1. Cardiology
Careers
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2. Careers in Cardiology Electrocardiography Technician
Cardiovascular Technologist
Cardiologist

3. Electrocardiography Technician
Uses an electrocardiograph to record the electrical activity of the heart as a tracing.
Electrocardiograms help diagnose and evaluate cardiovascular disease.
Determines if the tracing is accurate and prepares a report for the physician.

4. Cardiovascular Technologist
May need up to 4 years of education and training.
Works directly with cardiologists.
Heart Surgery
Implant Pace Makers
Angioplasty
Cardiac Catherization
Ultrasound (Echocardigram)

5. STOP

6. Cardiology
Anatomy
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7. Heart
Composed of Cardiac Muscle
Involuntary

8. Gross Anatomy of the heart
Superior vena cava
Inferior vena cava
Right Atrium
Tricuspid Valve
Right ventricle
Pulmonary Valve
Pulmonary Artery
Pulmonary Vein
Left atrium
Mitral Valve
Left Ventricle
Aortic Valve
Aorta

9. Valves Tricuspid Valve Pulmonary Valve Mitral Valve Aortic Valve
Between right atrium and ventricle
Pulmonary Valve
Right ventricle and
Mitral Valve
Right Ventricle to Pulmonary Vein
Aortic Valve
Left Ventricle to Pulmonary Artery

10. Major Arteries Coronary Artery Circumflex Artery Acute Marginal Artery
Left and Right
Circumflex Artery
Acute Marginal Artery
Posterior Descending Artery
Left anterior descending artery
Diagonal arteries

11. Electrophysiology Sinoatrial (SA) node. Atrioventricular (AV) node.
Sends a signal for heart to beat 60 – 100 bmp
Atrioventricular (AV) node.
Bundle of His (AV bundle).
Bundle branches.
Purkinje fibers (network).

12. STOP

13. Cardiac Procedures Cardiology
Copyright © The McGraw-Hill Companies, Inc.

14. Echocardiagram Noninvasive Uses ultrasound waves Used to determine:
Image of the heart - Size of the heart, heart chambers and thickness of the heart muscle.
Pumping strength - is pumping at full strength or is weakened, are various parts of the heart pumped equally.
Valve problems - shape and motion of the heart valves. valve is narrowed or leaking and shows how severe the valve problem is.
Other uses - used to detect the presence of fluid around the heart, blood clots, or masses inside the heart, and abnormal holes between heart chambers. Exercise or dobutamine stress test to see how well the heart pumps when it is accelerated.

15. Cardiac Catheterization
This test looks at the structures of the heart.
A small tube is threaded through the client’s blood vessels to the heart, where pressure is measured and dye is injected.

16. Balloon angioplasty Used to compress plaque in arteries.
A catheter with a balloon on its end is inserted into a blood vessel; then the balloon is inflated to expand the blood vessel.

17. Stent placement Used to keep arteries open to allow blood flow.
Placed during cardiac catherization.

18. Valve Replacement one (or more) valve(s) becomes stenotic (stiff)
Infection or aging
may be repaired by:
using a ring to support a person's own valve
or the entire valve may be removed and replaced by an artificial valve.
Mechanical (made of metal or plastic) or tissue (made from animal valves or human valves taken from cadavers).
Chapter 25

19. CABG
Coronary Artery bypass graft.
Graft is veins taken from the leg.

20. Heart – Lung Machine
Used to oxygenate and circulate blood in a patient with no heart or lung function
machine requires that it be hooked up both to the aorta and the vena cava.

21. Pacemaker
needed when problems occur with the electrical conduction system of the heart
Signals the heart to beat when the heartbeat is too slow or irregular.

22. Defibrillator regulate electrical problems with the heart
Set to deliver a shock to the heart during
Ventricular Fibrillation
Ventricular Tachycardia
Cardiac arrest

23. Patient Risk bleeding during or after the surgery
blood clots that can cause heart attack, stroke, or lung problems
infection at the incision site
pneumonia
breathing problems
cardiac dysrhythmias/arrhythmias (abnormal heart rhythms)

24. ECG/EKG Determines how well the heart is pumping and contracting.
Checks for problems with the flow of electricity through the heart.
Diagnoses changes in the heart rhythm.
Checks for abnormal heart changes before surgery.
Assists in evaluating a person’s health after age 40.
Monitors or evaluates individuals with heart conditions.

25. The ECG Waveform
The deflections on a tracing rise above or fall below a straight line.
This line is known as an isoelectric line, or baseline.
Positive deflections go up (power up or begin to contract), negative ones go down (power down).
Each wave represents specific activity in the heart.

26. Working with Electrodes
Reusable electrodes – plates and bulbs.
Disposable electrodes – used to reduce possible contamination.

27. Proper Handling and Storage
Keep unused electrodes in a sealed plastic bag.
Check the expiration date.
Ensure the gel has not dried.
Always check electrodes before you use them.

28. ECG Machines Single-Channel ECG – monitors 12 leads individually.
Multichannel ECG – produces all 12 leads by recording 3 leads at once.

30. STOP

31. Cardiology
ECG / EKG
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32. EKG electrodes/wires 3 - 10 Wires available
Most will have a label on where to put them.

