An overview of Electrocardiograph - Essay Example

?Essay Inserts His/Her Inserts Grade Inserts (15 04, Outline Introduction 2. Duties of an Electrocardiograph technician 3. General anatomy of the heart 4. Internal heart structure 5. Coronary Circulation 6. Heart physiology 7. Basic electrophysiology 8. Conduction system of the heart 9. Fundamentals of electrocardiogram 10. The electrocardiographic grid waves 11. Definition of waves, segments, intervals and junctions 12. The normal electrocardiograph waves and complexes 13. The normal EKG segments, intervals and Junctions 14. Analyzing the EKG strip involves the following steps 15. EKG interpretation and Pathology Recordings with diagrams 16. Artifacts of EKG Recording with diagrams Ambulatory 17. Conclusion An overview of Electrocardiograph 1. Introduction The heart is a vital organ of the body and the works very heart. All the blood in the human body is pumped by blood from the heart to different parts of the body. Defects and conditions of the heart are life threatening. The medical field has conducted numerous studies and has come up with various diagnosis and technologies that can aid in the treatment heart conditions. The electrocardiogram is a machine that detects heart activity and is used to assist in diagnosis. Electrocardiogram technologists are being trained to join work with the physicians and cardiologist since the problems associated with heart are on the increase (Hummel et al, 1999, p. 34). This essay will discuss the human heart and how different tissues function to facilitate important functions. This paper will also discuss the electrocardiogram machine, electrophysiology and how it works. Moreover, the interpretation of the results will be discussed. 2. Duties of an EKG technician Electrocardiogram technician duty is to us appropriate medical equipment together with medical techniques to monitoring patient’s electrical transmissions of the heart. Medical equipment used includes the electrocardiogram whose data inform cardiologists and physician decision making on diagnosis. Electrocardiogram technician are often trained while working by the cardiologists or electrocardiogram supervisor. While in the cardiologist’s office or laboratory, an EKG technician task involves moving patients and equipment so that they can conduct procedure. Their work involves dealing with ill patients with heart conditions. When conducting an electrograph, the technician attaches electrodes to the patient on the appropriate position. The technician puts the switch in for the electrocardiogram to detect electrical impulse of the patient’s heart. The physician or the cardiologist present makes the reading for the electrocardiogram machine which is used to analyze the condition of the patient’s heart. Electrocardiogram technician can be assigned the duty of investigating the level of stress on a patient’s heart. The electrocardiogram technician attaches electrodes to the patient’s heart appropriately to connect the patient to the electrocardiogram machine. While the patient is exercising on the treadmill, the electrocardiogram technician makes baseline reading. The patient is subjected to low speed and high speed on the treadmill to provide reading at diversified physical force. Electrocardiogram technician with advanced training on Hotler tests can conduct the Hotler tests. This entails connecting an electrocardiogram to the patient. The patient is allowed to proceed with their daily routine and then the electrocardiogram is removed after a complete day. Then, the electrocardiogram technician uses a scanner to produce the data recorded in the electrocardiogram machine. 3. General anatomy of the heart The human heart is composed of cardiac muscle (made up of myocardium tissue) to form an organ that is cone shaped. Myocardium tissue forms a large portion of the heart. Endothelium refers to the inner part of the heart. The heart weighs between 0.2- 0.4 kilograms and can be compared to be the size of fist. The heart beats to support the flow of blood in the body, expands and contracts numerous times. The heart is found between the right and left lungs, enclosed between the lungs and ribcage and to the left side of the sternum (breast bone). The size of the heart is dependent on the size and age of the individual. The condition of the heart can affect the size of the heart. The heart is enclosed by a double layer of protective and connective tissue known as pericardium. Fibrous pericardium is found on the outside and protects the heart from close organs. Fibrous pericardium protects large blood vessels. Fibrous pericardium is attached to some body parts that include spinal column and diaphragm by ligaments. Serous pericardium holds fast to hearts surface. Serous pericardium is therefore attached to heart muscles. Between the fibrous pericardium and serous pericardium is pericardial fluid that reduces friction, since the heart moves when it beats (Gomella 2006, p. 347). 