right coronary artery 100% blocked, patient symptoms
General CAD symptoms: Angina, shortness of breath, arrhythmia.
Shortness of breath happens if CAD causes heart failure so your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe. Some people who have CAD have no signs or symptoms. This is called silent CAD. It may not be diagnosed until a person shows signs and symptoms of aMI, heart failure, or an arrhythmia(an irregular heartbeat). (online source, ???)
ruptured aneurism symptoms
A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the "worst headache" ever experienced. Common signs and symptoms of a ruptured aneurysm include: Sudden, extremely severe headache, Nausea and vomiting, Stiff neck, Blurred or double vision, Sensitivity to light, Seizure, A drooping eyelid, Loss of consciousness, Confusion (MayoClinic)
pericardial effusion as low amplitude of the QRS complex
When pt. has pericardial effusion, QRS complex will be lower voltage so appear smaller on EKG tracing because heart will be unable to expand as much as normal due to the fluid's pressure around the heart.
right and left pulmonary veins carry oxygenated blood from the lungs to the left atrium > bicuspid valve > left ventricle > aortic valve > arteries (systemic circulation throughout the body)
atherosclerosis of the arteries in the legs
Can cause intermittent claudication. muscle pain that occurs after you have walked a while. The pain stops after you rest for a while. Each time the pain occurs, it takes about the same amount of time for the pain to go away after you stop walking. Risk factors for claudication and PAD (peripheral artery disease) include high blood pressure, diabetes, high cholesterol, cigarette smoking and older age. Claudication is also more likely in people who already have atherosclerosis in other arteries, such as the arteries in the heart or brain. People who have claudication may have already had heart attacks or strokes. (from online source)
situated in the wall of the right atrium adjacent to the septum between the atria
CAD resulting from arteriosclerosis or atherosclerosis may be caused by?
Coronary artery disease is coronary arteries not functioning properly to supply oxygen and nutrients to heart muscle. Can be from carotid artery stenosis/narrowing or occlusion/blockage. Both of these things can be from arteriosclerosis (hardening of arteries) or atherosclerosis (plaque (fat and cholesterol) buildup in lumen of arteries). Factors contributing are things that put a strain on the circulatory system like: changeable: hypertension, high cholesterol, smoking, obesity, poor diet, etc. unchangeable: gender, age, family history, etc.
Atherosclerosis is a disease of the arteries in which fatty material and plaque are deposited in the wall of an artery, resulting in narrowing of the arterial lumen and eventual impairment of blood flow.
Creatine phosphokinase (CPK) is an enzyme (3 types) and can be tested in the blood to diagnose a heart attack; levels reduce 3 to 4 days after the MI has occurred; these levels would show elevation 4 to 8 hours after an MI and if tested would confirm an MI had occurred. Female levels should be 26 to 140 IU/L (international units per liter), men should be 38 to 174 IU/L
CPK-2 (type 2) (also called CPK-MB) is found mostly in the heart and specifically these levels elevate 2 to 6 hours after MI and reduce 2 to 3 days after MI
Medline (online) says: CPK-2 levels rise 3 - 6 hours after MI. If there is no further heart muscle damage, the level peaks at 12 - 24 hours and returns to normal 12 - 48 hours after tissue death.
Increased CPK-2 levels may also be due to: Electrical injuries, AED use, heart injury, inflammation of heart, open heart surgery but NOT angina, pulmonary embolism or CHF
last item in conduction path, network of fibers that actually make the heart muscles contract; 1. sinoatrial (SA) node, 2. atrioventricular (AV) node, 3. Bundle of His (AV bundle), 4. bundle branches, and the 5.Purkinje fibers (network).
congestive heart failure is a condition where the heart can't pump enough blood to the body's other organs. diagnosed with signs, symptoms, pt. history, echocardiogram and other diagnostic tests. And chest x-ray will reveal pulmonary edema and cardiomegaly; B(brain)-type natriuretic peptide will be elevated in the blood. pt will be treated with diuretics, antihypertensives, digoxin
caffeine causes vasoconstriction which causes blood pressure to increase
coronary artery thrombosis
clot in the coronary artery, may cause occlusion (blockage); can cause part of the heart muscle to die if it is not getting oxygen and nutrients, which will cause an MI
deep vein thrombosis or thrombophlebitis occurs when a blood clot develops in a deep vein, usually in the legs. most common in adults over 60, and with adults with impaired mobility (paralysis, wheelchair-bound); usually occurs secondary to vessel injury and blood stasis caused by poor circulation and mobility. platelets begin to gather and fibrin formation occurs in areas of injury creating a blood clot and then inflammation occurs. Other factors include clotting disorders, heart failure, estrogen use, cancer, obesity, pregnancy; pt. will have a dull ache in area of clot, feelings of heaviness, localized edema, redness, heat. Usually confirmed with compression ultrasound or D-Dimer blood test, sometimes radiographic venography. Given anticoagulants like Coumadin to treat. Pt. should rest and relax until condition is resolved
measures a substance in the blood that is released when a blood clot dissolves, or confirms a clot is present, usually done after patient comes in with pain, area where a clot is located will be red, swollen and hot. This test is cheaper than using ultrasound tests (or an MRI or CT scan-very, very expensive) to confirm the presence of a clot.
