Basic ECG Interpretation
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Chapter 20 *Lecture Powerpoint the Circulatory System: Blood Vessels and Circulation
Chapter 20 *Lecture PowerPoint The Circulatory System: Blood Vessels and Circulation *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The route taken by the blood after it leaves the heart was a point of much confusion for many centuries – Chinese emperor Huang Ti (2697–2597 BC) believed that blood flowed in a complete circuit around the body and back to the heart – Roman physician Galen (129–c. 199) thought blood flowed back and forth like air; the liver created blood out of nutrients and organs consumed it – English physician William Harvey (1578–1657) did experimentation on circulation in snakes; birth of experimental physiology – After microscope was invented, blood and capillaries were discovered by van Leeuwenhoek and Malpighi 20-2 General Anatomy of the Blood Vessels • Expected Learning Outcomes – Describe the structure of a blood vessel. – Describe the different types of arteries, capillaries, and veins. – Trace the general route usually taken by the blood from the heart and back again. – Describe some variations on this route. 20-3 General Anatomy of the Blood Vessels Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Capillaries Artery: Tunica interna Tunica media Tunica externa Nerve Vein Figure 20.1a (a) 1 mm © The McGraw-Hill Companies, Inc./Dennis Strete, photographer • Arteries carry blood away from heart • Veins -
Spreading the Love: the Circulatory System
Chapter 10 Spreading the Love: The Circulatory System In This Chapter ᮣ Understanding the heart’s rhythm and structure ᮣ Identifying the heart’s chambers and valves ᮣ Tracing arteries, veins, and capillaries ᮣ Touching on fetal circulation his chapter gets to the heart of the well-oiled human machine to see how its central Tpump is the hardest-working muscle in the entire body. From a month after you’re con- ceived to the moment of your death, this phenomenal powerhouse pushes a liquid connec- tive tissue — blood — and its precious cargo of oxygen and nutrients to every nook and cranny of the body, and then it keeps things moving to bring carbon dioxide and waste products back out again. In the first seven decades of human life, the heart beats roughly 2.5 billion times. Do the math: How many pulses has your ticker clocked if the average heart keeps up a pace of 72 beats per minute, 100,000 per day, or roughly 36 million per year? Moving to the Beat of a Pump Also called the cardiovascular system, the circulatory system includes the heart, all blood vessels, and the blood that moves endlessly through it all (see Figure 10-1). It’s what’s referred to as a closed double system; the term “closed” is used for three reasons: because the blood is contained in the heart and its vessels; because the vessels specifically target the blood to the tissues; and because the heart critically regulates blood flow to the tissues. The system is called “double” because there are two distinct circuits and cavities within the heart separated by a wall of muscle called the septum. -
Cardiovascular System 9
Chapter Cardiovascular System 9 Learning Outcomes On completion of this chapter, you will be able to: 1. State the description and primary functions of the organs/structures of the car- diovascular system. 2. Explain the circulation of blood through the chambers of the heart. 3. Identify and locate the commonly used sites for taking a pulse. 4. Explain blood pressure. 5. Recognize terminology included in the ICD-10-CM. 6. Analyze, build, spell, and pronounce medical words. 7. Comprehend the drugs highlighted in this chapter. 8. Describe diagnostic and laboratory tests related to the cardiovascular system. 9. Identify and define selected abbreviations. 10. Apply your acquired knowledge of medical terms by successfully completing the Practical Application exercise. 255 Anatomy and Physiology The cardiovascular (CV) system, also called the circulatory system, circulates blood to all parts of the body by the action of the heart. This process provides the body’s cells with oxygen and nutritive ele- ments and removes waste materials and carbon dioxide. The heart, a muscular pump, is the central organ of the system. It beats approximately 100,000 times each day, pumping roughly 8,000 liters of blood, enough to fill about 8,500 quart-sized milk cartons. Arteries, veins, and capillaries comprise the network of vessels that transport blood (fluid consisting of blood cells and plasma) throughout the body. Blood flows through the heart, to the lungs, back to the heart, and on to the various body parts. Table 9.1 provides an at-a-glance look at the cardiovascular system. Figure 9.1 shows a schematic overview of the cardiovascular system. -
Venous Circulation of the Human Cardiac Conduction System
