CHAPTER 10 – Cardiovascular System The Language of Cardiology Chapter 10 Teaching Overview When one considers all the work the heart performs, it is astounding. Capture students’ attention and interest by reiterating the statistics from the beginning of Lesson 10.1 1 associated with the functions of the heart (e.g., “If you have a healthy heart rate of 60 beats per minute and live to be 80 years old, your heart will be at 2,522,880,000 times. Your heart pumps approximately 2,000 gallons of blood each day. In 80 years of life, it will have pumped a total of 58,400,000 gallons of blood). Crucial information for students to learn in this chapter includes the medical terms associated with the functions of the heart, including those used to describe the types and nature of circulation of the blood. Most students will have heard of a heart attack— activate their pre-existing knowledge to teach them the medical language used to communicate about the components, functions, disorders, and treatments associated with the heart and cardiovascular system. As with all lessons in this Lesson Planning Guide, you can and should modify them to best meet the needs of your students, your schedule, and your curricula. Teacher to Teacher: • The National Heart, Lung, and Blood Institute of the National Institutes of Health has an excellent publication called, “Act in Time to Heart Attack Signs. Small Group Lesson Plan.” It is available at the link http://www.nhlbi.nih.gov/health/prof/heart/mi/sm_group.pdf. • Preview the terms related to the specific circulation systems: peripheral, systemic, pulmonary, coronary. Chapter 10: Learning Outcomes Upon successful completion of the lessons in this chapter, your students will . . . 10.1 Describe the position of the heart. 10.2 Relate the structure of the heart to its functions. 10.3 Describe the blood flow through the heart. 10.4 Discuss the cardiac cycle. 10.5 Explain disorders of the heart. 10.6 Identify the circulatory systems. 10.7 Relate the structure of the blood vessels to their functions. 10.8 Explain disorders of the circulatory systems. 10.9 Identify diagnostic procedures used in cardiovascular disorders. 10.10 Discuss therapeutic procedures used in cardiovascular disorders. 10.11 Describe pharmacologic agents used in the treatment of cardiovascular disorders. 10.A Use the medical terms of cardiology to communicate and document in writing accurately and precisely in any health care setting. 10.B Use the medical terms of cardiology to communicate verbally with accuracy and precision in any health care setting. 10.C Using word elements, construct medical terms associated with cardiology. 10.D Deconstruct medical terms associated with cardiology into their word elements. 10.E Use correctly the approved abbreviations for cardiac terms. 10.F Identify the health professionals involved in the care of cardiac patients. Note: These lessons are designed with ultimate flexibility in mind. When customizing the lessons for your own class, always choose activities that are most relevant to your curriculum, your students, and your teaching goals—especially if you do not have time to implement all the provided activities into your class period. Lesson 10.1: Heart Total Time: 50 Minutes Lesson 10.1 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 10.1.1 Describe the location of the heart and its relation to other structures. 10.1.2 Discuss the functions of the heart. 10.1.3 Identify the chambers of the heart and the pathway blood takes through them. 10.1.4 Explain the causes of the sounds of the heartbeat heard through a stethoscope. 10.1.5 Identify the blood supply to the heart muscle. 10.1.6 Distinguish between contraction and relaxation during the heart cycle. 10.1.7 Describe the electrical properties of the heart. Prepare Your Materials: • Cardboard paper towel tubes – (one for every two students). • Lesson 10.1 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources.” • Lesson 10.1 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Smart devices with Internet access: computers, tablets, cell phones. Instructor Lesson Plan Date:__________ Chapter 10—Lesson 10.1
TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES
Warm-up & Introduction 10 min Activity Description: Motivating students to learn about the heart. Step 1: Tell students the story of how French physician Rene Theophile-Hyacinthe Laennec invented the stethoscope in 1816: Since ancient Greek times, physicians put their ears directly against patients’ chests to hear the heartbeat. Laennec himself used this method. As the story goes, Laennec had to examine an obese young woman one day when it occurred to him that he might be able to hear the heartbeat through a tube. He rolled some paper into a cylinder, then pressed one end to the patient’s chest. He is reported to have said, “I was surprised and pleased to hear the beating of the heart much more easily than if I had applied my ear directly to the chest.” He then went on to manufacture the first stethoscope, which was a simple wooden tube (about 10 inches long and one inch in diameter), as well as a few other designs following that. Ask students why they think this may have worked and discuss their ideas. Step 2: Tell students they are going to experience what it must have been like for Laennec. Put students into groups of two and give each group a paper towel tube. Step 3: Have students listen to their partner’s heartbeat by placing the tube over their partner’s heart. Count the beats in a 30-second period and multiply by two to calculate the person’s beats-per- minute. Step 4: Repeat this activity after students try running in place for 60 seconds to see how the heart rate increases. Step 5: Explain to students that the heart beats faster during and following exercise. This is necessary to pump more blood (containing oxygen) to the muscles that are working. Cardboard paper towel tubes 10.1.1 10.1.2 10.1.4