carotid artery stenosis
narrowing of a carotid artery usually from artherosclerosis (plaque buildup), causes angina, can cause part of the heart muscle to die if it is not getting oxygen and nutrients, which will cause an MI
Also Lanoxin. Slows the heart rate and may restore normal sinus rhythm in atrial fibrillation pts. and increases cardiac contractility, strengthening the pumping force of the heart for CHF pts
an anticoagulant medication, generic name is warfarin, given to patients who have had a blood clot
is used to study the various functions of the heart; by injecting dye or opening arteries using balloon agioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressure within each chamber of the heart and across the valves can be measured.
EKG machine-recorder, amplifier, sensor
he sensor is the electrodes/lead/ portion of the machine capturing the data
the amplifier would amplify the data into something to be interpreted, the computer part of the machine
the recorder is the machine itself as in a Holter monitor that records events or can be the part of the machine that records the data on the EKG paper or translates the data into something that makes sense
ECG tracing represent?
conduction of electricity through the heart, electrical activity of the heart
painless test using sound waves to create images of the heart. provides info about size and shape and how well the chambers and valves are working. can identify areas of heart muscle that are not contracting normally, can detect possible blood clots in the heart, fluid buildup in the pericardium and problems with the aorta, congenital defects, heart valve defects
looks inside blood vessels by injecting dye into artery, then looking with an X-ray. The dye outlines narrow spots and blockages on the x-ray images. X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems. A thin tube (catheter) goes into the artery through a hole in the skin about the size of the tip of a pencil. A substance called contrast agent (x-ray dye) is injected to make the blood vessels visible on the x-ray.
Artifact in Lead II, check right arm and left leg electrodes
if they are falling off or not attached to the skin properly, it would have wandering baseline occurring. If electricity was close by 60-cycle or AC interference. If leads were switched for positive and negative locations-the graph would be inverted and peak below the baseline. If muscle spasms are occurring on these limbs, somatic tremor would occur.
standard lead, bipolar lead, 1st of the 1st 3 leads, standard limb lead.
Right Arm placement, Lead I records RA(-) to LA(+).
Measures flow of electrical current in 2 directions at the same time.
speed of EKG paper
horizontal direction = speed, rate,
0.04 seconds, for the little square (1 mm)
25 mm per second or 25 little squares or 5 big squares per second.
1,500 small blocks equals 1 minute.
300 big blocks equals 1 minute.
At the normal paper speed, one second equals 25 mm, or five heavy lines.
Therefore, each vertical heavy line represents 0.20 of second.
5th intercostal space, on the mid-clavicular line
angina, shortness of breath, arrythmias.
The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.
serum troponin levels
Diagnosis of MI is based on presenting signs and symptoms and results of diagnostic testing including 12-lead ECG and blood tests to check cardiac enzymes. The most reliable blood test is the troponin level, which determines how much heart damage has occurred.
myocardial infarction (1)
heart attack: occurs when blood supply to part of the myocardium is severely reduced or stopped; blockage is usually due to atherosclerosis, preventing blood flow in coronary arteries; defined as the death of the heart muscle related to coronary artery occlusion (blockage) which cuts off the supply of oxygen and nutrients; over 1 million people per year, about half die. Pain radiating down left arm might signal, or to jaw, atypical symptoms: lower back pain, nausea, headache, usually in Premenstrual females with diabetes.
myocardial infarction diagnosis
Diagnosis of MI based on presenting signs and symptoms and results of diagnostic testing including 12-lead ECG and blood tests to check cardiac enzymes. The most reliable blood test is the troponin level, whic determines how much heart damage has occurred. After pt. is stable, testing including nuclear heart scan, cardiac catheterization, and coronary angiography may be done to determine the extent of CAD and whether surgical intervention is needed.
myocardial infarction (2)
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
heart wall is made up of the endocardium (inside), myocardium (muscle) and epicardium. Then there is a fluid-filled space called the pericardial space and then the pericardium surrounds the entire heart like a sac.
2nd item in electricity flow 1. sinoatrial (SA) node, 2. atrioventricular (AV) node, 3. Bundle of His (AV bundle), 4. bundle branches, and the 5.Purkinje fibers (network). Has a delay which allows for atrial contraction and a more filling of the ventricles. A small mass of tissue that is situated in the wall of the right atrium adjacent to the septum between the atria, passes impulses received from the sinoatrial node to the ventricles by way of the bundle of His, and in some pathological states replaces the sinoatrial node as pacemaker of the heart.
tachycardia-lots of QRS complexes on EKG
more than 100 bpm
bradycardia-few QRS complexes on EKG
less than 60bpm
Every tiny box on the horizontal axis of the EKG paper represents ___________ seconds.
Every tiny box on the horizontal axis of the EKG paper represents 0.04 seconds.
ground or reference electrode
always RL (right leg) Does not gather information.
