- Common pulse sites.

Common pulse sites

The pulse may be palpated in any place that allows an artery to be compressed against a bone. 

In Upper limb:

• Axillary pulse: located inferiorly of the lateral wall of the axilla 
• Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery).
• Radial pulse: located on the lateral of the wrist (radial artery). 
• Ulnar pulse: located on the medial of the wrist (ulnar artery).

In Lower limb:

• Femoral pulse: located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine (femoral artery).
• Popliteal pulse: Above the knee in the popliteal fossa, found by holding the bent knee. The patient bends the knee at approximately 124°, and the physician holds it in both hands to find the popliteal artery in the pit behind the knee (Popliteal artery).
• Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus (dorsalis pedis artery).
• Tibialis posterior pulse: located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the medial malleolus (posterior tibial artery). It is easily palpable over Pimenta's Point.

- Importance of ECG (EKG).

Importance of ECG (EKG).

• The Electrocardiogram (ECG or EKG) is a graph that records the electrical activity of the heart.
• The ECG records these electrical cardiac currents (voltages,potentials) by means of metal electrodes placed on the surface of the body.

- 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.