- ECG (EKG) Paper.

ECG Paper.

The output of an ECG recorder is a tracing on a graph or a standard  paper  traveling at a rate of 25 mm/s.

This paper is divided into large squares and each large square is divided into small squares

Time is represented on the x-axis, and voltage, or amplitude is represented on the y-axis.

- Precipitating factors of Heart Failure.

Precipitating factors of Heart Failure. 

There are multiple factors Precipitating Heart Failure in already diseased Heart.

"HEART FAILED"

-Ischemic heart and arm pain!

Ischemic heart and arm pain!

You must remember that cardiac ischemic pain may present with shoulder,arm, or forearm pain unassociated with chest comfort..

Local symptoms that aren't affected by movement or palpation of the arm should suggest remote cause e.g cervical spine or Ischemic heart disease.

- Classification of Blood Pressure for Adults According AHA.

Classification of Blood Pressure for Adults According to American Heart Association. 

-Some Tricks in history taking of cardiac patient.

Some Tricks in history taking of cardiac patient.

 Rapidly assess the patient to determine whether the patient in acute distress or life threatening condition which need immediate action , then a comprehensive history is taken.

- Classification of Blood Pressure for Adults JNC 7

Classification of Blood Pressure for Adults According Joint National Committee 7

- Reading Music and ECG.

Some people have compared learning to read EKGs with learning to read music.

In both instances, one is faced with a completely new system not rooted in conventional language and full of unfamiliar shapes and symbols.

But there really is no comparison. The simple lub-dub of the heart cannot approach the subtle complexity of a Beethoven string quartet, the multiplying tonalities and rhythms of Stravinsky's Rite of Spring, or even the artless salvos of a rock-and-roll band. 

Source: Only EKG Book You'll Ever Need,,Thaler, Malcolm S. The 5th Edition, p.g 4

- Blood Pressure and Mean Arterial Pressure.

Blood Pressure and Mean Arterial Pressure

Blood pressure (BP) or "arterial blood pressure"  is the pressure exerted by circulating blood upon the walls of blood vessels.

It  is one of the principal vital signs.

During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure.

The blood pressure in the circulation is principally due to the pumping action of the heart. (1)

Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of mean blood flow depends on the resistance to flow presented by the blood vessels.

Mean blood pressure decreases as the circulating blood moves away from the heart through arteries and capillaries due to viscous losses of energy.

- Congestive Heart Failure Animation.

Congestive Heart Failure Animation

- Cardiac output.

 Cardiac output

Cardiac output: is the volume of blood being pumped by the heart in one minute.

Cardiac output = Stroke Volume × Heart rate.

Cardiac output is usually expressed in liters/minute.

 Cardiac output is changed by change of heart rate and stroke volume.

- Pressure Reflexes and Mean Arterial Pressure.

Pressure Reflexes and Mean Arterial Pressure.  

When Mean Arterial Pressure rises Baroreceptors fire, signal goes to the medulla, parasympathetic activity goes up, Sympathetic Activity goes down, which ends up resulting in an decrease in cardiac output and peripheral resistance and so decrease Mean Arterial Pressure.

- Cardiac Cycle.

Cardiac Cycle.

The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. (1)

A single cycle of cardiac activity can be divided into two basic phases - diastole and systole.

- Isovolumetric Contraction.

Isovolumetric Contraction  

This video talks about the isovolumetric contraction of the ventricles.

- Regulating Stroke Volume.

Regulating Stroke Volume

There are three primary mechanisms that regulate EDV and ESV, and therefore SV.

- What Stroke Volume is and How to Calculate it?

What Stroke Volume is and How to Calculate it?  

This video talks about what stroke Volume is,the difference between end diastolic volume and end systolic volume.


Ventricular stroke volume (SV) is the difference between the ventricular end-diastolic volume (EDV) and the end-systolic volume (ESV).

- Normal shape and Waves in ECG/EKG

Normal shape and Waves in ECG/EKG  

• P wave: represents depolarization of the atrial muscle.
• QRS complex : represents depolarization of both ventricles.
• T wave: return of the ventricular mass to its resting electrical state "repolarization"
• U wave: repolarization of the papillary muscles.