60 cycle interference occurs when?
because of electrical interference
repolarization and T wave
The T wave represents ventricular repolarization. As repolarization occurs, the ventricular muscles relax. Normal T waves are in the same direction as the QRS complex and the P wave.
Sinoatrial (SA) node (pacemaker) 60 to 100 bpm
Initiates heart at a rate of 60 - 100 beats per minute with electrical impulse that causes depolarization. Small, round structure that consist of Purkinje fibers, located in right atrium area. 1st item in list for electricity flow 1. sinoatrial (SA) node, 2. atrioventricular (AV) node, 3. Bundle of His (AV bundle), 4. bundle branches, and the 5.Purkinje fibers (network).
AVR, AVL, AVF, (augmented)
V1, V2, V3, V4, V5, V6 (precordial)
bipolar leads, standard leads, 1st 3 leads, standard limb leads.
Right Arm, Left Arm, Left Leg
Lead I records RA(-) to LA(+).
Lead II records RA(-) to LL(+).
Lead III records LA(-) to LL (+).
Measures flow of electrical current in 2 directions at the same time.
bipolar/standard limb leads
Einthoven is the scientist credited with the developing the first EKG machine. The Einthoven triangle is formed by three of the limb electrodes; those on the right arm, the left arm, and the left leg.
AVR, AVL, AVF
The second 3 leads are known as augmented leads because their tracings are (augmented) increased in size by the EKG machine in order to be interpreted. They are also known as unipolar leads because they measure toward one electrode on the body. The voltage is very low with the augmented leads because of the angle of measurement; therefore the EKG waveform will be very small. Unipolar.
Augmented Right Arm Lead. Lead aVR records electrical activity from midway between the left arm and left leg to the right arm. Lead aVR is usually a negative deflection. If it does not produce a negative deflection, you might have the electrodes or lead wires placed incorrectly.
Augmented Left Arm Lead. Lead aVL records electrical activity from the midpoint between the right arm and left leg to the left arm.
Augmented Foot Lead. Lead aVF records electrical activity form the midpoint between the right arm and left arm to the left leg.
Precordial leads, horizontal across chest, V1, V2, V3, V4, V5, V6
The last six leads are the chest leads. Also known as precordial, these leads are located in front of (pre) the heart (cor). Unipolar because they are measured in one direction only. Numbered from V1 to V6. Unipolar.
are disposable, 12-Lead EKG uses 10 electrodes. Electrodes are small sensors placed on the skin to receive the electrical activity from the heart, and leads are covered wires that conduct the electrical impulse from the electrodes to the EKG machine.
Wandering baseline shift, occurs when the tracing drifts away form the center of the graph paper. Baseline shift can have many causes. Typically, it is due to improper electrode application such as the following:
Too loose or incorrect electrode application; Tension or pulling on electrode lead wires; Too little electrode gel or solution; Old or dried out electrode gel or solution; Corroded or dirty electrodes; Oil, lotion, or dirt under the electrodes
A-fib, irregularly irregular
arteries become thick and stiff (hardening of arteries)
any use of ultrasound to diagnose (Called echocardiography when used in heart), can be used to find clots, incompetent valves (venous insufficiency), fluid accumulation, blocked/occlusion artery, stenosis/narrowing of artery in legs, etc.
What is Pericardial effusion?
The accumulation of excess fluid around the heart. The space between the pericardial sac and the heart wall normally contains a very small amount of fluid. Fluid buildup is often related to inflammation caused by disease or injury, but can also occur without inflammation. When the volume of fluid exceeds the pericardium's "full" level, pericardial effusion puts pressure on the heart, causing poor heart function. Untreated, can cause heart failure or death. (Mayo)
Right and left coronary artery
The right coronary artery supplies blood mainly to the right side of the heart. The right side of the heart is smaller because it pumps blood only to the lungs.The left coronary artery, which branches into the left anterior descending artery and the circumflex artery, supplies blood to the left side of the heart. The left side of the heart is larger and more muscular because it pumps blood to the rest of the body.
The heart muscle, like every other organ or tissue in your body, needs oxygen-rich blood to survive. Coronary circulation. The aorta (the main blood supplier to the body) branches off into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, which supply oxygen-rich blood to the entire heart muscle.
Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. (from CAD) Angina may feel like pressure or a squeezing pain in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. This pain tends to get worse with activity and go away when you rest. Emotional stress also can trigger the pain.
Augmented lead placement
bipolar lead placement
augmented leads ECG tracings
pulmonary circulation simplified
1. sinoatrial (SA) node, 2. atrioventricular (AV) node, 3. Bundle of His (AV bundle), 4. bundle branches, 5.Purkinje fibers (network).
Deoxygenated blood: Superior and inferior venae cavae > right atrium > tricuspid valve > right ventricle > pulmonary semilunar valves > pulmonary trunk > Pulmonary arteries > lung tissue(Pulmonary circulation) > Pulmonary veins(oxygenated blood) > left atrium > bicuspid valve > left ventricle > aortic semilunar valves > aorta > body tissues (systemic circulation) returning deoxygenated blood to inferior and superior venae cavae