Basic Heart Anatomy and Function (11:54)
Cathy Lockett introduces herself and goes over the lecture schedule. She explains the following terms: endocardium, myocardium, epicardium, STEMI, pericardial sac, pericarditis, depolarization, repolarization, sinus node, relative refractory period, R-on-T phenomenon, automaticity, and action potential.
Conduction System in the Heart (09:34)
Lockett shows an animation of an impulse initiated in the atrium traveling through the heart and explains how to read an EKG strip, including determining ST segment elevation or depression. Learn about bundle branch blocks.
QRS Patterns and QT Interval (14:03)
Lockett explains normal Q, R, and S waves; pathological Q waves indicating dead heart tissue; normal and long QT intervals; QTc; and Bazett's formula. Hear how to determine left or right bundle branch blocks in V1.
Reading a Rhythm Strip (07:08)
Lockett covers how to interpret an EKG, including calculating heart rate with a six second strip and by counting and dividing squares into 1,500.
Sinus Bradycardia (08:20)
Hear how to identify sinus bradycardia on a rhythm strip. Learn about causes and treatments with atropine, transcutaneous pacing, and epinephrine or dopamine continuous infusion.
Escape Rhythms (12:14)
Lockett explains how to identify junctional and ventricular escape rhythms on a rhythm strip. Idioventricular rhythms occur when only Purkinje Fibers conduct. Learn about causes, including sick sinus syndrome and medications. Treatments include atropine, pacing, and epinephrine or dopamine infusions.
Heart Blocks (32:05)
Lockett goes over how to identify first, second and third degree heart blocks on a rhythm strip. Long PR intervals prolong heart sounds S1 and S2 and eventually drop a beat, causing the Wenckebach phenomenon. Hear causes and treatments.
Sinus Tachycardia and Supraventricular Tachycardia (16:23)
Lockett explains how to identify sinus tachycardia on a rhythm strip; hear causes and corresponding treatments. SVT includes atrial tachycardia, junctional tachycardia, or AV nodal reentry tachycardia; hear symptoms, causes and treatments.
Atrial Fibrillation (14:06)
Lockett explains how to identify atrial fibrillation on a rhythm strip. Categories include paroxysmal, persistent, longstanding, permanent, and nonvalvular. It can reduce cardiac output and cause clot formation. Learn about strict and lenient heart rate control. Treatment includes cardioversion, medications, and radiofrequency ablation.
Atrial Flutter (14:11)
Lockett distinguishes atrial flutter from fibrillation and explains how to identify it on a rhythm strip. The vena cavotricuspid isthmus in the right atrium causes Type 1 atrial flutter; hear causes and treatments and learn about the Lewis Lead.
Ventricular Arrhythmias (11:06)
Lockett explains how to identify monomorphic ventricular tachycardia, Torsades de pointes, and ventricular fibrillation on a rhythm strip. Hear causes and treatments for each condition.
Coronary Artery Perfusion (10:36)
Lockett discusses the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery. Learn about conditions caused by occlusions to each, and what it means to be left or right coronary artery dominant.
Lead Placement (11:39)
Lockett provides a history of EKG monitoring and explains frontal plane leads 1-3 and AVR, AVL, and AVF. High lateral leads look at the left ventricle. Inferior leads look at the right coronary RCA. Learn about V lead 1-6 placement.
Right Ventricular and Posterior Lead Placement (15:10)
Lockett explains the R wave progression. Learn about moving the V4 wire to identify a right ventricular STEMI and placing V leads 7-9 to identify a posterior STEMI using the rule of three. Lockett discusses ST depression and STEMI reciprocal changes.
Coronary Artery EKG Review (01:47)
Hear complications from and EKG leads corresponding to RCA occlusion, posterior STEMI, right ventricular STEMI, anteroseptal STEMI, and lateral STEMI.
Axis Conduction (08:38)
Using leads 1 and AVF to divide the heart into four quadrants and the "thumbs" tool, Lockett explains right axis deviation, abnormal left axis, and indeterminate axis or extreme right axis.
Axis Variants (07:26)
Lockett discusses axis deviations for right and left ventricular hypertrophies, left posterior hemiblocks, left anterior hemiblocks, left ventricle lateral MI, inferior MI, WPW syndrome and hyperkalemia, and right and left bundle branch blocks. Learn about normal pacemaker function.
Acute Coronary Syndrome (09:36)
Acute coronary syndrome can include STEMI, non-STEMI or unstable angina. Lockett explains stable and unstable plaques, and typical and atypical angina symptoms. Hear how to identify an NSTEMI on an EKG.
Patient Risk Stratification (03:32)
An NSTEMI has cardiac enzymes; unstable angina does not. Non-specific ST segment T wave changes means slight ST depression and T wave inversion. Lockett explains how to use the Heart Score to predict a major adverse coronary event.
Ischemic Changes on a Rhythm Strip (09:53)
Lockett uses a systematic approach to checking EKG leads. She identifies a PAC, positive axis, and inverted T waves in leads 1, AVL, and V1 through V6 indicating anterior/septal ischemia.
STEMI Changes on a Rhythm Strip (07:00)
Lockett explains peaked T waves in the hyper-acute phase, ST elevation and T wave inversion in the acute phase, and pathological Q waves in the infarction stage. After the MI, ST segments should decrease to baseline but T waves may remain inverted for weeks.
