11 Cardiology

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Chapter Contents

Introduction

Anatomy of the Heart

Blood’s Path Through the Heart

Cardiac Cycle

Heart Sounds

Blood Pressure

Common Cardiac Diseases and Treatments

Diagnostic Studies and Procedures

Chapter Summary

Object ives

After completing this chapter, you will be able to:

• Name and describe the anatomic structures ofthe heart and associated blood vessels.

• Explain cardiac conduction and describe the car-diac cycle.

• Discuss blood pressure measurement and howblood pressure readings are obtained.

• Describe common diseases and disorders relatedto the heart and their treatments.

• Discuss common laboratory tests and diagnosticstudies used to identify heart disease.

CardiologyCardiology

INTRODUCTION

Cardiology is a medical speciality dealing with the diag-nosis and treatment of diseases and disorders of theheart. The term derives from the Latin word cardium,which is borrowed from the Greek word kardia. Cardiumis used to describe the heart in other words using thecombining forms card/i and cardi/o, such as cardiopul-monary (relating to the heart and lungs) and cardiovas-cular (relating to the heart and blood vessels or circula-tion).

The heart is a complex organ that supplies the bodywith the blood and oxygen it needs to function properly.Relatively simple in function, the heart’s primary pur-pose is to pump blood, 24 hours a day, 70 to 80 times aminute. With each beat, the heart pumps blood thatdelivers life-sustaining oxygen and nutrients to 300 tril-lion cells. The rhythmic beating of the heart is a cease-less activity, beginning before birth and ceasing only atthe end of life.

The heart pumps blood through a closed circuit ofvessels as it passes through the various areas of the bodyin a continuous loop. In this journey, blood containingoxygen and nutrients is pumped from the heart to everypart of the body. On the way back to the heart, the bloodpicks up waste products for disposal by the kidneys and

other organs before entering the heart again for anothertrip.

Although major advances have occurred in physi-cians’ understanding of the heart and ways to treat car-diac disorders, the workings of the heart and the dis-eases that affect it still present the medical professionwith diagnostic and therapeutic challenges. This chapterreviews the structure and function of the heart, commondiseases and disorders affecting heart function, and theclinical tests and procedures used to diagnose and treatheart disease.

ANATOMY OF THE HEART

The human heart is a four-chambered muscular organthat works to pump blood through the body. Althoughmost of the hollow organs of the body do have muscularlayers, the heart is composed almost entirely of muscle.

Although it is convenient to describe the flow ofblood through the right side of the heart and thenthrough the left side, it is important to realize that theheart is actually two different, but anatomically con-nected, pumps that contract at the same time. The rightside of the heart receives blood from the body andpumps it into the lungs to gather oxygen, whereas theleft side receives the oxygenated blood from the lungs

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and pumps it to the rest of the body, where oxygen andnutrients are delivered to tissues and waste products aretransferred to the blood for removal by other organs(such as the kidneys).

The heart is located in the middle of the chest,behind and slightly to the left of the sternum, and iscomposed of membranous layers, chambers, valves, anda variety of blood vessels, as shown in Figure 11.1

Layers

A double-layered membrane called the pericardiumsurrounds the heart like a transparent sac. The outerlayer of the pericardium is attached by ligaments to thespinal column, diaphragm, and other parts of the body.The inner layer of the pericardium is attached to theheart itself. Three layers of tissue form the heart wall: theouter layer of the heart wall is the epicardium, the mid-dle layer, or heart muscle itself, is the myocardium, and

the inner layer which lines the heart’s chambers andcovers its valves is the endocardium.

Chambers

Chambers are compartments of the heart throughwhich blood flows. The internal cavity of the heart isdivided into four chambers, two on the left and two onthe right. Each of the two upper chambers is called theleft and right atrium (plural, atria). The atria serve asreservoirs for blood. Each atrium is connected by itsown valve to a chamber below it. The two lower cham-bers are called the left and right ventricles which areresponsible for collecting blood from the right and leftatria and pumping it out of the heart. The left atriumand ventricle are responsible for receiving oxygen-richblood from the lungs and pumping it throughout thebody. The right atrium and ventricle are responsible forreceiving deoxygenated blood from the various areas of

272 PART II. MEDICAL SPECIALTIES

Aortic arch

Aorta

Superior vena cava

Pulmonaryveins

Atrial septum

Left ventricle

Aortic valve

Mitral valve

Left atrium

Ventricular septum

Pericardium

Epicardium

Myocardium

Endocardium

Tricuspid valve

Inferior vena cava

Deoxygenated blood

Oxygenated blood

Right ventricle

Pulmonaryartery

Pulmonary semilunar valve

Right atrium

FIGURE 11.1. Anatomy of the heart. The red and blue arrows show the flow of oxygenated and de-oxygenated blood through theheart muscle. Reprinted with permission from Willis MC. Medical Terminology: A Programmed Learning Approach to the Language ofHealth Care. Baltimore: Lippincott Williams & Wilkins, 2002.


the body and pumping it to the lungs for gas exchangeto occur.

Valves

A valve is a device used to control the flow of liquids.Pumps require valves to keep fluid flowing in onedirection, and the heart is no exception. The heart’svalves are the structures that open and close with eachheartbeat to ensure the proper sequence of blood flowthrough the heart. The tricuspid valve is locatedbetween the right atrium and right ventricle. The pul-monary valve opens from the right ventricle to thepulmonary artery. The mitral valve is located betweenthe left atrium and left ventricle. Finally, the aorticvalve is between the left ventricle and the aorta, themajor arterial blood vessel that begins in the left ven-tricle and delivers oxygenated blood to the rest of thebody. Each valve contains flaps, called leaflets, whichopen and close like spring-loaded doors that open inone direction only to regulate blood flow and preventbackflow of blood from ventricles to the atria during aheartbeat.

Arteries and Vessels

The heart’s role is to pump oxygen-rich blood to everycell in the body. Blood vessels—a network of intercon-necting arteries, arterioles, capillaries, venules, andveins—provide the pathway in which blood is trans-ported between the heart and body cells.

The blood vessels of the body each have a differentfunction:

• Arteries and arterioles—distribute• Capillaries—exchange• Veins and venules—collect

Arteries carry blood away from the heart to supplyorgans and tissues with oxygen and nutrients. All arter-ies, except the pulmonary artery (and the umbilicalartery in the fetus) carry oxygenated blood. The largestartery in the body is the aorta, which, as mentioned,carries blood from the heart to the rest of the body. Itbranches off from the heart and divides into manysmaller arteries called arterioles, which adjust theirdiameter to increase or decrease blood flow to a particu-lar body tissue. Capillaries are thin-walled vessels thatallow oxygen and nutrients to pass from the arterioles ofthe blood into tissues and allow waste products to passfrom tissues into the blood. Blood then flows from thecapillaries into very small veins called venules. Venulesare small vessels that gather blood from the capillaries;these venules, in turn, drain into veins, the larger vesselsthat carry deoxygenated blood back to the heart. Allveins, except the pulmonary vein (and the umbilicalvein in the fetus) carry deoxygenated blood.

The coronary arteries comprise a network of bloodvessels that supply oxygen- and nutrient-rich blooddirectly to the heart’s muscle tissue (see Figure 11.2). Twomajor coronary arteries, called the right coronary artery(RCA) and the left coronary artery (LCA) branch fromthe aorta near the top of the heart. The main branch of theRCA is called the posterior descending artery (PDA). Theinitial segment of the left coronary artery is called the leftmain coronary. It branches into two slightly smaller arter-ies called the left anterior descending artery (LAD) andthe left circumflex artery (LCA). The LAD is located onthe surface of the front side of the heart, whereas the LCAcircles around the left side of the heart and is embedded inthe surface of the back of the heart. The lesser coronaryvessels include the two diagonal branches (D1 and D2)which arise from the LAD, and the two obtuse marginalbranches, which arise from the LCA (OM1 and OM2).

Unrestricted flow of blood through a coronary arteryis crucial for optimal heart function. When cholesterolplaque accumulates to the point of blocking the flow ofblood through a coronary artery, the cardiac muscletissue fed by the coronary artery beyond the point of theblockage is deprived of oxygen and nutrients, whichprevents this area of tissue from functioning properly.

11 • Cardiology 273

Transcription

Tip:

The term aorta means that

which is hung. Aristotle was the

first to apply the name to this artery because the

arching curve of the aorta as it exits the heart and

descends into the body looks something like a mod-

ern-day clothes hanger.

Transcription

Tip:

It is helpful to remember

location of the atria by visualiz-

ing the architecture of a Roman house, from where

the term atrium derives. The atrium was an entrance

where a person was greeted before moving into

other rooms.The atria are the first chambers in the

heart to receive blood before it empties into the ven-

tricles to be pumped throughout the body.


This condition is called a myocardial infarction (MI),or a heart attack.

BLOOD’S PATH THROUGH THE HEART

Blood is carried into the heart through the several vessels,all of which empty into two major veins: the superiorvena cava and the inferior vena cava. The superior vena

cava carries blood from the upper body to the rightatrium (it is called superior because it means near the top).The inferior vena cava carries blood from the lowerbody to the right atrium (inferior means situated below).Blood in the right atrium empties into the right ventricle.When the ventricle contracts, the blood is ejected intothe pulmonary artery, the blood vessel that takes bloodfrom the heart to the lungs. From the lungs, oxygen-richblood travels to the left atrium through the pulmonaryveins, the vessels responsible for carrying blood fromthe lungs to the heart. The left atrium empties bloodinto the left ventricle. The left ventricle pumps the bloodinto the aorta, and from there, it travels throughout thebody.

CARDIAC CYCLE

Like all pumps, the heart requires a source of energy inorder to function. The heart’s pumping energy comesfrom an electrical conduction system within the heartmuscle. Cardiac conduction is the name given to theelectrical conduction system that controls the heart rate.This system generates electrical impulses that cause theheart muscle to contract and relax, enabling it to pumpblood throughout the body. This contracting and relax-ing of the heart muscle is a two-part pumping actioncommonly called a heartbeat.

