Medical Transcription Fundamentals
Chapter11 — Cardiology
Medical Transcription Fundamentals
Lesson Plans
Chapter 11—Cardiology
Learning Objectives:
The lesson plan for each objective starts on the following page.
11-1 Name and describe the anatomic structures of the heart and associated blood vessels.
11-2 Explain cardiac conduction and describe the cardiac cycle.
11-3 Discuss blood pressure measurement and how blood pressure readings are obtained.
11-4 Describe common diseases and disorders related to the heart and their treatments.
11-5 Discuss common laboratory tests and diagnostic studies used to identify heart disease.
11-6 Discuss the Insight relating to cardiology.
11-7 Discuss the soundalike terms regarding cardiology.
11-8 Identify the combining forms used in relation to cardiology and the heart.
11-9 Review the abbreviations used in cardiology.
11-10 Explain the terminology used when transcribing cardiology documents.
You Will Need:
Gather the following materials for the following lessons:
11-1 A segment of a rubber hose, 1 inch in diameter.
11-3 Several manual sphygmometers and/or digital blood pressure machines.
11-4 Stedman’s Medical Dictionary or Physicians' Desk Reference, several copies.
11-5 An EKG machine.
11-8 A set of 3x5 index cards for each combining form listed in the Combining Forms table at the end of Chapter 11 (students will provide).
11-9 A set of 3x5 index cards for each abbreviation listed in the Abbreviations table at the end of Chapter 11 (students will provide).
Date:
Objective 11-1: Name and describe the anatomic structures of the heart and associated blood vessels.
Lecture Outline—Objective 11-1
/Figures, Tables, and Features
/Resources and
In-Class Activities
/Outside Assignments/ Evaluation
/Instructor’s Notes
/Content / Text / PPt /
Introduction
v Cardiology—the medical speciality dealing with the diagnosis and treatment of diseases and disorders of the heart.
v The heart pumps blood around a closed circle or circuit of vessels in a continuous loop from birth to death.
Anatomy of the Heart
v The heart—composed almost entirely of muscle.
v The heart is actually two different pumps
Ø The right side pumps blood into the lungs to gather oxygen.
Ø The left side pumps oxygenated blood to the rest of the body.
v Layers
Ø The pericardium surrounds the heart like a transparent sac.
Ø Three layers in heart wall
§ Outer: epicardium,
§ Middle: myocardium,
§ Inner: endocardium.
v Chambers—2 on the left, 2 on the right
Ø Upper chambers—left and right atria.
Ø Lower chambers—left and right ventricles.
Ø Left atrium and ventricle receive oxygen-rich blood and pump it to the body.
Ø Right atrium and ventricle receive deoxygenated blood from the body and pump it to the lungs for gas exchange to occur.
v Valves—open and close to ensure proper blood flow
Ø Tricuspid valve—between the right atrium and right ventricle.
Ø Pulmonary valve—opens from the right ventricle to the pulmonary artery.
Ø Mitral valve--between the left atrium and left ventricle.
Ø Aortic valve—between the left ventricle and the aorta.
Ø Each valve contains leaflets
§ Regulate blood flow
§ Prevent backflow of blood from ventricles to the atria
v Arteries and Vessels
Ø Blood Vessels – a network of interconnecting arteries, arterioles, capillaries, venules, and veins that provide the pathway in which blood is transported between the heart and the body cells.
Ø Arteries and arterioles – carry blood away from the heart
Ø Capillaries
§ Act as a bridge between arteries and veins.
§ Allow oxygen and nutrients to pass from the blood into tissues and allow waste products to pass from tissues back into the blood.
Ø Veins and venules—carry blood back to the heart
Ø Coronary Arteries
§ Left coronary artery (LCA) and right coronary artery (RCA) branch from the aorta.
§ Posterior descending artery (PDA)—main branch of RCA.
§ Left main coronary—initial segment of the left coronary artery.
§ The LCA branches into the left anterior descending artery (LAD) and the left circumflex artery (LCA).
§ The lesser coronary vessels
· Diagonal branches (D1, D2), which arise from the LAD
· Obtuse marginal branches (OM1, OM2), which arise from the LCA.
§ Myocardial infarction (MI)—results from blockage of coronary arteries by plaques
v Blood’s Path Through the Heart
Ø Blood empties into vena cavae:
§ Superior vena cava: Carries blood from upper body to right atrium
§ Inferior vena cava: Carries blood from lower body to right atrium
Ø Blood in right atrium empties into right ventricle
Ø Pumped by pulmonary artery to lungs
Ø Through left atrium and left ventricle
Pumped into the aorta for circulation throughout the body / 271
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11.1,
Anatomy of the heart, p. 272
Figure
11.2, The coronary arteries and veins, p. 274 / In-Class Activity
Make PowerPoint slides for this chapter available to students as a handout or by posting them on a school web site or sending them as an e-mail attachment prior to class. The students can use slide show sheets to follow lecture and supplement with handwritten notes.