-Action Potentials and Contraction in Cardiac Muscle Cells

Action Potentials and Contraction in Cardiac Muscle Cells 

This videos shows how the Action potential is generated in cardiac muscle cells and how this results in Contraction of the Heart.

 When the action potential happens, calcium ions are released from the Sarcoplasmic reticulum, causing the plateau.

 Calcium ions then trigger muscle contraction.

- How Adrenaline and Acetylcholine Affect Heart Rate?

How Adrenaline and Acetylcholine Affect Heart Rate?  
This video discusses the effect of Adrenaline and Acetylcholine on heart rate.

- How Blood Flows Through the Heart.

How Blood Flows Through the Heart.  

This video explans the process of how blood flows through the heart.

It shows blood entering via the vena cave to the Right atrium, then getting pumped into the right ventricle, to the pulmonary vein to the lungs, to the left atria, left ventricle and then via the aorta to the rest of the body.

- Net Hydrostatic Pressure and Filtration Pressure.

Net Hydrostatic Pressure and Filtration Pressure  

This video explains what Net Hydrostatic pressure is and how to calculate it.

Also shows how filtration pressure is determined by Net Hydrostatic Pressure and Osmotic pressure.

Lastly, it shows how High Blood Pressure can lead to Edema...

 Enjoy!

- Permanent Pacemaker implanation Animation (2).

Permanent Pacemaker implanation Animation.  

- Temporary Transvenous Pacemaker Review.

Temporary Transvenous Pacemaker Review.

 This video Descripes basics of temporary transvenous pacemaker insertion..

- Permenant Pacemaker implantation animation (1).

Permenant Pacemaker implantation animation.

 

- The Pacemaker Potential of the SA Node and the AV Node.

The Pacemaker Potential of the SA Node and the AV Node  

- Permenant Pacemaker Placement.

Permenant Pacemaker Placement.  

This Animation discusses what happens during a Permenant pacemaker placement.

- Insertion of Transvenous Pacemaker.

Insertion of Transvenous Pacemaker.

Learn how to insert Transvenous temporary Pacemaker.

- Avoiding Problems with Temporary Cardiac Pacing.

Avoiding Problems with Temporary Cardiac Pacing.  

- Permanent Pacemaker implanation animation.

Permanent Pacemaker implanation animation.  

- How to use the transvenous pacemaker?

How to use the transvenous pacemaker ?

This is short video explaning How to use the transvenous temporary pacemaker.

- Temporary cardiac Pacemakers.

Temporary cardiac Pacemakers.

Temporary Pacemakers may be:-

1. Epicardial pacing:- is used during open heart surgery when the surgical procedure create atrio ventricular block. The electrodes are placed in contact with the outer wall of the ventricle (epicardium) to maintain satisfactory cardiac output until a temporary transvenous electrode has been inserted.
2. Transvenous pacing:- Temporary transvenous pacing involves two components, ie obtaining central venous access and intracardiac placement of the pacing wire.A pacemaker wire is placed into a vein (internal jugular vein , subclavian or femoral veins) under sterile conditions, and then passed into the right atrium then right ventricle. The pacing wire is then connected to an external pacemaker outside the body. Transvenous pacing is often used as a bridge to permanent pacemaker placement. It can be kept in place until a permanent pacemaker is implanted or until there is no longer a need for a pacemaker and then it is removed. Transvenous pacing usually done under imaging for proper positioning of the electrodes.

- Artificial cardiac pacemaker.

Artificial cardiac pacemaker.

It is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart so it mimics the action of your natural pacemaker..

Pacemakers can be temporary (here) or permanent.

Pacemaker consists of two parts:

1. The pulse generator: This small metal container houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart.
2.  Leads: These flexible, insulated wires deliver the electrical pulses to your heart.

Pacemakers monitor your heartbeat and, if it's too slow, the pacemaker will speed up your heart rate by sending electrical signals to your heart. In addition, most pacemakers have sensors that detect body motion or breathing rate, which signals the pacemaker to increase your heart rate during exercise to meet your body's increased need for blood and oxygen. 