The cardiac cycle is the sequence of events in oneheartbeat. Throughout the cardiac cycle, the right andleft atria continuously accept blood returning to theheart from the body while the two ventricles push bloodout of the heart to be circulated into the body. In its sim-plest form, the cardiac cycle is the simultaneous con-traction of the two atria, followed a fraction of a secondlater by the simultaneous contraction of the two ventri-cles. The cardiac cycle has two basic components: Thecontraction phase, called systole, occurs when blood isejected from the chambers of the heart. The relaxationphase, called diastole, occurs when the heart is at restand the chambers fill with blood in preparation for thenext contraction.

Figure 11.3 illustrates the process of the cardiac cycle.The electrical stimulus for the heart to pump beginswith the sinoatrial (SA) node, a small mass of special-ized tissue located near the rear wall of the right atriumthat causes the heart to beat. The SA node is often calledthe heart’s natural pacemaker because it sets the rate andrhythm of the heartbeat. The SA node generates an elec-trical impulse, which begins traveling down through theconduction pathways in the heart muscle, similar to theway electricity flows through power lines from a powerplant. When this impulse fires, it spreads through thewalls of the right and left atria, which are filled withblood. The impulse causes the atria to contract so thatblood will flow from the atria into the ventricles.


Aortic arch

Rightcoronaryartery

Posteriordescendingcoronaryartery

Left anteriordescendingcoronaryartery

Left maincoronaryartery

Circumflexcoronaryartery

FIGURE 11.2. The coronary arteries and veins. Coronary arteries(in red) arise from the aorta and encircle the heart. Coronary veins(above) are shown in blue. Reprinted with permission fromSmeltzer SC, Bare BG. Textbook of Medical-Surgical Nursing, 9thed. Philadelphia: Lippincott Williams & Wilkins, 2000.

Transcription

Tip:

Listen for the abbreviation TIMI

(pronounced like timmy), when

transcribing reports that describe the treatment of a

patient with myocardial infarction.TIMI stands for

thrombolysis in myocardial infarction and is a grad-

ing system (using grades 0-3) that refers to the

reperfusion of blood flow achieved after the applica-

tion of thrombolytic therapy. It is transcribed with

lowercase grade, followed by an Arabic numeral.

Example: “The patient achieved a TIMI grade 3 flow

at 60 minutes following thrombolytic therapy.”


The impulse then travels to another section of nodaltissue called the atrioventricular (AV) node, which lieson the right side of the partition that divides the atria.Located near the center of the heart, the AV node is likea bridge between the atria and ventricles and serves as akind of gatekeeper, delaying the electrical impulse fromthe atria for about one-tenth of a second before relayingit on to the ventricles. This pause is important because itpermits the atria to complete their contraction andempty their blood into the ventricles. This allows theventricles to fill before they contract, or open, releasingthe blood to its destination—from the right ventricle tothe lungs, and from the left ventricle to the aorta for dis-tribution to the body.

From here, the impulse travels on to the right and leftventricles by way of a system of specialized nerve fibersthat carry the electrical signals throughout the ventricles.The impulse travels to the first of these fiber bundlescalled the bundle of His (pronounced like hiss). Theimpulse moves along the bundle of His as it divides intothe right and left pathways called bundle branches. Atthe base of the heart the right and left bundle branches

further divide into microscopic muscle branches calledthe Purkinje fibers. When the impulses reach thesefibers, they trigger the ventricles to contract and pushblood out into the lungs and body.

As the blood moves from the ventricles into the pul-monary artery and aorta for circulation throughout thebody, the atria relax and are filled once again with bloodby the veins, and the cycle begins again. This cycle lasts,on the average, six-sevenths of a second. This series ofcontractions, or heartbeats, is repeated over and overagain, increasing in frequency during times of exertionor stress and decreasing in frequency during times ofrest.

HEART SOUNDS

The sounds associated with the heartbeat, called heartsounds, are due to vibrations in the tissues and bloodcaused by closure of the valves. Heart sounds are usuallydivided into normal and abnormal heart sounds. Ahealthy heart makes a sound described as a lub-dub,


SA node

Right bundle

Left bundle

Purkinje fibers

Bundle of His

AV node

SAnode

Firing from SA node across atria (contraction of atria) to AV node

Firing from AV node to bundle of His,down right and left bundle branches

Firing of Purkinje fibers showing contraction of ventricles

AV node

Purkinjefibers

Bundle of His

FIGURE 11.3. The cardiac cycle. This SA node fires and follows the impulse to the AV node, the bundle of His, the bundle branches,and finally to the Purkinje fibers. Reprinted with permission from Willis MC. Medical Terminology: A Programmed Learning Approachto the Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.


which occurs with each heartbeat. This sound comesfrom the valves closing inside the heart during eachheartbeat. The lub sound, called the first heart sound(S1 or S1), is caused by the closure of the mitral and tri-cuspid valves as the blood enters the ventricles from theatria. These valves close to prevent blood from flowingback into the atria. The dub sound, called the secondheart sound (S2 or S2) is caused by the closure of theaortic and pulmonary valves at the end of ventricularsystole, or when blood is released from the ventricles. Asthe ventricles empty, the valves close. A brief period ofsilence between S1 and S2 represents diastole, or ven-tricular relaxation as the ventricles fill with blood com-ing from the atria.

The sounds of the heart should be sharp and crisp,with a brief moment of silence between each heartbeat.If the valves do not close properly and leak, the soundwill not be clear but blurred and abnormal. Abnormalheart sounds are called murmurs and may sound likelub-shhh-dub or lub-dub rumble when heard through astethoscope. A murmur does not necessarily indicate adisease or disorder, and not all heart disorders causemurmurs.

Abnormal heart sounds can be described as murmurs,gallops, friction rubs, heaves, clicks, snap, and splitting.Murmurs can be described as melodic, innocent, earlypeaking, high-frequency, crescendo/decrescendo, functional,holosystolic, diastolic, systolic ejection, and regurgitant.

Murmurs are classified, or graded, based on thedegree to which they are audible. This 6-point gradingsystem is indicated by numerals (grades 1-6), with grade1 being barely detectable and grade 6 being so loud itcan be heard with a stethoscope just above the chestwall. Express murmurs with a virgule (slash) betweenthe murmur grade and the scale used. For example, amurmur may be dictated as “a 2 over 6 murmur”, whichwould indicate the murmur is a grade 2 on a scale of 1 to 6. This value is transcribed as a grade 2/6 murmur.Roman numerals are not used to categorize cardiac mur-murs. Some other examples:

Dictated: grade 2/6 diastolic murmur

Transcribed: grade 2/6 diastolic murmur

Dictated: grade 2 and a half over 6 murmur

Transcribed: grade 2.5/6 murmur

Dictated: grade 2 to 3 over 6 murmur

Transcribed: grade 2/6 to 3/6 murmurNot grade 2-3/6 murmur

Dictated: grade 3 over 6 crescendo decrescendomurmurGrade 3/6 crescendo-decrescendo mur-mur

A healthy adult has a resting heart rate, or pulse, ofabout 60 to 80 beats per minute. A normal heart rate iscalled sinus rhythm. Arrhythmia means a lack of a nor-mal heart rhythm (indicated by the prefix a-). A moreaccurate term to describe what are commonly referred toarrhythmias is dysrhythmia, which means an abnormalheart rhythm. Some common terms used to describedysrhythmia are as follows:

• Bradycardia, a slow heartbeat, defined as usuallyless than 60 beats per minute.

• Tachycardia, a fast heart rate, defined as greaterthan 100 beats per minute.

• Atrial flutter, which is an arrhythmia in which theatrial rhythm is regular, but the rate is abnormallyfast.

• Fibrillation refers to an uncoordinated, irregularcontraction of the heart muscle which may origi-nate in the atria (called atrial fibrillation) or theventricles (called ventricular fibrillation).

• Heart block, which is an impaired conduction ofthe heart’s electrical impulses, leading to a slowheartbeat.


Transcription

Tip:

When transcribing objective

findings of the heart, listen for

the terms S1 and S2. The letter S refers to sounds of

the heart. S1 and S2 refer to the first and second

heart sounds, which generally are always heard.

When mention is made of an S3 or S4, the physician

is referring to a murmur or some other type of

abnormality of the heart.

Transcription

Tip:

A bruit is an abnormal heart

sound or murmur heard on aus-

cultation.The plural form of this term is bruits, but

because of the term’s French origin, the s is not pro-

nounced, although often heard in dictation.

Therefore, both the singular and plural forms of the

term is correctly pronounced as broo-ee. Sometimes

dictators will mispronounce the term as broot. Do

not transcribe the term as brute.


• Paroxysmal atrial tachycardia, which is a rapidheart rate that starts and stops suddenly and unpre-dictably.

• Premature atrial contraction, which describes anextra heartbeat that originates from the atria beforeit should.

Sometimes abnormal heart rhythms can lead to cardiacarrest, which occurs when the heart suddenly stopspumping effectively and begins to flutter wildly, failingto pump blood to the vital organs of the body. If theheart’s normal rhythm is not reestablished immediately,death will follow within minutes.

BLOOD PRESSURE

The beats of the heart create a pulsating force that keepsblood moving to all parts of the body through the arter-ies. Blood pressure is the measurement of this force, orthe pressure exerted by the circulating volume of bloodon the walls of the arteries, the veins, and the chambersof the heart each time the heart pumps. Blood pressureis at its highest when the heart pumps blood, or the con-traction of the left ventricle, and called the systolic pres-sure and is the top number given in a blood pressuremeasurement. When the heart is at rest, between beats,the pressure falls to its lowest point; this is called dias-tolic pressure and is the bottom number given in ablood pressure measurement. Blood pressure variesconstantly according to time of day, level of physicalexertion, and with anxiety, stress, emotional changes, orother factors.

