Lesson Plans

Medical Transcription Fundamentals

Lesson Plans

Chapter 11 — Cardiology

Learning Objectives:

The lesson plan for each objective starts on the following page.

11-1 Name and describe the anatomic structures of the heart and associated blood vessels.

11-2 Explain cardiac conduction and describe the cardiac cycle.

11-3 Discuss blood pressure measurement and how blood pressure readings are obtained.

11-4 Describe common diseases and disorders related to the heart and their treatments.

11-5 Discuss common laboratory tests and diagnostic studies used to identify heart disease.

11-6 Discuss the Insight relating to cardiology.

11-7 Discuss the soundalike terms regarding cardiology.

11-8 Identify the combining forms used in relation to cardiology and the heart.

11-9 Review the abbreviations used in cardiology.

11-10 Explain the terminology used when transcribing cardiology documents.

You Will Need:

Gather the following materials for the following lessons:

11-1 A segment of a rubber hose, 1 inch in diameter.

11-3 Several manual sphygmometers and/or digital blood pressure machines.

11-4 Stedman’s Medical Dictionary or Physicians' Desk Reference , several copies.

11-5 An EKG machine.

11-8 A set of 3x5 index cards for each combining form listed in the Combining Forms table at the end of Chapter 11 (students will provide).

11-9 A set of 3x5 index cards for each abbreviation listed in the Abbreviations table at the end of Chapter 11 (students will provide).

Page 11-1

Copyright © 2009 Lippincott Williams & Wilkins


Chapter11 — Cardiology

Date:

Objective 11-1: Name and describe the anatomic structures of the heart and associated blood vessels.

Lecture Outline

—

Objective 11-1

Content

Introduction



Cardiology—the medical speciality dealing with the diagnosis and treatment of diseases and disorders of the heart.



The heart pumps blood around a closed circle or circuit of vessels in a continuous loop from birth to death.

Anatomy of the Heart



The heart—composed almost entirely of muscle.



The heart is actually two different pumps



The right side pumps blood into the lungs to gather oxygen.



The left side pumps oxygenated blood to the rest of the body.



Layers



The pericardium surrounds the heart like a transparent sac.



Three layers in heart wall



Outer: epicardium,



Middle: myocardium,



Inner: endocardium.



Chambers—2 on the left, 2 on the right



Upper chambers—left and right atria.



Lower chambers—left and right ventricles.



Left atrium and ventricle receive oxygen-rich blood and pump it to the

Figures, Tables, and Features

Text PPt

272

272

271

271

4

3

2

1

Figure

11.1,

Anatomy of the heart, p. 272

Resources and

In-Class Activities

Outside Assignments/

Evaluation

In-Class Activity

Make PowerPoint slides for this chapter available to students as a handout or by posting them on a school web site or sending them as an e-mail attachment prior to class.

The students can use slide show sheets to follow lecture and supplement with handwritten notes.


Choose one student to select one of the terms related to the anatomy of the heart. Have students play a “To Tell The Truth” type game, taking turns asking the student “yes” or

“no” questions based on the information learned to determine the anatomic term chosen by the student. The winner gets to select the next term and the game is played again.

OLC: List the chambers, ventricles and valves of the heart and explain each function.

Instructor’s Notes

Page 11-2




Lecture Outline

—

Objective 11-1

Content body.



Right atrium and ventricle receive deoxygenated blood from the body and pump it to the lungs for gas exchange to occur.



Valves—open and close to ensure proper blood flow



Tricuspid valve—between the right atrium and right ventricle.



Pulmonary valve—opens from the right ventricle to the pulmonary artery.



Mitral valve--between the left atrium and left ventricle.



Aortic valve—between the left ventricle and the aorta.



Each valve contains leaflets



Regulate blood flow



Prevent backflow of blood from ventricles to the atria



Arteries and Vessels



Blood Vessels – a network of interconnecting arteries, arterioles, capillaries, venules, and veins that provide the pathway in which blood is transported between the heart and the body cells.



Arteries and arterioles – carry blood away from the heart



Capillaries



Act as a bridge between arteries and veins.



