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New Hampshire EMT-Intermediate Cardiology

This comprehensive training program covers the anatomy of the heart, cardiovascular disease prevention strategies, and the electrical properties of the heart, enabling EMT-Intermediates in New Hampshire to effectively respond to cardiac emergencies. Topics include identifying risk factors for coronary artery disease, interpreting ECG readings, recognizing arrhythmias, and providing timely interventions. Learners will gain practical skills in CPR, defibrillation, and interpreting ECG results according to AHA guidelines.

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New Hampshire EMT-Intermediate Cardiology

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  1. New Hampshire EMT-IntermediateCardiology New Hampshire Division of Fire Standards & Training and Emergency Medical Services

  2. Objectives • Describe the incidence, morbidity, and mortality of cardiovascular disease. • Discuss prevention strategies that may reduce morbidity and mortality of cardiovascular disease. • Identify the risk factors most predisposing to coronary artery disease.

  3. Objectives • Describe the anatomy of the heart, including the position in the thoracic cavity, layers of the hear chambers, and location and function of cardiac valves. • Identify the major structures of the vascular system. • Describe the distribution of the coronary arteries and the parts of the heart supplied by each artery. • Differentiate the structuraland functional aspects of arterial and venous blood vessels.

  4. Objectives continued • Define the following terms that refer to cardiac physiology: • Stroke volume • Starling’s Law • Preload • Afterload • Cardiac output • Blood pressure • Describe the electrical properties of the heart. • Describe the normal sequence of electrical conduction through the heart and state the purpose of this conduction system.

  5. Objectives continued • Describe the location and function of the following structures of the electrical conduction system: (C-1) • SA node • Internodal and interatrial tracts • AV node • Bundle of His • Bundle branches • Purkinje fibers • Define cardiac depolarization and repolarization and describe the major electrolyte changes that occur in each process. (C-1) • Describe an ECG. (C-1) • Explain the purpose of ECG monitoring and its limitations. (C-1)

  6. Objectives continued • Define the following terms as they relate to the electrical activity of the heart: • Isoelectric line • QRS complex • P wave • State the numerical values assigned to each small and each large box on the ECG graph paper for each axis. • Define ECG artifact and name the causes. • Correlate the electrophysiological and hemodynamic events occurring throughout the entire cardiac cycle with the various ECG wave forms, segments and intervals. • Relate the cardiac surfaces or areas represented by the ECG leads . • Given an ECG, identify the arrhythmia. • Describe a systematic approach to analysis and interpretation of cardiac dysrhythmias.

  7. Objectives continued • Describe the dysrhythmias originating in the sinus node and the ventricles. • Describe the process and pitfalls of differentiating wide QRS complex tachycardias. • Describe the term “cardiac arrest”. • Describe the arrhythmias seen in cardiac arrest. • Identify the critical actions necessary in caring for the patient with cardiac arrest. • Explain how to confirm asystole using the 3-lead ECG. • List the clinical indications for defibrillation. • Describe the most commonly used pharmacological agents in the management of cardiac arrest for EMT-Intermediates. • Identify resuscitation. • Identify circumstances and situations where resuscitation efforts would not be initiated. • Identify local protocol dictating circumstances and situations where resuscitation efforts would be discontinued.

  8. Objectives continued • Integrate the pathophysiology principles to the assessment of the patient with cardiac arrest. • Synthesize assessment findings to formulate a rapid intervention for a patient in cardiac arrest. • Describe the conditions of pulseless electrical activity. • Value and defend the urgency in rapid determination of and rapid intervention of patients in cardiac arrest. • Identify the location of the structures listed in cognitive objective #2. • Demonstrate how to set and adjust the ECG monitor settings to varying patient situations. • Demonstrate a working knowledge of various ECG lead systems • Demonstrate satisfactory performance of psychomotor skills of basic and advanced life support techniques according to the current American Heart Association standards and guidelines, including: • Cardiopulmonary resuscitation • Defibrillation • Demonstrate how to record an ECG

  9. Incidence • Prevalence of cardiac death outside of a hospital • Supportive statistics • Prevalence of warning signs and symptoms for cardiac emergencies • Supportive statistics • Increased recognition of need for early reperfusion

  10. Morbidity/ mortality • Reduced with early recognition • Reduced with early access to EMS system

  11. Risk factors • Age • Family history • Hypertension • Lipids • Male sex • Smoking • Carbohydrate intolerance

  12. Possible contributing risks • Diet • Female sex • Obesity • Oral contraceptives • Sedentary living • Personality type • Psychosocial tensions