Nearly every encounter with a medical providerincludes a blood pressure reading that is entered intothe medical record. Blood pressure can be measured man-ually with an instrument called a sphygmomanometer,which measures the maximum pressure (systolic) andlowest pressure (diastolic) made by the beating of theheart. An inflatable cuff is wrapped around a patient’supper arm and kept in place with Velcro. A tube leads

out of the cuff to a rubber bulb. Another tube leads fromthe cuff to a gauge with an indicator on it that points ata number corresponding to the blood pressure reading.Air is then forced into the cuff, increasing the pressureand tightening the cuff around the patient’s upper arm.The person taking the blood pressures places the stetho-scope to the patient’s arm and listens to the pulse whilethe air is slowly released from the cuff.

Blood pressure is measured in terms of millimetersof mercury (mmHg). Two numbers are involved inmaking a blood pressure reading, expressed as a frac-tion, for example, 120/80. The systolic blood pressure,or the top number, represents the maximum pressurein the arteries as the heart contracts and pumps bloodinto the arteries. It is measured when the pulse is firstheard through the stethoscope. The diastolic pressure,which is the bottom number, reflects the minimumblood pressure as the heart relaxes following a contrac-tion and is measured from the moment the sound of thepulse is no longer audible.

Blood pressure can also be measured at home usingan electronic automatic blood pressure gauge with adigital readout.

COMMON CARDIAC DISEASES AND TREATMENTS

Heart disease affects the heart and the blood vessels thatsupply the heart muscle. Some disorders of the bloodvessels can also affect the heart directly. Common termsthat may be heard when transcribing symptoms of car-diac problems include cyanosis, a bluish discolorationof the skin and mucous membranes resulting from alack of oxygen in the blood, or pallor, which meanspaleness or a decrease or absence of color in the skin.Edema refers to an accumulation of abnormal amountsof fluid in the intercellular tissues, pericardial sac, andother tissues of the body. Diaphoresis refers to profuse


Indicate whether the following sentences are true (T) or false (F).

1. The tricuspid valve is located in the right atrium. T F

2. Three layers of tissue form the heart wall. T F

3. Abnormal heart sounds are called systoles. T F

4. Veins carry oxygen-rich blood away from the heart. T F

5. The cardiac cycle is the sequence of events in one heartbeat. T F

SKILLS QUICK CHECK 11.1 ✓


sweating associated with elevated body temperature,physical exertion, or stress. Finally, angina, also calledangina pectoris, is severe chest pain that lasts for severalminutes and results from an inadequate supply of oxy-gen and blood flow to the heart muscle.

Hypertension

Hypertension, or high blood pressure, describes a con-dition in which the pressure of the blood in the arteriesis too high, raising the possibility of damage to the heartand to the walls of the blood vessels. This can occurwhen the heart pumps blood too forcefully around thebody, or when arteries narrow, inhibiting blood flow.There are two types of hypertension: primary hyperten-sion, in which there is no identifiable cause; and sec-ondary hypertension, where another disease or med-ication is the cause. Hypertension causes a number ofhealth complications, including heart disease andstrokes. In most cases, the cause of hypertension isunknown, but some researchers believe that a familyhistory of hypertension, smoking, and a diet high in saltand fat resulting in obesity are contributing factors.Stress and excessive alcohol consumption are alsothought to play a role.

Because of the role hypertension plays in stroke andheart attacks, the first line of treatment is to attempt tobring blood pressure under control with diet andlifestyle modification. Drug therapy is the next step.Depending on the circumstances, various classes ofdrugs are available to treat hypertension:

• Diuretics. Diuretics decrease blood pressure byeliminating extra sodium and fluid from the body.The blood vessels do not have to hold so much fluidto circulate, and, thus, blood pressure is reduced.Diuretic medications may include triamterene/hydrochlorothiazide (Dyazide), furosemide (Lasix),or spironolactone (Aldactone).

• Beta-blockers. Beta-blockers decrease heart rateand the amount of blood the heart pumps out witheach beat, and relax the blood vessels, which reducesblood pressure. Examples of these drugs includeatenolol (Tenormin), metoprolol (Lopressor), orpropranolol (Inderal).

• Angiotensin-converting enzyme (ACE) inhibitors.These drugs are used to inhibit the formation of anaturally occurring substance, angiotensin II, whichis a very potent chemical that causes the musclessurrounding blood vessels to contract and therebynarrows the blood vessels. The narrowing of the ves-sels increases the pressure within them, causingblood pressure to rise. Angiotensin II is formedfrom angiotensin I in the blood by the angiotensinconverting enzyme. ACE inhibitors prevent produc-

tion of angiotensin II and as a result, blood vesselsdilate and blood pressure drops. These drugs mayinclude lisinopril (Prinivil), benazepril (Lotensin),enalapril (Vasotec), quinapril (Accupril) or ramipril(Altace).

• Calcium-channel blockers. Calcium channel block-ers inhibit the movement of calcium into the mus-cle cells of the heart and arteries. Calcium is neededfor these muscles to contract. Calcium channelblockers work to decrease the force of the heart’spumping action (cardiac contraction) and relaxingthe muscle cells in the walls of the arteries, whichhelps them to open and reduce blood pressure.Commonly prescribed calcium-channel blockersinclude verapamil (Calan), diltiazem (Cardizem),and nifedipine (Procardia XL).

• Angiotensin II receptor blockers (ARBs). LikeACE inhibitors, ARBs block the action of theenzyme that causes blood vessels to narrow. As aresult, blood vessels may relax and open up. Thismakes it easier for blood to flow through the ves-sels, which reduces blood pressure. Additionally,these drugs increase the release of sodium andwater into the urine, which also lowers blood pres-sure. ARBs reduce blood pressure as effectively asACE inhibitors but without some of the side effects(such as a cough) associated with ACE inhibitors.Medications commonly prescribed in this categoryinclude losartan (Cozaar), olmesartan (Benicar),telmisartan (Micardis), and valsartan (Diovan).

Coronary Artery Disease

Coronary artery disease (CAD) refers to the narrowingof the coronary arteries to the extent that the heart mus-cle no longer receives an adequate supply of blood.


Transcription

Tip:

The cardiac medication digoxin

(Lanoxin) is dispensed in 125-

mcg (0.125-mg) or 250-mcg (0.25-mg) tablets for oral

administration. Do not confuse the dosing of mg

(milligrams) and mcg (micrograms). A milligram is

larger than a microgram.Therefore, if the physician

dictates a zero before the dosage number, the mea-

surement is always mg, not mcg; conversely, if the

larger number is dictated, you would use the mea-

surement of mcg, not mg.


CAD is also called cardiac ischemia. The term ischemiacomes from the word components ischi, to hold back,and –emia, blood. Cardiac ischemia is the name for lackof blood flow and oxygen to the heart muscle.

CAD is caused by the gradual buildup of fattydeposits called plaque in the coronary arteries. Thisbuildup of plaques, called atherosclerosis, causes thearteries to become narrow and to harden, thereby reduc-ing the flow of blood through them, giving it the layterm hardening of the arteries (see Figure 11.4). The med-ical term for the narrowing of any blood vessel, valve orpassage is called stenosis. Eventually, the diminishedblood flow due to the stenosed artery may cause condi-tions such as angina, dyspnea (shortness of breath), ormyocardial infarction.

Over time, CAD can weaken the heart muscle andprevent it from pumping blood the way it should, a con-dition known as heart failure. Congestive heart failure(CHF) occurs when the heart’s weak pumping actioncauses a buildup of fluid, called congestion, in thelungs and other body tissues. The lung congestion thatresults from heart failure may cause some people toexperience breathing difficulties while lying down. Thiscondition, called orthopnea, requires a person to keephis or her head elevated by sitting or standing in order tobe able to breathe comfortably. Paroxysmal nocturnaldyspnea (PND) is a sudden onset of breathing difficultyoccurring at night, usually an hour or two after the indi-vidual has fallen asleep. The term derives from the termsparoxysmal, relating to the sudden onset of a symptom;nocturnal, pertaining to the hours of darkness or night;

and dyspnea, which, as mentioned before, means short-ness of breath or difficulty breathing.

CAD is treated in a variety of ways. A number of med-ications can help reduce angina and minimize thechance of blood clots forming at the sites of blockages.Nitrates, such as nitroglycerin, relieve angina by dilatingblood vessels, making it easier for the heart to pump asufficient amount of blood through the body. Many ofthe antihypertensive medications described previouslyare also used to treat CAD.

In severe cases, surgical intervention may be required.Angioplasty, also called percutaneous transluminalcoronary angioplasty (PTCA), is a procedure that opensnarrowed arteries by using a catheter, which is a thin,flexible tube with a tiny balloon attached. First, thecatheter is inserted into an artery in the leg and guidedto the site of the stenosis, or narrowed portion, of thecoronary artery. The catheter’s position at the artery siteis confirmed by fluoroscopy, which is a continuous x-ray beam that is passed through a body part beingexamined and then transmitted to a television-typemonitor so that the body part and its motion can beseen in detail. Physicians will often refer to the use offluoroscopy in procedures by dictating the phrase,“under fluoroscopic guidance . . .” or “images obtainedby fluoroscopy. . . .”

Once the catheter’s position is confirmed, the physi-cian introduces a tiny balloon into the catheter. The bal-loon is directed through the narrowed portion of theartery and inflates it in order to flatten the plaqueagainst the artery wall, thereby widening the channelthrough which blood can flow. The balloon and catheterare then removed from the body.

To keep the artery from re-stenosing, or narrowingagain after an angioplasty procedure, an expandablestent is implanted at the site of the blockage to keep theartery from collapsing. A stent is a mesh-like stainlesssteel tube that has a rectangular design, as shown inFigure 11.5. In this procedure, a balloon is attached tothe catheter, as in standard angioplasty, but in this pro-cedure, the balloon is used to deploy and dilate the stentat the site of the narrowed artery in order to reduce therate of arterial restenosis and acute reclosure followingangioplasty.