Allow oxygen and nutrients to pass from the blood into tissues and allow waste products to pass from tissues back into the blood.



Veins and venules—carry blood back to


Resources and


Text PPt

273

273

6

5

Figure

11.2, The coronary arteries and veins, p. 274


Demonstrate to students that the aorta is the largest


Evaluation

Page 11-3





Lecture Outline

—

Objective 11-1


Resources and



Evaluation

Content Text PPt the heart



Coronary Arteries



Left coronary artery (LCA) and right coronary artery (RCA) branch from the aorta.



Posterior descending artery

(PDA)—main branch of RCA.



Left main coronary—initial segment of the left coronary artery.



The LCA branches into the left anterior descending artery (LAD) and the left circumflex artery

(LCA).



The lesser coronary vessels



Diagonal branches (D1, D2), which arise from the LAD



Obtuse marginal branches

(OM1, OM2), which arise from the LCA.



Myocardial infarction (MI)— results from blockage of coronary arteries by plaques

 Blood’s Path Through the Heart



Blood empties into vena cavae:



Superior vena cava: Carries blood from upper body to right atrium



Inferior vena cava: Carries blood from lower body to right atrium



Blood in right atrium empties into right ventricle



Pumped by pulmonary artery to lungs



Through left atrium and left ventricle

Pumped into the aorta for circulation throughout the body

274

8

7

9 artery in the body. Show the students a segment of a rubber hose that is 1 inch in diameter, the same diameter as the aorta, to show how large this vessel really is. Pass around the rubber hose for students to inspect.

Legend : PPt, PowerPoint; IRCD, Instructor Resource CD-ROM; SRCD, Student Resource CD-ROM, OLC, Online Course.

Page 11-4





Date:

Objective 11-2: Explain cardiac conduction and describe the cardiac cycle.

Lecture Outline

—

Objective 11-2

Content

The Cardiac Cycle



Cardiac cycle—the sequence of events in one heartbeat. Cardiac conduction is the name given to the conduction system that controls the heart rate.



Two basic components



Contraction phase (systole)—blood is ejected from chambers of the heart.



Relaxation phase (diastole)—heart is at rest and chambers fill with blood.



Process:



The SA node generates an electrical impulse that travels to the AV node.



The AV node delays the impulse to give the atria time to contract.



The impulse travels on to the bundle of

His.



The impulse travels to the left and right bundle branches off the bundle of His.



The impulse travels to the Purkinje fibers.



Ventricles contract, pushing blood out of them into the lungs and body.



The tricuspid and mitral valves shut tight and the pulmonary and aortic valves open so the atria can fill with blood again.



The heart rests for a moment and the cycle begins again.



Heart sounds—vibrations in the tissues and blood caused by closure of the valves.

Text

275

274


PPt

12

11

10 Figure

11.3, The cardiac cycle, p. 275

Page 11-5


Resources and



Evaluation

In-Class Activity :

Have students determine their own heart rates by taking their pulse.

Demonstrate how to obtain a pulse either from the wrist or the carotid artery in the neck. Tell the students to count the number of beats they feel in 10 seconds and multiply by 6, which will equal the resting heart rate per minute. Have students take their pulse while seated, and then stand up and march in place at a fast pace for 1 minute, and take the pulse again.

Compare the results.


Have students research the

Internet for web sites that contain .wav files of different heart sounds and

Outside Assignment


Internet to learn about pacemakers. Under what circumstances would a person would require a pacemaker device? What heart defects would require a pacemaker? What kinds of pacemakers are available? Have them write a short paper on their findings. The next day, have students discuss their findings with the class.

OLC: Incorporate online activity from the outside assignment regarding the pacemaker.




Lecture Outline

—

Objective 11-2

Content



Lub-dub-sound of valves closing



Lub-(S1)—closure of the mitral and tricuspid valves at the beginning of a ventricular contraction.



Dub-(S2) —closure of the aortic and pulmonary valves at the end of ventricular systole, or when blood is released from the ventricles.



Murmur-abnormal heart sound.



Normal heart rate—sinus rhythm.



Abnormal heart rhythm— arrhythmia/dysrhythmia. Other terms:



Bradycardia, a slow heartbeat, defined as usually less than 60 beats per minute.