  13. Prevention Strategies • Early recognition • Education • Alteration of life style

  14. Anatomy of the Heart

  15. Anatomy of the heart

  16. Tissue Layers • Pericardium: protective sac surrounding the heart. Two layers. • Myocardium: middle layer of the heart, unique muscle cells that have the ability to conduct electrical impulses from one muscle cell to another, thus allowing the heart to contract • Endocardium: inner layer of heart, bathed in blood

  17. Tissue Layers

  18. Pericardial Membrane

  19. Chambers • Atria: superior chambers that receive incoming blood • Right & Left • Ventricles: inferior chambers that pump blood out of the heart • Right & Left

  20. Heart Valves • Tricupid Valve: right aterioventricular valve; 3 cusps or leaflets • Bicupid (Mitral) Valve: left aterioventricular valve; 2 cusps or leaflets • Pulmonic Valve: right semilunar valve • Aortic Valve: left semilunar valve

  21. Coronary Circulation • Left Coronary Artery • Anterior Descending Artery • Circumflex Artery • Right Coronary Artery • Posterior Descending Artery • Marginal Artery

  22. Blood flow of the heart

  23. Cardiac Cycle • Right and left Ventricles contract together • Pressure of contraction produces closure of AV valve and opens aortic and pulmonic valves • Systole: Contraction phase, usually referring to ventricular contraction • Disatole: relaxation phase, usually referring to ventricles, much longer than systole (.52 seconds versus .28 seconds) • As rate increases, length of diastole decreases with less reduction in length of systole • Phase during which most coronary artery filling occurs (about 70%)

  24. Vascular System • Arterial System • arteries • arterioles • capillaries • Venous System • venules • veins

  25. Cardiac Physiology • To understand EKGs you must thoroughly understand the pumping actions of the cardiac cycle • Diastole: relaxation phase • Systole: contraction phase

  26. Cardiac Physiology • Stroke volume • Starling’s Law • Preload • Afterload • Cardiac Output • Blood Pressure

  27. Electrical Properties of the Heart

  28. Sinoatrial (SA) node

  29. Internodal and interatrial tracts

  30. Atrioventricular (AV) node

  31. Bundle of His

  32. Bundle branches

  33. Purkinje fibers

  34. Depolarization • Process by which muscle fibers are stimulated to contract by the alteration of the electrical charge of a cell. Accomplished by changes in electrolyte concentrations across the cell membrane.

  35. Intrinsic Rates • Pacemaker cells capable of self initiated depolarization • Found throughout conduction system except AV node • SA node: 60-100/minute intrinsic rate • AV Junction tissue: 40-60/minute intrinsic rate • Ventricles (bundle branches & Purkinje fibers): 20-40/minute intrinsic rate

  36. Repolarization • Once cells have depolarized, the electrolytes are pumped back to their resting or polarized state. This process is called repolarization.

  37. Autonomic nervous system relationship to Cardiovascular system • Medulla • Carotid sinus and baroreceptor • Location • Significance • Parasympathetic system • Sympathetic • Alpha-vasoconstriction • Beta • Inotropic • Dromotropic • Chronotropic

  38. ECG Monitoring

  39. EGC Monitoring • Electrical activity of the heart • Does NOT indicate mechanical activity of the heart. • Must take a pulse.

  40. ECG Components

  41. Relationship of ECG to the heart

  42. Dysrhythmias are the most common complication within the first few hours of chest pain • Life-threatening – usually ventricular fibrillation • Non-life-threatening – may require pre-hospital intervention • Warning dysrhythmias – may be forerunners of life-threatening dysrhythmias and require pre-hospital intervention

  43. Basic concepts of ECG monitoring • ECG is graphic display of heart’s electrical activity • Body acts as a giant conductor of electrical current • ECG obtained by applying electrodes on body surface which detect changes in voltage of cells between sites of the electrodes

  44. Basic concepts of ECG monitoring • Voltage may be positive (upward deflection) or negative (downward deflection) • These changes are input to ECG machine, amplified and displayed visually on a scope and/or graphically on ECG paper • Recorded as a continuous curve of waves and deflections called the electrocardiogram (ECG) • Monitoring lead: any lead that shows very clear wave forms, very often, lead II • Information that can be gained from a monitoring lead or rhythm strip: • How fast the heart is beating • How regular the heartbeat is

  45. ECG Graph Paper

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