Dr Ibrahim Samaha

- 2010 Guidelines for CPR

2010 Guidelines for CPR

- Baby CPR.

Baby CPR

.

-Child CPR.

Child CPR

Note that the main difference between the adult CPR and child CPR is the intial 5 breaths and the usage of one hand if the child is small in size.

- How to perform CPR on adults.

- How to perform CPR on adults

- The Chain of Survival.

 The Chain of Survival.

The series of actions linking the victim of sudden cardiac arrest with survival are called the "Chain of Survival".

All four links of the chain must be strong.

- Vegetations On Mitral Valve.

Vegetations On Mitral Valve.

Vegetations On Mitral Valve seen by portable echo in 18 years old Egyptian female with mitral regurgitation..Complaining of Fever,had CS 15 days ago..
With pansystolic murmur heard maximally over the apex of the heart.

This  Diagnosing a case of "Infective Endocarditis"

 Dr Ibrahim

- Types of ST segment depression in ECG.

Types of ST segment depression in ECG.

•  ST segment take 2-3 small squares from "J" point where "S" wave ends..
• "J" point is small square after "R" wave when "s" wave not found.
•  ST depression is significant if it is more than small square below the isoelectric line.

*There are three types of ST depression:

- Recording a 12 Lead ECG.

Recording a 12 Lead ECG.






This film is designed to give clinical students and professionals an insight into the procedure.

- Contents of Posterior mediastinum.

Contents of Posterior mediastinum:

  "DATES"

•  Descending aorta
•  Azygos and hemiazygous veins
•  Thoracic duct
•  Esophagus
•  Sympathetic trunk/ganglia

- Captopril side effects.

Captopril side effects (an ACE inhibitor)

 "CAPTOPRIL"

• Cough
• Angioedema/ Agranulocystosis
• Proteinuria/ Potassium excess
• Taste changes
• Orthostatic hypotension
• Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
• Renal failure (and renal artery stenosis contraindication)/ Rash
• Indomethacin inhibition
• Leukopenia/ Liver toxicity

- Beck's triad of cardiac temponade.

Beck's triad of cardiac temponade:-

1. Decrease of systolic blood pressure.
2. Distended jugular vein.
3. Diminished heart sounds (quite heart).

- Parasites affecting Heart.

Parasites affecting Heart

"Heart Team" 

Heterophyes heterophyes (Eggs)

Taenia solium (cysticercosis), 
Trichinella spiralis (Trichina capsule),
Trypanosoma cruzi (Leishmanial form),
Toxoplasma gondii (true tissue cyst).

Echinococcus granulosus (Hydatid cyst).
Acanthocheilonema perstans (Adult worm in the pericardium).
Mansonella ozzardi (Adult worm in the pericardium).

or  Arabic students can use the word "Hatem"

Dr Ibrahim

-No in ASD.

No in Atrial septal defect.

• No murmur due to ASD itself but murmur of relative MS,PS.
• No ACEIs if HF occur but give diuretics and digitalis.
• No spontanous closure of ASD.
• No symptoms or signs in small ASD.

Dr Ibrahim

-Complications of Tetralogy of fallot.

Complications of Tetralogy of fallot collected in the word..

 "Inches" 

• Infective endocarditis,Low I.Q.
• Neurological (e.g Brain abscess,cerebrovascular accidents)
• Cyanotic spell,Clubbing.
• Hematological(e.g polycythemia,IDA,Thrombosis).
• Hyperuracemia and gout,Heart Failure (rare).
• Exercise intolerance.
• Squatting,Scoliosis,Stunted growth.

  Dr Ibrahim

- Painless myocardial infarction!

Causes of Painless myocardial infarction!

 "diet"

• Dyspnea,DM
• Impaired consciousness (e.g. coma or under anesthesia).
• Elderly.
• Transplanted heart.

Dr Ibrahim,,

- Emergency in mitral stenosis!

Emergency in mitral stenosis!

Mitral stenosis may came to ER with complications which need urgent interference..collected in the word "Chart"..

• Cardiac asthma (Acute pulmonary edema)
• Haemoptysis
• Atrial fibrillation.
• Rheumatic activity.
• Thromboembolic complications e.g stroke.