Lecture 15 min Lesson 10.1 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 10.1 PowerPoint Presentation 10.1.1 10.1.2 10.1.3 10.1.4 10.1.5 10.1.6 10.1.7
Active Learning & Practice 15 min Activity Description: Students will use the Web to learn more about the heart and the diseases and disorders that affect it. Step 1: Have students access the website for “The Human Heart – An Online Exploration from the Franklin Institute.” The link to follow is: https://www.fi.edu/heart-engine-of-life Step 2: Divide students into four groups and have each group research one of the four topics available on the website: • Structure of the Heart • Vessels – Taking a Blood Pressure • Systems – The coronary circulation • Monitoring the Heart Step 3: Inform each group that they will demonstrate what they learned about the heart from their assigned topic. Give the groups 10 to 15 minutes to peruse their topic and decide what to share with the rest of the students. Encourage them to take notes and form an outline of the main things they want to tell the class about. Smart devices with Internet access (computers, tablets, cell phones) 10.1.2 10.1.3 10.1.4 10.1.5 10.1.6 10.1.7
Review 10 min Step 1: Give each group the chance to present their findings about the heart. Step 2: After each group has presented their information, encourage students to ask questions and comment on what they learned about the heart, its function, and its monitoring. Textbook, Lesson 10.1 exercises 10.1.2 10.1.3 10.1.4 10.1.6 10.1.7
Homework Assignment • Students read Lesson 10.2 in the textbook and complete Lesson 10.2 exercises. • Complete Lesson 10.1 exercises from the textbook. • Tell students to identify two or three helpful web resources about the circulatory system and bring the URLs to class next time. Textbook
Lesson 10.1 Masters • (none)
Lesson 10.2: Disorders of the Heart Total Time: 50 Minutes Lesson 10.2 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 10.2.1 Describe common types of cardiac arrhythmias. 10.2.2 Explain common disorders of the heart valves. 10.2.3 Discuss common disorders of the heart wall and its blood supply. 10.2.4 Describe hypertensive heart disease and congestive heart failure. 10.2.5 Discuss congenital heart disease. Prepare Your Materials: • Dry erase board • Smart devices with Internet access: computers, tablets, cell phone. • Markers • Blank sheets of paper • Lesson 10.2 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 10.2 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. Instructor Lesson Plan Date: __________ Chapter 10—Lesson 10.2
TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES
Warm-up & Review 10 min Step 1: Distribute Lesson 10.1 Review Quiz to students. The quiz can also be submitted for a grade. Step 2: Have students answer the questions. Step 3: When students are finished, go over the correct answers to ensure understanding. Create a 10-question review quiz from Lesson 10.1 exercises (Review Lesson 10.1 terms) 10.1.1 10.1.2 10.1.3 10.1.4 10.1.5 10.1.6 10.1.7
Introduction 10 min Step 1: Go around the room and ask students to describe briefly any heart problems he/she or a family member or friend has had and what effects the problem produced within the individual or in the family. Step 2: While each student is describing the problem, write on the board the correct medical name of the problem. Step 3: When several medical terms for heart disorders are on the board, ask all the students to share what they know about any of the disorders. Step 4: Synthesize what has been said so far and use this as lead in for the lecture/discussion. Dry erase board 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6
Lecture 15 min Lesson 10.2 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 10.2 PowerPoint Presentation 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6
Active Learning & Practice 10 min Activity Description: Students will create “Warning” fliers to educate lay people about cardiac disorders. Step 1: Arrange students into small groups Step 2: Give each group an appropriate cardiac disorder and tell them they will be creating a “warning” flier to educate people about the disorder. Step 3: Explain the flier will be no larger than an 8.5 x 11- inch paper, should not contain too much text, be colorful, and give the information “at a brief glance.” Smart devices with Internet access (computers, tablets, cell phone) Markers Paper 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6
Step 4: Have students share their fliers with the rest of the class. The fliers can then be hung in the classroom or hallways.
