhythm

49. Arrhythmias ATRIAL PREMATURE ATRIAL CONTRACTION (PAC) ATRIAL FLUTTER
ATRIAL FIBRILLATION (A-FIB)
VENTRICULAR
PREMATURE VENTRICULAR CONTRACTION (PVC)
VENTRICULAR TACHYCARDIA (V-TACH)
VENTRICULAR FIBRILLATION (V-FIB)
SUPRAVENTRICULAR TACHYCARDIA (SVT)
ASYSTOLE

50. PAC Premature atrial contraction (PAC)
Can occur in anyone but usually goes unnoticed.
Most common forms of arrhythmias. 
the premature discharge of an electrical impulse in the atrium, causing a premature contraction. 
A PAC is premature, because the it occurs earlier than the next regular beat should have occurred.

52. Atrial Flutter
the electrical signal travels along a pathway within the right atrium. It moves in an organized circular motion, or "circuit," causing the atria to beat faster than the ventricles of your heart.

53. Atrial Fibrillation
Many impulses begin and spread through the atria, competing for a chance to travel through the AV node. The resulting rhythm is disorganized, rapid and irregular. Because the impulses are traveling through the atria in a disorderly fashion, there is a loss of coordinated atrial contraction.

54. Premature Ventricular Contraction (PVC)
Early, extra heartbeats that originate in the ventricles. Most of the time, PVCs don’t cause any symptoms or require treatment. This type of arrhythmia is common and can be related to stress, too much caffeine or nicotine, or exercise. They can be also be caused by heart disease or electrolyte imbalance.

55. Ventricular Tachycardia
A rapid heartbeat that originates in the ventricles. The rapid rhythm keeps the heart from adequately filling with blood, and less blood is able to pump through the body. V-tach can be serious, especially in people with heart disease.

56. Ventricular Fibrillation
An erratic, disorganized firing of impulses from the ventricles. The ventricles quiver and cannot generate an effective contraction, which results in a lack of blood being delivered to the body. This is a medical emergency that must be treated with cardiopulmonary resuscitation (CPR) and defibrillation (delivery of an energy shock to the heart muscle to restore a normal rhythm) as soon as possible.

57. Superventricular Tachycardia SVT
Supraventricular tachycardia (SVT) is a cardiac arrhythmia characterized by very rapid or erratic beating. 
heart racing/palpitations, dizziness or light-headedness, chest pain, breathlessness

58. Asystole
Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. 

59. Artifact