ELECTROCARDIOGRAM & HEART SOUNDS Learning Objectives

By the end of today's laboratory you will: Explain the time relationships between the electrical activity of the heart (as recorded in the ECG) and the mechanical activity of the heart (as judged from the heart sounds) HEART SOUNDS

The closure of the heart valves is responsible for the

characteristic sound produced by the heart, usually referred to as a lub-dup sound.

The lower-pitched lub sound occurs during the early

phase of ventricular contraction. This is produced by closing of the atrioventricular (mitral and tricuspid) valves.

These valves prevent blood from flowing back into the

atria. When the ventricles relax, the blood pressure drops below that in the artery, and the semilunar valves (aortic and pulmonary) close, producing the higher-pitched dup sound.

Malfunctions of these valves often produce an audible

murmur, which can be detected with a stethoscope.

A Wiggers' diagram.

Standard Connection Attach the positive electrode to the left wrist, the negative to the right wrist, and the ground to the right leg.V

Alternative Electrode Connection Alternative connection:

positive electrode to the left upper arm negative electrode to the right upper arm

ground to either wrist *Do not place the electrodes over the major muscles of the upper arm, because muscle activity interferes with the signal

recorded from the heart. Exercise 3 You will measure and correlate the ECG and heart sounds in a resting volunteer. Using a Stethoscope

It is generally better to use the bell than the diaphragm because it reduces room noise. The earpieces should point slightly forward to match the direction of the external auditory canal. Tap on the bell; if you do not hear sounds clearly, rotate the bell 180 on its endpiece.

PROCEDURE

The volunteer should place the bell of the stethoscope on the left side of their chest, using the right hand. (It is easy enough to do this under one's shirt.) The stethoscope should be moved to different positions until the student listening to the stethoscope hears clear heart sounds. The sounds are soft, and room noise must be kept low. Once clear heart sounds are heard, the volunteer should hold the stethoscope in place with the right hand while the student listening to the stethoscope listens and records.

Click Start to record the ECG, and press the push-button switch on hearing 'lub' and release it on 'dub'. After a few heart beat cycles, click Stop. Channel Trace Buttons Normally each channel only displays a single data trace. Sometimes, however, it is more convenient to be able to overlay the traces, like shown on the left. The vertical scale only applies to one of the traces. Click on either of the buttons to see how the vertical scale on the left becomes the one belonging to the data trace of the same color as the button. Analysis To make it easier to compare the recordings in the two channels, the LabTutor panel has been set up to display the recordings overlaid. With the Channel Trace buttons you can select which of the two channels is 'active' in the panel. Note the correlation between Event and ECG signals. Using the Marker and Waveform Cursor, follow the instructions below to measure the time between the peak of

the R wave and the Event signal going high.

Select the ECG channel as active Place the Marker on the R wave Select the Event channel as active Use the waveform cursor and select the Event signal
going high

Insert this time into the table

Now measure the time between the peak of the T wave and the Event signal going low.

Select the ECG channel as active Place the Marker on the T wave Select the Event channel as active Use the waveform cursor and select the Event signal
going low

Insert this time into the table

Troubleshooting

Make sure students check the electrode connections and placement. Artifacts can result from movement of the Bio Amp cable and leads.

If the electrodes are connected backwards (i.e. positive electrode on right arm), the ECG signal will appear inverted. Reattach the cables the in the proper configuration. Make sure students are not wearing metal jewelry. Make sure that electrode cream is used on the reusable ECG electrodes. Weak heart sounds signal The bell of the stethoscope may not be placed firmly enough over the apex of the heart. The head piece of the stethoscope may be turned so that the diaphragm is connected. Rotate the stethoscope head piece and try again. ECG and heart sounds

1. Explain why ventricular contraction (systole) and the lub sound occur immediately after the QRS complex.

QRS complex represents the upstroke of the ventricular action potential, with ventricular contraction starting soon after. The lub sound is generally thought to be due to the closure of the AV valves but part of the sound may derive from mechanical events in ventricular muscle.

2. Explain why ventricular relaxation (diastole) and the dup sound occur after the T wave.

The T wave represents ventricular repolarization, with ventricular relaxation following soon after. The dup sound is associated with closure of the aortic and pulmonary valves. THANK YOU

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