Review 5 min Activity Description: Answer the questions in Lesson 10.2 exercises. Step 1: Have students complete the exercises in Lesson 10.2 of the textbook on their own on paper. Step 2: Have the students read out their answers aloud and give other students the opportunity to correct them if necessary. Reinforce their correct pronunciation. Textbook, Lesson 10.2 exercises 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6
Homework Assignment • Students read Lesson 10.3 and complete Lesson 10.3 exercises. • Review Word Analysis & Definition (WAD) Tables from Lessons 10.1 and 10.2. Textbook 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6
Lesson 10.2 Masters • (none)
Lesson 10.3: Circulatory Systems Total Time: 50 Minutes Lesson 10.3 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 10.3.1 Explain the functions of the peripheral circulation. 10.3.2 Identify the major arteries and veins in the body. 10.3.3 Match the structure of the different blood vessels to their functions. 10.3.4 Explain the dynamics and control of blood flow in the circulatory systems. 10.3.5 Describe the effects of common disorders of the circulatory systems on health. Prepare Your Materials: • Web resources brought in by students – In Lesson 10.1, the homework assignment was for students to bring in the URLs for websites containing helpful information on the circulatory system and the heart. • Examples of travel brochures, fliers, or pamphlets • Paper • Markers • Lesson 10.3 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 10.3 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Smart devices with Internet access: computers, tablets, cell phone. Instructor Lesson Plan Date: __________ Chapter 10—Lesson 10.3
TIME
ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES
Warm-up & Review 15 min Activity Description: Review of Lesson 10.2. Step 1: Distribute Lesson 10.2 Review Quiz to students. The quiz can also be submitted for a grade. Step 2: Have students answer the questions. Step 3: When students are finished, go over the correct answers to ensure understanding. Create a 10 – 15 question quiz from questions in Lesson 10.2 exercises (Review Lessons 10.2 concepts) 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5
Introduction 5 min Activity Description: Examine the articles on and pictures concerning the circulatory system brought in by students (from the Lesson 10.1 homework assignment.) Step 1: Ask students to share with the class the websites they found helpful and any important information they learned about the circulatory system, its function, and the diseases and disorders that affect it. URLs of helpful circulatory system resources (to be brought in by students as per the Lesson 10.1 homework assignment) Smart devices with Internet access (computers tablets, cell phone) with Internet access 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Lecture 20 min Lesson 10.3 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 10.3 PowerPoint Presentation 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Active Learning & Practice 10 min Activity Description: Students will create a travel brochure for a tour through the circulation system of the human body. Step 1: Explain to students that they have been hired by a travel agency to design and develop a travel brochure for their newest tour: a luxury cruise through the human circulatory system. Examples of travel brochures Paper Markers 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Step 2: Ask students to identify some of the characteristics of travel brochures. Sample responses: • Highlights of tourist attractions • Descriptions of sights • Descriptions of activities • Information about the geography and culture of the area • Methods of transportation • Photographs of sights • Travel schedule (itinerary) • Cost • Travel warnings or travel insurance offers Step 3: Have students work in small groups to design their travel brochure. Tell them to select at least two diseases or disorders that could be used to describe possible dangers of this tour (they can offer travel insurance if they choose.) Step 4: Allow groups to present their circulatory system travel brochures to the other groups in the class when they are finished. Smart devices with Internet access – to get photographs of parts of the circulatory system they could feature in their brochures
Review 5 min Step 1: As a group, go over the exercises in Lesson 10.3 in the textbook. Step 2: Reinforce correct pronunciation and use of each medical term. In addition, review the types of circulatory systems as well (cardiac circulation, coronary circulation, etc.). Textbook, Lesson 10.3 exercises 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Homework Assignment • Complete remaining Lesson 10.3 exercises. • Review all Word Analysis & Definition (WAD) Tables from Lessons 10.1, 10.2, and 10.3. • Students read Lesson 10.4 and complete Lesson 10.4 exercises. 10.1.2 10.1.3 10.1.4 10.1.5 10.1.6 10.1.7 10.2.1 10.2.2 10.2.3 10.2.4 10.2.5 10.2.6 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Lesson 10.3 Masters • (none)
Lesson 10.4: Cardiovascular Procedures and Pharmacology