The stent is crimped over a balloon and inserted intothe area of a blockage after the artery has been expandedby angioplasty. When the stent is in position, the bal-loon is inflated, allowing the stent to be expanded untilit hugs the arterial wall. The balloon is then deflated andremoved from the body with the catheter while the stentstays in position. Like scaffolding on a building, thestent supports the artery walls to prevent it from nar-rowing again. Stents are being used with increasing fre-quency in association with angioplasty procedures.

When the blockage in an artery is calcified or sodense that a balloon cannot be placed to widen the


Anterior interventricularartery

Plaque buildup in artery wall

FIGURE 11.4. Coronary artery disease. Plaque buildup in thearteries narrows vessels, inhibiting blood flow through the heart.Reprinted with permission from Willis MC. Medical Terminology:A Programmed Learning Approach to the Language of HealthCare. Baltimore: Lippincott Williams & Wilkins, 2002.


artery wall, other devices are used. Plaque can be cutout, ablated with a laser, or bored out using a surgicaldrill bit (a procedure called atherectomy).

Coronary artery bypass graft surgery (CABG, pro-nounced like cabbage), is a more extensive surgical pro-cedure which restores circulation when occluded, orblocked, coronary arteries prevent normal blood flow tothe heart muscle. In this procedure, occluded arteries arereplaced with segments (called grafts) from vessels inother parts of the body which are used to bypass theblocked coronary artery and improving blood flow.

Conventional CABG surgery is done by opening thepatient’s chest with an incision over the sternum (breastbone) and dividing it to expose the heart. Bypasses maybe performed using different blood vessels: Vessels inthe chest wall called the left internal mammary artery(LIMA) or right internal mammary artery (RIMA) maybe used as grafts; but more often, the greater saphenousvein, which is a large vein located in the leg and thigh, isremoved (surgeons refer to this as harvesting the vein) tobe used for the bypass procedure. This harvested vein isreferred to as a saphenous vein graft (SVG).

During the operation, the patient is connected to aheart-lung machine, which is used to provide circula-tion and oxygenate the blood while the heart isstopped by the surgical team in order to perform thebypass. Depending on the number and location of the

blockages, the surgeon might perform between oneand seven bypasses. When complete, the new healthyartery or vein graft then carries the oxygenated bloodaround the blockage in the coronary artery. When thebypass procedure is completed and the graft is in place,the heart is restarted. Once the heart beats normally, thepatient is removed from the heart-lung machine, thesternum is closed with stainless steel wire sutures, andthe chest and leg wounds are closed with sutures orclips.

Cardiomyopathy

Cardiomyopathy is a general term for the progressiveimpairment of the structure and function of themyocardium, or muscle tissue of the heart. The termderives from the components cardi/o (heart), my/o (mus-cle), and -pathy (disease). Damage prevents the heartfrom functioning normally, or the walls of the tissuethicken or harden, causing the heart to resist filling tocapacity. Cardiomyopathy progresses in most cases,and it is one of the main diseases requiring heart trans-plantation.

Dilated cardiomyopathy refers to overall enlarge-ment (dilation) of the heart chambers, especially theventricles. Although this enlargement is a key part ofdilated cardiomyopathy, it is not the initial problem butrather the heart’s own response to a weakness of heartmuscle and poor pumping ability, resulting in heart fail-ure. Hypertrophic cardiomyopathy is an overgrowth ofheart muscle that can impair blood flow both into andout of the heart. The walls of the ventricles thicken (acondition called hypertrophy) and become stiff, eventhough the workload of the heart is not increased.Restrictive cardiomyopathy is a disorder in which the


Transcription

Tip:

The classification of cardiac

failure widely used by physicians

was developed by the New York Heart Association.

This system ascribes the severity of a patient’s cardiac

failure using Roman numerals I through IV, with I

being asymptomatic and IV denoting severe cardiac

failure, symptomatic at rest. Transcribe this value

using lowercase class, followed by a roman numeral

(I through IV). Examples:

New York Heart Association class II.

NYHA class I.

IMPRESSION: Cardiac failure, class III.

FIGURE 11.5. Vascular stent used in coronary angioplasty.When the stent expands, each rectangle stretches to a diamondshape. The expanded stent supports the artery and helps preventrestenosis. Reprinted with permission from Nursing Procedures,4th ed. Ambler: Lippincott Williams & Wilkins, 2004.


ventricles become stiff, but not necessarily thickened,and do not fill normally with blood between heartbeats.Cardiomyopathy may be caused by chronic cardiac dis-ease, excessive alcohol intake, infection due to viruses,or vitamin deficiency disorders. The most commoncause, however, is scarring and dilation of the heart mus-cle as a result of a previous heart attack or other forms ofatherosclerosis.

Usually cardiomyopathy cannot be completelyreversed or cured. However, depending on the type ofcardiomyopathy, certain drugs may be prescribed, atleast initially, to decrease the heart’s workload, regulatethe heartbeat, and help prevent blood clot formationand fluid accumulation in the body. These drugs includeACE inhibitors, anticoagulants (commonly called bloodthinners), and diuretics to remove excess fluid from thebody.

Valvular Heart Disease

Heart valves regulate the flow of blood through theheart’s four chambers. If these valves malfunction, theheart’s ability to pump blood can be impeded. If heartvalves do not close completely, blood can leak backthrough the valve when it should be closed. This leakageof blood back through the valve is called regurgitation.Valves may not open completely, resulting in bloodpumping through a blocked or narrowed opening,called stenosis, as discussed above. Regurgitation andstenosis can affect any of the heart valves and are namedaccording to the site of the defect, such as mitral valveregurgitation, tricuspid regurgitation, and aortic regurgi-tation; or mitral valve stenosis, aortic stenosis, and tri-cuspid stenosis.

Mitral valve prolapse is a disorder in which theheart’s mitral valve, which separates the left atrium andleft ventricle, bulges slightly back into the left atriumwhen it closes, causing regurgitation of blood backthrough the valve and into the atrium. Physicians diag-nose mitral valve prolapse after hearing the characteris-tic clicking sound of the disorder through a stethoscope;hence this disorder is also referred to as click-murmursyndrome. Although prolapse may involve any valve orcombination of valves, the mitral valve is the most com-mon site of prolapse.

In most cases, mitral valve prolapse is harmless, doesnot cause symptoms, and does not need to be treated. Ina small number of cases where it causes severe mitralregurgitation, it would need to be treated with surgery.Patients with mitral valve prolapse may be prescribedantibiotics before surgical, dental, or medical proce-dures to prevent the risk of bacterial endocarditis.Bacterial endocarditis is an invasion of bacteria from thebloodstream which can lead to deformity and destruc-tion of the valve leaflets.

Pericarditis

Pericarditis is an inflammation of the pericardium thatsurrounds the heart. There is a small amount of fluidbetween the inner and outer layers of the pericardium.When the pericardium becomes inflamed, the amountof fluid between its two layers increases, compressingthe heart and interfering with its ability to functionproperly.

Pericarditis may be acute or chronic. The sharp chestpain associated with acute pericarditis occurs when thepericardium rubs against the heart’s outer layer. Insome cases, the inflammation causes fluid to accumu-late in the pericardial sac, a condition known as peri-cardial effusion. This collection of excess fluid in thepericardium can place pressure on the heart, squeezingit and interfering with its ability to fill adequatelyand pump blood efficiently. This disorder, known ascardiac tamponade, results in less blood leaving theheart, causing a dramatic drop in blood pressure andliterally smothering the life out of it. If left untreated,even for a few minutes, cardiac tamponade can befatal.

Pericarditis may be caused by a bacterial or fungalinfection, invasion by cancer cells, or by certain dis-eases such as AIDS, cancer, or tuberculosis. It may alsobe precipitated by a heart attack or serious chest injury.Pericarditis also can develop shortly after a majorheart attack due to the irritation of the underlyingdamaged heart muscle. In addition, a delayed form ofpericarditis may occur weeks after a heart attack orheart surgery because of antibody formation. Thisdelayed pericarditis is known as Dressler syndrome.Many experts believe Dressler’s is due to an autoim-mune response, a mistaken inflammatory response bythe body to its own tissues—in this case, the heart andpericardium.

Treating pericarditis often involves consideration ofthe underlying cause as well as the severity of the peri-cardial inflammation. Mild cases of pericarditis mayget better on their own without treatment. People withmore severe cases may need to be hospitalized fortreatment, which typically includes anti-inflammatorymedications or corticosteroids to reduce inflamma-tion, and analgesics or narcotics to ease pain. Fluidmay be drained from the pericardium using a tech-nique called pericardiocentesis, also referred to as apericardial window. In this procedure, a surgeon usesa sterile needle or a catheter to remove and drain theexcess fluid from the pericardial cavity. In cases oflong-term inflammation and chronic recurrences thatpermanently thicken and scar the pericardium, a surgi-cal procedure called a pericardiectomy is performed,in which the portion of the pericardium that hasbecome rigid, compromising the functioning of theheart, is removed.



Congenital Heart Disorders

A congenital heart defect is a structural problem in theheart that is present at birth. A baby’s heart begins todevelop shortly after conception. During development,structural defects can occur. The abnormality can be theresult of an inherited disorder, or acquired while thefetus is growing in the uterus due to exposure to a sub-stance that causes abnormal development. These defectscan involve the walls of the heart, the valves of the heart,and the arteries and veins near the heart.

Atrial Septal Defect

An atrial septal defect (ASD), sometimes referred to asa “hole in the heart,” is a hole in the atrial septum thatseparates the atria of the heart. The defect allows bloodto flow from one atrium to the other, usually from theleft side to the right side, causing extra blood flow in theright atrium, in the right ventricle, or to the lungs. Leftuntreated, ASD can lead to arrhythmias, stroke, andeventual damage to the arteries and the small blood ves-sels in the lungs. Most ASDs close on their own as theheart grows during childhood. Large holes that do notclose on their own are usually corrected with surgery.Once the defect has been closed or repaired, most chil-dren need no additional treatment.

