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Experiment 28 Monitoring EKG An electrocardiogram, or EKG, is a graphical recording of the electrical events occurring within the heart. A typical EKG tracing consists of five identifiable deflections. Each deflection is noted by one of the letters P, Q, R, S, or T. The P wave is the first waveform in a tracing and represents the depolarization of the heart’s atria. The next waveform is a complex and consists of the Q, R, and S deflection. The QRS complex represents the depolarization of the heart’s ventricles. The deflection that represents the repolarization of the atria is usually undetectable because of the intensity of the QRS waveform. The final waveform is the T wave and it represents the repolarization of the ventricles. Because an EKG is a recording of the heart’s electrical events, it is valuable in diagnosing diseases or ailments that damage the conductive abilities of the heart muscle. When cardiac muscle cells are damaged or destroyed, they are no longer able to conduct the electrical impulses that flow through them. This causes the electrical signal to terminate at the damaged tissue or directed away from the signal flow. The termination or redirection of the electrical signal will alter the manner in which the heart contracts. A cardiologist can look at a patient’s electrocardiogram and determine the presence of damaged cardiac muscle based on the waveform as well as the time interval between electrical events. In this activity, you will use the EKG sensor to make a five-second graphical recording of your heart's electrical events. From this recording, you will identify the previously mentioned waveform components and determine the time intervals associated with each. OBJECTIVES In this experiment, you will Use the EKG Sensor to graph your heart’s electrical activity. Determine the time interval between EKG events. Calculate heart rate based on your EKG recording. Figure 1 Biology with Computers 28 - 1 Experiment 28 MATERIALS computer Vernier computer interface Logger Pro Vernier EKG Sensor disposable electrode tabs PROCEDURE 1. Connect the EKG Sensor to the Vernier computer interface. Prepare the computer for data collection by opening the “28 Monitoring EKG” file in the Biology with Computers folder. 2. Attach four electrode tabs as follows: A single patch should be placed on the inside of the right upper forearm (below elbow), on the inside of the left upper forearm (below elbow), on the left ankle, and on the right ankle. This last connection is the ground electrode. (If you wear a tank-top, we can get better results by placing the arm electrode tabs on the shoulders or more medially just below the clavicles.) Green (negative) Red (positive) Black (ground) 3a. Connect the EKG clips to the electrode tabs as Figure 2 follows: Connect the negative clip to the right arm, the positive clip to the left arm, and the ground clip to the right ankle. This configuration is called Lead I. 3b. Sit in a reclined position in a chair or lie flat on top of a lab table. The arms should be hanging at the side unsupported. When everything is positioned properly, click to begin data collection. If your graph has a stable baseline as shown below, continue to Step 4. If your graph has an unstable baseline, collect a new set of data by clicking . Repeat data collection until your graph has a stable baseline. Figure 3: Stable baseline 28 - 2 Figure 4: Unstable baseline Biology with Computers Monitoring EKG 4. Click the Examine button, , to analyze the data. As you move the mouse pointer across the screen, the x and y values are displayed in the Examine window that appears. For three heart beats, identify the various EKG waveforms using Figure 5 and determine the time intervals listed below. Record the average for each set of time intervals in Table 1. P-R interval: QRS complex: Q-T interval: time from the beginning of P wave to the start of the QRS complex. time from Q deflection to S deflection. time from Q deflection to the end of the T. 5. Calculate the heart rate in beats/min using the EKG data. Remember to include the time between the end of the T Wave and the beginning of the next P Wave. Use the total number of seconds for one full heart cycle in the equation. Record the heart rate in Table 1. # beats minute 1 beat __ seconds 60 seconds 1 minute 6. Print a copy of your EKG. Identify and label the various waveforms. 7. Remove the positive clip from the left arm and attach it to the left ankle. The ground clip always stays on the right ankle. This configuration is called Lead II. Repeat steps 3b–6. 8. Remove the negative clip from the right arm and attach it to the left arm. This configuration is called Lead III. Repeat steps 3b–6. Biology with Computers 28 - 3 Experiment 28 DATA Table 1 Interval Time (s) Lead I Lead II Lead III P-R QRS Q-T Heart Rate beats/min beats/min beats/min Table 2 Standard Resting Electrocardiogram Interval Times P - R interval 0.12 to 0.20 s QRS interval less than 0.10 s Q - T interval 0.30 to 0.40 s QUESTIONS 1. The electrocardiogram is a powerful tool used to diagnose certain types of heart disease. Why is it important to look at the time intervals of the different waveforms? 2. What property of heart muscle must be altered in order for an EKG to detect a problem? Explain. 3. Based on what you have learned regarding electrocardiograms, can they be used to diagnose all heart diseases or defects? Explain. 4. Describe a cardiovascular problem that could be diagnosed by a cardiologist using an electrocardiogram. 28 - 4 Biology with Computers Monitoring EKG MEAN ELECTRICAL AXIS The QRS mean electrical axis can be calculated by plotting the vectors of two of the three standard leads (lead I, lead II and lead III) on a grid as shown on the left. The grid is simply a rearrangement of Einthoven’s triangle as shown in the diagram below. To calculate the mean electrical axis of the QRS complex in this example, standard leads I and III were used but any combination of two of the three could have been used. The vectorial sum of the deflections of the QRS complex for each lead is calculated in millimeters. In this example the Q wave is -2.5 mm deep and the R wave is +16 mm high to give a sum of +13.5 mm for lead I Step One: The point corresponding to this sum is then located on lead I (the positive direction being towards the arrow of each lead) and a perpendicular is dropped from lead I. Biology with Computers 28 - 5 Experiment 28 Step Two: The same is done for lead III. Step Three: A line is then drawn from the center of the grid through the point of intersection of the two perpendicular lines to obtain the mean electrical axis. In this case, the mean electrical axis of the QRS complex is 58 degrees which is within the normal range. ex http://www.technion.ac.il/~eilamp/plottingaxis1.html 28 - 6 Biology with Computers Monitoring EKG EXTENSION Using data collected with the EKG Sensor, it is possible to determine a more accurate maximum heart rate value for an individual. The commonly used formula for calculating maximum heart rate is: 220 bpm – Individual’s Age = Max Heart Rate While this formula is sufficient for general purposes, it fails to take into account physical differences such as size, and fitness level. For example, an individual that engages in regular exercise will likely have a heart that operates more efficiently due to the effects of athletic training. To calculate your exertional heart rate, do the following: a. Run in place or perform some type of exercise, such as jump-n-jacks, for 1-minute. b. Repeat Steps 1 – 4 to collect and analyze your electrocardiogram. When analyzing the data in Step 4, only determine the average Q-T interval. c. Divide 60 seconds by the Q-T interval to calculate your maximum heart rate. Biology with Computers 28 - 7