Total Time: 50 Minutes Lesson 10.4 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 10.4.1 Detail cardiologic tests, treatment procedures, and drug treatments. 10.4.2 Detail tests, treatment procedures, and drug treatments related to the vascular system. Prepare Your Materials: • Lesson 10.4 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources.” • Lesson 10.4 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Smart devices with Internet access: computers, tablets, cell phone. • Cardiovascular Procedures and Treatments Handout – found on Pages 10-15 and 10-16 of this Instructor Manual • Cardiovascular Procedures and Treatments Answer Key ---found on Pages 10-17 through 10-21 of this Instructor Manual. Instructor Lesson Plan Date: ______________ Chapter 10—Lesson 10.4
TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES
Warm-up & Review 5 min Activity Description: Step 1: Go over the answers to Lesson 10.3 exercises in a round robin manner. Clarify concepts that students have difficulty understanding. Step 2: Listen for and correct any mispronunciation of medical terms. Textbook, Lesson 10.3 exercises 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5
Introduction 5 min Ask students about their familiarity with cardiac testing and procedures. Have friends or anyone in their family had cardiac testing or procedures? Do they know of anyone taking cardiac medications (statins, anticoagulants, beta blockers, calcium channel blockers, ACE inhibitors)? If the student doesn’t know the classification of the drug, do they know the name of the drug and why the person is taking it? Does the student know any precautions or side effects of the drug that the person is taking? 10.4.1 10.4.2
Lecture 20 min Lesson 10.4 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 10.4 PowerPoint Presentation
Active Learning & Practice 15 min Activity Description: Step 1: Pair students together. Step 2: Distribute Cardiovascular Procedures and Treatments Handout found on Pages 10-15 and 10-16 Textbook Cardiovascular Procedures and Treatments Handout
Step 3: Assign each pair of students to a diagnostic procedure or treatment. Students should use a smart device to look up the following information on their topic: 1. What the abbreviation of the test stands for? 2. How is the procedure or treatment done? 3. What is the purpose of the procedure or treatment? 4. What patient preparation or education is necessary for the procedure or treatment? Step 4: Each pair of students reports their findings to the class. Smart device with Internet access (computer, tablet, cell phone)
Review 5 min Reinforce how time is crucial for problems related to the heart muscle. Tell students that the heart muscle needs a constant supply of oxygen rich blood; any condition that limits the amount of oxygen supplied to the heart muscle must be identified through diagnostic testing and reversed through therapeutic procedures.
Homework Assignment • Complete Chapter 10 Review exercises. • Review all Word Analysis & Definition (WAD) Tables from Chapter 10 Lessons. • Students read Chapter 11, Lesson 11.1 Textbook, Chapter 10 Review exercises 10.1.2 – 10.1.7 10.2.1 – 10.2.6 10.3.1 – 10.3.5 10.4.1 – 10.4.2
Lesson 10.4 Cardiovascular Procedures and Treatments Handout
Procedure/Meaning of Abbreviation How Procedure is Done Purpose of Procedure Patient Preparation/Education
Blood tests: cholesterol, LDL, HDL, Triglycerides, BNP, CK, CRP, Troponin I & T
EKG/ECG
TEE
Cardiac catheterization
Coronary Angiogram
Echocardiogram
CABG
PTCA
Heart transplant
Cardioversion
Defibrillation
Pacemaker
Implantable Cardioverter/defibrillator
Lesson 10.4 Cardiovascular Procedures and Treatments Handout - Answers
Procedure/Meaning of Abbreviation How Procedure is Done Purpose of Procedure Patient Preparation/Education
Blood tests: cholesterol, LDL, HDL, Triglycerides, BNP, CK, CRP, Troponin I & T LDL- low density lipoprotein (lousy) HDL – high density lipoprotein (good) CRP- C-reactive protein CK- creatine kinase BNP- B-type natriuretic peptide Phlebotomy Cholesterol, LDL, HDL & triglycerides are used to determine risk factors for heart disease; BNP is used to diagnose and monitor heart failure; CRP is a risk factor for atherosclerosis and CAD; Troponin I & T are used to confirm MI. It is best for the patient to be fasting (only water) for at least 8 hours prior to cholesterol and triglycerides testing. If cholesterol, triglyceride, HDL or LDL levels are abnormal, the patient may need education on dietary modifications. The patient may be started on medication to reduce elevated cholesterol and triglyceride levels.
EKG/ECG (electrocardiogram) While in a supine position, 6 small, sticky electrodes are placed on the patient’s chest and 4 electrodes are placed on the limbs. Records the electrical impulses that stimulate the heart to contract. Evaluates presence of arrhythmias, conduction defects, myocardial injury and damage, hypertrophy of heart muscle and pericardial diseases There is no prep for the test. The patient should avoid greasy or oily skin creams because that prevents good contact of the electrodes with the skin. Avoid full leg hosiery because electrodes need to be placed on the legs. Wear a shirt that can easily be removed (button down is best). The patient’s chest, arms and lower legs are exposed. If there is a lot of chest hair, the area may need to be shaved. Reassure the patient that there is no electric current. The test takes about 10 minutes total but less than one minute to record the electrical impulses of the heart.