Ventricular Septal Defect

A ventricular septal defect (VSD) is a hole, or defect, inthe wall that separates the ventricles of the heart. In thenormal heart, the ventricular septum prevents bloodfrom flowing directly from one ventricle to the other. Ina heart with a VSD, blood can flow between the two ven-tricles. Children with large VSDs may develop conges-tive heart failure from extra blood flow from the left ven-tricle through the right ventricle to the lungs. Bacterialendocarditis, an infection of the lining of the heart,valves, or arteries, can develop as a result of VSD, as canventricular arrhythmias. As with an ASD, most VSDsclose on their own or are so small that they do not needtreatment. On occasion, children and adults may needsurgery or other procedures to close the VSD, but no fur-ther treatment is required after the VSD is repaired.

Patent Ductus Arteriosus (PDA)

Patent ductus arteriosus (PDA) is a condition in whichthere is an abnormal circulation of blood between twoof the major arteries leading from the heart, the aortaand pulmonary artery. Before birth, these two arteriesare connected by a blood vessel called the ductus arte-riosus, which is an essential part of the fetal circulation.After birth, the vessel is supposed to close within a fewdays as part of the normal changes that occur in the

baby’s circulation. In some babies, however, the ductusarteriosus remains patent, or open. This opening allowsblood to flow directly from the aorta into the pul-monary artery, which can put a strain on the heart andincrease the blood pressure in the pulmonary artery. Inmost cases, the PDA will shrink and go away completely.If it does not close, corrective surgery can be performed.

Transposition of the Great Vessels

Transposition of the great vessels occurs when thelocation of the aorta and pulmonary artery, jointlyreferred to as “the great vessels,” is anatomicallyswitched. The aorta comes off the right ventricle insteadof the left, and the pulmonary artery comes off the leftventricle instead of the right. Therefore, instead of theoxygen- and nutrient-rich blood that is meant to passthrough the aorta, blood without oxygen is pumped tothe body. Babies born with transposition are cyanotic,or have a bluish coloration to the skin, shortly afterbirth because of the low oxygen in their blood.

The most common surgical procedure to correct thisdefect is called an arterial switch operation, in which themajor arteries are switched, connecting the aorta to theleft ventricle and the pulmonary artery to the rightventricle, thereby allowing oxygenated blood to flow tothe body.

Tetralogy of Fallot

Tetralogy of Fallot (pronounced as fa-LOW) is a condi-tion that causes lower-than-normal oxygen levels in theblood, which leads to cyanosis. This congenital defectactually consists of a combination of four differentheart defects (hence the prefix, tetra-): a VSD;obstructed outflow of blood from the right ventricle tothe lungs, called pulmonary stenosis; a displacedaorta, which causes blood to flow into the aorta fromboth the right and left ventricles; and an abnormalenlargement of the right ventricle, called right ventric-ular hypertrophy. The severity of the symptoms isrelated to the degree to which the flow of blood fromthe right ventricle is obstructed. Surgery to repair heartdefects is always done when the infant is very young.Sometimes more than one surgery is needed. The firstsurgery may be done to help increase blood flow to thelungs, and a surgery to correct the underlying problemis done at a later time.

DIAGNOSTIC STUDIES AND PROCEDURES

There is no single test for the wide variety of coronarydiseases experienced by patients. The diagnostic test



used depends on a number of factors, especially theseverity of the symptoms and the type of disease thosesymptoms represent. A physician may perform sometests to rule out other etiologies for a patient’s symp-toms, or others to check the severity of symptoms beforemaking a diagnosis.

Blood Tests

Blood tests that measure different components in theblood to determine the overall health of the blood andthe heart include the following:

• C-reactive protein test (CRP). C-reactive protein isa substance found in the blood when inflamma-tion occurs, such as fatty buildup in artery walls.CRP levels help predict cardiac risk.

• Homocysteine. Homocysteine is an amino acidthat is normally found in small amounts in theblood. Higher levels of homocysteine are associ-ated with increased risk of heart attack and othervascular diseases. The levels may be high due to adeficiency of folic acid or vitamin B12, resultingfrom heredity, older age, kidney disease, or certainmedications.

• Lipoprotein (a) or Lp(a). Lipoprotein (a), dictatedas L P little A, is a biochemical in the body; highconcentrations of Lp(a) are associated with prema-ture coronary disease.

• Cholesterol particle test. The cholesterol particletest measures the size of the low-density lipoprotein(LDL) cholesterol, called bad cholesterol, particles inthe blood. “Pattern A” particles are larger andlighter, whereas “Pattern B” particles are smaller


Circle the letter corresponding to the best answer to the following questions.

1. Coronary artery disease is also known as

A. CABG.B. cardiac angiography.C. cardiac ischemia.D. hypertension.

2. A buildup of plaque in the coronary arteries is known as

A. atherosclerosis.B. arteriomyosis.C. angina pectoris.D. MI.

3. Blood pressure is measured with an instrument called a(an)

A. syringometer.B. stethoscope.C. EKG monitor.D. sphygmomanometer.

4. A heart defect or problem present at birth is known as a

A. ventriculomegaly.B. atrial heart defect.C. myocardial heart defect.D. congenital heart defect.

5. Progressive impairment and function of the myocardium is known as

A. cardiomyopathy.B. ventricular septal defect.C. patent ductus ateriosis.D. pericarditis.



and more dense. People with Pattern B LDL cho-lesterol are more likely to have atherosclerosisand heart disease. This test is dictated as “PatternA” (or “Pattern B”) particle size, where the wordpattern and the A or B are enclosed in quotationmarks.

• Lipid profile. This test evaluates the risk of coronaryheart disease in a patient. It measures total choles-terol; LDL; high-density lipoprotein (HDL), calledgood cholesterol; and triglycerides.

• Blood sugar (glucose). This test detects the pres-ence of diabetes and glucose intolerance, both ofwhich indicate a significant cardiac risk.

• B-type natriuretic peptide (BNP). This test mea-sures the amount of the BNP hormone in theblood. BNP is made by the heart, and if the heart isworking harder over an extended period (such asfrom heart failure), the heart releases more BNPand the value will be elevated.

• Cardiac enzyme studies. These blood valuesmeasure the levels of the cardiac enzymes tro-ponin, creatine kinase (CK), myocardial bandenzymes of creatine kinase (CK-MB), creatinephosphokinase (CPK), and myocardial bandenzymes of creatine phosphokinase (CPK-MB)in the blood. Elevated levels of cardiac enzymesindicate heart muscle damage. These enzymes,normally found in high numbers inside the cellsof the heart, are needed for those cells to func-tion. When these cells are injured, such as duringa heart attack or other cardiac trauma, theseenzymes are released into the bloodstream. Bymeasuring the levels of these enzymes, physi-cians can determine if cardiac tissue has beendamaged, the size of an adverse heart event (suchas a heart attack), and approximately when theevent occurred.

Electrocardiogram

An electrocardiogram (EKG, also called ECG) is a diag-nostic test that analyzes the electrical activity of theheart. Recorded from electrodes attached to the surfaceof the body, the EKG produces a graphic representationor tracing of the electrical activity of the heart as it con-tracts and relaxes. The EKG can detect abnormal heart-beats, some areas of damage, inadequate blood flow,and heart enlargement.

During the test, electrodes used to measure electricalimpulses, called leads, are placed on the patient’s armsand legs and across the chest wall. The leads are thenconnected to the EKG machine. These leads, 12 in all,are transcribed as a combination of letters and numbersaccording to their location on the body as leads I, II, and

III, aVR, aVL, and aVF, and, finally, leads V1 through V6.Each electrical impulse detected by the leads is recordedonto a strip of paper as a waveform. Any deviation fromthe shape of the waveform, or the interval betweenwaveforms on the strip is indicative of a possible heartdisorder. Figure 11.6 illustrates a waveform tracingshowing normal sinus rhythm compared to the wave-form appearance of abnormal rhythms.

Below are same common terms used to transcribeEKG terminology.

EKG leads (including augmented limb and precor-dial leads):

• lead I, lead II, lead III• aVR, aVL, aVF• V1, V2, V3, V4, V5, V6, V7, V8, V9

or V1, V2, V3, V4, V5, V6, V7, V8, V9

or sometimes dictated as sequential leads: V1 throughV9 (V1 through V9)not V1 through 5 or V1 through 5 (even if dictated)not V1-5 or V1-5

Tracing terms (in general, use all capital letters but largerand smaller letters may be used when denoting electro-cardiographic deflections):

• Q wave, q wave• R wave, r wave• S wave, s wave• T wave• T-wave inversion• QRS complex• QT interval• ST segment• ST-T elevation

Echocardiogram

An echocardiogram, often dictated as echo for short, is atest in which ultrasound is used to examine the anatomyof the heart. This procedure can display a cross-sectional“slice” of the beating heart, including the chambers,valves, and the major blood vessels that exit from the left


Transcription

Tip:

For terms such as T wave, in

which there is no hyphen, insert

a hyphen when the term is used as an adjective, such

as T-wave abnormality.


and right ventricles. The echocardiogram reveals impor-tant information about the anatomy of the heart, detectsheart valve abnormalities, and evaluates congenital heartdisease. A transducer is placed on the chest, and high-frequency sound waves are directed at the heart wall andvalves. The sound waves bounce, or echo, off the cardiacstructures, providing a two-dimensional image of thebeating heart, which is viewed on a computer screen. Byapplying the transducer at particular areas of the chest,most of the important cardiac structures can be imagedby the echocardiogram.

