Study Module 2, NHA CET Exam Preparation and EKG Fundamentals

Epicardium

connective tissue that forms a sac around the heart

Myocardium

consists of involuntary striated muscle tissue and is responsible for physical contraction of the heart muscle

Endocardium

lines the chambers of the heart and forms the surface of the valves

4 chambers of the heart

right atrium, right ventricle, left atrium, left ventricle

Heart location

center of thoracic cavity, behind the sternum

Interatrial septum

wall dividing the atria

Interventricular septum

wall dividing the ventricles

Valves

control the direction of blood flow through the heart

Chordae Tendineae

support floppy valve leaflets and prevents regurgitation of blood into other chambers of the heart

4 valves of the heart

tricuspid valve, bicuspid valve, pulmonary valve, aortic valve

Atrioventricular valves

tricuspid and bicuspid valves

Semilunar valves

pulmonary and aortic valves

Tricuspid valve

separates right atrium from right ventricle

Bicuspid valve

separates the left atrium from the left ventricle

Pulmonary valve

between the right ventricle and pulmonary arteries

Aortic valve

between the left ventricle and the aorta

Right atrium receives blood from

inferior and superior vena cavas

Right atrium pumps blood through the _____ valve and into the ____ _____

tricuspid valve, right ventricle

Right ventricle pumps blood through the pulmonary ______ to the pulmonary arteries and then to the _______

veins, lungs

Blood becomes oxygenation through the ____ ____ of the lungs

capillary beds

Oxygenation blood returns to the _____ _____ through the pulmonary veins

left atrium

Left atrium pumps blood through the _____ valve to the ____ _____

bicuspid valve, left ventricle

Left ventricle pumps blood through the ______ valve into the aorta

aortic

The _____ delivers oxygenated blood to the heart muscle and the rest of the body

aorta

Right Coronary Artery (RCA)

carry oxygenated blood to the right atrium and ventricle, part of the left atrium, and the inferior wall of the left ventricle

SA node is a natural

pacemaker

AV junction acts as a

pacemaker if SA node fails

PR interval

time needed for an electrical impulse to travel from the SA node through the AV node to the ventricles

PR interval starts

P wave begins and ends at the beginning of Q wave

PR interval expected interval is

0.12-0.20 seconds

Ectopic beats

cause premature atrial, junctional, or ventricular complexes

Bundle of His

impulse is conducted by AV node

Standard grid

1mm wide by 1mm tall

Vertical side of EKG is measured in

millivolts

Horizontal side of EKG is measured in

milliseconds

Standard speed

25 mm/second

Standard amplitude/gain

10 mm/1mV

Standard Calibration

10mm tall by 5mm wide

Wilson's Central Terminal (WCT)

right arm, left arm, left foot

Unipolar leads

considered positive; V1-V6 leads

Precordial leads

V1-V6

Augmented leads

AVR, AVL, AVF

AVR

voltage to the right arm

AVL

voltage to the left arm

AVF

voltage to the left leg

Bipolar leads

positive and negative poles; Leads I, II, & III

Lead I

record impulses between left and right arms

Lead II

record impulses between right arm and left leg

Lead III

record impulses between left arm and left leg

Place limb electrodes on ___ areas

fleshy

Items needed for EKG

power source, electrodes, leads w/ clips, graph paper, alcohol wipes, gauze pads, scissors or shaving equipment, pillows, blankets

Decrease gain to 5 mm/mv for

large or too tall waveforms

increase gain to 20 mm/mV for

small waveforms

Increase speed to 50 mm/second for

tachycardia

Decrease speed to 12.5 mm/second for

bradycardia

Clean leads with

isopropyl alcohol or alcohol-based cleaners

Angle of Louis/Sternal Angle

used for proper lead (V1-V6) placement

V1

4th intercostal space, right of sternum; red

V2

4th intercostal space, left of sternum; yellow

V3

midway between V2 & V4; green

V4

5th intercostal space, midclavicular line; blue

V5

5th intercostal space, midway between V4 & V6, at anterior axillary line; orange

V6

5th intercostal space, at midaxillary line; purple

Limb lead colors are

white, black, red, and green

White limb lead

right arm

Black limb lead

left arm

Red limb lead

left leg

Green limb lead

right leg

Ambulatory monitoring is for

24 hr or longer

Types of ambulatory monitoring

3- or 5-lead

5-lead EKG is

Holter monitor

3-lead EKG is

telemetry

Colors for Holter monitor

white, red, black, brown, green

Colors for 3-lead EKG

white, black, red

Colors for telemetry

white, black, red, green, and brown

For stress testing, which leads change position, precordial or limb?

Limb

What conditions require a right-sided EKG

inferior wall ST segment elevation, MI, dextrocardia, patients under 8 years old

What condition would require a posterior EKG?

inferior wall infarction

What is the result of proper lead placement?

positive deflection

2 ways artifacts can occur

patient and nonpatient factors

Patient factor to cause artifacts

shivering, phone, talking

Nonpatient factors to cause artifacts

wall outlet, machine

Wandering baseline

wavelike up-and-down movement throughout the tracing caused by improper electrode placement

Somatic tremor

uneven spikes on EKG tracing caused by muscle movement

AC interference

electronic devices on or near a patient causing an electrical interference

Interrupted baseline

break in the baseline or a fully nonrecorded lead can be noted caused by broken wires or disconnected leads

When should an EKG tech monitor a patient heart rate until it reaches the target heart rate?

Stress testing

How to calculate target heart rate

(220 - age) * 0.85

During a stress test these symptoms are to be reported to the provider

dizziness, lightheadedness, nausea, severe SOB, tingling sensations, numbness, CP, extreme fatigue

Abnormal signs during stress testing are

abnormal vital signs, excessive tachycardia, hypotension, arrhythmias, PVCs, ventricular tachycardia, supraventricular tachycardia, heart blocks, T wave inversion, ST segment changes

Three domains of the NHA CET exam

Safety/Compliance & Coordinated Care, EKG Acquisition, EKG Analysis & Interpretation.

HIPAA regulation in healthcare

Protects patient privacy and medical records.

OSHA enforcement in healthcare settings

Workplace safety and infection control practices.

Scope of practice for EKG techs

The procedures and actions legally permitted for a technician to perform.

Universal precautions

Infection control methods treating all human blood and fluids as infectious.

Importance of communication in patient care

Ensures understanding, trust, and safety in care.

Factors affecting patient communication

Language, culture, religion, age, gender, and disability.

Normal vital signs indicators

Baseline for evaluating patient health and spotting abnormalities.

Patient preparation for stress testing

Wear comfortable clothing, avoid caffeine, follow fasting instructions.

Holter monitor usage

Continuous 24-48 hour monitoring of heart activity.