TEE (Trans-esophageal echocardiogram) A flexible tube with a transducer at its tip is guided down the patient’s esophagus. Provides high-quality moving, close-up pictures of the heart and blood vessels. Used to diagnose and assess heart and blood vessel problems and conditions such as MI, coronary heart disease, congenital heart disease, aortic aneurysm, endocarditis, cardiomyopathy, heart valve disease, injury to the aorta, and blood clots due to a-fib. Usually done in a hospital. Fasting is necessary for several hours prior to the test. Remove dentures or oral prosthesis before the test. Patient may be given IV medication to relax so they will need a ride home after the test. Patient may need specific instructions regarding stopping blood thinners or certain medications prior to the test.
Cardiac catheterization A small puncture is made through the skin and into a large blood vessel. A small straw-shaped tube (sheath) is inserted into the blood vessel. A catheter is inserted into the blood vessel through the sheath and guided up into the heart. Provides information on how well the heart is working, identifies problems and allows procedures to open blocked arteries (angioplasty, stent placement). During the Cath, dye can be injected, and x-rays taken of the flow of blood through the heart and coronary circulation; the pressure in the 4 chambers can be checked; blood samples and measurement of the oxygen content in the 4 chambers can be taken; look for defects in valves or heart chambers; Bx an area; evaluate the ability of chambers to contract. Consent form signed. NPO 6-8 hours prior to the test. Tell the doctor if you are allergic to anything, especially shellfish, latex, iodine, or x-ray dye. An IV will be started. The patient may receive medication to relax. The puncture site for the Cath is cleaned and shaved (usually the groin area). The area is numbed prior to the insertion of the sheath. A pressure dressing is applied to the site after the procedure. Circulation to the lower extremity is checked frequently. The test lasts about an hour. The patient will be given specific instructions about post-procedure care of the insertion site; watch for s/s of infection; resuming medications.
Coronary Angiogram A small catheter is inserted through the skin into an artery in either the groin or the arm. With the aid of fluoroscopy, the catheter is advanced to the opening of the coronary arteries. Radiographic dye is injected, and x-rays are taken as the dye circulates through the coronary arteries. This test is the “gold standard” to evaluate the extent and severity of coronary artery blockages. The results help the physician select the optimum treatment plan for the patient (CABG, stent, balloon angioplasty, atherectomy, medication) Done in a hospital setting. The patient is placed in a supine position. An IV will be started and the patient given medication to relax. The area where the catheter is inserted is cleaned and shaved (groin or arm). The area will be numbed before the catheter is inserted. The patient may feel a flushing sensation, metallic taste in the mouth, headache, or nausea from the dye. The patient will have to lie still during the procedure. The procedure takes 20-30 minutes.
Echocardiogram – (ECHO) The echocardiographer squirts jelly on the patient’s chest. A transducer, or probe is placed on the chest and slides across the chest on the jelly. Sound waves are bounced from the transducer to the structures of the heart. The return signals are received by the transducer and converted by a computer to images on the screen. An ECHO is used to assess the structure and function of the heart. It is a noninvasive procedure. It can assess the size of the heart; size of each chamber; appearance and function of each of the 4 heart valves; assess the septa; and assess the pericardium. The test can be performed at a patient’s bedside. It is painless and takes about 15 minutes. The lights may be dimmed to help see the images on the screen. The patient’s chest will be exposed, and they may be asked to roll onto their left side and take deep breaths, so the probe can better “see” the heart.
CABG (Coronary artery by-pass graft) Cardiac surgeon makes an incision down the middle of the chest and saws through the sternum. The heart is cooled with iced salt water, and a preservative solution is injected into the coronary arteries. Cardiopulmonary by-pass is established by placing plastic tubes in the right atrium to channel venous blood out of the body for passage through a plastic sheeting (membrane oxygenator) in the heart lung machine. The oxygenated blood is returned to the body. The main aorta is clamped off to maintain a bloodless field and to allow bypasses to be connected to the aorta. The saphenous vein from the leg and the internal mammary artery are the most commonly used vessels for the bypass. The graft vessel is sewn to the coronary artery beyond the narrowing or blockage. The other end is attached to the aorta. Performed for significant narrowing and blockages of the coronary arteries. CABG creates new routes around narrowed and blocked arteries, allowing sufficient blood flow to deliver oxygen and nutrients to the heart muscle. Consent form is signed. The patient is anesthetized and placed on cardio-pulmonary bypass after the chest has been opened. The procedure takes about 4 hours. At the end of surgery, the sternum is wired closed and the chest incision is sutured. Chest tubes are placed to allow drainage of fluids and blood. The breathing tube is removed shortly after surgery. Patients are out of bed and transferred from ICU the following day. Discharge occurs several days post-op. Specific discharge instructions will be given to the patient prior to discharge.