Cardiac Stress Test

A cardiac stress test, sometimes called a treadmillstress test, is an exercise test to evaluate the heart forproblems that show up only when the heart is workinghard. As the body works harder during the test, itrequires more oxygen; thus the heart must pump moreblood. This test can show if the blood supply is reducedin the arteries that supply the heart.

In the basic stress test, EKG leads are placed on thepatient’s chest to provide electrocardiographic signalsthat are monitored during the test. The patient’s heartrate and rhythm are observed while the test progresses


C. Tachycardia (sinus)

B. Bradycardia

A. Normal Sinus Rhythm (NSR)

FIGURE 11.6. Electrocardiographic wave form. These electrocardiogram tracings show two types of arrhythmia compared to normal.A. Normal sinus rhythm. B. Bradycardia. C. Tachycardia. Reprinted with permission from Willis MC. Medical Terminology: AProgrammed Learning Approach to the Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.

Transcription

Tip:

Exercise capacity in a stress

test is measured by the Bruce

protocol, sometimes abbreviated as BPR, named

after the developer of the standardized treadmill test

for diagnosing and evaluating heart and lung dis-

eases. The measurement of aerobic exercise capacity

is expressed in metabolic equivalents (METS). For

example: “The patient’s exercise duration was 10

minutes using the Bruce protocol to a peak workload

of 10.5 METS.”


from a slow walk on the treadmill to a faster pace andwalking on an incline; certain changes in the rate andrhythm may suggest the heart itself is not receivingenough blood.

A nuclear scan, or thallium stress test, is sometimesused along with a treadmill or bicycle stress test. Thescan can show areas of the heart that lack blood flowand are damaged, as well as revealing problems with theheart’s pumping action. When the patient reaches his orher maximum level of exercise, a small amount ofradioactive material called thallium is injected into avein where it travels through the bloodstream. Then thepatient lies down on a special table under a gammacamera, a special camera that can see the thallium andtake pictures as the thallium mixes with the blood in thebloodstream and heart’s arteries and enters heart musclecells. A less-than-normal amount of thallium detectedin the heart muscle cells is an indicator that this part ofthe heart muscle does not receive a normal blood sup-ply and might be damaged.

Cardiac Catheterization andCoronary Angiography

Cardiac catheterization, along with a simultaneous pro-cedure, coronary angiography, allows the visualizationof the heart and the coronary arteries that supply bloodto the heart muscle. This procedure can evaluate block-ages in coronary arteries, the function of the valves andother heart structures, and coronary circulation andstructural disorders. A thin catheter is inserted into anartery or vein and threaded through major blood vesselsinto the heart chambers. At the tip of the catheter, vari-ous instruments may be attached that measure the pres-sure of blood in each chamber, view the interior of bloodvessels, or remove a tissue sample from inside the heart

for examination later. During the coronary angiographyportion of the examination, a radiopaque dye is insertedthrough the catheter into the coronary arteries to viewclear images of the blood vessels as the heart pumps.

Multiple Gated Acquisition Scan

A multiple gated acquisition (MUGA) scan is a nonin-vasive test that uses a radioactive isotope called tech-netium to evaluate the functioning of the heart’s ventri-cles. The MUGA scan is performed to determine if theheart’s left and right ventricles are functioning properlyand to diagnose abnormalities in the heart wall. Duringthe MUGA scan, leads are placed on the patient’s bodyso that an EKG can be conducted simultaneously. Thena small amount of technetium is injected into an armvein, and a special camera is used to follow the move-ment of the technetium through the blood circulating inthe heart. The camera displays multiple images of theheart in motion and records them on a computer forlater analysis.

CHAPTER SUMMARY

The heart, which pumps blood through the circulatorysystem, is vital to survival. Body tissues need a continu-ous supply of oxygen and nutrients, and metabolicwaste products have to be removed. Without theseessential processes, cells soon undergo irreversiblechanges that lead to death. A critical understanding ofthe anatomy and function of the heart and familiaritywith the ongoing diagnostic and therapeutic advancesin managing heart disease are key factors in success attranscribing medical reports in the field of cardiology.


Fill in the blank with the correct meaning of the following abbreviations.

1. EKG

2. CABG

3. CK

4. HDL

5. BNP




• I • N • S • I • G • H • T •

The Heart Brain

Western science has long believed that the brain’s responses to external stimuli were the sole source of human

emotion, whereas the hollow muscle of the heart possessed no emotion or intellect of its own. However, neuro-

physiologists have discovered that the heart is, in fact, is a sensory organ with its own functional intrinsic “brain”

that communicates with and influences the brain via the nervous system and other pathways.

Dr. J. Andrew Armour, Associate Professor of Pharmacology, University of Montreal, pioneered the concept that

the “heart brain” is a network of neurons, neurotransmitters and proteins that send messages to the body.

Through his research, he found that, like the brain, the heart contains support cells and a complex electrical cir-

cuitry that enable it to act independently, learn, remember, and transmit information from one cell to another.

According to these studies, the type of information sent from the heart to the brain can influencing human per-

ceptions, emotions, and thought processes. Some evidence to support this theory includes the documented tes-

taments of heart-transplant patients who have taken on the habits, tastes, and memories of their dead donors.

This led many researchers to conclude that the same type of memory-encoding neurons found in the brain are

also found in the heart.

With new discoveries supporting the existence of a connection between the heart and the brain, neurocardiol-

ogy is becoming increasingly relevant in the management of heart disease. Researchers hope that an under-

standing of how the neurons of the heart can exert dynamic control over emotions will help patients to focus on

the power of the heart to facilitate beneficial changes in all parts of the body.



Common Soundalike Words

Word Soundalike Word Pronunciation Soundalike Pronunciation

atherosclerosis: a form of ath’er-b-skler-b’sis arteriosclerosis: a clogging or ar-tTr’T-b-skler-b’sis

arteriosclerosis in which plaques hardening of the arteries.

containing cholesterol and other

material are formed within the arthrosclerosis: a stiffening or ar’thrb-skler-b’sis

arteries. hardening of the joints.

median sternotomy: an incision mT’dT-an mediastinotomy: incision into mT’dT-as-ti-not’[-mT

through the midline of the sternum st_r-not’[-mT the mediastinum.

usually used to gain access to the

heart, mediastinal structures, and

great vessels.

BNP (B-type natriuretic peptide): bee-en-pee BMP (basic metabolic panel): bee em-pee

a cardiac laboratory test as an a panel of blood tests,

indicator for myocardial infarction, containing several evaluations

which will always be a one-number with several values.

value.

cor: another term for the heart. kbr core: the central part of kbr

anything.

ejection: the act of driving or T-jek’sh\n injection: the introduction in-jek’sh\n

throwing out by physical force of a medicinal substance

from within (as in ejection or nutrient material into

fraction. In cardiology, the subcutaneous tissue, muscular

measurement of the blood tissue, or other places.

pumped out of the ventricles.

infarction: a blockage in an in-fark’sh\n infraction: a violation or in-frak’sh\n

artery causing tissue death encroachment upon something

due to lack of oxygen-rich (as the law).

blood.

arrhythmia: loss of rhythm; ^-rith’mT-^ erythema: redness of the skin er-i-thT’m^

denoting especially an due to capillary dilation.

irregularity of the heartbeat.

stent: a device used to stent’ stint: an unbroken period of stint’

provide support for a time during which something

bodily orifice or cavity. is done.

pericardial: surrounding the per-i-kar’-dT-^l precordial: relating to the prT-kbr’dT-^l

heart precordium or the front of

the heart.

nitrate: a salt of nitric acid; nU’trQt nitrite: a salt of nitrous acid; nU’trUt

found in cardiac medications. found on urinalysis.



Combining Forms

Combining Form Meaning

ablat/o take away

anastom/o establish an opening

angi/o, vas/o, vascul/o vessel

aort/o aorta

arter/o, arteri/o artery

ather/o fatty plaque

atri/o atrium

cardi/o, coron/o heart

cholesterol/o cholesterol

congest/o accumulation of fluid

cyan/o blue

ectop/o outside of a place

fibrillo/o muscle fiber/nerve fiber

infarct/o area of dead tissue

isch/o keep back, block

jugul/o jugular (throat)

lipid/o lipid (fat)

lumin/o lumen (opening)

my/o muscle

ox/o oxygen

palpit/o to throb

percardi/o pericardium

perone/o fibular (lower leg bone)

phleb/o, ven/o vein

regurgitat/o flow backward

rhythm/o rhythm

sphygm/o pulse

sten/o narrowness; constriction

steth/o chest

thromb/o clot

valv/o, valvul/o valve

ventricul/o ventricle

Add Your Own Combining Forms Here:

Abbreviation Meaning

ACE angiotensin-converting enzyme

ARB angiotensin II receptor blocker

ASD atrial septal defect

BNP B-type natriuretic peptide

CABG coronary bypass artery graft

CAD coronary artery disease

CHF congestive heart failure

CK creatine kinase

CPK creatine phosphokinase

CRP C-reactive protein

EKG (also electrocardiogram

called ECG)

HDL high-density lipoprotein, or good

cholesterol

LAD left anterior descending artery

LCA left coronary artery

LCA left circumflex artery

LDL low-density lipoprotein, or bad

cholesterol

LP(a) lipoprotein (a)

METS metabolic equivalents

MI myocardial infarction

mmHg the measurement of blood pressure

values

MUGA multiple gated acquisition scan

PDA posterior descending artery OR

patent ductus arteriosus

PND paroxysmal nocturnal dyspnea

PTCA percutaneous transluminal coro-

nary angioplasty

RCA right coronary artery

SA sinoatrial (node)

TIMI thrombolysis in myocardial infarction

VSD ventricular septal defect

Add Your Own Abbreviations Here:

ABBREVIATIONSABBREVIATIONS



Term Meaning

angina Severe chest pain that lasts for several minutes and results from an inadequate

supply of oxygen and blood flow to the heart muscle.

angina pectoris Another term for angina.

angioplasty A procedure that opens narrowed arteries by using a catheter with a balloon

on its tip; also referred to as percutaneous transluminal coronary angioplasty

(PTCA).

