Chapter 37

Electrocardiography

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy of the Heart

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

Deoxygenated blood
Oxygenated blood

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy of the Heart

Coronary arteries
Click here to see an animation

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

The Cardiac Cycle

and the ECG Cycle

Baseline or isoelectric line

Positive deflection
Negative deflection
Each cardiac cycle takes about 0.8 second

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

The Cardiac Cycle

and the ECG Cycle
P, QRS, and T waves

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Types of Electrocardiographs
ECG telephone transmissions
Facsimile electrocardiograph
Interpretive electrocardiograph

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Caring for equipment

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Standard Resting Electrocardiography

Performing 12-lead electrocardiogram

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Standard Resting Electrocardiography

Click Here to play the video

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Interference or Artifacts

Somatic tremor artifacts

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cardiac Arrhythmias
Click Here to play the video

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Other Diagnostic Tests

Loop ECG
Thallium stress test
Echocardiography/ultrasonography

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.