Electrocardiogram (ECG) Test Strips Analysis, Summaries of Digital Image Processing

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BASICS ECGS

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TEST

STRIPS

Anatomy of the Heart

The heart, a fist-sized muscular organ located in the mediastinum, is the central structure of the cardiovascular system. It is protected by the bony structures of the sternum anteriorly, the spinal column posteriorly, and the rib cage. The heart is roughly conical, with the base of the cone at the top of the heart and the apex (the pointed part) at the bottom. It is rotated slightly counterclockwise, with the apex tipped anteriorly so that the back surface of the heart actually lies over the diaphragm.

BASICS

Location of the heart

Clinical Tip: The cone-shaped heart has its tip (apex) just above the diaphragm to the left of the midline. This is why we may think of the heart as being on the left side—the strongest beat can be heard or felt there.

BASICS

Layers of the Heart

The heart is composed of several different layers of tissue. Surrounding the heart itself is a protective sac called the pericardium. This double-walled sac has an inner, serous (visceral) layer and an outer, fibrous (parietal) layer. Between these layers is the pericardial cavity, which contains a small amount of lubricating fluid to prevent friction during heart contraction. The layers of the heart wall itself include the epicardium, or outermost layer; the myocardium, the thick middle layer of cardiac muscle; and the endocardium, the smooth layer of connective tissue that lines the inside of the heart.

Endocardium Parietal Myocardium pericardium (heart muscle) Epicardium (visceral pericardium)

Fibrous pericardium (pericardial sac)

Pericardial cavity Layers of the heart

Clinical Tip: The pericardial cavity contains a small amount of lubricat- ing fluid to prevent friction during heart contraction.

BASICS

Heart Chambers and Great Vessels

the ventricles. These are the primary pumping chambers, the left having a thicker myocardial layer than the right.enters the heart and to help fill the lower chambers. The more thickly muscled lower chambers of the heart areThe superior chambers of the heart are the right and left atria. Their primary function is to collect blood as it The heart is a hollow muscle with an internal skeleton of connective tissue that creates four separate chambers.

Brachiocephalic

artery

Superior vena cava

Left common carotid artery

Left subclavian artery Aortic arch

pulmonary veinsRightpulmonary arteryRight Inferior vena cavaRight atrium

Tricuspid valve

semilunar valvePulmonary

Left atriumLeft pulmonary artery Left ventricleMitral valveLeft pulmonary veins septumInterventricularvalveAortic semilunar Apex

tendineae Chordae

ventricleRight

musclesPapillary

Heart

• Anterior section (arrows show direction of blood flow)

Coronary Arteries and Veins

of the aortic valve.tem. The left and right coronary arteries are the first to branch off the aorta, just above the leaflets The coronary arteries and veins provide blood to the heart muscle and the electrical conduction sys-

BASICS

Aorta Left coronary artery descending branchAnterior

Coronary sinus

veinartery andPosterior

Small

cardiac vein

Right coronary artery

A

B

Circumflex branch veinGreat cardiac

Right coronary vein

(A) Anterior view

(B) Posterior view

Cardiovascular System—Major Arteries

BASICS

Occipital Internal carotid Vertebral Brachiocephalic Aortic arch

Maxillary Facial External carotid Common carotid Subclavian Axillary Pulmonary Celiac Left gastric Hepatic Splenic Superior mesenteric Abdominal aorta

Right common iliac Internal iliac External iliac

Femoral

Popliteal

Anterior tibial

Posterior tibial

Intercostal Brachial Renal Gonadal Inferior mesenteric Radial Ulnar Deep palmar arch

Superficial palmar arch

Deep femoral

BASICS

Cardiovascular System–Major Veins

Superior sagittal sinus Inferior sagittal sinus Straight sinus Transverse sinus Vertebral External jugular Internal jugular Subclavian Brachiocephalic Pulmonary Hepatic Hepatic portal Left gastric Renal Splenic Inferior mesenteric Internal iliac

Femoral

External iliac

Great saphenous

Popliteal

Small saphenous

Anterior tibial

Anterior facial Superior vena cava

Axillary Cephalic Hemiazygos Intercostal Inferior vena cava Brachial Basilic Gonadal Superior mesenteric

Dorsal arch

Volar digital

Dorsal arch

Common iliac

BASICS

Systolic and Diastolic Phases in the Heart

Left atrium

Pulmonary artery

Aorta

Diastole

Atrial systolic phase Ventricular systolic phase

Pulmonary Superior vein vena cava Right atrium

Pulmonary valve Tricuspid valve Right ventricle

Inferior vena cava

Aortic valve Mitral valve Left ventricle

Septum

Papillary muscle

BASICS

Electrical Conduction System of the Heart

Electrophysiology

Structure Function and Location

Sinoatrial (SA or sinus) Dominant pacemaker of the heart, located in node upper portion of right atrium. Intrinsic rate 60—100 bpm. Internodal pathways Direct electrical impulses between the SA and AV nodes and spread them across the atrial muscle.

Atrioventricular (AV) Part of the AV junctional tissue, which includes node some surrounding tissue plus the connected bun- dle of His. The AV node slows conduction, creating a slight delay before electrical impulses are carried to the ventricles. The intrinsic rate is 40–60 bpm. Bundle of His At the top of the interventricular septum, this bun- dle of fibers extends directly from the AV node and transmits impulses to the bundle branches.

Left bundle branch Conducts electrical impulses to the left ventricle. Right bundle branch Conducts electrical impulses to the right ventricle.

Purkinje system The bundle branches terminate with this network of fibers, which spread electrical impulses rapidly throughout the ventricular walls. The intrinsic rate is 20–40 bpm.

Bundle of His

Left bundle branch

Purkinje fibers

Right bundle branch

AV Node

SA Node Internodal pathways

Conduction system of the heart

Continued

Progression of Depolarization Through the Heart

BASICS

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SA Node

Atrial depolarization

Apical depolarization

Left ventricular depolarization

Septal depolarization

AV Node

Clinical Tip: Mechanical and electrical functions of the heart are influ- enced by proper electrolyte balance. Important components of this balance are sodium, calcium, potassium, and magnesium.

BASICS

Correlation of Depolarization and Repolarization

With the ECG

R

P T

Q S Ventricular depolarization

Ventricular repolarization

Atrial depolarization