Tachycardia, a fast heart rate, defined as greater than 100 beats per minute.



Atrial flutter, which is an arrhythmia in which the atrial rhythm is regular, but the rate is abnormally fast.



Fibrillation refers to an uncoordinated, irregular contraction of the heart muscle which may originate in the atria

(called atrial fibrillation) or the ventricles (called ventricular fibrillation).



Heart block, which is an impaired conduction of the heart’s electrical impulses, leading to a slow heartbeat.



Paroxysmal atrial tachycardia, which is a rapid heart rate that

Text

Page 11-6


PPt

13

14


Resources and

In-Class Activities listen to each one. Then discuss their findings.

How were the sounds different in each?


Evaluation




Lecture Outline

—

Objective 11-2

Content starts and stops suddenly and unpredictably.



Premature atrial contraction, which describes an extra heartbeat that originates from the atria before it should.

Text PPt


Resources and



Evaluation



Page 11-7




Date:

Objective 11-3: Discuss blood pressure measurement and how blood pressure readings are obtained.

Lecture Outline

—

Objective 11-3

Text

277

PPt

15

Figures, Tables, and

Features

Resources and



Evaluation

Blood Pressure



 heart pumps.

Content

Blood pressure—the measurement of this force, or the force of the blood pushing against the walls of the arteries each time the



Systolic pressure is the blood pressure at its highest when the heart beats, pumping the blood.



Diastolic pressure is the blood pressure at its lowest, when the heart is at rest, between beats.

Sphygmomanometer—measures blood pressure. Indicated in terms of millimeters of mercury, abbreviated as mmHg.



Two numbers are involved in making a blood pressure reading, expressed as a fraction, for example, 120/80.



The systolic blood pressure, or the top number, represents the maximum pressure in the arteries as the heart contracts and pumps blood into the arteries.



The diastolic pressure, which is the bottom number, reflects the minimum blood pressure as the heart relaxes following a contraction.

In-Class Activity :

Have students experience taking blood pressure or having their own blood pressure taken. This can be done two ways:

(a) Invite someone from the school nursing staff to visit the classroom, demonstrate how blood pressure is measured, and explain what the results mean. The nurse can then take students' blood pressure; OR

(b) Bring in several sphygmomanometers, both manual and digital.

Ask for a volunteer and demonstrate to the class how to take a blood pressure. Then have the students take turns taking each other’s blood pressure. Have the students write down their completed measurements.

At the end, have students compare the results.

Outside Assignments

Skills Quick Check 11.1, p.

277

Can be completed in class or assigned as homework.

Legend : PPt, PowerPoint; IRCD, Instructor Resource CD-ROM; SRCD, Student Resource CD-ROM.


Page 11-8




Date:

Objective 11-4: Describe common diseases and disorders related to the heart and their treatments.

Lecture Outline

—

Objective 11-4

Content

Common Cardiac Diseases and Treatments



Signs of heart problems:



Cyanosis: Bluish tinge



Pallor: Paleness



Edema: Swelling of tissues



Diaphoresis: Excessive sweating



Angina (angina pectoris): Severe chest pain



Hypertension—a condition in which the pressure of the blood in the arteries is too high



Primary hypertension—where there is no identifiable cause.



Secondary hypertension—where another disease or medication is the cause.



Treatments:



Diuretics—Promote excretion of excess water in the body, lowering the blood pressure within the vessels.



Beta-blockers—Slow the heart rate and reduce the force of the heartbeat.



Angiotensin-converting enzyme

(ACE) inhibitors—prevent the formation of angiotensin II that constricts the blood vessels.



Calcium-channel blockers—

Text PPt

17

16

278

277


Features

Resources and



Evaluation


Choose one student to select one of the terms related to diseases and disorders of the heart.

Have students play a “To

Tell The Truth” type game, taking turns asking the student “yes” or “no” questions based on the information learned to determine the disease or disorder term chosen by the student. The winner gets to select the next term and the game is played again



Internet and locate information about the effects of uncontrolled hypertension. Have them write a brief summary of the diseases and disorders that are a result of untreated hypertension, including signs, symptoms, and treatments.