PTCA (Percutaneous transluminal coronary angioplasty) An incision is made in the groin and a catheter is inserted. Contrast dye is injected through the catheter to highlight coronary artery obstruction. A tube with a deflated balloon is inserted through the catheter to the blockage. The balloon is inflated to widen the artery by pushing the plaque aside. To hold the artery open, a wire mesh tube (stent) is inserted. Once the procedure is completed, the catheter is removed from the artery. This procedure is performed on people with blockages in the arteries of the heart, especially if they are experiencing chest pain and discomfort. It can also be performed if lifestyle changes and medications have not been effective, or after an MI. The procedure is performed in a hospital. Consent form must be signed. Patient must be NPO for several hours prior to the test. An IV is started and the patient is given medication to relax, and a blood thinner. The area where the catheter is inserted (usually the groin) is numbed, cleaned and shaved. After the catheter is removed, a pressure dressing is applied and circulation to the lower extremities is checked. The procedure takes 1-2 hours to complete. Specific discharge instruction will be given regarding care of the site and resuming medications.
Heart transplant The donor and recipient’s hearts are removed. The donor heart is sutured at the large blood vessels that enter and leave the heart. The recipient is a person with end-stage heart disease. The recipient’s other organs must be in good shape. Transplants cannot be performed in patients with infection, cancer, bad diabetes mellitus, and patients who abuse alcohol and tobacco. Transplant patients must undergo psychological testing to identify social and behavioral factors that could interfere with recovery, compliance with medications and lifestyle changes post-op. The donor heart must be compatible with the recipient’s immune system. A consent form is signed. The patient is anesthetized, the chest is opened, and the heart is removed. After the transplant, the patient is transferred to the ICU. Chest tubes are in place. The patient will need to take up to 30 pills/day to prevent organ rejection and may need to make lifestyle changes. The patient must recognize signs of organ rejection and must take precautions to prevent infections.
Cardioversion An IV line is started, and a sedative will be administered. A synchronous electric shock will be administered through two paddles placed on the chest (right upper shoulder area and under the left breast). The shock lasts less than a second and momentarily stops the heart so that the normal rhythm can be reset. Some patients need more than 1 shock to restore normal heart rhythm. Cardioversion is a way to restore a regular rhythm to a heart that is beating irregularly or too fast. A consent form is signed. The procedure is performed in a hospital. After an IV is started and a sedative has been administered, the patient’s chest is exposed. Two paddles are placed on the chest (upper right shoulder and left lower chest, under the breast) and an electric shock is delivered. If needed, an additional shock(s) is administered. The patient wakes up quickly and has no recollection of the event. The procedure takes about 30 minutes to perform. The skin on the chest where the paddles were placed may become irritated. The patient should ask the doctor about applying lotion and creams to the areas. The patient can usually go home the day of the procedure. Specific instructions about anti-arrhythmic medications will be given.
Defibrillation (AED – automated external defibrillation) A nonsynchronous electric shock is applied to the heart. Two electrodes are placed on the chest (one on the right upper shoulder and one under the left breast). The operator presses the “shock” button and delivers a shock to the heart which momentarily stops it so that the SA can resume normal electrical activity. Indicated for v-fib and v-tach. Make sure that the patient has no pulse. Expose the chest, wipe the chest with a dry cloth and attach the electrode pads (upper right shoulder and under left breast). If there is a lot of hair, shave the areas first. Depress the shock button. If there is no pulse, or v-fib or v-tach continues, perform CPR for 2 minutes then shock again if needed.
Pacemaker A small incision is made in the skin, just under the collarbone. The pacemaker is implanted under the subcutaneous tissue. Tiny wires from the pacemaker are inserted into a nearby vein directly into the ventricle of the heart. The wires sense when the heart isn’t beating correctly, and they send electric charges to the heart to stimulate it to beat at a predetermined rate. Pacemakers only work when needed. The patient’s heart rate is too slow, the heart doesn’t beat regularly or there is a block in the heart’s electrical pathways. Consent form is signed. The patient is anesthetized. A small incision is made just under the collarbone and the pacemaker is inserted under the subcutaneous tissue. Tiny wires from the pacemaker are inserted into a nearby vein. The wires sense the electrical activity of the heart. If the heart is not beating at a predetermined rate, tiny electric charges are sent to the heart muscle to stimulate it to beat. The patient should learn to check and record their pulse rate. The batteries last about 5-10 years and will need to be replaced. The patient should report shortness of breath, swelling in legs, feeling faint or passing out. Carry ID card and tell airport security about the pacemaker. If you use a cell phone, hold it to the ear furthest from the pacemaker site. Don’t carry the cell phone close to the pacemaker. Microwaves will not affect the pacemaker.
