1. Medical Assisting Chapter52
PowerPoint® to accompany
Medical Assisting Chapter52
Second Edition
Ramutkowski  Booth  Pugh  Thompson  Whicker
Chapter 52
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

2. Electrocardiography and Pulmonary Function Testing
Objectives
52-1 Describe the anatomy and physiology of the heart.
52-2 Explain the conduction system of the heart.
52-3 Describe the basic patterns of an electrocardiogram (ECG.)
52-4 Identify the components of an electrocardiograph and what each does.
52-5 Explain how to position the limb and precordial electrodes correctly.

3. Electrocardiography and Pulmonary Function Testing
Objectives (cont.)
Describe in detail how to obtain an ECG.
Identify the various types of artifacts and potential equipment problems and how to correct them.
Discuss how the ECG is interpreted.
52-9 Define exercise electrocardiography.
52-10 Explain the procedure of Holter monitoring.
52-11 Describe the anatomy and physiology of the lung.

4. Electrocardiography and Pulmonary Function Testing
Objectives (cont.)
52-12 Describe various types of spirometers.
52-13 Describe the procedures of performing spirometry.

5. Introduction
You may be responsible for performing, screening, and/or diagnostic testing in the physician’s office.
It is not uncommon for patient to have cardiovascular or respiratory problems.
You will learn how to correctly perform testing on the cardiac and respiratory systems.

6. Electrocardiography and Pulmonary Function Testing
Your role will be to perform:
Electrocardiography – graphic recordings of the electrical impulses of the heart
Pulmonary function tests – measure and evaluate a patient’s lung capacity and volume

7. Anatomy of the Heart
Muscular pump that circulates blood throughout the body
Carries oxygen and nutrients to tissues and removes waste products
Pumping action begins in the muscle tissue of the heart (myocardium)
Double pump
Right side
Left side
A description of the anatomy and physiology of the heart will help you better understand electrocardiography.

8. Anatomy of the Heart
Right side receives blood from the body and pumps blood to the lungs where carbon dioxide is exchanged for oxygen.
Oxygenated blood flows into the left side of the heart and is pumped into the aorta and to all parts of the body.

9. Heart Valves and Vessels
Aorta
Tricuspid Valve
Vena Cava
Bicuspid Valve
Pulmonary Artery
Aortic Valve
Pulmonary Veins
Pulmonary Valve
Using the on-screen pen draw a line from the label to its location.

10. Physiology of the Heart
Two pumps – divided into separate chambers that work as a single unit.
Contraction of the atria (systole) followed by the contraction of the ventricles moves the blood.
Diastole – follows systole by a relaxation phase.
The sequence of systole and diastole is a complete heartbeat (cardiac cycle) and lasts about 0.8 second.

11. Conduction System of the Heart
Sinoatrial (SA) node pacemaker of the heart – right atrium.
Atrioventricular (AV) node – bottom of right atrium.
Bundle of His
Purkinje fibers
Cardiac cycle is controlled by specialized tissues in the heart wall that transmit electrical impulses.
These impulses cause the heart to contract.

12. Conduction System Bundle of His SA Node Bundle Branches AV Node
Purkinje Fibers
Using the on-screen pen draw a line from the label to its location.

13. Conduction and Electrocardiography
Transmission, magnitude, and duration of the various electrical impulses of the heart
Electrocardiograph – machine that measures and displays impulses of the heart

14. Basic Pattern of the Electrocardiogram
Peaks and valleys called waves are labeled P, Q,R,S,T,U. Each letter represents part of the pattern.
Basic Pattern of ECG

15. Types of Electrocardiographs
Standard machine – 12 lead that records 12 different views at once
Single channel – one lead and records only one view

16. Lead Placement
Limb leads – six leads, three are standard, three are augmented leads
Bipolar leads monitor two limbs
Augmented leads monitor one limb and a point midway between two other limbs (unipolor)