Dr Ibrahim,,

- Atrial Fibrillation: Cardioversion - animation.

Atrial Fibrillation: Cardioversion (animation.)

- Cardiovascular Examination video.

The cardiovascular examination: narrated and illustrated.  

• Introduction.
• general examination.
• pericordial examination.
• final consideration.

- Peripheral Signs of Infective Endocarditis.

Peripheral Signs of Infective Endocarditis.

1-Roth’s spots: Oval shaped, white centered hemorrhages present on the retina of some patients with infective endocarditis on the funduscopic examinations.

(From the collection of Sanjay Sharma, St George’s University of London, UK) 

NB: Roth's spots, or white-centered retinal hemorrhages, may be seen in a variety of conditions, including: leukemia, subacute bacterial endocarditis, ischemic events associated with elevated venous pressure, and systemic vascular conditions with capillary fragility.

- Talley's Cardiovascular examination.

Talley's Cardiovascular examination.

- Heart Anatomy Animated Video..

Heart Anatomy Animated Video..

A Doctor walks you through an animated video about the amazing human heart.

- Quick facts about heart anatomy and physiology.

Quick facts about heart anatomy and physiology.

• Your heart is located between your lungs in the middle of your chest, immediately behind and slightly to the left of your sternum.
• In this location, it is protected by the sternum  in front, the spinal column in back, and the ribs and lungs on the sides.
•  It weighs approximately 250 to 300 grams (9 to 11 oz) in females and 300 to 350 grams (11 to 12 oz) in males.(1)
• The heart is about the size of a human fist.
• The pericardium is a double-walled sac containing the heart and the roots of the great vessels. Pericardium is a tough double layered membrane which covers the heart. The space between the two layers of it is filled with a pericardium fluid which protects the heart from any kind of external trauma..the outermost fibrous pericardium and the inner serous pericardium.
• The heart actually pumps blood through two very distinct circulatory systems  ... Systemic system and Pulmonary system..
• The systemic system is the system in which fresh oxygenated blood pumps out through the arteries and in which deoxygenated blood returns to the heart through the veins.
• The pulmonary system is the system  in which Deoxygenated blood is pumped out of the heart through the pulmonary arteries into the lungs, and recharged oxygenated blood returns to the heart through the pulmonary veins. It is this recharged oxygenated blood that gets pumped out through the systemic circulatory system..
• The only veins which carry oxygenated blood are the 4 pulmonary veins.
• The only artery which carry deoxygenated blood is the pulmonary artery.

*References:- 

(1)Kumar, Abbas, Fausto: Robbins and Cotran Pathologic Basis of Disease, 7th Ed. p. 556

- Conductive system of the Heart.

Conductive system of the Heart.

The Function of the heart is to contract rhythmically and pump blood to the lungs for oxygenation and then to pump this oxygenated blood into the general (systemic) circulation.

The signal for cardiac contraction is the spread of electrical currents through the heart muscle.
 
In normal Conditions, these electrical currents are produced by  pacemaker cells of the Sinoatrial node (SAN), located on top of the right atrium near the opening of the superior vena cava at a rate of 100 per minute.

- Basics Of Electrocardiography Part-2.

Basics Of Electrocardiography Part-2.

- Basics of Electrocardiography Part-1.

Basics of Electrocardiography Part-1.

- Basics Of Echocardiography Part-2 (series-2).

Basics Of Echocardiography Part-2

(series-2).

- Basics Of Echocardiography Part-1(series-2).

Basics Of Echocardiography Part-1

(series-2)

- Basics Of Echocardiography Part-2(series-1).

Basics Of Echocardiography Part-2

(series-1)

- Basics Of Echocardiography Part-1(series-1)

Basics Of Echocardiography Part-1

(series-1)

-Paramedic Intern quick Cardiac Examination.

Paramedic Intern quick Cardiac Examination.

Pro EMS Center for MEDICS, Cambridge, Massachusetts Paramedic Intern Smith performs a quick cardiac examination on her patient..

• Inspection.
• Palpation.
• Auscultation.