Br Heart J: first published as 10.1136/hrt.42.5.508 on 1 November 1979. Downloaded from British Heart J7ournal, 1979, 42, 508-513 Venous circulation of the human cardiac conduction system 0. ELI SKA AND M. ELI KoVA From the Department of Anatomy, Faculty of Medicine, Prague 2, U nemocnice 3, Czechoslovakia summARY The venous bed ofthe sinuatrial node in 25 human hearts and the atrioventricular conduction system in 50 human hearts were investigated after injection into different veins of the heart. Blood is drained from the sinuatrial node in two directions; that from the intermediate and upper parts of the node blood is directed upwards, draining into the junctional area ofthe superior vena cava with the right atrium. From the intermediate and the lower parts ofthe node the venous return is directed downwards, draining directly into the right atrium between the musculi pectinati. The venous return from the ventricular conduction system is drained by three routes. The main route from the atrioventricular node and the atrioventricular bundle passes into the thebesian vein, which opened in 78 per cent of the cases studied into the right atrium next to the coronary sinus. The other route from the node and bundle is via a vein which accompanies the atrioventricular nodal artery, draining eventually into the middle cardiac vein. The third route takes venous blood from the lower part ofthe atrioventricular bundle and is drained to the tributaries of the great cardiac vein, interconnecting with the branches of the above two veins. The venous return from the ventricular bundle-branches is drained into the oblique septal veins. -
Cellular and Molecular Mechanisms of Functional Hierarchy of Pacemaker Clusters in the Sinoatrial Node: New Insights Into Sick Sinus Syndrome
Journal of Cardiovascular Development and Disease Review Cellular and Molecular Mechanisms of Functional Hierarchy of Pacemaker Clusters in the Sinoatrial Node: New Insights into Sick Sinus Syndrome Di Lang and Alexey V. Glukhov * Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA; [email protected] * Correspondence: [email protected] Abstract: The sinoatrial node (SAN), the primary pacemaker of the heart, consists of a heterogeneous population of specialized cardiac myocytes that can spontaneously produce action potentials, generat- ing the rhythm of the heart and coordinating heart contractions. Spontaneous beating can be observed from very early embryonic stage and under a series of genetic programing, the complex heteroge- neous SAN cells are formed with specific biomarker proteins and generate robust automaticity. The SAN is capable to adjust its pacemaking rate in response to environmental and autonomic changes to regulate the heart’s performance and maintain physiological needs of the body. Importantly, the origin of the action potential in the SAN is not static, but rather dynamically changes according to the prevailing conditions. Changes in the heart rate are associated with a shift of the leading pacemaker location within the SAN and accompanied by alterations in P wave morphology and PQ interval on ECG. Pacemaker shift occurs in response to different interventions: neurohormonal modulation, cardiac glycosides, pharmacological agents, mechanical stretch, a change in temperature, Citation: Lang, D.; Glukhov, A.V. and a change in extracellular electrolyte concentrations. It was linked with the presence of distinct Cellular and Molecular Mechanisms anatomically and functionally defined intranodal pacemaker clusters that are responsible for the of Functional Hierarchy of Pacemaker Clusters in the Sinoatrial Node: New generation of the heart rhythm at different rates. -
Abnormalities Caused by Left Bundle Branch Block - Print Article - JAAPA
Marquette University e-Publications@Marquette Physician Assistant Studies Faculty Research and Physician Assistant Studies, Department Publications 12-17-2010 Abnormalities Caused by Left undB le Branch Block James F. Ginter Aurora Cardiovascular Services Patrick Loftis Marquette University, [email protected] Published version. Journal of the American Academy of Physician Assistants, Vol. 23, No. 12 (December 2010). Permalink. © 2010, American Academy of Physician Assistants and Haymarket Media Inc. Useded with permission. Abnormalities caused by left bundle branch block - Print Article - JAAPA http://www.jaapa.com/abnormalities-caused-by-left-bundle-branch-block/... << Return to Abnormalities caused by left bundle branch block James F. Ginter, MPAS, PA-C, Patrick Loftis, PA-C, MPAS, RN December 17 2010 One of the keys to achieving maximal cardiac output is simultaneous contraction of the atria followed by simultaneous contraction of the ventricles. The cardiac conduction system (Figure 1) coordinates the polarization and contraction of the heart chambers. As reviewed in the earlier segment of this department on right bundle branch block (RBBB), the process begins with a stimulus from the sinoatrial (SA) node. The stimulus is then slowed in the atrioventricular (AV) node, allowing complete contraction of the atria. From there, the stimulus proceeds to the His bundle and then to the left and right bundle branches. The bundle branches are responsible for delivering the stimulus to the Purkinje fibers of the left and right ventricles at the same speed, which allows simultaneous contraction of the ventricles. Bundle branch blocks are common disorders of the cardiac conduction system. They can affect the right bundle, the left bundle, or one of its branches (fascicular block), or they may occur in combination. -