:

In-Class Activity :

Assign each student the name of one drug that is used to treat heart disease.

Ask the students to use a medical dictionary,

Physicians Drug

Reference , or other resource (including the

Internet) to find out more about the type of drug, class, indications, dosages,

OLC: Have students contact their local healthcare clinic and

"interview" the EKG technician. Prepare a short paper on the symptoms a patient should have before an EKG is ordered. Ask the technician to describe the procedure of placing leads on the patient. There are 10-lead tracings as well as 12-lead tracings. If possible, ask the EKG technician for a copy of an

EKG.


Page 11-9




Lecture Outline

—

Objective 11-4

Content decrease the heart's pumping strength and relax blood vessels.



Coronary artery disease (CAD)



Refers to the narrowing of the coronary arteries sufficiently to prevent adequate blood supply to the heart muscle.



Also called cardiac ischemia.



Cause: the gradual buildup of plaques in the coronary arteries (atherosclerosis)



Arteries become hardened and narrowed, reducing the flow of blood through them, also called hardening of the arteries



Symptoms: Angina pectoris (intense chest pain), dyspnea (shortness of breath), or a heart attack.



Other complications of CAD



Heart failure—weakened heart muscle does not pump the way it should.



Congestive heart failure (CHF)—

The heart's weak pumping action causes congestion in the lungs and other body tissues.



Result: Breathing difficulties while lying down (orthopnea) or the sudden onset of breathing difficulty occurring at night, usually after falling asleep (paroxysmal nocturnal dyspnea).



Treatment:



Medications—nitrates dilate blood vessels, making it easier for the heart to pump blood through the body. Hypertension medications can also be used.

Text

278

PPt

19

18


Features

Figure

11.4, Coronary artery disease, p. 279

Resources and

In-Class Activities and side effects.

Page 11-10



Evaluation




Lecture Outline

—

Objective 11-4

Content



Surgical interventions



Angioplasty opens narrowed arteries by using a catheter that is inserted into an artery in the leg and guided to the site of the blockage in the coronary artery of the heart. In order to keep the artery from re-stenosing, or narrowing again after an angioplasty procedure, an expandable stent is implanted at the site of the blockage to keep the artery from collapsing.



Coronary artery bypass graft

(CABG) surgery—a procedure in which section of vein or artery from another part of the body (a graft) is used to bypass a blockage in a coronary artery.



Cardiomyopathy—the progressive impairment of the structure and function of the myocardium.



Dilated cardiomyopathy—overall enlargement of the heart chambers



Hypertrophic cardiomyopathy—an overgrowth of heart muscle that can impair blood flow both into and out of the heart.



Restrictive cardiomyopathy—the ventricles become stiff and do not fill normally with blood between heartbeats.



Valvular heart disease—results in leaking valves (regurgitation) or blocked valves

Text

280

281

Page 11-11


PPt

20

21


Features

Figure

Vascular stent used in coronary angioplasty, p.

280

Resources and



Evaluation




Lecture Outline

—

Objective 11-4

Content

(stenosis).



Pericarditis – an inflammation of the pericardium that surrounds the heart



Complications:



Pericardial effusion— accumulation of fluid in the pleural sac.



Cardiac tamponade—when excess fluid causes compression of the heart.



Treatment—draining fluid via catheter.



Congenital Heart Disorders



Atrial septal defect (ASD)



Called a hole in the heart, a hole in the atrial septum that separates the atria of the heart.



Treatment: Hole usually closes on its own as child grows.



Ventricular septal defect (VSD)



Like ASD but hole, or defect, in the wall that separates the ventricles of the heart.



Treatment: As with ASD, hole usually closes over time, but large defects may require surgical closure.



Patent ductus arteriosus



Abnormal circulation of blood between the aorta and pulmonary artery due to the blood vessel that connects them, the ductus arteriosus, remaining open (patent) and not closing after birth.



Treatment: Condition will go away on its own, or corrective surgery

Text

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281

Page 11-12


PPt

22

23


Features

Resources and



Evaluation




Lecture Outline

—

Objective 11-4


Features

Resources and


Content Text PPt can be performed.



