Cardiology

Front 1

Mediastinum

Back 1

the chest cavity that contains the heart

Front 2

Pericardium

Back 2

protective covering surrounding the heart

Front 3

Epicardium

Back 3

Outer layer of the heart, continuos with the pericardium

Front 4

Myocardium

Back 4

Middle layer of the heart, muscle

Front 5

Endocardium

Back 5

Inner layer of the heart, continuous with tunica intima of blood vessels

Front 6

Atrioventricular (AV) valves

Back 6

separate atria from ventricles

Front 7

Bicuspid (mitral) valve

Back 7

separates left atrium from left ventricle

Front 8

Tricuspid valve

Back 8

separates right atrium from ventricle

Front 9

Chordae tendinease

Back 9

cords holding valve leaflets

Front 10

Papillary Muscles

Back 10

attach to chordae tindineae

Front 11

Semi lunar valves

Back 11

go from ventricles to arteries, prevent back flow of blood into the ventricle

Front 12

Pulmonic Valve

Back 12

Prevents back flow of blood from pulmonary artery into right ventricle

Front 13

Aortic Valve

Back 13

prevents back flow of blood from aorta into left ventricle

Front 14

Cardiac Cycle

Back 14

one complete heartbeat

Front 15

Systole

Back 15

contraction phase of heartbeat

Front 16

Diastole

Back 16

relaxation phase of heartbeat, when atria and ventricles are filling. Lasts longer then the systole phase

Front 17

Stroke Volume (SV)

Back 17

amount of blood ejected from either ventricle during one contraction

Front 18

Cardiac Output (CO)

Back 18

amount of blood pumped through cardiovascular system in one minute.

Front 19

CO =

Back 19

SV x heart rate (HR)
- expressed in liters/min

Front 20

End diastolic volume

Back 20

volume in ventricle prior to contraction

Front 21

End systolic volume

Back 21

volume in ventricle after contraction

Front 22

Ejected Fraction (EF)

Back 22

Stroke volume/end diastolic volume. The % of ventricular blood volume that is pumped out with each contraction

Front 23

LVEF

Back 23

left ventricular ejection fraction, a measure of heart functionality

Front 24

>50%

Back 24

normal

Front 25

35%- 50%

Back 25

indicative of weakened myocardium

Front 26

<35%

Back 26

very bad

Front 27

EF can be determined by

Back 27

-echocardiography measurements
- gated myocardial perfusion imaging studies
-MUGA (multi gated acquisition scan) the gold standard for determining LVEF

Front 28

Sinoatrial (SA) node

Back 28

dominant pacemaker of the heart. Paces at 60-100 bbm

Front 29

Atrioventricular (AV) node

Back 29

another pacemaker along the conduction tissue pathway. Paces at 40-60 bbm.

Front 30

Bundle of HIS

Back 30

transits impulses to left ventricle

Front 31

Left bundle branch

Back 31

conducts impulses to left ventricle

Front 32

Right bundle branch

Back 32

conducts impulses to right ventricle

Front 33

Purkinje fibers

Back 33

network of fibers that conduct impulses throughout ventricular walls. Also, a pacemaker; paces at 20-40 bbm

Front 34

Depolarization

Back 34

electrical charge in the myocyte is changed to positive by a shift in electrolytes on either side of the cell membrane.
- Causes muscles fiver to contract

Front 35

Re-polarization

Back 35

Chemical pumps reestablish an internal negative charge in the myocyte

Front 36

Electrolyte balance

Back 36

is important for our hearts!
- This involves sodium, potassium, calcium, and magnesium.

Front 37

Electrocardiogram

Back 37

(EKG) - a record of the heart's electrical activity

Front 38

Movement of electrolytes

Back 38

The depolarization from the SA node through the atria is caused by fast moving sodium ions (NA+)

Front 39

The depolarization is carried through the AV node by the slower moving

Back 39

calcium ions (Ca+)

Front 40

Conduction through the ventricular system, after the

Back 40

AV node, is by fast sodium ions (Na+)

Front 41

Re-polarization is caused by

Back 41

potassium ions (K+) leaving the myocytes

Front 42

Cardia Cycle in Detail

Back 42

The wiggly lines commonly seen

Front 43

Sa node sends a wave of depolarization that spreads outward through the aria, causing them to contract.