Location of the Human Sinus Node in Black Africans
ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e o a t r a c n h A Research Meneas et al., Anat Physiol 2017, 7:5 ISSN: 2161-0940 DOI: 10.4172/2161-0940.1000279 Research article Open Access Location of the Human Sinus Node in Black Africans Meneas GC*, Yangni-Angate KH, Abro S and Adoubi KA Department of Cardiovascular and Thoracic Diseases, Bouake Teaching Hospital, Cote d’Ivoire, West-Africa *Corresponding author: Meneas GC, Department of Cardiovascular and Thoracic Diseases, Bouake Teaching Hospital, Cote d’Ivoire, West-Africa, Tel: +22507701532; E-mail: [email protected] Received Date: August 15, 2017; Accepted Date: August 22, 2017; Published Date: August 29, 2017 Copyright: © 2017 Meneas GC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Abstract Objective: The purpose of this study was to describe, in 45 normal hearts of black Africans adults, the location of the sinoatrial node. Methods: After naked eye observation of the external epicardial area of the sinus node classically described as cavoatrial junction (CAJ), a histological study of the sinus node area was performed. Results: This study concluded that the sinus node is indistinguishable to the naked eye (97.77% of cases), but still identified histologically at the CAJ in the form of a cluster of nodal cells surrounded by abundant connective tissues. It is distinguished from the Myocardial Tissue. -
4B. the Heart (Cor) 1
Henry Gray (1821–1865). Anatomy of the Human Body. 1918. 4b. The Heart (Cor) 1 The heart is a hollow muscular organ of a somewhat conical form; it lies between the lungs in the middle mediastinum and is enclosed in the pericardium (Fig. 490). It is placed obliquely in the chest behind the body of the sternum and adjoining parts of the rib cartilages, and projects farther into the left than into the right half of the thoracic cavity, so that about one-third of it is situated on the right and two-thirds on the left of the median plane. Size.—The heart, in the adult, measures about 12 cm. in length, 8 to 9 cm. in breadth at the 2 broadest part, and 6 cm. in thickness. Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. The heart continues to increase in weight and size up to an advanced period of life; this increase is more marked in men than in women. Component Parts.—As has already been stated (page 497), the heart is subdivided by 3 septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers, viz., right and left atria, and right and left ventricles. The division of the heart into four cavities is indicated on its surface by grooves. The atria 4 are separated from the ventricles by the coronary sulcus (auriculoventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. -
Blood Vessels
BLOOD VESSELS Blood vessels are how blood travels through the body. Whole blood is a fluid made up of red blood cells (erythrocytes), white blood cells (leukocytes), platelets (thrombocytes), and plasma. It supplies the body with oxygen. SUPERIOR AORTA (AORTIC ARCH) VEINS & VENA CAVA ARTERIES There are two basic types of blood vessels: veins and arteries. Veins carry blood back to the heart and arteries carry blood from the heart out to the rest of the body. Factoid! The smallest blood vessel is five micrometers wide. To put into perspective how small that is, a strand of hair is 17 micrometers wide! 2 BASIC (ARTERY) BLOOD VESSEL TUNICA EXTERNA TUNICA MEDIA (ELASTIC MEMBRANE) STRUCTURE TUNICA MEDIA (SMOOTH MUSCLE) Blood vessels have walls composed of TUNICA INTIMA three layers. (SUBENDOTHELIAL LAYER) The tunica externa is the outermost layer, primarily composed of stretchy collagen fibers. It also contains nerves. The tunica media is the middle layer. It contains smooth muscle and elastic fiber. TUNICA INTIMA (ELASTIC The tunica intima is the innermost layer. MEMBRANE) It contains endothelial cells, which TUNICA INTIMA manage substances passing in and out (ENDOTHELIUM) of the bloodstream. 3 VEINS Blood carries CO2 and waste into venules (super tiny veins). The venules empty into larger veins and these eventually empty into the heart. The walls of veins are not as thick as those of arteries. Some veins have flaps of tissue called valves in order to prevent backflow. Factoid! Valves are found mainly in veins of the limbs where gravity and blood pressure VALVE combine to make venous return more 4 difficult. -
Sudden Death in Racehorses: Postmortem Examination Protocol