Implantable Cardioverter/defibrillator (ICD) A battery-powered device placed under the skin (like a pacemaker). Thin wires connect the ICD to the heart. If an abnormal rhythm is detected, the device will deliver an electric shock to the heart to restore a normal heartbeat. Patients at risk for life-threatening ventricular arrhythmias. If the heartbeat is too slow, it works as a pacemaker and sends tiny electric signals to the heart. If the heartbeat is too fast or chaotic, it gives the defibrillation shock to stop the abnormal rhythm. Same as pacemaker. In addition, beware of electronic article surveillance (EAS) systems – don’t stay near the system longer than necessary and don’t lean up against them. Metal detectors for security- don’t lean against the system and tell security personnel to use alternate form of inspection instead of hand-held metal detector. Headphones should be kept at least 6 inches away from the ICD. No MRI’s or ESWL.
End of Chapter Answer Exercises Page 323 A. Ans 1: cardiology Ans 2: cardiologist Ans 3: cardiovascular Ans 4: cardiac B. Ans 1: B: technician who uses ultrasound to observe the structures of the heart Ans 2: D: draws patient blood samples for laboratory testing Ans 3: E: medical doctor specializing in disorders of the cardiovascular system Ans 4: A: medical doctor specializing in surgery of the heart and peripheral blood vessels Ans 5: C: assists physicians in the diagnosis and treatment of cardiovascular disorders Exercises Page 325 A. Ans 1: visceral; parietal Ans 2: pulmonary; systemic B. Ans 1: endo/cardium Ans 2: myo/cardium Ans 3: epi/cardium Exercises Page 327 A. Ans 1: atria Ans 2: septa Ans 3: venae cavae Ans 4: ventricles B. Ans 1: B: receives blood from the left ventricle Ans 2: D: empties blood into the right atrium Ans 3: A: receives blood from the right ventricle Ans 4: C: empties blood into the left atrium Exercises Page 329 A. Ans 1: 3 Ans 2: 1 Ans 3: 5 Ans 4: 2 Ans 5: 4 B. Ans 1: systole Ans 2: diastole Exercises Page 331 A. Ans 1: palpit/ation Ans 2: fibrill/ation Ans 3: paroxysm/al Ans 4: tachy/card/ia Ans 5: brady/card/ia Ans 6: a/rrhythm/ia Exercises Page 333 A. Ans 1: F: cardiomyopathy Ans 2: D: pericarditis Ans 3: G: prolapse Ans 4: H: stenosis Ans 5: C: cor pulmonale Ans 6: B: cardiomegaly Ans 7: A: incompetence Ans 8: E: rheumatic fever Exercises Page 335 A. Ans 1: sedentary Ans 2: fibrotic Ans 3: asystole Ans 4: occluding Ans 5: necrosis Ans 6: perfused Exercises Page 337 A. Ans 1: E: abnormal opening between the atria Ans 2: D: congenital heart defect that is made up of four congenital abnormalities Ans 3: F: abnormal opening between the ventricles Ans 4: B: artery remains open instead of normally closing after birth Ans 5: G: heart is unable to pump enough blood to meet the body’s needs Ans 6: A: force of the blood pushing on the vessel walls Ans 7: C: chronic elevated blood pressure Exercises Page 339 A. Ans 1: A: key Ans 2: B: lit Ans 3: A: cat B. Ans 1: circulation Ans 2: peripheral Ans 3: pulmonary Ans 4: artery Exercises Page 341 A. Ans 1: B: pulmonary veins Ans 2: C: ascending aorta Ans 3: D: expiration Ans 4: A: right atrium Ans 5: B: blood Ans 6: D: popliteal artery Ans 7: C: intercostal Ans 8: D: systemic Ans 9: D: below the collarbone Ans 10: B: pulmonary Exercises Page 343 A. Ans 1: D: -ule Ans 2: D: femor- Ans 3: C: throat B. Ans 1: venule Ans 2: arteriole Ans 3: capillary Ans 4: jugular Exercises Page 345 A. Ans 1: A: radial Ans 2: E: vasoconstriction Ans 3: G: intima Ans 4: H: tunica Ans 5: C: adventitia Ans 6: F: media Ans 7: D: pedal Ans 8: B: vasodilation Exercises Page 347 A. Ans 1: B: inflammation Ans 2: C: at the side Ans 3: B: vein Ans 4: C: hardening Ans 5: B: swelling Ans 6: A: dilated Ans 7: A: clot or plug Ans 8: A: clot Exercises