Back 43

This is represented by the P wave on the EKG.

Front 44

The depolarization wave travels through the

Back 44

conduction fibers through the AV node.

Front 45

There is a delay in conduction as the wave moves through the

Back 45

AV node.

Front 46

The delay allows the ventricles to fill

Back 46

before contracting. This delay is represented by the P-R interval on the EKG

Front 47

Once depolarization reaches the AV node, it is conducted

Back 47

rapidly through the ventricular conducting system.

Front 48

It moves through the Bundle of HIS, through the left and right ventricle bundle branches,

Back 48

and into the Purkinje fibers. THe ventricles contract. This is represented by the QRS complex on he EKG.

Front 49

After the ventricles contract they begin the process of re polarization, represented by

Back 49

the plateau on the EKG called the ST segment.

Front 50

The broad T wave represents the

Back 50

final, rapid phase of ventricular re polarization.

Front 51

EKG

Back 51

A recording of the heart's electrical activity.

Front 52

Leads ( also called views)

Back 52

monitor the voltage changes in electrodes placed in different positions of the body

Front 53

Voltage changes are amplified and displayed on

Back 53

an oscilloscope and on graph paper.

Front 54

Each lead looks different because the placement of the

Back 54

electrode changes, and the electrical activity in each area of the body is different.

Front 55

Incorrect placement of the electrodes can

Back 55

turn a normal ECK into a abnormal EKG

Front 56

EKG

Back 56

For cardiac monitoring and gating during nuclear medicine procedure, a 3-electrode EKG is used.

Front 57

The three leads are

Back 57

black, red and white.

Front 58

The white is placed on the

Back 58

patient's right clavicle

Front 59

The black lead is placed on the

Back 59

patient's left clavicle

Front 60

The red lead is placed on the

Back 60

patient's chest just left of midline and near the 4th intercostal space.

Front 61

Remember:
White on

Back 61

right

Front 62

Smoke (black) over

Back 62

fire (red)

Front 63

EKG analyses are performed using a

Back 63

12 lead EKG

Front 64

For a 12-lead EKG, four wires are attracted to each limb and six

Back 64

wire are attached to the chest. The ten wires provide 12 different leads (views)

Front 65

Electrodes are placed on the right arm RA, left arm LA,.....

Back 65

right left RL and left leg LL

Front 66

Six leads are views from these four electrodes :

Back 66

standard leads I, II, III

Front 67

Augmented leads =

Back 67

aVR, aVL, aVF

Front 68

EKG Lead Placement

Back 68

Look at Diagram

Front 69

The four limb electrodes each have a positive and element to them.

Back 69

Together the four electrodes produce 6 leads, I, II, III, aVR, aVF, and aVL

Front 70

The 6 chest leads are all unipolar and are all

Back 70

positive

Front 71

They are placed on the chest as shown on the diagram, slide 23

Back 71

They are numbered V1 through V6

Front 72

The ECG tracing shows progressive changes in the

Back 72

wave forms coming from leads V1 through V6

Front 73

A wave of depolarization traveling toward a positive electrode causes

Back 73

a positive (upward) deflection in the ECK tracing.

Front 74

A wave of depolarization traveling away from a positive electrode causes

Back 74

a negative (downward) deflection in the EKG tracing.

Front 75

P wave

Back 75

atrial depolarization (contraction)

Front 76

PR interval

Back 76

time in which depolarization wave travels from atria to ventricles.

Front 77

QRS interval

Back 77

Q is the first negative deflection,

Front 78

R is the positive deflection

Back 78

S is the second negative deflection, ventricular depolarization (contraction)

Front 79

ST segment

Back 79

time between ventricular depolarization and depolarization

Front 80

T wave

Back 80

rapid phase of ventricular re polarization

Front 81

U wave

Back 81

small rounded wave following T wave, represents re polarization of Purkinje fibers, not always present see more often with a slow HR.

