1. Cardiology and Lymphatics
Chapter 27
Cardiology and Lymphatics

3. Learning Objectives
Identify key structures of the cardiovascular and lymphatic systems
Describe the electrical conduction system of the heart
Discuss the roles played by the cardiovascular and the lymphatic systems
Define and spell terms related to the cardiovascular and lymphatic systems

4. Learning Objectives
Define the role of the medical assistant in the cardiology office
Identify common cardiovascular and lymphatic disorders
List commonly used word elements related to the cardiovascular and lymphatic systems

5. Learning Objectives
Give at least 10 examples of how new cardiology-related terms may be created by combining prefixes, suffixes, and combining forms
Describe physical examination techniques used to evaluate the cardiovascular and lymphatic systems

6. Learning Objectives
List and describe types of cardiovascular testing done in or out of the cardiology office
Demonstrate the performance of an electrocardiogram (ECG)

7. Structures of the Heart
Epicardium
Myocardium
Endocardium
Atrium
Ventricles
Septum

8. Circulatory System Arteries (carry oxygenated blood)
Veins (carry deoxygenated blood)
Major arteries: aorta, pulmonary arteries
Major veins: pulmonary veins and superior and inferior vena cava
Capillaries

9. Circulatory System
Structures of the circulatory system

10. Heart Hollow, muscular organ Generates its own contractions
Enclosed in pericardial sac, pericardial fluid
Two-sided pump

11. Conduction System of Heart
SA node
AV node
Bundle of His
Purkinje fibers

12. Cardiac Cycle Contraction and relaxation of heart Systole Diastole
0.8 seconds
Blood pressure
Written as 110/72
Systole—highest pressure of contraction
Diastole—relaxation of heart, condition of vessels away from heart

13. Circulatory System
Aorta—largest artery carries blood away from the heart; thick, muscular walls; high pressure, blood is rich in oxygen
Veins—less oxygenated blood, less pressure, valves prevent backflow
Capillaries—microscopic vessels, place where exchange of oxygenated blood and deoxygenated takes place

14. Lymphatic System
Lymphatic vessels parallel arteries, veins, capillaries
Lymph fluid in lymphatic vessels
Muscle contractions move lymph through body, no pump
Lymph nodes and glands
Immunity

15. Structures of Lymphatic System
Lymph—fluid, watery substance, excess fluid in tissues
Interstitial fluid—lymph in tissue spaces
Lymphatic vessels—vessels that carry lymph
Lymph nodes—tonsils, adenoids
Nodes found throughout body but higher concentrations are found in groin, neck, and axilla

16. Lymph Glands Thymus—produces T lymphocytes, shrinks in size with age
Spleen—rich blood supply, produces white blood cells and antibodies, can survive without spleen

17. Common Diseases and Disorders
Hypertension (high blood pressure)— consistent blood pressure >140/90, secondary and primary hypertension, known as the silent killer, treatment includes modifying risk factors and medication

18. Coronary Artery Diseases
CAD—lumen of arteries become narrow due to deposits of fat on artery walls
Treatment includes lifestyle modifications, medications, angioplasty

19. Myocardial Infarction
MI (heart attack)— death of heart muscle
Life-threatening emergency
Aggressive treatment includes medications, hospitalization, respiratory support

20. Heart Failure
Congestive heart failure—inability of heart to pump blood effectively
Left-sided heart failure, right-sided heart failure
Treatment—medications including diuretics, antihypertensives, and digoxin

21. Aneurysm Abnormal dilation in vessel wall usually due to weakness
Treatment includes “watchful waiting” and surgery

22. Common Diseases and Disorders
Atrial fibrillation—common type of heart arrhythmia, atria do not contract regularly
Treatment—medications, cardioversion, and possible ablation
Varicose veins—enlarged, dilated superficial veins, mostly legs, treatment includes rest, elevation, support hose, ligation

23. Common Diseases and Disorders
Deep vein thrombosis (DVT)—blood clot in deep vein, usually legs, treatment includes medication, rest, elevation, warm compresses
Shock—inadequate perfusion and oxygenation due to low blood pressure, varying degrees of shock, treatment includes quick diagnosis, medications

24. Common Diseases and Disorders
Anemia—decreased amount of red blood cells, treatment depends on underlying cause and may include supplements
Leukemia—malignancy of blood and blood-forming tissues, different types, treatment varies according to type of leukemia