4. Internal heart structure The heart consists of four chambers. The right atrium (auricles), left atrium, right ventricle and left ventricle. Septum separates the right chambers and the left chambers. Atriums have less muscular walls than the ventricles. The left side of the heart oxygenates blood and the right side of the heart deoxygenates blood. The heart is made up of valves that regulate blood flow. Tricuspid valve is responsible for regulating blood flow for right atrium and right ventricle. Pulmonary valve regulate blood that is flowing from right ventricle to pulmonary artery. Pulmonary artery transport blood to lungs for oxygenation. Mitral valve transport oxygenated blood to left ventricle from left atrium. Aortic valve allows oxygenated blood from left ventricle to the aorta, where it enters the body. Aorta is the largest artery in the body. The opening between the right atrium and right ventricle is the tricuspid valve. Tricuspid valve is shielded by a valve known as auriculo ventricular. Tricuspid valve has three flaps which are attached to the ventricle walls by chorda tendinae (tendons). Vena cavae are two major blood veins that collect deoxygenated blood. They are referred to as superior vena cava or inferior vena cava. The latter accumulate deoxygenated blood from lower body parts while the former gather blood from the upper body parts. Semilunar valve guards blood backflow at junction linking right ventricle and pulmonary artery (Baltazar 2009, p. 1). Bicuspid valve and tricuspid valve stop blood from flowing back to the auricles after entering the ventricles once the ventricles is pumping blood into blood vessels. Auricles chambers receive while ventricles pump (Gomella 2006, p. 167). 5. Coronary Circulation Coronary circulation is the blood movement through the heart tissue. Goldberger (2012, p. 17) note that coronary circulation can also be seen as blood circulation in blood vessels in myocardium (muscles of the heart). Coronary arteries are blood vessels that enrich myocardium with oxygenated blood, while, cardiac veins are blood vessels that remove deoxygenated blood. Epicardial coronary arteries are found in the surface of the heart and regulate levels of coronary blood flow to the appropriate levels as required by the heart. Subendocardial coronary arteries run inside myocardium. Coronary arteries are the only arteries that supply blood to the myocardium. Therefore, coronary arteries are seen as end circulation which means that blood supply redundancy is very little; hence, blocked vessels could be grave. Coronary arteries are characteristically narrow. The right and left coronary arteries of the heart branch from aorta emanating from aortic valve. Right coronary artery has several branches that supply right ventricle with blood. The right coronary artery has branches known as posterior interventricular branches that nourish the left ventricle with blood. The left coronary artery supply blood to the left side of the heart and appears larger than the right coronary artery. As a result, the left coronary artery require rigorous flow of blood. Then the left coronary artery branches into circumflex and anterior interventricular. Anterior interventricular supplies blood to ventricular septum and ventricles. Circumflex through left atrium and left ventricle nourish the left chambers to link with posterior of the heart right coronary artery. 6. Heart physiology The heart being a muscular organ is always pumping blood to different parts of the body. The tissues that make up the cardiac muscles are strong and facilitate rhythmic contraction and relaxation movements the entire lifetime of a human being. The movements that describe the movements of the heart are systolic and diastolic. Systole occurs when the heart contracts while diastole happens when the heart relaxes. Systole occurs when the blood is forced to leave the chambers and join the heart to depart the heart causing a contraction. The left ventricle forces blood into aorta and from right ventricle into pulmonary artery. When the ventricles contract pressure increases. The pressure is referred to as systolic pressure. Diastole causes relaxation of ventricle muscle. When the ventricles relax space for receiving blood from atria is created. Diastolic pressure is created because pressure decreases after the ventricles relax. The muscle tissue of the heart has nerve fibers that make up a network. The network of nerves facilitates relaxation and contraction of the heart by enabling the cardiac muscles flow efficiently in a rhythmic manner. The coordination of the muscles causes the heart to have pumping strokes that appear wave-like. Septum which divides the heart does not allow the left and the right side of the heart to communicate directly. If there is communication between the two sides a septum defect could be the cause. In a normal situation, blood travels to from the left to the right or from the right to right only through the lungs. 