Transposition of the great vessels



The location of the aorta and pulmonary artery, referred to collectively as the great vessels, is switched.



Treatment: Arterial switch operation, in which the major arteries are switched back..



Tetralogy of Fallot



Too little oxygen levels in the blood, leading to cyanosis.



A combination of four different heart defects: VSD; obstructed outflow of blood from the right ventricle to the lungs, called pulmonary stenosis; a displaced aorta, which causes blood to flow into the aorta from both the right and left ventricles; and abnormal enlargement of the right ventricle, called right ventricular hypertrophy.



Treatment: Surgery to increase blood flow and correct the defects.

24



Evaluation



Internet for a heart disorder or condition not discussed in the chapter and have them write a one-page paper about the condition, including the origin of the name of the disorder, symptoms, causes, and treatments.



283



Page 11-13




Date:

Objective 11-5: Discuss common laboratory tests and diagnostic studies used to identify heart disease.

Lecture Outline

—

Objective 11-5

Content

Diagnostic Studies and Procedures



Blood Tests—evaluate the patient’s risk of acquiring vascular disease, heart attack, or stroke:



C-reactive protein (CRP) test. A substance in the blood that occurs with inflammation, such as fatty buildup in artery walls.



Homocysteine—an amino acid that is normally found in small amounts in the blood; higher levels are associated with increased risk of heart attack and other vascular diseases.



Lipoprotein (a) or Lp(a): A biochemical in the body; higher concentrations are associated with premature coronary disease.



Cholesterol particle test. Measures the size of the LDL particles to determine risk of atherosclerosis and heart disease.



Lipid profile. This test evaluates the risk of coronary heart disease in a patient.



It measures total cholesterol, bad cholesterol (LDL), good cholesterol

(HDL), and triglycerides.



Blood sugar (glucose). Tests for diabetes and glucose intolerance, both of which indicate a significant cardiac risk.



B-type natriuretic peptide (BNP). A hormone made by the heart. Elevated

PPt

26

25

Text

282

282


Features

Resources and



Evaluation


Choose one student to select one of the terms related to a diagnostic test or study relating to the heart. Have students play a “To Tell The Truth” type game, taking turns asking the student “yes” or “no” questions based on the information learned to determine the term chosen by the student. The winner gets to select the next term and the game is played again.

OLC: Explain the differences in electrocardiogram and echocardiogram.

OLC: Research "cardiac catheterization" on the internet or in a medical journal/textbook of your choice. List the indications for this procedure as well as outcome.


Page 11-14




Lecture Outline

—

Objective 11-5

Content values mean the heart is working harder, indicative of heart failure.



Cardiac enzyme studies. Measure the levels of the cardiac enzymes troponin, creatine kinase (CK), creatine phosphokinase (CPK), and myocardial banding of creatine phosphokinase (CK-

MB) in the blood. Elevated levels may indicate damage to the heart muscle, as such as from a heart attack.



Electrocardiogram (EKG)



Analyzes the electrical activity of the heart



Produces a graphic representation or tracing of the electrical activity of the heart



Can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement.



Impulses detected by the leads are recorded as waveforms. Deviation in the shape or interval of the waveform is indicative of a possible heart disorder.



Echocardiogram



Uses ultrasound to examine the heart anatomy.



Sound waves echo off cardiac structures, providing a 2-D image of the beating heart on a computer screen.



Cardiac Stress Test



Also called a treadmill stress test



An exercise test to evaluate the heart for problems that show up only when the heart is working hard.

 The patient’s heart rate and rhythm are observed while patient exercises at

Text

284

284

285


Features

PPt

27

29

28

Figure

11.6,

Electrocardiographic wave form, p. 285

Page 11-15


Resources and



If you have access to an

EKG machine, bring one to the class to show the students how the leads are connected to the patient and how the machine works. Alternatively, you can ask an EKG technician to speak to the class about the procedure of the EKG, the terminology used, and to show tracings of normal and abnormal heart rhythms.


Evaluation




Lecture Outline

—

Objective 11-5


Features

Resources and


Content Text PPt different levels.