Page 349 A. Ans 1: E: enzyme released by dead myocardial cells Ans 2: A: “good” cholesterol Ans 3: B: “bad” cholesterol Ans 4: C: used to diagnose and monitor congestive heart failure Ans 5: D: produced by the endothelial cells of the arteries Exercises Page 351 A. Ans 1: electrocardiography Ans 2: electrodes Ans 3: electrocardiograph Ans 4: electrocardiogram B. Ans 1: catheterization Ans 2: catheter Ans 3: catheterize Exercises Page 353 A. Ans 1: A: automated external defibrillator Ans 2: C: thrombolysis B. Ans 1: B: occluded coronary artery Ans 2: A: arrhythmia Ans 3: A: arrhythmia Exercises Page 355 A. Ans 1: FDA Ans 2: tPA Ans 3: AV Ans 4: ACE Ans 5: ARB Ans 6: CCB B. Ans 1: dromo/tropic Ans 2: chrono/tropic Ans 3: ino/tropic Chapter 10 Review A. Ans 1: D: stent Ans 2: E: transplant Ans 3: G: defibrillation Ans 4: I: thrombolysis Ans 5: C: atherectomy Ans 6: A: radiofrequency ablation Ans 7: F: CABG Ans 8: B: rotational atherectomy Ans 9: H: PTCA B. Ans 1: phlebotomist Ans 2: cardiologist Ans 3: cardiovascular technician Ans 4: sonographer C. Ans 1: VSD Ans 2: PDA Ans 3: PVD Ans 4: CAD Ans 5: CHF Ans 6: TOF; CHD Ans 7: CABG D. Ans 1: coronary; occluded; myocardium; necrotic Ans 2: stenosis; prosthetic; atheroma Ans 3: etiology; myocardium; idiopathic Ans 4: phlebitis; thrombi E. Ans 1: contract; atrial systole; relax; ventricular diastole Ans 2: atrial diastole; contract; ventricular systole Ans 3: heartbeat F. Ans 1: B: maintaining respiration Ans 2: B: mediastinum Ans 3: E: apex Ans 4: D: valves G. Ans 1: B: sternum Ans 2: B: infarct Ans 3: B: normal heartbeat Ans 4: C: tamponade Ans 5: B: MI and PAT Ans 6: A: blood flows in only one direction Ans 7: B: a process H. Ans 1: C: occasionally humans Ans 2: C: murmur Ans 3: D: chordae tendinae Ans 4: C: SA node Ans 5: C: arteries Ans 6: C: hilum Ans 7: E: an internal organ Ans 8: D: diffusion Ans 9: B: pulmonary I. Ans 1: asystole Ans 2: necrosis Ans 3: dysrhythmia Ans 4: murmur Ans 5: chronotropic Ans 6: statins Ans 7: shunt Ans 8: catheter Ans 9: diuretic Ans 10: carotid J. Ans 1: cardiologist Ans 2: cardio Ans 3: electrocardiogram Ans 4: cardiology Ans 5: cardiovascular Ans 6: electrocardiograph Ans 7: sphygmomanometer K. Ans 1: _____/ablat/ion Ans 2: ____/angio/plasty Ans 3: de/fibrill/ation Ans 4: ______/sclero/therapy/_____ Ans 5: ______/ather/ectomy L. Ans 1: statins Ans 2: inotropics Ans 3: anticoagulants Ans 4: diuretics Ans 5: chronotropics M. Ans 1: B: around the heart Ans 2: E: right atrium and right ventricle Ans 3: B: dilatation Ans 4: A: space between the cells of a structure or organ N. Ans 1: E: used when people are unable to do physical exercise Ans 2: J: ECG Ans 3: K: Holter monitor Ans 4: G: exercise tolerance test Ans 5: B: through esophagus to record heart valves Ans 6: I: lipid profile Ans 7: H: sporadic symptoms Ans 8: C: echocardiography Ans 9: L: identifies calcium in arteries Ans 10: D: detects patterns of pressure in the heart Ans 11: M: nuclear imaging Ans 12: A: venogram Ans 13: F: coronary angiogram O. Ans 1: not Ans 2: strive together Ans 3: quality of Ans 4: failure of valves to close completely Ans 5: bad, difficult Ans 6: rhythm Ans 7: condition Ans 8: an abnormal heart rhythm Ans 9: n/a Ans 10: artery Ans 11: small Ans 12: small artery Ans 13: middle Ans 14: partition Ans 15: structure Ans 16: area between the lungs containing the heart, aorta, venae cavae, esophagus, and trachea Ans 17: n/a Ans 18: vein Ans 19: record Ans 20: recording of a vein Ans 21: n/a Ans 22: sinew Ans 23: change Ans 24: affecting the contractility of the heart muscle Ans 25: n/a Ans 26: time Ans 27: change Ans 28: affecting the heart rate Instructor Manual for Medical Language for Modern Health Care David M. Allan, Rachel C. Basco 9780077820725, 9781260084931