Front 82

The EKG tracing is recorded at a constant

Back 82

speed of 25mm/sec

Front 83

Each small box on the paper is

Back 83

1 mm x 1mm

Front 84

Each large box is

Back 84

5mm x 5mm

Front 85

Each small box is

Back 85

0.04 seconds

Front 86

Each large box is

Back 86

0.20 seconds

Front 87

Calculating heart rate

Back 87

Method 1: Count the number of large boxes between the 2 R waves and divide into 300.
- 60 sec/min divided by 0.20 sec/large box = 300 large boxes/min

Front 88

Counting Heart Rate

Back 88

Method 2: Count the number of small boxes between R waves and divide by 1500
- Used for vert fast heart rates

Front 89

For irregular heart rates, count the number of R-R intervals

Back 89

in a six second strip and multiply by 10

Front 90

Normal values

PR interval

Back 90

0.12- 0.20 sec

Front 91

QRS Complex

Back 91

0.06 - 0.10 sec

Front 92

QT Interval

Back 92

0.30 - 0.46 sec

Front 93

Rate

Back 93

Pacing from the SA node generates a sinus rhythm.
- Normal sinus rhythm is 60 to 100 beats per minute.

Front 94

When the Sa node paces at a rate less than 60 bpm, it is called a

Back 94

sinus brachycardia

Front 95

When the SA node paces at a rate greater than 100 bpm, it is called a

Back 95

trachycardia

Front 96

Rhythm is either

Back 96

regular or irregular.

Front 97

Sinus Arrhythmia

Back 97

The Sa node paces irregularly

Front 98

The R-R interval is

Back 98

irregular

Front 99

P wave is normal, PR interval is normal,

Back 99

QRS complex is normal

Front 100

Atrial Arrhythmia's

P Waves

Back 100

differ in appearance from sinus P waves, indicating irregularity in atrial contractions

Front 101

Premature Atrial Contraction (PAC)

Back 101

A single complex occurs earlier than expected, then normal sinus rhythm resumes

Front 102

Atrial Fibrillation (A-fib)

Back 102

many sites in the atria are generating depolarization waves

Front 103

No distinguishable P wave

Back 103

PR interval not measurable

Front 104

Rate 100 - 160 bpm

Back 104

Rhythm - regular

Front 105

Atrial Flutter

Back 105

P wave replaced with multiple flutter waves
- Rate around 110 bpm
- Rhythm - regular

Front 106

First Degree AV Block

Back 106

Caused by delayed conduction through the AV node
- Characterized by prolonged PR interval (>5 small blocks or 0.20 sec)

Front 107

Ventricular Tachycardia

Rate 180 - 190 bpm

Back 107

Rhythm regular
- Abnormal tissues in the ventricular generate rapid contractions.
- Poor cardiac output results.
***This is an emergency situation

Front 108

Ventricular Fibrillation (V-Fib)

Rate:

Back 108

300 +
Disorganized electrical signals caused the ventricles to quiver instead of contract
- There is no blood being pumped to the brain or body
- Use the defibrillator ASAP!!

Front 109

Myocardial Infarct (MI)

Back 109

Rhythm - Regular
Rate- 80 bpm
P wave- normal, QRS complex, - normal
ST segment does not return to baseline

Front 110

Asystole

Back 110

Rhythm - flat
Rate- 0 bpm
Carry out CPR and defibrillation

Front 111

Coronary Artery Disease (CAD)

Back 111

Blockage of one of the coronary arteries by plaque and cholesterol deposits

Front 112

PTCA

Back 112

Percutaneous transluminal coronary angiography

Front 113

The coronary arteries are accessed via skin incision, and the procedure is performed within the blood vessels.

Back 113

Radioplaque dye is used to show coronary arteries

Front 114

Stents and ballon catheters are

Back 114

deployed through the incision if needed

Front 115

Stents

Back 115

a tube use to prevent flow constriction

Front 116

Ballon Catheter

Back 116

A catheter with an inflatable ballon at its tip used to open or enlarge a blocked artery

Front 117

Stenting

Back 117

LOOK AT P.P

Front 118

ACID

Back 118

Automated implanted cardioverter defibrillator

Front 119

Pacemaker

Back 119

Cardo Terminology

Front 120

CABG

Back 120

Coronary artery bypass graft

Front 121

CHF

Back 121

Congestive heart failure

Front 122

Dyspnea

Back 122

difficulty breathing

Front 123

MI

Back 123

Myocardial infarction

Front 124

Angina

Back 124

Chest Pain