Cardiac- Human

1. Cardiac- Human

2. The heart is a muscular organ found in all vertebrates that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions. The term cardiac (as in cardiology) means "related to the heart" and comes from the Greek kardia, for "heart”.

4. Your heart is actually a double pump. The right side of the heart is made up of the right atrium (upper chamber) and the right ventricle (lower chamber). The right side receives blood that is low in oxygen from all the veins in the body, and then it pumps that blood through the pulmonary artery to the lungs, where it will become re-oxygenated. The left side of the heart consists of the left atrium (upper chamber) and the left ventricle (lower chamber). The left side of the heart receives this oxygen-rich blood from the lungs, which it then pumps through the aorta to the body.

6. Fun facts about your heart! • By the time you turn 70, your heart will have beat some two-and-a-half billion times (figuring on an average of 70 beats per minute.) • The left lung is smaller than the right lung to make room for the heart. • Women’s hearts beat faster than men’s. • According to German researchers, the risk of heart attack is higher on Monday than any other day of the week.

7. Most people think the heart is located on the left side but it is actually located almost in the center of the chest, between the lungs. It's tipped slightly so that a part of it sticks out and taps against the left side of the chest, which is what makes it seem as though it is located there. • Your heart beats about 100,000 times in one day, 35 million times in a year, and more than 2.5 billion times during an average life span. • Even at rest, the muscles of the heart work hard—twice as hard as the leg muscles of a person sprinting. • The aorta, the largest artery in the body, is almost the diameter of a garden hose. Capillaries, on the other hand, are so small that it takes ten of them to equal the thickness of a human hair.

8. RISKFACTORS • Do you smoke? • Drink alcohol? • What is your caffeine intake per day? • Do you use prescription or recreational drugs? • Do you exercise? • Describe your dietary patterns.

9. MEDICATIONS Are you taking prescription medications to treat blood pressure or irregular heart rhythm?

11. LIFESTYLE • What physical demands or emotional stress exists?

12. FAMILY HISTORY • Heart Disease • DM • High Cholesterol • Hypertension • Stroke • Rheumatic Heart Disease

13. PERSONAL HISTORY • Congestive heart failure • Congenital heart disease • Coronary artery disease • Dysrhythmias • murmurs

14. OTHER RISK FACTORS • Preexisting DM • Lung disease • Obesity • Hypertension

15. Blood Pressure and pulse aretwo most prominent numbers when initiating a cardiac assessment. They are the identifiers an individual’s cardiovascular health, and used to assess the immediate health of the heart organ. A Cardiac AssessmentInspection and Palpation 1. Blood PressureSystolicDiastolic (mmHg) Normal <120 <80 Prehypertension 120-39 80-89 Hypertension Stage 1 (Mild) 140-59 90-99 Stage 2 (Moderate to Severe) >160 >100 2. Pulse (beats per minute) Infants 120-160 Toddlers 90-140 Preschooler 80-110 School age 75-100 Adolescent 60-90 Adult 60-100

16. A Cardiac AssessmentInspection and Palpation • Blood pressure (BP) is the • force exerted on walls of an artery • pulsing blood under pressure from heart • blood flows throughout circulatory system due to pressure changes • from area of high pressure to area of low pressure Systolicpressure – the blood pressure measured during ventricular contraction (systole). The higher of the two measurements. This pressure produces the first sound (S1), characterized by a “lubb.” Diastolicpressure – the measure of pressure between contractions, pressure falls below that in the aorta and pulmonary artery, allowing these valves to close. As the valves close, the second heart sound (S2) is heard, “dubb,” in a normal heart. Factors influencing BP: Age Stress Ethnicity Gender Medications Smoking Activity Weight Daily Routine

17. The pulse - beats per minute (bpm) of the heart. • Palpation – the technique used in a physical examination to feel for relevant factors. It is what is perceivablebytouch. • Texture, Elasticity Rhythm • Consistencies Rate • Location on body Size Strengthof the Pulse - 0 – 4+ 0 = Absent, not palpable 1+ = Pulse diminished, thready, barely palpable 2+ = Expected, normal 3+ = Full pulse, increased, easy to palpate 4+ = Strong, bounding pulse (may be abnormal)

18. The Electrocardiogram (ECG) • reflects electrical activity of the conduction system of the heart • monitors regularity and path of electrical impulses of conduction system • doesnot reflect muscular work of the heart • normal sequence is called normalsinusrhythm (NSR) • NSR begins at the sinoatrial (SA) node . . . the PR interval • Through atrioventricular (AV) node, Bundle of His, Purkinje fibers • QRS complex = electrical impulse through ventricles, followed by contraction • QT interval represents ventricular depolarization/repolarization

19. PulseDetermination Possible system imbalances include: Tachycardia Bradycardia Dysrhythmias BloodPressureDetermination Possible system imbalances include: Hypertension Hypotension Orthostatic hypotension

20. Heart Sounds

21. Locations to Hear Heart Sounds The bell is held lightly, and the diaphragm is pressed firmly against the skin of the chest wall. This enhances the faint low-frequency vibrations from ventricular and atrial gallops. The high-pitched murmurs of aortic regurgitation and some cases of mitral regurgitation are better heard with the use of the diaphragm to filter out the low-frequency components of other distracting heart sounds.