7. Basic electrophysiology Josephson (2001, p. 17) notes that, electrophysiology is a study of the human being heart with engaging in surgery to analyze the electrical conduction system of the heart whether normal or abnormal. The test is conducted with aid of cardiac catheter and computerized electrocardiogram to generate tracing together with measurements precise to the functioning of the patient’s heart. Electrophysiology is conducted to diagnose and to locate specific electrical signal during a therapy. Hummel et al (1999, p. 56) mention that, electrophysiology is done when standard procedure, stress tests, hotler monitor, angiogram or echocardiogram is inadequate in diagnosing arrhythmia (for patient’s irregular heart rhythm). Since the electrodes are put on the patient’s heart, the electro physiologist detects the abnormalities of the heart and performs corrective procedure to treat the patient. Electrophysiology is recommended on patients with tachycardias, response to anti arrhythmic therapy, brandycardias and patient who have undergone resuscitation. Patients who need electrophysiology may show symptoms such as chest pain, fatigue, dizziness and difficulty in breathing. Before the patient goes for electrophysiology the medical professionals perform blood tests a week before the test and withdraw medication for patient if the medication will interfere with the test. The patient is usually sedated during electrophysiology. Patients are advised to rest on the bed hours after electrophysiology so that the site of catheter insertion heals. A normal heart has normal electrical impulse and initiates the impulses normally. A heart with abnormalities may reveal extra pathways, brandycardias and supraventricular tarchycardias, ventricular arrhythmias which confirm arrhythmias (Dubin, 2000, p. 45). 8. Conduction system of the heart In line with Baltazar (2009, p. 1), the heart consists of an electrical conduction system. The electrical conduction system consists of sinoatrial node, atrioventricular node, AV bundle, and bundle Branches (right and left). Sinoatrial node sets the pace for the heart naturally, by releasing regular electrical impulses. It is located at the upper area of the right atrium. Sinoatrial node initiates electrical impulse that causes every single heartbeat. The impulses are transmitted via the atria causing the contraction of the cardiac muscles in a rhythmic wave. The pace rate of the sinoatrial node are based on individual needs of the human body. The impulse send by the sonoatrial node is received by the antrioventricular node. Antrioventricular node is located in the lower side of the right atrium. Antrioventricular node similarly transmits the impulse through the ventricle network. Consequently, the result is contractions by the ventricles that resemble waves. The network of electrical in the ventricles exits the antrioventricular node either on the right or left bundle branches. Impulse received on the nerve fiber trigger the contraction of the cardiac muscle. Dubin (2000, p. 6) adds that, the heart being made up of up to a billion cells, most cells constitute ventricular walls and contractions that happen almost appear instantaneously. Sinoatrial node recharge when antrioventricular node is charging hence the heart does not stop for sinoatrial node to trigger another impulse. Therefore, there are three stages of a heartbeat, atrial depolarization, ventricular depolarization and reporalization of both atrial and ventricle. 9. Fundamentals of electrocardiogram Dubin (2000, p. 6) notes that, electrocardiogram is a machine that record information on the heart’s electrical activity for the atrial and ventricle complexes and waves. Electrodes connecting the electrocardiogram machine and the patient’s heart can provide a means of recording electrical activity for analysis. Electrocardiogram machine main objective is to sense flow of the patient’s heart activity by measuring on the patient’s skin. The functions of an electrocardiogram include computing a person’s heart rate on the monitor. The electrocardiogram assesses the pacemaker’s motions and regularity. When the patient has been administered medication the electrocardiogram can be used to evaluate the extent of response of the body or heart to the medication. An example of effects of medication that can be administered and monitored on an electrocardiogram machine is antiarrythmic. An electrocardiogram machine can give baseline reading of the heart prior, during and following a treatment or medical procedure. An electrocardiogram generates information that is useful for the cardiologist or physician that is specific and resourceful. The information may include details of hearts orientation in the chest. The electrocardiogram may reveal that there is a disturbance in the system of electrical conduction. Additionally, electrocardiogram may show how electrolyte and medication affects electrical impulses. Features such as damages of blood vessels or ischemic. The cardiac muscles can be viewed and the mass shown for easy assessment. The electrocardiogram is limited and may not show data on myocardium. When conducting the procedure the blood pressure as well as pulse is evaluated to support evidence on mechanical activity of the heart. 