angiotensin-converting Drugs that prevent the formation of angiotensin II in the blood vessels,

enzyme (ACE) inhibitors enabling blood vessels to dilate and decrease blood pressure.

anticoagulant A substance that hinders the clotting of blood; commonly called blood

thinner.

aorta The main trunk of the arterial system that begins in the left ventricle.

aortic valve The outgoing valve of the left ventricle.

angiotensin II receptor Drugs that block the action of the enzyme that causes blood vessels to

blockers (ARBs) narrow; similar to ACE inhibitors but without some of the side effects associ-

ated with ACE inhibitors.

arrhythmia An irregular heartbeat.

arteries Larger vessels that carry oxygen-rich blood away from the heart.

arterioles Smaller branches of the arteries that distribute blood to body tissues.

atherectomy A procedure in which a high-speed drill on the tip of a catheter is used to

shave plaque from blocked arterial walls.

atherosclerosis A buildup of plaques in the coronary arteries, causing the arteries to become

hardened and narrowed.

atria (singular, atrium) An upper chamber of the heart.

atrial fibrillation An uncoordinated, irregular contraction of the heart muscle which may orig-

inate in the atria.

atrial flutter An arrhythmia in which the atrial rhythm is regular, but the rate is abnormally

fast.

atrial septal defect (ASD) A hole in the atrium septum that separates the atria of the heart.

atrioventricular (AV) node The electrical connection between the atria and ventricles where electrical

impulses are delayed for a fraction of a second to allow the ventricles to fill

completely with blood.

bacterial endocarditis An infection leading to deformity and/or destruction of the inner layer of the

heart.

beta-blockers Drugs that slow the heart rate and reduce the force of the heartbeat.

blood pressure The force of blood exerted on the inside walls of blood vessels.

blood vessels A network of interconnecting arterial, arterioles, capillaries, venules, and veins

which provide the pathway in which blood is transported between the heart

and body cells.

bradycardia A slow heartbeat, usually less than 60 beats per minute.

Bruce protocol The standardized treadmill stress test used for diagnosing and evaluating

heart and lung diseases.

TERMINOLOGYTERMINOLOGY



Term Meaning

bruit An abnormal heart sound or murmur heard on auscultation.

B-type natriuretic A hormone in the blood made by the heart.

peptide (BNP)

bundle branches Pathways that branch off the bundle of His that help carry the electrical

(right and left) signals of cardiac conduction to the ventricles.

bundle of His Specialized nerve fibers that help carry the electrical signals of cardiac con-

duction to the ventricles.

calcium channel blockers Drugs that inhibit the movement of calcium into the muscle cells of the heart

and arteries, resulting in a decrease in the force of the heart’s pumping action

and the relaxing the muscle cells in the walls of the arteries,which helps them

to open and reduce blood pressure.

capillaries Thin-walled vessels that allow oxygen and nutrients to pass from blood to

tissues.

cardiac arrest A condition that occurs when the heart suddenly stops pumping effectively

and begins to flutter wildly, failing to pump blood to the vital organs of the

body.

cardiac catheterization A procedure using a catheter threaded into the heart chambers that identifies

possible problems with the heart or its arteries.

cardiac conduction The name given to the electrical conduction system that controls the heart

rate.

cardiac cycle The sequence of events of one heartbeat.

cardiac ischemia Another term for coronary artery disease (CAD).

cardiac stress test An exercise test that evaluates the heart for problems that appear when the

heart is working hard.

cardiac tamponade Compression of the heart caused by blood or fluid accumulation in the space

between the myocardium (the muscle of the heart) and the pericardium (the

outer covering sac of the heart).

cardiology The medical specialty dealing with the diagnosis and treatment of diseases

and disorders of the heart.

cardiomyopathy Progressive impairment of the structure and function of the myocardium.

cardiopulmonary Relating to the heart and lungs.

cardiovascular Relating to the heart and blood vessels or circulation.

catheter A small, thin, flexible tube.

chambers The compartments of the heart through which blood flows.

click-murmur syndrome Another term for mitral valve prolapse.

congestion Buildup of fluid in an organ or tissue.

congestive heart failure A condition that occurs when the heart’s weak pumping action causes a

buildup of fluid in the lungs and other body tissues.

coronary angiography The part of the cardiac catheterization procedure in which a dye is inserted

through the catheter to view images of the blood vessels as the heart pumps.

coronary arteries The network of blood vessels that supply oxygen- and nutrient-rich blood

directly to the heart’s muscle tissue.



Term Meaning

coronary artery bypass A surgical procedure in which a section of vein or artery from another part

graft (CABG) of the body is used to bypass a blockage in a coronary artery so that blood

flow is not hindered.

coronary artery disease (CAD) The narrowing of the coronary arteries sufficiently to prevent adequate blood

supply to the heart muscle; also called cardiac ischemia.

C-reactive protein A substance in the blood that is secreted when inflammation in the artery

walls occurs.

creatine kinase (CK) A cardiac enzyme.

creatine phosphokinase (CPK) A cardiac enzyme.

cyanosis A bluish coloration to the skin.

diagonal branches (D1, D2) Lesser coronary vessels that branch off the left coronary artery.

diaphoresis Profuse sweating associated with elevated body temperature, physical exer-

tion, or stress.

diastole The part of the cardiac cycle when blood fills the heart chambers.

diastolic pressure The bottom number in a blood pressure reading which represents the mini-

mum blood pressure as the heart relaxes following a contraction.

dilation Another word for enlargement.

dilated cardiomyopathy Overall enlargement of the heart chambers, especially the ventricles.

diuretics Drugs that act on the kidneys to promote the excretion of excess water in the

body.

Dressler syndrome A delayed form of pericarditis may occur weeks after a heart attack or heart

surgery because of antibody formation.

ductus arteriosus A blood vessel that connects the aorta and pulmonary artery.

dyspnea Shortness of breath.

echocardiogram A test in which ultrasound is used to examine the heart anatomy.

edema An accumulation of abnormal amounts of fluid in the intercellular tissues,

pericardial, sac, and other tissues of the body.

electrocardiogram (EKG, A graphic record of the electrical activity of the heart.

also called ECG)

endocardium The inner layer of the heart wall.

epicardium The outer layer of the heart wall.

fibrillation An uncoordinated, irregular contraction of the heart muscle.

fluoroscopy A continuous x-ray beam that is passed through a body part being examined

then transmitted to a TV-like monitor so that the body part and its motion can

be seen in detail.

graft A section of vein or artery from another part of the body transplanted to

another part of the body.

gamma camera A special scanning camera used during a stress test that takes pictures as thal-

lium mixes with the blood in the bloodstream and heart’s arteries and enters

heart muscle cells.

greater saphenous vein A large subcutaneous vein located in the leg and thigh.



Term Meaning

heart block An impaired conduction of the heart’s electrical impulses, leading to a slow

heartbeat.

heart failure A condition in which the heart muscle does not pump the way it should.

heart sounds The sounds associated with the heartbeat.

heartbeat An electrical impulse from the heart muscle.

heart-lung machine A machine that provides circulation and oxygenates the blood while the heart

is stopped during a coronary bypass procedure.

high-density lipoprotein A type of cholesterol known as good cholesterol.

(HDL)

homocysteine An amino acid used in cardiac risk factor testing.

hypertension A condition in which the pressure of the blood in the arteries is too high; also

called high blood pressure.

hypertrophic cardiomyopathy Overgrowth of the heart muscle that can impair blow flood in and out of the

heart.

hypertrophy A term meaning increase in size or thickening.

inferior vena cava The major vein that carries blood from the lower body to the right atrium.

leads Electrodes on an EKG/ECG machine used to measure electrical impulses of

the heart.

leaflets Flaps in the valves that regulate blood flow from the heart.

left anterior descending A smaller artery that branches off the left main coronary artery.

artery (LAD)

left circumflex artery (LCA) A smaller artery that branches off the left main coronary artery.

left coronary artery (LCA) A major coronary artery in the heart.

left internal mammary A vessel located on the left side of the chest wall.

artery (LIMA)

left main coronary The initial segment of the left coronary artery.

lipoprotein (a) A biochemical in the body measured in cardiac risk factor testing.

low-density lipoprotein (LDL) A type of cholesterol known as bad cholesterol.

lub-dub The normal sound of a heartbeat.

metabolic equivalents (METS) The measurement of aerobic exercise capacity.

millimeters of mercury A unit used to measure blood pressure.

(mmHg)

mitral valve The incoming valve of the left ventricle.

mitral valve prolapse An abnormality of the mitral valves in which one or both mitral valve flaps

close incompletely.

multiple gated acquisition A test that uses technetium to evaluate the function of the heart’s ventricles.

scan (MUGA)

murmurs Abnormal heart sounds.

myocardial band enzymes of A cardiac enzyme found in the cells of the heart.

creatine phosphokinase

(CK-MB)



Term Meaning

myocardial band enzymes of A cardiac enzyme found in the cells of the heart.

creatine phosphokinase

(CPK-MB)

myocardial infarction (MI) Another term for heart attack.

myocardium The middle layer of the heart wall.

nitrates A type of medication that relieves chest pain by dilating blood vessels.

nocturnal Pertaining to the hours of darkness or night.

nuclear scan A scan that shows areas of the heart that may lack blood flow.

obtuse marginals (OM1, OM2) Lesser coronary vessels that branch off the left coronary artery.

orthopnea Breathing difficulty while lying down.

pallor A paleness or decrease or absence of color in the skin.

paroxysmal Pertaining to the sudden onset of a symptom.

paroxysmal atrial tachycardia A rapid heart rate that start and stops suddenly and unpredictably.

paroxysmal nocturnal Difficulty breathing, experienced when lying down, which is caused by lung

dyspnea (PND) congestion that results from partial heart failure and occurring suddenly

at night.

patent Another word for open.

patent ductus arteriosis (PDA) A condition in which there is abnormal circulation of blood between the

aorta and pulmonary artery.

percutaneous transluminal A procedure that opens narrowed arteries by using a catheter with a balloon

coronary angioplasty (PTCA) on its tip; also referred to as angioplasty.

pericardectomy The surgical removal of the portion of pericardium that has become rigid,

compromising the function of the heart.

pericardial effusion A condition in which fluid accumulates in the pericardial sac.

pericardial window Another term for pericardiocentesis.

pericardiocentesis The drainage of excess fluid from the pericardial cavity with a catheter.

pericarditis An inflammation of the pericardium.

pericardium A double-layered membrane that surrounds the heart like a sac.

plaques Fatty deposits that build up in the coronary arteries.

posterior descending The main branch off the right coronary artery.

artery (PDA)

premature atrial contraction An extra heartbeat that originates from the atria before it should.

primary hypertension A form of hypertension in which there is no identifiable cause.

pulmonary stenosis A condition of obstructed outflow of blood from the right ventricle to the

lungs

pulmonary artery The blood vessel that takes blood from the heart to the lungs.

pulmonary valve The outgoing valve of the right ventricle.

pulmonary veins The vessels responsible for carrying blood from the lungs to the heart.