22. The 4 percordial areas are examined with diaphragm, including: • Aortic region (between the 2nd and 3rd intercostal spaces at the right sternal border) (RUSB – right upper sternal border). • Pulmonic region (between the 2nd and 3rd intercostal spaces at the left sternal border) (LUSB – left upper sternal border). • Tricuspid region (between the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border) (LLSB – left lower sternal border). • Mitral region (near the apex of the heard between the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart).

23. Cardiac cycle related to sounds & values:

24. Normal heart sounds are associated with heart valves closing, causing changes in blood flow Common: S1 : The first heart tone, or S1, forms the "lubb" of "lubb-dub" or "lubb-dup” It is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves S2: The second heart tone, or S2, forms the "dub" of "lubb-dub" or "lubb-dup” It is caused by the sudden block of reversing blood flow due to closure of the aortic valve and pulmonary valve at the end of ventricular systole Not so common: S3: Also called a protodiastolic gallop, ventricular gallop, or informally the "Kentucky" gallop (S1=ken; S2=tuc; S3=ky). It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth and some trained athletes. Later in life it may signal cardiac problems like a failing left ventricle as in dilated congestive heart failure (CHF). S3 is thought to be caused by the oscillation inrushing blood from the atria. S4: The rare fourth heart sound is sometimes audible in healthy children and again in trained athletes. Is called a presystolic gallop or atrial gallop. This gallop is produced by the sound of blood being forced into a stiff/hypertrophic ventricle. It is a sign of a pathologic state. Producing a rhythm sometimes referred to as the "Tennessee" gallop where S4 represents the "tenn-" syllable.

26. Animations of sounds and figures go here http://www.openheartsurgery.com/heart_sounds.html http://blaufuss.org/

27. What is a Murmur? • It maybe a normal or abnormal sound that is heard secondary to turbulent blood flow. • Characteristics of Murmurs: • Timing • Intensity • frequency • location

28. Heart Murmurs What causes a heart murmur? Heart murmurs may be caused by a number of factors or diseases, including: • defective heart valves • holes in the heart walls • pregnancy • fever • anemia (a decrease in the red cells in the blood) What are the different types of murmurs? All murmurs are analyzed for pitch, loudness, and duration. They are also graded according to their intensity (on a scale of one to six, with one being very faint and six being very loud). Types of murmurs include: systolic murmur - occurs during a heart muscle contraction. Systolic murmurs are divided into ejection murmurs (due to blood flow through a narrowed vessel or irregular valve) and regurgitant murmurs. diastolic murmur - occurs during heart muscle relaxation between beats. Diastolic murmurs are due to a narrowing of the mitral or tricuspid valves, or regurgitation of the aortic or pulmonary valves. continuous murmur - occurs throughout the cardiac cycle.

29. Aortic Stenosis

30. Echocardiography Lubna Piracha, D.O.

31. Acoustic Cardiography Acoustic cardiography has been developed much more recently. This diagnostic technique consists of recording and algorithmically interpreting contemporaneous digital ECG and cardiac acoustical data. This is accomplished by using electrodes placed in the same positions as those used for a standard electrocardiogram (ECG). However, in the V3 and V4 precordial positions it employs dual-purpose sensors that simultaneously acquire ECG and sound data from each of these locations.

32. Example of an Acoustic Cardiographic Tracing and Report. An acoustic cardiographic recording that includes a 12-lead ECG is shown. Below the ECG is a simultaneous sound tracing that reveals both an S3 and an S4. A segment of this sound tracing is also shown near the top right corner of the report and this segment includes labelling of the S3 and S4. At the top left of the report is the printed algorithmic interpretation of both the ECG and the heart sound findings. The ECG findings include an anterior myocardial infarction and evidence of left ventricular hypertrophy. The three dimensional image of the heart in the top right corner of the report indicates the location of the myocardial infarction in black ink. Immediately below the image of the heart is a horizontal bar graph that indicates the relative strength of the ECG evidence for the left ventricular hypertrophy. Abbreviations: int – interval; LVH – left ventricular hypertrophy; mV – millivolt; S3 – third heart sound; S4 – fourth heart sound; EMAT – electromechanical activation time; LVST – left ventricular systolic time.

33. Time-Frequency Analysis of Heart Sounds The figure presents a schematic of a single heart beat showing a simultaneous ECG and sound recording in the time domain (upper two traces) as well as the wavelet filter based time-frequency representation of the heart sound recording (scalogram). Abbreviations: P – ECG P wave; Q – ECG Q wave; T – ECG T wave; S1 – First heart sound; M – Mitral component; T – Tricuspic component; S2 – Second heart sound; A – Aortic component; P – Pulmonary component; S3 –Third heart sound; S4 – Fourth heart sound.

34. Time-frequency analysis of heart sounds for a subject with a systolic murmur. Illustrate the 2D and 3D scalogram views for a few beats from the acoustic cardiography rhythm strip shown above. Since murmurs have higher frequency components than diastolic heart sounds, they do not have to be high in intensity to be detected by the human ear.