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Chapter 37

Electrocardiography

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Anatomy of the Heart


Four chambers
Two upper chambers known as atria
Two lower chambers known as ventricles

Deoxygenated blood
Oxygenated blood

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Anatomy of the Heart


Coronary arteries
Click here to see an animation

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Electrical Conduction
System of the Heart
Sinoatrial (SA) node
Atrioventricular (AV) node
Bundle of His and Purkinje fibers

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Electrical Conduction
System of the Heart
Systole and diastole
Impulses can be recorded on ECG paper or
displayed on oscilloscope

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The Cardiac Cycle


and the ECG Cycle

Baseline or isoelectric line


Positive deflection
Negative deflection
Each cardiac cycle takes about 0.8 second

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The Cardiac Cycle


and the ECG Cycle
P, QRS, and T waves

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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

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Types of Electrocardiographs
Single-channel ECG >>
Multichannel ECG
Automatic ECG machines

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Types of Electrocardiographs
ECG telephone transmissions
Facsimile electrocardiograph
Interpretive electrocardiograph

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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

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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

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ECG Equipment
Sensors or electrodes
Disposable sensors
Detect electrical impulses on body surface from the
myocardium and relay them through cables

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ECG Equipment
Lead wires
Once self-adhesive sensors
are placed, lead wires from
the ECG machine are
attached

Caring for equipment

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Lead Coding
12 leads recorded using 10 lead wires
Necessary for identification and mounting
purposes
Newer ECGs automatically mark (code)
each lead

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The Electrocardiograph
and Lead Placement
12 leads record hearts electrical activity
Allows for 3D interpretation of activity
Amplification of electrical activity

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The Electrocardiograph
and Lead Placement
Galvanometer changes voltage into
mechanical motion
Stylus records motion

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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

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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

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Standard Resting Electrocardiography


Performing 12-lead electrocardiogram

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Standard Resting Electrocardiography


Click Here to play the video

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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

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Interference or Artifacts

Somatic tremor artifacts


Alternating current (AC) interference
Wandering baseline artifacts
Interrupted baseline artifacts

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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

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Cardiac Arrhythmias
Click Here to play the video

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Cardiac Arrhythmias
Atrial arrhythmias
Premature atrial contractions (PAC)
Paroxysmal atrial tachycardia (PAT)
Atrial fibrillation

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Cardiac Arrhythmias
Ventricular arrhythmias
Premature ventricular contractions (PVCs)
Ventricular tachycardia
Ventricular fibrillation

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Defibrillation
Electrical device that applies countershocks
to heart through electrodes or pads placed
on chest wall (AED)
Can convert cardiac arrhythmia into normal
sinus rhythm

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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 patients symptoms

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Holter Monitor
Medical assistants
role
Preparing patient
Instructing patient
Applying and removing
monitor

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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

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Holter Monitor
Removing the Holter Monitor
Patient returns to office
Tape is analyzed by scanner or computer
Written report sent to physician

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Other Diagnostic Tests


Treadmill stress test
Diagnose heart disorders and probable cause of
patients chest pain
Assess patients cardiac ability following cardiac
surgery
Noninvasive test
Patient exercises on treadmill at varying rates of speed

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Other Diagnostic Tests


Loop ECG
Thallium stress test
Echocardiography/ultrasonography

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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

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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

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