Purkinje fibers A specialized nerve fiber that helps carry the electrical signals of cardiac con-

duction to the ventricles.



Term Meaning

regurgitation Leaking or backward flow.

restrictive cardiomyopathy A disorder in which the ventricles become stiff but not necessarily thick-

ened, and do not fill with blood normally between heartbeats.

right coronary artery (RCA) A major coronary artery in the heart.

right internal mammary A vessel located on the right side of the chest wall.

artery (RIMA)

right ventricular hypertrophy An abnormal enlargement of the right ventricle.

saphenous vein graft The harvested vein used in a coronary artery bypass graft (CABG) procedure.

secondary hypertension A form of hypertension in which another disease or medication is the cause.

sinoatrial (SA) node A specialized cluster of cells in the heart that initiates the heartbeat.

sinus rhythm A normal cardiac rhythm.

sphygmomanometer An instrument that measures blood pressure.

stenosis Narrowing of a blood vessel.

stent A mesh-like metal tube placed in an artery to keep it open.

sternum The breast bone.

superior vena cava The major vein that carries blood from the upper body to the right atrium.

systole The part of the cardiac cycle in which the heart muscle contracts, forcing

the blood into the main blood vessels.

systolic pressure The top number in a blood pressure reading which represents the maximum

pressure in the arteries as the heart contracts.

tachycardia A resting heart rate of greater than 100 beats per minute.

technetium A radioactive isotope used to reveal abnormalities in the heart wall.

tetralogy of Fallot A condition that causes too little oxygen levels in the blood.

thallium Radioactive material that is injected into a vein to show damaged areas of

heart muscle.

thrombolysis in myocardial A grading system (grade 0 to 3) that evaluates reperfusion of blood flow

infarction (TIMI) achieved by thrombolytic therapy in a patient with myocardial infarction.

transposition of the great A condition in which the location of the aorta and pulmonary artery is

vessels switched.

treadmill stress test Another term for cardiac stress test.

tricuspid valve The incoming valve of the right ventricle.

troponin A cardiac enzyme found in the cells of the heart.

valve In the heart, the structures that open and close with each heartbeat to

ensure the proper sequence of blood flow through the heart.

veins Larger vessels that carry oxygen-poor blood back to the heart.

ventricles The lower chambers of the heart which collect blood from the right and left

atria and pump it out of the heart.

ventricular fibrillation An uncoordinated, irregular contraction of the heart muscle which may orig-

inate in the ventricles.

ventricular septal A hole in the wall that separates the ventricles of the heart.

defect (VSD)



Term Meaning

venules Small vessels that gather blood from the capillaries; these venules, in turn,

drain into the larger veins that carry deoxygenated blood back to the heart.

waveform The visual representation of each electrical impulse detected by leads during

an EKG/ECG.

Add Your Own Terms and Definitions Here:



REVIEW QUESTIONS

1. Describe the four chambers of the heart and the purpose of each.2. Name the three layers of the heart wall.3. Why is the heart considered to be double pump?4. Explain the difference between diastole and systole.5. What is the difference between primary hypertension and secondary hypertension?6. What is a congenital heart disorder?7. What is the role of a stent in an angioplasty procedure?8. Name the three vessels that can be used as a graft in a coronary artery bypass procedure.9. How are diuretics used to lower blood pressure?

10. Name the four valves of the heart and where they are located.

CHAPTER ACTIVITIES

Soundalike Word Choice

Circle the correct word in the following sentences.

1. Her laboratory data reflected a (BMP, BNP) of 47.5.2. (Cor, Cord): Regular rate and rhythm with no murmurs.3. His next exam revealed faint (brutes, bruits) on the right.4. Nitroglycerin is a kind of (nitrate, nitrite) medication.5. The patient was diagnosed a year ago with a non-Q-wave myocardial (infraction, infarction).6. The echocardiogram was normal with an (ejection, infection) fraction of 70%.7. Today the patient states he is doing quite well without any complaints of dyspnea on exer-

tion (PND, PMD) or orthopnea.8. Her lipid profile is satisfactory with normal total cholesterol, triglycerides, (HGL, HDL)

and (LGL, LDL).9. The cardiologist performed an angioplasty with placement of a (stent, stint) in the right

coronary artery.10. (Carbonate, Calcium) channel blockers decrease the heart’s pumping strength to help

lower blood pressure.

Creating Cardiology Words

Search for and combine the following prefixes, suffixes, and combining forms in the table below to cre-ate medical word that best fit the definition. Verify the spelling of the word you create with a medicaldictionary. The first answer is provided for you.

tachy- -gram electr/o

scler/o -osis peri-

-ia card/i, cardi/o rhythm/o

angi/o cyan/o brady-

a- -ic -itis

-plasty end/o -logy

ather/o nas/o -ism

1. Inflammation of the endocardium. endocarditis 2. Abnormally rapid heart rate. 3. A graphic trace of heart function. 4. Inflammation of the pericardium. 5. The study of the heart.



6. Abnormally slow heart rate.7. Relating to turning blue. 8. Hardening of the arteries.9. Abnormal heart rhythm.

10. Surgical recanalization or dilation a blood vessel.

Fill in the Blanks

Fill in the blanks with the correct terms.

1. What is the abbreviation for myocardial infarction?2. Name the medical specialty dealing with the heart.3. Which atrium receives blood from the body?4. What is the adjectival form of the word ventricle?5. What is the abbreviation for electrocardiogram?6. Which chamber contains the tricuspid valve?7. What is a normal heart rate called?8. Which test uses exercise to evaluate the heart?9. What is a leakage of blood back through a valve called?

10. What condition is referred to as a hole in the heart?

Combining Forms Practice

For each of the following terms, choose the correct combining form that corresponds to the meaninggiven:

1. vein van/o ven/o vein/i2. pulse sphygm/o angi/o atri/o3. blue valv/o ventricul/o cyan/o4. oxygen ox/o phleb/o steth/o5. chest arteri/o steth/o vas/o6. vessel ven/o vascul/o thromb/o7. aorta rhythm/o angi/o aort/o8. fatty plaque ather/o ven/o pericardi/o9. muscle vas/o my/o coron/o

10. heart cardi/o aort/o sphygm/o

Matching

Match the following abbreviations on the left with their corresponding meanings on the right.

1. ________ EKG a. A hole in the heart.

2. ________ PTCA b. Heart attack.

3. ________ ASD c. Drug used to prevent formation of angiotensin-II.

4. ________ RCA d. Graph of the electrical activity of the heart.

5. ________ CHF e. A vessel in the chest wall used as a graft.

6. ________ CABG f. A cardiac enzyme.

7. ________ MI g. Good cholesterol.

8. ________ HDL h. Buildup of fluid in lungs or body tissues.

9. ________ ACE i. Another name for an angioplasty procedure.

10. ________ BNP j. A graft from the vein in the thigh and leg.

11. ________ LIMA k. A test that uses technetium to evaluate the ventricles.

12. ________ SVG l. Bad cholesterol.

13. ________ LDL m. A hormone made by the heart.

14. ________ CK n. A major coronary artery.

15. ________ MUGA o. Cardiac bypass surgery.



TRANSCRIPTION PRACTICE

Open your word-processing software. Insert the student CD-ROM and locate the dictation forthis chapter. For each of the words in the “listen for these terms” list for each report, use a med-ical dictionary or other resources to identify and write down a brief definition of the term ona separate sheet of paper to attach with your work. Then listen to the dictation and transcribeeach report. Use the current date for each report where a date is indicated. Insert a heading intothe document if the text falls to a second page.

At the end of each report, indicate the name of the dictating physician under the signature lineand insert reference initials. For date dictated and transcribed and date of admission, use thecurrent date. Proofread your work, print one copy for your instructor along with your term def-initions, and save the completed report to your student disk.

Report #T11.1: Clinic NotePatient Name: Joseph WatsonMedical Record No.: WAT-34499Attending Physician: Lena Kushner, MD

Listen for these terms:percutaneousluminaldobutamineorthostatic hypotensionjugular venous pressurePMIhydrochlorothiazideisosorbide

Report #T11.2: Operative ReportPatient Name: Maria FigueroaMedical Record No.: 80345112Attending Surgeon: Andrea Biggs, MDAssistant: Michael Hubbard, MD

Listen for these terms:cardiopulmonary arrestpacing wirespressorsCordis (stent)Swan-Ganz catheter

Report #T11.3: Consultation LetterPatient Name: Larry JonesMedical Record No.: J-74901Attending Physician: Andrea Biggs, MDRequesting Physician: Priti Chawla, MD

Listen for these terms:goutcholecystectomysickle cell diseasescleral icterusapical murmur



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11 Cardiology

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