33. Lead Placement Some leads are positive and some are negative.
Where the leads are placed will determine what your picture will look like.
The 10 lead wires produce 12 different lead circuits.

34. The heart’s electrical conduction
Electrocardiograms are an electrical picture of the heart.
Electrical activity
precedes mechanical activity
coordinates all parts of the heart to contract at the same time
initiated in the sinoatrial (SA) node

35. Normal ECG waveform
P Wave
QRS Wave
T Wave

36. P wave Caused by Atrial depolarization Small initial bump on wave.
Signal sent through out the atrium to contract.
Small initial bump on wave.

37. QRS generates the generated by the depolarization of the ventricles.
You should be able to palpate a pulse with each QRS complex on the ECG monitor.
Systolic portion of blood pressure.

38. T wave Represents diastolic blood pressure. is larger than the P wave
is rounded or slightly peaked
represents ventricular repolarization or metabolic rest periods between heartbeats
Represents diastolic blood pressure.

39. Label the following waves.
STOP
Label the following waves.

40. PR interval (PRI)
consists of the period from the beginning of the P wave to the beginning of the QRS complex
represents SA node depolarization (contraction) to ventricular depolarization (contraction)

41. ST segment
consists of the isoelectric line between the end of the QRS complex and the beginning of the T wave
reveals information about the heart’s oxygen status
when elevated, is a key indicator of myocardial infarction (MI)

42. The graph Standardized 1mm = 0.04 sec. 5mm = 0.2 sec. Paper Speed
Chapter 25

43. Important “Times” P-R interval (PRI) = 0.1-0.2 second
QRS complex = <.12 seconds
Always use 6 second (30 large squares) strip to analyze an ECG waveform

44. Calibers Little protractor
Used to measure the distance and regularity of the wave.
Chapter 25

45. STOP
Chapter 25

46. Cardiology ECG / EKG (cont.)
Copyright © The McGraw-Hill Companies, Inc.

47. Parts of the EKG
Chapter 25

48. Reading EKG’s
Each EKG must be read in a particular way to diagnose a problem.
We Focus on
Wave configurations
Rates
Measurements
Wave relationships
Each cardiac arrhythmia has its own set of clues.

49. Rate We can tell heart rate by evaluating the strip. Rule of 300
Take the number of “big boxes” between neighboring QRS complexes, and divide this into The result will be approximately equal to the rate
Although fast, this method only works for regular rhythms.
Chapter 25

50. What is the heart rate?
(300 / 6) = 50 bpm

51. What is the heart rate?
(300 / ~ 4) = ~ 75 bpm

52. What is the heart rate?
(300 / 1.5) = 200 bpm

53. 10 Second Rule
As most EKGs record 10 seconds of rhythm per page, one can simply count the number of beats present on the EKG and multiply by 6 to get the number of beats per 60 seconds.
This method works well for irregular rhythms.

54. Rhythm Regular or Irregular
Can usually eye paper and see if it is regular.

55. Sinus Rhythms
Normal Sinus Rhythm (NSR) rate is and rhythm is regular

56. STOP

57. Abnormalities Sinus Atrial Junctional Ventricle
Categorized because the abnormality comes from one of the sites.

58. Sinus Rhythms
Normal Sinus Rhythm (NSR) rate is and rhythm is regular

59. Sinus bradycardia
Rate is less than 60 and rhythm is regular

60. Sinus tachycardia
Rate is more than 100 and less than 150 is usually regular

61. Sinus arrhythmia
Rate is and rhythm is irregular

62. Atrial Rhythm Abnormalities
P wave may be missing or abnormal
PR Interval
normal duration of 0.12 to 0.2 second
if longer than 0.2 second, a disease process may be affecting the cardiac conduction pathway
QRS may be missing after some P waves.
QRS is always normal, if it is present

63. Premature Atrial Contraction (PAC)
Rate is usually normal
May be regular except when the PAC occurs.
Some contractions have a shortened PRI
P wave may not be identified because it is buried in the T wave.

64. Atrial tachycardia (A Tach)
Rate is and usually regular.
PRI is shorter than normal
P wave may move up on the T wave or be buried in it (wet T).
Each P wave is followed by a QRS complex.

65. Atrial Flutter (AF) Atrial Rate is 250-400.
P waves are usually 0.2 seconds each
occur in clusters of 2, 3, or 4 (look like saw teeth).
Each cluster is followed by a QRS complex at regular intervals. Because of this, they are classified as being AF 2:1, 3:1, or 4:1.

66. Atrial fibrilliation (A-Fib)
Atrial rate is too fast to count
individual P waves may be difficult to identify.
Normal QRS complexes appear at irregular intervals.
There will be many more P waves than QRS complexes.
May cause blood clots to form and be sent to the brain, heart or lungs.

67. QRS complex normal duration is 0.06 to 0.1 second
duration greater than 0.12 seconds usually indicates prolonged ventricular conduction caused by a bundle branch block

68. Signal Continues atrioventricular (AV) node bundle of His
receives the atrial impulse and (after a brief pause to let the ventricles fill) transmits it to the ventricles via the bundle of His
bundle of His
collection of cardiac conduction fibers that splits into the right and left bundle branches
bundle branches
Purkinje fibers
rapidly stimulating ventricular muscle resulting in ventricular depolarization