In-Class Activity
Choose one student to select one of the terms related to the anatomy of the heart. Have students play a “To Tell The Truth” type game, taking turns asking the student “yes” or “no” questions based on the information learned to determine the anatomic term chosen by the student. The winner gets to select the next term and the game is played again.
In-Class Activity
Demonstrate to students that the aorta is the largest artery in the body. Show the students a segment of a rubber hose that is 1 inch in diameter, the same diameter as the aorta, to show how large this vessel really is. Pass around the rubber hose for students to inspect. / OLC: List the chambers, ventricles and valves of the heart and explain each function.
Legend: PPt, PowerPoint; IRCD, Instructor Resource CD-ROM; SRCD, Student Resource CD-ROM, OLC, Online Course.
Date:
Objective 11-2: Explain cardiac conduction and describe the cardiac cycle.
Lecture Outline—Objective 11-2
/Figures, Tables, and Features
/Resources and
In-Class Activities
/Outside Assignments/ Evaluation
/Instructor’s Notes
/Content / Text / PPt /
The Cardiac Cycle
v Cardiac cycle—the sequence of events in one heartbeat. Cardiac conduction is the name given to the conduction system that controls the heart rate.
v Two basic components
Ø Contraction phase (systole)—blood is ejected from chambers of the heart.
Ø Relaxation phase (diastole)—heart is at rest and chambers fill with blood.
v Process:
Ø The SA node generates an electrical impulse that travels to the AV node.
§ The AV node delays the impulse to give the atria time to contract.
Ø The impulse travels on to the bundle of His.
Ø The impulse travels to the left and right bundle branches off the bundle of His.
Ø The impulse travels to the Purkinje fibers.
Ø Ventricles contract, pushing blood out of them into the lungs and body.
Ø The tricuspid and mitral valves shut tight and the pulmonary and aortic valves open so the atria can fill with blood again.
Ø The heart rests for a moment and the cycle begins again.
v Heart sounds—vibrations in the tissues and blood caused by closure of the valves.
Ø Lub-dub-sound of valves closing
§ Lub-(S1)—closure of the mitral and tricuspid valves at the beginning of a ventricular contraction.
§ Dub-(S2) —closure of the aortic and pulmonary valves at the end of ventricular systole, or when blood is released from the ventricles.
Ø Murmur-abnormal heart sound.
Ø Normal heart rate—sinus rhythm.
Ø Abnormal heart rhythm—arrhythmia/dysrhythmia. Other terms:
§ Bradycardia, a slow heartbeat, defined as usually less than 60 beats per minute.
§ Tachycardia, a fast heart rate, defined as greater than 100 beats per minute.
§ Atrial flutter, which is an arrhythmia in which the atrial rhythm is regular, but the rate is abnormally fast.
§ Fibrillation refers to an uncoordinated, irregular contraction of the heart muscle which may originate in the atria (called atrial fibrillation) or the ventricles (called ventricular fibrillation).
§ Heart block, which is an impaired conduction of the heart’s electrical impulses, leading to a slow heartbeat.
§ Paroxysmal atrial tachycardia, which is a rapid heart rate that starts and stops suddenly and unpredictably.
§ Premature atrial contraction, which describes an extra heartbeat that originates from the atria before it should. / 274
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11.3, The cardiac cycle, p. 275 / In-Class Activity:
Have students determine their own heart rates by taking their pulse. Demonstrate how to obtain a pulse either from the wrist or the carotid artery in the neck. Tell the students to count the number of beats they feel in 10 seconds and multiply by 6, which will equal the resting heart rate per minute. Have students take their pulse while seated, and then stand up and march in place at a fast pace for 1 minute, and take the pulse again. Compare the results.
In-Class Activity
Have students research the Internet for web sites that contain .wav files of different heart sounds and listen to each one. Then discuss their findings. How were the sounds different in each? / Outside Assignment
Have students research the Internet to learn about pacemakers. Under what circumstances would a person would require a pacemaker device? What heart defects would require a pacemaker? What kinds of pacemakers are available? Have them write a short paper on their findings. The next day, have students discuss their findings with the class.
OLC: Incorporate online activity from the outside assignment regarding the pacemaker.
