1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 37 Electrocardiography

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anatomy of the Heart Four chambers –Two upper chambers known as atria –Two lower chambers known as ventricles Deoxygenated blood Oxygenated blood

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anatomy of the Heart Coronary arteries Click here to see an animation

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrical Conduction System of the Heart Sinoatrial (SA) node Atrioventricular (AV) node Bundle of His and Purkinje fibers

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrical Conduction System of the Heart Systole and diastole Impulses can be recorded on ECG paper or displayed on oscilloscope

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Cardiac Cycle and the ECG Cycle Baseline or isoelectric line Positive deflection Negative deflection Each cardiac cycle takes about 0.8 second

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Cardiac Cycle and the ECG Cycle P, QRS, and T waves

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Calculation of Heart Rate On ECG graph paper: –Every fifth line is darker than other lines –Time is measured on horizontal line –Voltage is measured on the vertical line

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Electrocardiographs Single-channel ECG >> Multichannel ECG Automatic ECG machines

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Electrocardiographs ECG telephone transmissions Facsimile electrocardiograph Interpretive electrocardiograph

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ECG Equipment Electrocardiograph paper –Black or dark blue –Wax or plastic coated –Heat and pressure sensitive –Heat of stylus can be adjusted to obtain a sharp tracing

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ECG Equipment Electrolyte –Help pick up electrical current produced by contraction and relaxation of heart –In form of gel, lotion, paste, or pre-saturated pads

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ECG Equipment Sensors or electrodes –Disposable sensors –Detect electrical impulses on body surface from the myocardium and relay them through cables

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ECG Equipment Lead wires –Once self-adhesive sensors are placed, lead wires from the ECG machine are attached Caring for equipment

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Lead Coding 12 leads recorded using 10 lead wires Necessary for identification and mounting purposes Newer ECGs automatically mark (code) each lead

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Electrocardiograph and Lead Placement 12 leads record heart’s electrical activity Allows for 3D interpretation of activity Amplification of electrical activity

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Electrocardiograph and Lead Placement Galvanometer changes voltage into mechanical motion Stylus records motion

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Electrocardiograph and Lead Placement Types of leads –Standard limb or bipolar leads –Augmented leads –Chest leads, precordial leads, or V leads Placement of electrodes

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Standardization of the Electrocardiograph Value of recording depends on accuracy Universal measurements One millivolt of cardiac electrical activity will deflect stylus exactly 10 mm high

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Standard Resting Electrocardiography Performing 12-lead electrocardiogram

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Standard Resting Electrocardiography Click Here to play the video

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Mounting the ECG Tracing Commercially prepared mounting forms Mount completed tracing after provider has reviewed entire recording Identify patient, date, age, blood pressure, height and weight, and cardiac medications

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Interference or Artifacts Somatic tremor artifacts Alternating current (AC) interference Wandering baseline artifacts Interrupted baseline artifacts

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cardiac Conditions and Diseases Myocardial infarctions (heart attack) –Primary cause of death in U.S. –Offer patient health tips as part of patient education Behaviors to adopt for a healthy heart

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cardiac Arrhythmias Click Here to play the video

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cardiac Arrhythmias Atrial arrhythmias –Premature atrial contractions (PAC) –Paroxysmal atrial tachycardia (PAT) –Atrial fibrillation

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cardiac Arrhythmias Ventricular arrhythmias –Premature ventricular contractions (PVCs) –Ventricular tachycardia –Ventricular fibrillation

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Defibrillation Electrical device that applies countershocks to heart through electrodes or pads placed onchest wall (AED) Can convert cardiac arrhythmia into normal sinus rhythm

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Holter Monitor Portable ambulatory electrocardiograph –Portable continuous recording of cardiac activity for a 24-hour period –Noninvasive test –Helps diagnose cardiac arrhythmias by correlating them with patient’s symptoms

30. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Holter Monitor Medical assistant’s role –Preparing patient –Instructing patient –Applying and removing monitor

31. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Holter Monitor Patient activity diary –Record all activities, emotional states, and time of their occurrence –Record chest pain and other symptoms and time of their occurrence

32. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Holter Monitor Removing the Holter Monitor –Patient returns to office –Tape is analyzed by scanner or computer –Written report sent to physician

33. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Diagnostic Tests Treadmill stress test –Diagnose heart disorders and probable cause of patient’s chest pain –Assess patient’s cardiac ability following cardiac surgery –Noninvasive test –Patient exercises on treadmill at varying rates of speed

34. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Diagnostic Tests Loop ECG Thallium stress test Echocardiography/ultrasonography

35. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cardiac Procedures Coronary angioplasty with and without stent –Balloon inflated inside coronary artery with or without stent –Keeps artery open Coronary artery atherectomy –Cutting away of plaque in blocked coronary artery

36. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Cardiac Diagnostic Tests Coronary artery bypass –Vein transplanted into blocked coronary artery(ies) –Blood supply reestablished to myocardium Cardiac computerized tomography and cardiac magnetic resonance