Nuclear scan or thallium stress test uses thallium injected into a vein during the test. A camera records whether the thallium is taken up by the heart muscle

(healthy areas) or not (damaged areas).



Cardiac Catheterization and Coronary

Angiography



Used extensively for the diagnosis and treatment of heart disorders not due to abnormalities in the coronary arteries.



A radiopaque dye is inserted through a catheter into the coronary arteries in order to view clear images of the blood vessels as the heart pumps.



MUGA (multiple-gated acquisition) scan



Used to determine if the heart's left and right ventricles are functioning properly and to diagnose abnormalities in the heart wall.



A small amount of technetium is injected into an arm vein, and a special camera is used to follow the movement of the technetium through the blood circulating in the heart.

286

286

30

31



Evaluation

Outside Assignments


286



Page 11-16




Date:

Objective 11-6: Discuss the Insight relating to cardiology.

Lecture Outline

—

Objective 11-6

Discuss the Insight:

“The Heart Brain”

Content Text

287’’

PPt

32


Features

Resources and



Evaluation


Read aloud the Insight article. Discuss the concept of the “heart brain.” Do students believe it is possible for the heart to convey emotion to the brain?



Internet on the “heart brain” theory and the history of its pioneer research, J. Andrew

Armour, and write a short paper on their findings.

OLC: Research the Internet on the “heart brain” theory and the history of its pioneer research, J. Andrew

Armour and write a short paper on the findings.



Page 11-17




Date:

Objective 11-7: Review the soundalike terms regarding cardiology.

Lecture Outline

—

Objective 11-7


Features

Content Text PPt

Review the common soundalike words in the textbook (table).

288 Table

Common soundalike words, p. 288


Resources and



Evaluation


Page 11-18




Date:

Objective 11-8: Identify the combining forms used in relation to cardiology and the heart.

Lecture Outline

—

Objective 11-8

Content

Review the combining forms list in the textbook

(table).

Text

289

PPt


Features

Table

289

Combining forms, p.

Resources and



Evaluation


Have students create flash cards using 3x5 index cards of the combining forms found in the table of combining forms in this chapter, p. 289, by placing the combining form on one side of the card and its meaning on the other side, to study in class and at home.



Page 11-19




Date:

Objective 11-9: Review the abbreviations commonly used in cardiology.

Lecture Outline

—

Objective 11-9

Content

Review abbreviations list in textbook (table).

Text

289


Features

PPt

Table

Abbreviations, p. 289

Resources and



Evaluation


Have students create flash cards using 3x5 index cards of the abbreviations found in the table of abbreviations in this chapter, p. 289 , by placing the abbreviation on one side of the card and its meaning on the other side, to study in class and at home.



Page 11-20




Date:

Objective 11-10: Correctly define, spell, and pronounce the chapter’s medical terms.

Lecture Outline

—

Objective 11-10

Content

The chapter’s medical terms, with their correct pronunciation and definitions, appear throughout the chapter and at the end of the chapter (table).

Text


Features

PPt

290 Table

Terminology, p. 290

Resources and



Evaluation

Remind students to add new terms learned from the activities in this chapter to the list of terms and definitions located at the end of the chapter.

In-Class Activity:

Have student transcribe the medical reports contained in the end-ofchapter transcription activities.


Assign for homework the end-of-chapter review questions and chapter activities.


As an optional extra credit assignment, you may ask students to watch a medical program on television. The program must be a true life type documentary about the daily work routine in a hospital or emergency room

(not a sitcom or fictional drama program). Have the students write down every medical term they hear while watching the program. Then ask them to locate the definition of the term using their medical resources or the Internet.

Have them hand in their papers with the name of the program viewed, the date, and the list of terms with their definitions in order to receive extra credit for the assignment.


Page 11-21




Lecture Outline

—

Objective 11-10

Content Text PPt


Features


Resources and



Evaluation

Evaluation

Create an exam for Chapter

11 using the Brownstone

Test Generator on the

IRCD.


Page 11-22


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Medical Transcription Fundamentals

Lesson Plans

Chapter 11 — Cardiology

Learning Objectives:

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Chapter 11 — Cardiology

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