10. The electrocardiographic grid and waves The electrocardiographic grid is a representation of measurement of voltage plotted on a vertical axis. The axis is on time. The voltage and time are detected when electrodes that are connected to the machine provide a difference. Usually, a distance is deflected depending on the voltage to be measured. The electrocardiogram waves are recorded on a specified graph designed for recording the waves. The graph is constructed in a manner that grid like square boxes of one millimeter squared appear. The electrocardiogram machine records twenty five millimeters per second. Consequently, one millimeter on the horizontal is equal to 0.04 seconds to 0.2 seconds intervals. On the vertical grid the electrocardiogram takes the measurement of the height on the graph which is tantamount to 10 millimeter of the standard calibration. Estimation of the rate can be achieved through a countdown using the grid. On the grid small and large boxes on the grid can be counted between the two P waves that follow and the two R waves that follow. For the small boxes the number between two following P waves for atrial together with the number squires between of two following R waves for ventricles rates are used. The number of small boxes is divided by 1500 to get the correct number of beats in a minute. Similarly, the number of boxes obtained for the large boxes of the grid into 300 hundred to obtain the beats in a minute. 11. Definition of waves, segments, intervals and junctions Waves in an electrocardiogram are in the form of P, T or QRS waves. P waves denote atria depolarization. QRS waves stand for ventricle depolarization and T represents repolarization of the ventricle. Atria repolarization is almost impossible to be detected or viewed and when detected it is denoted as Ta wave. There are other waves that can appear abnormally such as delta waves. Delta waves slight portion of the QRS wave. Epsilon wave is seen towards the end of QRS wave. Osborn wave is also visibly when QRS wave is ending in rigorous hypothermia (Canover 2003p. 41). Wagner (2007, p. 11) notes that, a segment can be defined as the space between two waves. The PR segment begins after P wave and ends at the beginning of QRS complex. ST segments begin on end of QRS and ends at the beginning of T wave. In the cardiogram, a segment can also be described as isoelectric interval. An interval can be defines as the region in a cardiogram that covers one segment with one or several waves. PR interval begins at end of P wave and diminishes at the beginning of QRS. An interval can be interpreted as an impulse conducted from a section of atrium on the top towards the ventricle. QT interval begins where QRS starts and ends at the completion of T wave. An interval stands for the electrical systolic action performed by the heart. A junction is placed between a QRS and ST segment . 12. The normal electrocardiograph waves and complexes Normal electrocardiogram starts with a P wave that deflects atria depolarization (from right side to left then to inferiority)An active atrial appears on electrocardiogram as P wave vertically in leads. the first precordial lead denoted as V1 is negative and signifies depolarization of posterity on the left side of the atrium. P wave amplitude does not exceed 2.5 millimeters and tenth of a second which is representative of a reduced amount of three boxes. Sometimes the P wave has a notch which separating left from right atrial actions. PR segment detects isoelectric segment, which is deflected as well depolarized by abnormalities of atria caused by pericarditis or infarction of atrium. Normal PR measurements for the intervals are between 0.12 and 0.2 seconds. QRS complexes timing is between 0.06 to 0.10 seconds. Q waves normally remains bellows 0.03 seconds and bellow 3milimetres depth. R wave remains within 20 to 25 millimeters height. QRS complex may be 30 to 105 degrees from the frontal axis indicating that there is a positive in the leads for the complexes. T wave faces identical direction with the QRS. The QT interval rate is subject to heart rate with the average normal heart beat being 70 beats per minute (Josephson, 2001, p. 57). 13. The normal EKG segments, intervals and Junctions ST segmentation is ventricular depolarized at the end and is begin before repolarization commences. Normal segment is seen as a period of electrocardiology silence. Sometimes ST segmentation is called a J point. Normal segmentation has a concavity that is slightly elevated and has isolectric. Segmentation can be placed horizontally and depressed under the isoelectric line. Segmentation is different in diverse people and can be concave or convex or on a down slope. The segment occurs in about 0. 08 seconds following a QRS complex. The interval normally reflects time. PR interval gives time taken by an impulse to reach the AV node. QRS interval gives the length in time that is taken for impulse to travel to depolarize ventricles. QT interval gives the time for the onset of ventricular depolarization to the finish of ventricular repolarization. QT interval can be viewed to give the time taken between Q and T waves from beginning to the end. A junction can be placed where tissues meet. A junction allows escape of rhythm. The blockage of junction can cause a problem if the tissue are blocked and interfere with normal functioning. 