VDIXXX10.1177/1040638716687004Sudden death in racehorsesDiab et al. 687004research-article2017 Special Issue Journal of Veterinary Diagnostic Investigation 1 –8 Sudden death in racehorses: postmortem © 2017 The Author(s) Reprints and permissions: sagepub.com/journalsPermissions.nav examination protocol DOI: 10.1177/1040638716687004 jvdi.sagepub.com Santiago S. Diab,1 Robert Poppenga, Francisco A. Uzal Abstract. In racehorses, sudden death (SD) associated with exercise poses a serious risk to jockeys and adversely affects racehorse welfare and the public perception of horse racing. In a majority of cases of exercise-associated sudden death (EASD), there are no gross lesions to explain the cause of death, and an examination of the cardiovascular system and a toxicologic screen are warranted. Cases of EASD without gross lesions are often presumed to be sudden cardiac deaths (SCD). We describe an equine SD autopsy protocol, with emphasis on histologic examination of the heart (“cardiac histology protocol”) and a description of the toxicologic screen performed in racehorses in California. By consistently utilizing this standardized autopsy and cardiac histology protocol, the results and conclusions from postmortem examinations will be easier to compare within and across institutions over time. The generation of consistent, reliable, and comparable multi-institutional data is essential to improving the understanding of the cause(s) and pathogenesis of equine SD, including EASD and SCD. Key words: Cardiac autopsy; equine; exercise; racehorses; -
Young Adults. Look for ST Elevation, Tall QRS Voltage, "Fishhook" Deformity at the J Point, and Prominent T Waves
EKG Abnormalities I. Early repolarization abnormality: A. A normal variant. Early repolarization is most often seen in healthy young adults. Look for ST elevation, tall QRS voltage, "fishhook" deformity at the J point, and prominent T waves. ST segment elevation is maximal in leads with tallest R waves. Note high take off of the ST segment in leads V4-6; the ST elevation in V2-3 is generally seen in most normal ECG's; the ST elevation in V2- 6 is concave upwards, another characteristic of this normal variant. Characteristics’ of early repolarization • notching or slurring of the terminal portion of the QRS wave • symmetric concordant T waves of large amplitude • relative temporal stability • most commonly presents in the precordial leads but often associated with it is less pronounced ST segment elevation in the limb leads To differentiate from anterior MI • the initial part of the ST segment is usually flat or convex upward in AMI • reciprocal ST depression may be present in AMI but not in early repolarization • ST segments in early repolarization are usually <2 mm (but have been reported up to 4 mm) To differentiate from pericarditis • the ST changes are more widespread in pericarditis • the T wave is normal in pericarditis • the ratio of the degree of ST elevation (measured using the PR segment as the baseline) to the height of the T wave is greater than 0.25 in V6 in pericarditis. 1 II. Acute Pericarditis: Stage 1 Pericarditis Changes A. Timing 1. Onset: Day 2-3 2. Duration: Up to 2 weeks B. Findings 1. -
Basic Rhythm Recognition
Electrocardiographic Interpretation Basic Rhythm Recognition William Brady, MD Department of Emergency Medicine Cardiac Rhythms Anatomy of a Rhythm Strip A Review of the Electrical System Intrinsic Pacemakers Cells These cells have property known as “Automaticity”— means they can spontaneously depolarize. Sinus Node Primary pacemaker Fires at a rate of 60-100 bpm AV Junction Fires at a rate of 40-60 bpm Ventricular (Purkinje Fibers) Less than 40 bpm What’s Normal P Wave Atrial Depolarization PR Interval (Normal 0.12-0.20) Beginning of the P to onset of QRS QRS Ventricular Depolarization QRS Interval (Normal <0.10) Period (or length of time) it takes for the ventricles to depolarize The Key to Success… …A systematic approach! Rate Rhythm P Waves PR Interval P and QRS Correlation QRS Rate Pacemaker A rather ill patient……… Very apparent inferolateral STEMI……with less apparent complete heart block RATE . Fast vs Slow . QRS Width Narrow QRS Wide QRS Narrow QRS Wide QRS Tachycardia Tachycardia Bradycardia Bradycardia Regular Irregular Regular Irregular Sinus Brady Idioventricular A-Fib / Flutter Bradycardia w/ BBB Sinus Tach A-Fib VT PVT Junctional 2 AVB / II PSVT A-Flutter SVT aberrant A-Fib 1 AVB 3 AVB A-Flutter MAT 2 AVB / I or II PAT PAT 3 AVB ST PAC / PVC Stability Hypotension / hypoperfusion Altered mental status Chest pain – Coronary ischemic Dyspnea – Pulmonary edema Sinus Rhythm Sinus Rhythm P Wave PR Interval QRS Rate Rhythm Pacemaker Comment . Before . Constant, . Rate 60-100 . Regular . SA Node Upright in each QRS regular . Interval =/< leads I, II, . Look . Interval .12- .10 & III alike .20 Conduction Image reference: Cardionetics/ http://www.cardionetics.com/docs/healthcr/ecg/arrhy/0100_bd.htm Sinus Pause A delay of activation within the atria for a period between 1.7 and 3 seconds A palpitation is likely to be felt by the patient as the sinus beat following the pause may be a heavy beat.