17. Precordial Leads Placement
Lead Placement
Precordial leads – six leads (unipolar)
Placed across the chest
Precordial Leads Placement

18. Obtaining an ECG Prepare the room and equipment
Quiet, protected from interruptions
All other electrical equipments off
Sturdy and comfortable exam table
Ensure equipment is working properly

19. Obtaining an ECG (cont.)
Preparing the patient
Introduce yourself
Explain the procedure
Answer any questions
Complete ECG procedure accurately

20. Troubleshooting
You must recognize artifacts and identify sources of interferences.
Caused by improper techniques, poor conduction, outside interference, or improper handling.

21. Troubleshooting (cont.)
Wandering baseline-causes somatic interference or mechanical problem
Flat line – loose or disconnected wire
Extraneous marks – careless handling

22. Interpreting the ECG Heart rhythm Heart rate Intervals and segments
You will not be responsible for interpreting an ECG
Sometimes knowing how they are interpreted will allow you to recognize a problem that requires immediate attention.
Heart rhythm
Heart rate
Intervals and segments
Wave changes

23. Exercise Electrocardiography
Stress tests - assesses the heart’s conduction system during exercise when the demand for oxygen increases.
Measures the patient’s responses to workload.

24. Holter Monitoring
Electrocardiography device that includes a small cassette recorder worn around a patient’s waist or shoulder strap to record the heart’s electrical activity.
Patient is to do normal daily activities and keep a written log of activities and of stress or symptoms experienced.

25. Apply Your Knowledge
Where is the atrioventricular node located?

26. Apply Your Knowledge -Answer
Where is the atrioventricular node located?
The atrioventricular (AV) node is located at the bottom of right atrium

27. Anatomy of the Respiratory System
Composed of nose, pharynx, larynx, trachea, two bronchi, and the lungs
The alveoli is where exchange of gases between the air and the blood (external respiration) occurs

28. Physiology of the Respiratory System
External respiration :
Ventilation – movement of air in and out of the lungs
Diffusion:
Passive process wherein oxygen and carbon dioxide cross the capillary and alveolar membranes and enters the capillaries or alveoli

29. Physiology of the Respiratory System (cont.)
Perfusion (internal respiratory) –
Exchange of oxygen in the blood for carbon dioxide in the cells of the body tissue and organs
Perfusion, diffusion, and ventilation occur simultaneously

30. Pulmonary Function Testing
Evaluates lung volume and capacity.
Used to evaluate shortness of breath.
Help detect and classify pulmonary disorders.
Asthma
Cystic fibrosis
COPD

31. Spirometry
Spirometer – Measures air taken in by and expelled by the lungs.
Forced vital capacity (FVC) – greatest volume of air that can be expelled when a person performs rapid, forced expiration.
Types of spirometers:
Computerized
Mechanical

32. Performing Spirometry
Patient preparation:
Inform the patient about conditions that could affect the test accuracy.
Explain that he/she will wear a nose clip.
Be sure patient forms a tight seal around the mouthpiece with his/her lips.
Position the patient – chin slightly elevated and neck slightly extended.

33. Performing Spirometry (cont.)
Performing the maneuver:
Urge patient to blow hard and to continue blowing until you tell them to stop.
Obtain three acceptable maneuvers.
Observe the patient for signs of breathing difficulty.
Notify physician immediately if symptoms occur.

34. Apply Your Knowledge
What does FVC abbreviate?

35. Apply Your Knowledge -Answer
What does FVC abbreviate?
Forced vital capacity (FVC) – greatest volume of air that can be expelled when a person performs rapid, forced expiration.

36. Medical Assistant Summary
Electrocardiography and pulmonary function testing play a vital role in diagnosis and treatment of cardiac and pulmonary disease.
You need to know the basics of the conduction system of the heart, components of the ECG, and the correct techniques to get a spirometry reading.

37. End of Chapter
End of Chapter