**A&P 2 Unit 16 & 18 (Lab) [The Heart, Part 2] Flashcards
Sinoatrial (SA) Node
- The heart’s natural pacemaker, with fastest rate of depolarization (100/min)
- Right atrium near opening of SVC
Atrioventricular (AV) Node
- Lower right atrium
- Medial to tricuspid valve
- AV node briefly delays the impulse
Atrioventricular (AV) Bundle
- Pathway between AV node and bundle branches
- Creates the only electrical connection between the atria and ventricles through a non-conducting fibrous “skeleton”
Bundle Branches (Right & Left)
Two branches through the interventricular septum towards apex
Purkinje Fibers
Conduct the impulse from apex, superiorly, in the outer ventricular walls
Internodal Pathways
- Located in the walls of the atria.
- Links the SA node to the AV node.
- Function: Distributes the action potential to the contractile cells of the atria.
Two Features Allow the Depolarizations to Spread Rapidly
- Gap junctions
- Branching Cardiac Fibers
Explain the role of gap junctions in the spread of depolarization in the myocardium.
They directly connect the cytoplasm of two cells, which allows various molecules and ions to pass freely between cells.
Summary of depolarization through the conduction system and muscle
- SA node depolarizes
- Electrical activity goes rapidly to AV node via internodal pathways
- Depolarization spreads more slowly across atria. Conduction slows through AV node.
- Depolarization moves rapidly through ventricular conducting system to the apex of the heart.
- Depolarization wave spreads upward from the apex.
The atria and ventricles are two separate bundles of muscle, separated by an internal fibrous septum
- The atria contract as a unit.
- After a brief delay in the AV node, the impulse spreads to the ventricles.
- The ventricles contract as a unit (while the atria relax).
Electrocardiogram (ECG, EKG)
The ECG records the heart’s electrical activity (pacemaker cells and contractile cells)
- Electrodes at the skin surface detect the directions of depolarizations and repolarizations
- The instrument (electrocardiograph) records and displays the data from pairs of different electrode combinations. Each combination is called a Lead.
- There are 12 Leads, each providing a different electrical view of the heart
P Wave
Atrial depolarization:
- Begins when SA node fires
- Depolarization travels through atria
- Atria contract
QRS Complex
Ventricular depolarization:
- Depolarization reaches the ventricles
- Through bundle branches, Purkinje fibers
- Ventricles contract
- Atria repolarize during QRS (hidden wave)
T Wave
Ventricular repolarization:
- As T wave peaks, ventricles are relaxing
Auscultation
The technique of listening to body sounds
Stethoscope
Detects and amplifies body sounds (heart, lungs, GI tract)
Diaphragm (Stethoscope)
- Flat, broad side
- Used most often in heart auscultation
- Light pressure – for higher-pitched sounds
- Heavier pressure – for lower-pitched sounds
Bell (Stethoscope)
- Smaller, concave side
- Detects low-pitched sounds
S1
- Beginning of ventricular systole
- Blood turbulence as AV valves close
- “LUB”
S2
- Beginning of ventricular diastole
- Blood turbulence as SL valves close
- “DUB”
Areas Where Heart Valves are Best Heard
- Aortic Area
- Pulmonic Area
- Tricuspid Area
- Mitral Area
Aortic Area
2nd intercostal space at right sternal border
Pulmonic Area
2nd intercostal space at left sternal border
Triscuspid Area
4th intercostal space at left sternal border
Mitral Area
5th intercostal space at midclavicular line
Aortic Area
Pulmonic Area
Triscuspid Area
Mitral Area
Heart Rate
- Heart muscle contracts on its own
- The heart is controlled indirectly by signals from the brain & by hormone, mostly in form of adjusting heart rate.
Tachycardia
- Heart rate that exceeds the normal range.
- In general, a resting heart rate over 100 beats per minute is accepted as tachycardia.
Bradycardia
- Heart rate of under 60 beats per minute (BPM), although it is seldom symptomatic until the rate drops below 50 BPM.
- It sometimes results in fatigue, weakness, dizziness, and at very low rates fainting.
- A waking heart rate below 40 BPM is considered absolute bradycardia.
Regular (Heart Rhythm)
- Sinus rhythm is the normal beating of the heart, as measured by an electrocardiogram (ECG).
- It has certain generic features that serve as hallmarks for comparison with normal ECGs
Regularly Irregular (Heart Rhythm)
Rhythms where the ‘background’ heart rate is regular but there are occasional extra beats or missed beats. For example venticular ectopics would cause extra beats, some forms of heart block will caused missed beats.
Irregularly Irregular (Heart Rhythm)
There is no regularity to the heart rate with varying beat to beat intervals at all times - the commonest example of this is atrial fibrillation where the natural pacemaker of the heart is not functioning and the ventricles respond to irregular electrical stimuli from above. Try and look at some ECG rhythm strips to see the effect.
2 Causes of Heart Murmurs
- Regurgitation
- Stenosis
Regurgitation
The valve does not close properly and blood backflows
Stenosis
The valve is too narrow
SA Node
AV Node
AV Bundle
Bundle Branches
Purkinje Fibers
Internodal Pathways
P Wave
QRS Complex
T Wave