Heart attacks & detection

 Pressure, a feeling of fullness or a squeezing pain in
the center of your chest that lasts for more than a few
minutes
 Pain extending beyond your chest to your shoulder,
arm, back, or even to your teeth and jaw
 Increasing episodes of chest pain
 Prolonged pain in the upper abdomen
 Shortness of breath
 Sweating
 Impending sense of doom
 Fainting
 Nausea and vomiting

 Age.
 Tobacco.
 Diabetes.
 High blood pressure.
 High blood cholesterol or triglyceride levels.
 Family history of heart attack.
 Lack of physical activity.
 Obesity.
 Stress.
 Illegal drug use.
 Gender
 High blood pressure
 Alcohol
 Oral contraceptive pill

Abnormal heart
rhythms
Heart failure.
Heart rupture.
Valve problems.

 Electrocardiogram (ECG).
 Blood tests
 Echocardiography ("echo")
 Cardiovascular magnetic resonance imaging
(CMR)
 Cardiac stress test
 Auscultation
 Holter monitor
 Electrophysiology study

Sphygmomanometer
Cardiac marker
Coronary catheterization
Fractional flow reserve (FFRmyo)
Intravascular ultrasound (IVUS)
Optical coherence tomography
(OCT)
Electrocardiography (ECG or EKG)

ABHISEK ANAND
C.T.I.T SHAHPUR JALANDHAR

WHAT IS AN ECG & EKG
 Allows for detection of
conduction abnormalities
 Helpful with non-cardiac
diseases (e.g. pulmonary embolism or
hypothermia)
 Helps detect electrolyte disturbances (hyper- &
hypokalemia)
 A recording of the electrical activity of the heart
over time.

 Horizontally
• One small box - 0.04 s
• One large box - 0.20 s
 Vertically
• One large box - 0.5 mV

• SA node
(Sinoatrial node)
• AV Junction
( Atrioventricular (AV)
junction)
• His-Purkinje
• Myocardial cells
• Electrical potential
• Autonomic Nervous
system

Action potential
 Depolarization
 Repolarization
 Critical electrolytes
 Sodium, potassium, calcium
 Excitability

Limb Leads Precordial Leads

Bipolar I, II, III -
(standard limb leads)

Unipolar aVR, aVL, aVF V1-V6
(augmented limb leads)

A transmembrane electrical gradient
(potential) is maintained, with the interior of
the cell negative with respect to outside the
cell
(-90mv) and (+30mv) inside and outside the cell
 Caused by unequal distribution of ions
inside vs. outside cell
Na+ higher outside than inside cell
Ca+ much higher “ “ “ “
K+ higher inside cell than outside
 Maintenanceby ion selective channels,
active pumps and exchangers

Depolarization of ventricals

Depolarization of artria Repolarization
of the ventricals

Repolarization
of purkinje fiber

 Divided into five phases
(0,1,2,3,4)
• Phase 0 – opening of fast Na
channels and rapid
• depolarization
 Drives Na+ into cell (inward
current),
changing membrane
potential
 Transient outward current due
to movement
of Cl- and K+
• Phase 1 – initial rapid
repolarization
 Closure of the fast Na+
channels
 Phase 0 and 1 together
correspond to the R and S
waves of the ECG

 Phase 2 - plateau phase
• sustained by the balance between
the inward movement of Ca+ and
outward movement of K+
• Has a long duration compared to
other nerve and muscle tissue
• Normally blocks any premature
stimulator signals (other muscle
tissue can accept additional
stimulation and increase
contractility in a summation effect)
• Corresponds to ST segment of the
ECG.
• Phase 3 – repolarization
• K+ channels remain open,
• Allows K+ to build up outside the
cell, causing the cell to repolarize
• K + channels finally close when
membrane potential reaches
certain level
• Corresponds to T wave on the
ECG

•Phase 4 - resting phase (restingmembrane
potential)
•At (-90mv) stable
•Phase cardiac cells remain in until
stimulated
•Associated with diastole portion of heart
cycle

 Echocardiography (echo or
echocardiogram) is a type
of ultrasound test that uses
high-pitched sound waves
to produce an image of the
heart. The sound waves are
sent through a device called
a transducer and are
reflected off the various
structures of the heart.
These echoes are converted
into pictures of the heart
that can be seen on a video
monitor.
There is no special
preparation for the test.

Ultrasound gel is applied to the
transducer to allow
transmission of the sound
waves from the transducer to
the skin
The transducer transforms the
echo (mechanical energy) into
an electrical signal which is
processed and displayed as an
image on the screen.
The conversion of sound to
electrical energy is called the
piezoelectric effect

There are 5 basic components of an ultrasound scanner that
are required for generation, display and storage of an
ultrasound image.
1. Pulse generator - applies high amplitude voltage to
energize the crystals
2. Transducer - converts electrical energy to mechanical
(ultrasound) energy and vice versa
3. Receiver - detects and amplifies weak signals
4. Display - displays ultrasound signals in a variety of
modes
5. Memory - stores video display

sometimes known as cardiac MRI, is a medical
imaging technology for the non-invasive assessment of
the function and structure of the cardiovascular system.
It is derived from and based on the same basic
principles as magnetic resonance imaging (MRI) but
with optimization for use in the cardiovascular system.
These optimizations are principally in the use of ECG
gating and rapid imaging techniques or sequences. By
combining a variety of such techniques into protocols,
key functional and morphological features of the
cardiovascular system can be assessed.

A cardiac stress test with
Myocardial Perfusion Imaging (MPI)
is a non-invasive test (no
surgery or cutting skin). This test
takes four (4) hours and is done in
three (3) parts with
breaks between each part. A cardiac
stress test with MPI is done to study
the blood flow
to your heart during stress and at
rest. This test helps your doctor
diagnose coronary
artery disease (CAD).

 Heart sounds are generated by the beating heart and the
resultant flow of blood through the cardiac circulation, also
referred to as the heartbeat. In cardiac auscultation, the nurse
uses a stethoscope to listen for normal heart sounds and any
other adventitious sounds or murmurs that may be present.

 In healthy adults, there are two normal heart sounds often
described as a lub and a dub (or dup), that occur in sequence
with each heart beat. These are the first heart sound (S1) and
the second heart sound (S2), produced by the closing of the
atrioventricular valves (tricuspid and mitral valves ) and the
semilunar valves (pulmonic and aortic) respectively.

AUSCULTATION OF THE HEART
• be sure to use both sides of the stethoscope to
examine the heart
• the diaphragm is best for hearing high-pitched sounds,
including S1, S2 and most heart murmurs
• the bell is bests for hearing low-pitched sounds,
including S3, S4 and a few murmurs (e.g. mitral
stenosis)
• use LIGHT TOUCH when using the bell. Pressure
turns it into a diaphragm

•A biomarker is a substance used as an
indicator of a biologic state. It is a
characteristic that is objectively measured
and evaluated as an indicator of normal
biologic processes, pathogenic processes,
or pharmacologic responses to a
therapeutic intervention.
•Cardiac markers are substances released
from heart muscle when it is damaged as a
result of myocardial infarction.

Heart attacks & detection

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Heart attacks & detection