-causes of Inequality in the amplitude of the peripheral pulses.

Inequality in the amplitude of the peripheral pulses may result from:

1. Obstructive arterial diseases, most commonly atherosclerosis
2. Aortic dissection 
3. Aortic aneurysm
4. Takayasu disease
5. Coarctation of the aorta
6. Supravalvular aortic stenosis in which the right carotid, brachial, and radial pulses are larger in amplitude and volume than those on the left side because of the preferential streaming of the jet toward the innominate artery.

- Heart.

The human heart is a myogenic muscular organ,which pumps blood throughout the blood vessels by repeated, rhythmic contractions.

The heart is principally composed of cardiac muscle and connective tissue. Cardiac muscle is an involuntary striated muscle tissue found only in this organ and responsible for the ability of the heart to pump blood.

Heart rate:- is the number of heartbeats per unit of time, typically expressed as beats per minute (bpm). 

Heart Structure

The heart is made of four chambers, and blood flows through them in order:
 right atria>> right ventricle>> left atria>> left ventricle.

Between the right and left sides, though, the blood goes through the lungs to exchange carbon dioxide it collected in the body for oxygen it can carry to the body.

Blood enters the right atria from the venous system, and exits the left ventricle through the aorta into the arterial system.

Blood flows from the atrium to the ventricle during a heart beat based on the synchronous contraction of the heart muscle. Between each atrium and ventricle, there is a valve.

Valves are also found where the heart and aorta, and heart and pulmonary artery meet.

 Heart valves:

1. Tricuspid valve - separates the right atrium and ventricle.
2. Pulmonary valve - separates the right side of the heart from the pulmonary circulation.
3. Mitral valve - separates the left atrium and ventricle.
4. Aortic valve - separates the left side of the heart and the aorta.

The wall of the human heart is composed of three layers: (1,2)

1. The outer layer is called the epicardium, or visceral pericardium since it is also the inner wall of the pericardium.
2. The middle layer is called the myocardium and is composed of cardiac muscle which contracts.
3. The inner layer is called the endocardium and is in contact with the blood that the heart pumps.Also, it merges with the inner lining (endothelium) of blood vessels and covers heart valves.

*References:

1. Pratiyogita Darpan (April 2009). Competition Science Vision. Pratiyogita Darpan. pp. 55–. Retrieved 7 June 2012. 
2. "Heart". MedicaLook. Medicalook.com. Retrieved 2010-05-03

- Normal pulse rates according to age.

 Normal pulse rates at rest, in beats per minute (BPM):(1)

• newborn (0—3 months old)>> 100-150 BPM
• infants (3 — 6 months) >>  90–120 BPM
• infants (6 — 12 months) >> 80-120 BPM
• children (1 — 10 years) >> 70–130 BPM
• children over 10 years and adults, including seniors >> 60–100 BPM
• well-trained adult athletes >>   40–60 BPM

 

References:

 (1)U.S. Department of Health and Human Services - National Institutes of Health.

- How your heart works? Cardiac Cycle.

How your heart works?
Cardiac Cycle.

Have you heard your heart beat?

What is the sound like? Yes, it sounds like 'lubb-dubb', 'lubb-dubb'! 

This sound is produced when the heart produces a pressure when it beats.

Now, what causes the beating of the heart? The sequence of events that take place during a single heart beat is known as the Cardiac Cycle. It is not so simple. It is a complex process which involves a sequence of activities and that too within 0.8 sec.

- Heart Failure: Causes Treatments and Living Well.

Heart Failure: Causes Treatments and Living Well

Dana McGlothlin, MD, examines innovative strategies for coping with and treating heart failure.

- Cardiology.

Cardiology is a medical specialty dealing with disorders of the heart (specifically the human heart).

The field includes medical diagnosis and treatment of :

1. congenital heart defects
2. Disorders of the coronary circulation.
3. Disorders of the myocardium.
4. Disorders of the pericardium.
5. valvular heart disease.
6. Diseases of blood vessels (vascular diseases).
7. electrophysiology (electrical properties and conduction diseases of the heart). 

Physicians who specialize in this field of medicine are called cardiologists.