STEMI Treatment (13:07)
Angina patients should have a 12 lead EKG. Blood work includes cardiac enzymes, coagulation panel, CBC, kidney function, electrolytes, BNP level, and fasting lipid panel. After imaging, MONA treatment begins; hear nitroglycerin contraindications and learn about anti-coagulation, dual anti-platelet therapy, fibrinolytic therapy and PCIs.
Extensive Anterior STEMI Changes on a Rhythm Strip (05:52)
Lockett identifies lateral STEMI elevation in leads 1 and AVL, and anterior septal STEMI elevation in leads VI to V4. Patients are prone to cardiogenic shock and systolic heart failure.
Right Coronary Artery Blockage Changes on a Rhythm Strip (09:13)
Inferior STEMIs may have a right ventricular or posterior STEMI. Patients need fluid to improve preload; diuretics and nitroglycerin are contraindicated. Other treatments include oxygen, aspirin, anti-coagulation therapy, antiplatelet therapy, and reperfusion therapy. Lockett discusses EKG readings.
Discharge Therapy (06:03)
Myocardial infarction patients are prescribed baby aspirin, and either clopidogrel/Plavix, prasugrel/Effient, or ticagrelor/Brilinta for 12 months. Smoking cessation therapy, cardiac rehabilitation and exercise are recommended. Lockett discusses SPRINT Trial results and AHA statin therapy recommendations, and shares her cardiovascular risk results.
Heart Mechanics (12:44)
Lockett discusses valve anatomy and explains how to listen to heart sounds. Learn about the S2 split and S3 and S4 gallops. Patients in atrial fibrillation or flutter have no atrial kick.
Electrical and Mechanical Heart Events (02:14)
Lockett walks through the process of the heart filling, valves opening, conduction, and contraction on both sides of the heart.
Hear how diuretics and volume impact preload; drugs manipulate stroke volume and contractile force of cardiac output; and vasodilation or vasoconstriction impact afterload resistance. Lockett explains the formula for systemic and pulmonary vascular resistance, and how to determine patient hemodynamics without a catheter.
Sympathetic and Parasympathetic Nervous Systems (07:12)
Lockett explains the effects of norepinephrine and epinephrine on heart rate, blood pressure, pulse pressure, conduction, contractile force, and skin perfusion. The parasympathetic nervous system slows heart rate and conduction, vasodilates and decreases blood pressure. Learn about neurohormonal modulation.
Heart Failure (16:20)
Systemic perfusion is inadequate due to pump failure; hear signs, risk factors, classes and stages. Lockett discusses diastolic and systolic heart failure. In systolic failure, neurohormonal modulation occurs. Echocardiograms diagnose heart failure; learn about treatments and drug timing.
Heart Failure Drugs (10:07)
Lockett covers indications, dosage and side effects for ACE inhibitors, beta blocker therapy, digoxin, loop diuretics, and aldosterone antagonists. Learn about a drug combining hydralazine and isosorbide nitrate, ivabradine/Corlanor, and Entresto that combines valsartan and neprilysin inhibitors.
Heart Failure Device Therapy (10:24)
Lockett discusses biventricular pacing, ICD therapy, destination therapy and left ventricular assist devices, and the cardioMEMS or pulmonary artery sensor. BioZ impedance cardiography provides a noninvasive hemodynamic profile. Lockett discusses drugs decreasing preload and afterload, and talks about discharge therapy measures.
Dilated or congestive cardiomyopathy causes are either idiopathic, hereditary, or caused by viral myocarditis. The left ventricle dilates, causing systolic heart failure, mitral regurgitation, pulmonary congestion, and increased preload. Learn about symptoms and drug and surgical treatments, including the Dor procedure.
Hypertrophic Cardiomyopathy (09:55)
The left ventricle wall and the septum hypertrophy, caused by genetics or excess circulating catecholamines. Myofibrils scar and reshape, causing symmetrical or asymmetrical septal hypertrophy, mitral valve regurgitation, and hypertrophic obstructive cardiomyopathy (HOCM) in 30-50% of patients. Hear symptoms and treatment, including surgical options.
The pericardium becomes inflamed, causing pericardial friction rub and chest pain with deep breathing. Lockett explains EKG changes. Causes include virus, end stage renal failure, post-STEMI, and open heart surgery. Treatments include high dose aspirin, colchicine or steroids and narcotic analgesics.
Valvular Dysfunction: Mitral Stenosis, Regurgitation, and Prolapse (12:05)
Mitral valve leaflets calcify, become fibrotic or sclerose; commissures fuse, dilating the left atrium and restricting blood to the left ventricle. In mitral regurgitation, both the atrium and ventricle dilate. Lockett explains "parachuting" of the chordae tendineae into the left atrium. Hear causes and symptoms for all conditions.
Valvular Dysfunction: Aortic Stenosis and Insufficiency (10:51)
The aortic valve opening narrows, prolonging systolic ejection time; the left ventricle dilates, thickens, and shrinks the chamber. Surgical treatments include valve surgery and transcatheter aortic valve replacement. Lockett explains aortic regurgitation. Learn about heart sounds for all four valvular dysfunctions.
Valvular Dysfunction Treatment (15:17)
Lockett covers drug and surgery options for treating mitral stenosis, mitral regurgitation, aortic stenosis and aortic insufficiency. Learn about drug contraindications, conventional open heart valve surgery, and transcatheter aortic valve replacement, including post-operative care.
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