Legend: PPt, PowerPoint; IRCD, Instructor Resource CD-ROM; SRCD, Student Resource CD-ROM, OLC, Online Course.
Date:
Objective 11-3: Discuss blood pressure measurement and how blood pressure readings are obtained.
Lecture Outline—Objective 11-3
/Figures, Tables, and Features
/Resources and
In-Class Activities
/Outside Assignments/ Evaluation
/Instructor’s Notes
/Content / Text / PPt /
Blood Pressure
v Blood pressure—the measurement of this force, or the force of the blood pushing against the walls of the arteries each time the heart pumps.
Ø Systolic pressure is the blood pressure at its highest when the heart beats, pumping the blood.
Ø Diastolic pressure is the blood pressure at its lowest, when the heart is at rest, between beats.
v Sphygmomanometer—measures blood pressure. Indicated in terms of millimeters of mercury, abbreviated as mmHg.
Ø Two numbers are involved in making a blood pressure reading, expressed as a fraction, for example, 120/80.
§ The systolic blood pressure, or the top number, represents the maximum pressure in the arteries as the heart contracts and pumps blood into the arteries.
§ The diastolic pressure, which is the bottom number, reflects the minimum blood pressure as the heart relaxes following a contraction. / 277 / 15 / In-Class Activity:
Have students experience taking blood pressure or having their own blood pressure taken. This can be done two ways:
(a) Invite someone from the school nursing staff to visit the classroom, demonstrate how blood pressure is measured, and explain what the results mean. The nurse can then take students' blood pressure; OR
(b) Bring in several sphygmomanometers, both manual and digital. Ask for a volunteer and demonstrate to the class how to take a blood pressure. Then have the students take turns taking each other’s blood pressure. Have the students write down their completed measurements. At the end, have students compare the results. / Outside Assignments
Skills Quick Check 11.1, p. 277
Can be completed in class or assigned as homework.
Legend: PPt, PowerPoint; IRCD, Instructor Resource CD-ROM; SRCD, Student Resource CD-ROM.
Date:
Objective 11-4: Describe common diseases and disorders related to the heart and their treatments.
Lecture Outline—Objective 11-4
/Figures, Tables, and Features
/Resources and
In-Class Activities
/Outside Assignments/ Evaluation
/Instructor’s Notes
/Content / Text / PPt /
Common Cardiac Diseases and Treatments
v Signs of heart problems:
Ø Cyanosis: Bluish tinge
Ø Pallor: Paleness
Ø Edema: Swelling of tissues
Ø Diaphoresis: Excessive sweating
Ø Angina (angina pectoris): Severe chest pain
v Hypertension—a condition in which the pressure of the blood in the arteries is too high
Ø Primary hypertension—where there is no identifiable cause.
Ø Secondary hypertension—where another disease or medication is the cause.
Ø Treatments:
§ Diuretics—Promote excretion of excess water in the body, lowering the blood pressure within the vessels.
§ Beta-blockers—Slow the heart rate and reduce the force of the heartbeat.
§ Angiotensin-converting enzyme (ACE) inhibitors—prevent the formation of angiotensin II that constricts the blood vessels.
§ Calcium-channel blockers—decrease the heart's pumping strength and relax blood vessels.
v Coronary artery disease (CAD)
Ø Refers to the narrowing of the coronary arteries sufficiently to prevent adequate blood supply to the heart muscle.
Ø Also called cardiac ischemia.
Ø Cause: the gradual buildup of plaques in the coronary arteries (atherosclerosis)
§ Arteries become hardened and narrowed, reducing the flow of blood through them, also called hardening of the arteries
Ø Symptoms: Angina pectoris (intense chest pain), dyspnea (shortness of breath), or a heart attack.
Ø Other complications of CAD
§ Heart failure—weakened heart muscle does not pump the way it should.
§ Congestive heart failure (CHF)—The heart's weak pumping action causes congestion in the lungs and other body tissues.
§ Result: Breathing difficulties while lying down (orthopnea) or the sudden onset of breathing difficulty occurring at night, usually after falling asleep (paroxysmal nocturnal dyspnea).
Ø Treatment:
§ Medications—nitrates dilate blood vessels, making it easier for the heart to pump blood through the body. Hypertension medications can also be used.
§ Surgical interventions
· Angioplasty opens narrowed arteries by using a catheter that is inserted into an artery in the leg and guided to the site of the blockage in the coronary artery of the heart. In order to keep the artery from re-stenosing, or narrowing again after an angioplasty procedure, an expandable stent is implanted at the site of the blockage to keep the artery from collapsing.