25. Common Diseases and Disorders
Hodgkin disease (lymphoma)—malignancy of lymph system, treatment may include chemotherapy, radiation, and possibly bone marrow transplantation
Non-Hodgkin lymphoma—group of malignancies, treatment may include radiation, chemotherapy, and bone marrow transplantation

26. AIDS
Acquired immune deficiency syndrome— late-stage infection of HIV which progressively weakens immune system
Treatment includes medications and general measure to improve immune system
Currently there is no cure and no vaccine to prevent AIDS

27. Medical Specialty
Cardiology—medical specialty that focuses on the study and treatment of disorders of the cardiovascular system
Cardiologist—medical doctor specializing in the diagnosis and treatment of patients with cardiovascular disorders

28. Assisting With Examination
Medical assistant prepares patient for exam
Checks vital signs
Obtains health history, may include family history, risk factors for CAD, new or unusual symptoms
Assists patient as necessary
Assists physician as necessary

29. Electrocardiography ECG—noninvasive procedure
Electrocardiograph— machine to record electrical heart activity
Electrocardiogram—written record of electrical heart activity

30. Electrocardiograph paper
Paper is heat and pressure sensitive
Vertical and horizontal lines 1 mm each
Bold vertical and horizontal lines 5 mm each

31. Standardization ECG machine must be standardized or calibrated
Correct standardization is 10 mm vertical deflection, 2 mm horizontal

32. Leads and Electrodes Placed on patient’s arms, legs, and chest
Color-coded wires assure correct placement
Leads record electrical activity between positive and negative electrodes

33. Preparing the Patient Make patient as comfortable as possible
Instruct patient to undress to the waist, properly gown/drape
Position patient in supine or semi-Fowler position
Record medications and vital signs
Assure patient that the procedure is painless

34. Rhythm Interpretation
P wave—atrial depolarization
Q,R,S complex—ventricular depolarization
ST segment—no electrical activity
T wave—ventricular repolarization

35. Waveforms
ECG waves include:
P wave
Q,R,S complex
ST segment
T wave

36. Artifacts Distracting and irrelevant marks on ECG
If present, may have to repeat ECG
Causes include somatic tremor, wandering baseline, AC interference, and interrupting baseline

37. Somatic Tremor Small, irregular, jagged peaks Fuzzy appearance
Caused by muscle movement
Comfort patient, keep patient still, encourage to not talk

38. Wandering Baseline Entire tracing strays from baseline
Patient movement, faulty connections
Keep patient still, clean electrodes, check connections

39. Alternating Current (AC) Interference
Series of short spikes
Electrical currents
Ground ECG machine with three-prong cord in outlet, avoid crossing lead wires, unplug nearby equipment

40. Interrupted Baseline Large, irregular fluctuations
Patient movement, broken lead wires
Keep patient still, replace lead wires

41. Artificial Cardiac Pacemaker
Device that delivers electrical impulses to stimulate heartbeat
Used when natural heartbeat is too slow or irregular
Implanted under patient’s skin
Physician sets pacemaker’s pace

42. Implantable Cardioverter Defibrillator
Slightly larger than pacemaker
Some devices are combination pacemaker and defibrillator
Used in patients with life-threatening arrhythmias
When patient is in life-threatening rhythm, the device delivers an electrical shock to restore normal sinus rhythm

43. Cardiac Stress Test Evaluates heart’s response to physical exercise
Patient walks on treadmill or is given IV medication to stimulate response
During test heart rate, BP is monitored and any symptoms are noted
Constant monitoring is important

44. Holter Monitoring
Portable device monitors patient’s heart for 24- or 48-hour period
Used when patient has irregular heartbeat or symptoms are intermittent
Electrodes are placed on patient’s chest; the monitor is placed in a small pouch
Patient records activities in a journal

45. Holter Monitoring
Patient returns to clinic where recording from monitor is downloaded

46. Event Recorder “King of Hearts”
Small, portable monitor, placed around the patient’s neck or in shirt pocket
Electrodes on patient’s chest are activated when symptoms occur

47. Discussion Identify structures of the heart
List functions of the heart
List organs of the lymphatic system
Discuss conduction system of the heart and an artificial pacemaker
Identify sites for electrode placement in electrocardiogram

48. Credits