1. ADVANCED CARDIAC MONITORING HEALTH TECH 2 LANCASTER HIGH SCHOOL

2. Chapter 22 Objectives Identify the structures of the heart. Compare and contrast the pulmonary and systemic circulation. Trace the pathway of the blood. Describe coronary circulation. Explain the cardiac cycle. Identify what takes place during systole and diastole phases. Define the qualities of the heart and their relationship to the cardiac conduction system. Describe the parts and function of the conduction system. Explain the conduction system as it relates to the ECG. Discuss the electrical stimulation of the heart as it relates to the ECG waveform. Identify each part of the ECG waveform. Describe the heart activity that produces the ECG waveform. Identify parts of the waveform Explain the nursing assistants role Return demonstrate the application of a 12-lead ECG

3. Chapter 23 The Cardiovascular System Anatomy of the Heart –Center of chest –Under the sternum and between the lungs –About the size of your fist –Weighs about 10.6 oz or 300 grams –Average beats per minute = 72 –Total output = 5 liters per minute

4. Chapter 24 Heart Layers Pericardial Space Parietal Pericardium Endocardium Myocardium Epicardium (Visceral Pericardium)

5. Chapter 25 Heart Chambers Left Ventricle Left Atrium Right Ventricle Right Atrium

6. Chapter 26 Heart Valves and Vessels Vena Cava Aorta Pulmonary Veins Pulmonary Artery Tricuspid Valve Bicuspid Valve Aortic Valve Pulmonary Valve

7. Chapter 27 Pulmonary Circulation Deoxygenated blood enters the right atrium from the superior and inferior vena cava. From the right atrium, blood passes through the tricuspid valve to the right ventricle. Right ventricle pumps the blood through the pulmonary semilunar valve into the pulmonary artery then to the lungs. From the lungs, pulmonary veins transport the blood to the left atrium.

8. Chapter 28 Systemic Circulation Oxygenated blood enters the left atrium, passes through the mitral valve into the left ventricle. Left ventricle pumps blood through aortic semilunar valve to aorta. From aorta, blood circulates throughout the body. Deoxygenated blood from the body returns to the heart via the superior and inferior vena cava.

9. Chapter 29 Coronary Circulation Oxygenated blood from left ventricle, to the aorta, to the coronary arteries Left main coronary artery –Has more branches than right main since left side of heart is more muscular Deoxygenated blood returns to right atrium via coronary veins and coronary sinus.

10. Chapter 210

11. Chapter 211 Unique Qualities of the Heart Automaticity - heart’s ability to initiate electrical impulse Conductivity - ability of myocardial cells to receive and conduct electrical impulses Contractivity - ability of the heart muscle to shorten in response to electrical impulse Excitability - ability of the heart to respond to impulse or stimulus

12. Chapter 212 Diastole – Relaxation Phase Blood returns to the heart via superior and inferior vena cava. Blood flows from the right atrium through the tricuspid valve into the right ventricle. Blood from the pulmonary veins flows from the left atrium through the mitral valve into the left ventricle.

13. Chapter 213 Systole - Contraction Phase Contraction creates pressure, opening the pulmonary and aortic valves. Blood from the right ventricle flows to the lungs. Blood from the left ventricle flows through the aorta to the body.

14. Chapter 214 Pathways for Conduction Sinoatrial (SA) node –Located in upper right portion of right atrium –Initiates the heartbeat –Pacemaker of the heart (60 - 100 beats per minute) –Normal conduction begins in SA node

15. Chapter 215 Pathways for Conduction (Cont’d) Bundle of His (AV bundle) –Located next to the AV node –Transfers electrical impulse from atria to ventricles via bundle branches

16. Chapter 216 Pathways for Conduction (Cont’d) Atrioventricular (AV) node –Located on floor of right atrium –Causes delay in electrical impulse –Can act as pacemaker if SA node is not working (40 - 60 bpm)

17. Chapter 217 Pathways for Conduction (Cont’d) Purkinje fibers (network) –Electrical pathway for each cardiac cell –Activate left and right ventricles simultaneously –Produce an electrical wave

18. Chapter 218 ECG Waveform ECG waveform –Recorded activity of depolarization and repolarization –Isoelectric line - baseline when no electrical activity occurs –Discovered by Einthoven

19. Chapter 219 ECG Waveform (Cont’d) P wave –First deflection –Positive –Occurs when atria depolarize –Small, compared to other ECG waves

20. Chapter 220 ECG Waveform (Cont’d) Q wave –Represents conduction of impulse down interventricular septum –Negative deflection –Less than 1/4 the height of R wave

21. Chapter 221 ECG Waveform (Cont’d) R wave –First positive wave of QRS complex –Represents conduction of electrical impulse to left ventricle –Usually easiest to find

22. Chapter 222 ECG Waveform (Cont’d) S wave –First negative deflection after R wave –Represents conduction of electrical impulse through both ventricles

23. Chapter 223 ECG Waveform (Cont’d) T wave –Represents ventricular repolarization –Normal T wave is in same direction as QRS complex and P wave

24. THE NURSING ASSISTANTS ROLE Recognizing and reporting abnormalities 1.The waveform Longer PR interval ST interval changes No return to the baseline between QRS and T wave Increase in size of the T wave New dsyrhythmia

25. THE NURSING ASSISTANTS ROLE 2. The Patient –unconsciousness –c/o chest pain SOB Dizziness Setting up continuous monitoring Obtaining a 12-lead ECG

26. DYSRHYSTHMIAS When electrical impulse doesn’t travel in orderly manner through the conduction system. 6 types based on where the change in impluse or interruption occurs

27. DYSRHYTHMIAS SA Node –Occur when impulses are fired at a rate faster or slower than normal. Sinus bradycardia Sinus tachycardia (sinus rhythm is the 60-100)

28. DYSRHYTHMIAS Atrial –Impluses begin in the atria rather than the SA node Atrial flutter Atrial fibrillation

29. Dysrhythmias Atrioventricular Junction –Begin in the area around the av node and the bundle of his (AV junction) Junctional rhythm Atrioventricular nodal re-entry tachycardia

30. DYSRHYTHMIAS Ventricular dysrhythmias –Begin in the ventricles below the bundle of His causing the blood to not circulate through the body. Premature ventricular contraction Ventricular tachycardia Ventricular fibrillation Idioventricular rhythm

31. DYSRHYTHMIAS Atriaventricular Blocks –Problem with the av node that prevent the impluse from the sa node from traveling town to the ventricles. First degree –Sent but at a slower rate Second degree –Some impluses are conducted Third degree –No impulse is conducted

32. DYSRHYTHMIAS Bundle branch block –When the bundle branch is unable to conduct the impluse down to the purkinje fibers

33. Automatic Blood Pressure Monitoring

34. Observations to Report to the Nurse Immediately sterile dressing covering the insertion site is loose, wet, or soiled redness, swelling, drainage, or bleeding at the insertion site blood in the tubing tubing is disconnected a change in the position of the patient or the bed (in other words, the transducer needs to be leveled and zeroed) a change in the waveform or pressure reading on the monitor complains of pain, numbness, or tingling in the hand patient’s hand is pale, blue, or cold

35. Telemetry