14. Analyzing the EKG strip involves the following steps There are five steps that can be used for strip interpretation. The kind of rhythms determines the course of treatment to be administered. In the first stage, the electrocardiogram technician checks at the rhythm to asses if the rhythm is normal or irregular. They note if the rate is very fast, medium speed or too slow. 60 to 100 beats are considered the most appropriate hemodynamic hemorrhage. When the rate is bellow 60 beats or exceeds 100 beats, hemodynamic instability can be experienced. The second stage is to evaluate if the heart rhythm is regular. The rhythms emanate from pace setters and are transmitted to regularly. Irregular rhythm suggests that the beats are not released regularly and there could be abnormal beats which can be caused by certain conditions. The third step involves examining all the components and the shape of complex. Complex are narrow in nature, when it is large abnormalities in conduction can be pointed out. Wide complex could result into problems for the patient. The fourth step involves checking the position of P wave. The electrocardiogram technologist finds out if P wave go before QRS complex, which denotes normal function of conduction from atria to ventricle. When p wave does not appear, the impulse could be emanating from a different part of the heart. The final step establishes if all the complexes are alike. In a normal conduction each beat follow a similar pattern. Complexes that are diverse could indicate that impulses could be passing in wrong pathways. In a summary form the first determines if the rhythm is between 60 to 100 beats in a minute. Step two checks if rhythm is regular. Step three checks if the complex is narrow or with blockages. The fourth step checks if the rhythm is preceded by the P wave. The final stage investigates the state of all the complexes and if they look alike (Ecman, 1990, p. 56). 15. EKG interpretation and Pathology Recordings Randal (2004, p. 54) mentions that when interpreting electrocardiogram it is important to identify the normal behavior of heart. A heart in good condition will have R waves that are very tall. There will be U waves that are prominent. Additionally, ST segments might look elevated and be elevated. This means that there is a high take off of and repolarization is early and benign. The sinus arrhythmic may appear extremely exaggerated. There is going to be a functional rhythm and the heart may have a heart block of the first degree. Moreover, the atrial pacemaker may seem wondering while there may occur wenckebach phenomenon. 16. Artifacts of EKG Recording The following are the basic requirements for ambulatory systems. They include consumption of power that is low, detection for low voltage power battery, ability to obtain the electrocardiogram leads simultaneously. Wireless communication, small in size, operation time of the battery should be a minimum of 24 hours continuously and obtain a recording ability with functions of display and enough storage in real time. It consists of two blocks which are fitted with a transmitter and a receiver. The transmitters function is to condition, process, digitalize, encode and transmit to the electrocardiogram leads together with battery information to be received. The receiver detects information transmitted via the electrocardiogram where it is decoded. The Signal is send computer for recording display and storage. 17. Conclusion An electrocardiogram technologist assists in the use of electrocardiogram machine in a physician’s room or laboratory to generate information used for diagnosis. The human heart is made up of muscle tissue, located between the lungs and pump blood to different parts of the body. The electrocardiogram records hearts activity and presents them on a screen or recorded tape where the information is analyzed. The electrocardiogram records heart orientation, heart disturbance, effects of medication on heart and base line reading of heart activity. The electrocardiogram requires interpretation from an expert. Abnormalities detected can be treated for patients to recover. Reference List Baltazar, R. F. (2009). Basic and Bedside Electrocardiography.New York: Lippincott Williams & Wilkins. Canover, M. B. (2003) Understanding Electrocardiography. Philadelphia, PA: Mosby. Dubin, D. (2000). Rapid Interpretation of EKG's. Florida, USA: Cover Publishing Company. Ecman, M. (1990). ECG interpretation. New York: Springhouse Corporation. Gomella, L. (2006). Clinician's Pocket Reference. New York: McGraw-Hill Medical. Goldberger, A. L. (2012). Clinical Electrocardiography: A Simplified Approach. Philadelphia, PA: Saunders. Hummel, J. D., Kalbfleisch, S. J. and J. M. Dillon.  (1999). Pocket Guide for Cardiac Electrophysiology. Philadelphia: W. B. Saunders Company. Josephson, M. E. ( 2001). Clinical Cardiac Electrophysiology: Techniques and Interpretations. Philadelphia: Lippincott Williams & Wilkins Publishers. Randal, D. C. (2004). ECG Interpretation. Hayes Barton Press. Wagner, G. S. (2007). Marriott's Practical Electrocardiography. New York: Lippincott Williams & Wilkins. Read More