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Block 13 - The Development of Cardiorespiratory Disease > ALS Lecture 12 - The Rhythm of the Heart DONE > Flashcards

ALS Lecture 12 - The Rhythm of the Heart DONE Flashcards

1
Q

the electrical system of the heart (4)

A

sinus node, atrio-ventricular node, His-Purkinje system, cardiac myocytes

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2
Q

sinus node (2)

A

pacemaker, electrical impulses start here

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3
Q

atrio-ventricular node (2)

A

slows down atrial impulse, prevents very high atrial rates transmitted to ventricles

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4
Q

His-Purkinje system (2)

A

spreads electrical impulse rapidly, synchronously through left and right

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5
Q

cardiac myocytes (2)

A

conduct from H-P system, then contract

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6
Q

electrical pathway of heart (6 steps)

A
  1. impulse begins at SAN
  2. spread across atria, atria contract
  3. AVN stimulated, signal delayed
  4. impulse down bundle of His, goes left and right
  5. up Purkinje fibres in ventricles
  6. ventricles contract from base up
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7
Q

label the diagram of the electrical pathway of the heart (A)

A

done

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8
Q

what drives the rate of sinus node firing? (2)

A

sympathetic NS, parasympathetic NS

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9
Q

increased PNS activity does what?

A

bradycardia

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10
Q

decreased PNS activity does what?

A

tachycardia

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11
Q

examples of increased PNS activity (3)

A

sleep, fainting, fitness

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12
Q

examples of decreased PNS activity (4)

A

exercise, blood loss, heart failure, atropine

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13
Q

increased SNS activity does what?

A

tachycardia

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14
Q

decreased SNS activity does what?

A

bradycardia

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15
Q

examples of increased SNS activity (5)

A

exercise after 1st minute, fear, heart failure, adrenaline, salbutamol

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16
Q

examples of decreased SNS activity (3)

A

rest and sleep, beta-blockers, fainting

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17
Q

P wave

A

atrial depolarisation

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18
Q

PR interval

A

time for impulses to go from SAN to AVN

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19
Q

PR interval is between

A

start of P wave, start of QRS

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20
Q

PR segment

A

conduction from AVN, down bundle of His, up Purkinje fibres

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21
Q

QRS complex

A

ventricular depolarisation

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22
Q

ST segment

A

ventricles depolarised during plateau of action potential

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23
Q

T wave

A

ventricular repolarisation

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24
Q

QT interval

A

time between end of ventricular depolarisation and repolarisation

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25
Q

U wave

A

repolarisation of papillary muscles/Purkinje fibres

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26
Q

label the diagram of ECG (B)

A

done

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27
Q

normal PR interval

A

<200msec, <5 small squares

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28
Q

normal QRS complex

A

<110msec, <3 small squares

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29
Q

normal QT interval is ___ _____

A

rate dependent

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30
Q

normal QT interval

A

<460msec, <12 small squares

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31
Q

QTc

A

QT interval corrected for rate

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32
Q

QTc =

A

QT / square root of RR interval in seconds

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33
Q

QTc and QT are the same at

A

60bpm

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34
Q

on ECG, one small square =

A

40msec

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35
Q

on ECG, one large square =

A

200msec

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36
Q

one minute is how many large squares?

A

300

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37
Q

to get the heart rate in bpm we

A

divide 300 by number of large squares between each RR interval

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38
Q

if there are 4 large squares between the peaks of QR, what is the heart rate in bpm?

A

300/4 = 75bpm

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39
Q

in normal sinus rhythm, what is the ratio of P wave to QRS?

A

1:1, P wave in front of every QRS

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40
Q

look at the ECG showing normal sinus rhythm (C)

A

done

41
Q

take a look at ECGpedia (D)

A

done

42
Q

ectopic pacemaker

A

excitable cells cause premature heartbeat outside normal SA node function

43
Q

ectopic pacemaker pathophysiology (3 steps)

A
  1. ectopic pacemaker initiates beat, premature contraction
  2. does not follow normal signal pathway
  3. can make heart refractory or incapable of normal function
44
Q

types of ectopic pacemaker (3)

A

atrial, junctional, ventricular

45
Q

bradycardia is a heart rate of

A

60bpm or less

46
Q

a person may have resting bradycardia due to

A

good fitness

47
Q

bradycardia questions after “are the QRS complexes regular?”

A

Q. if yes, is there a P-wave in front of each QRS complex with normal AV delay?

  • if yes = sinus bradycardia
  • if no = heart block
48
Q

bradycardia questions after “are the QRS complexes irregular?”

A

Q. are there P waves?

  • if no = slow AF
  • if yes = look at relationship between P waves and QRS
49
Q

look at sinus bradycardia ECG example (E)

A

done

50
Q

in sinus bradycardia ECG (2)

A

wide impulse separation, normal impulses

51
Q

what are QRS complexes like in sinus bradycardia?

A

regular

52
Q

what are P waves like in sinus bradycardia? (2)

A

P wave before QRS, normal AV delay

53
Q

look at first degree heart block ECG example (F)

A

done

54
Q

in first degree heart block, the QRS complexes are

A

regular

55
Q

in first degree heart block, P waves are

A

before each QRS

56
Q

in first degree heart block PR interval is

A

prolonged

57
Q

prolonged PR interval shows

A

delay in conduction from SAN -> AVN

58
Q

2 types of second degree AV block

A

type 1 - Wenckebach

type 2 - Mobitz II

59
Q

look at the second degree AV block type 1 (Wenckebach block) ECG example (G)

A

done

60
Q

what are QRS complexes like in second degree AV block type 1 (Wenckebach block)?

A

irregular

61
Q

describe complexes 1, 2 and 3 in second degree AV block type 1 (Wenckebach block)

A

complex 1 - P wave followed by QRS with normal PR interval
complex 2 - P wave with QRS but longer PR interval
complex 3 - PR interval very long, followed by P wave, no QRS

62
Q

second degree AV block type 1 (Wenckebach block) heart block type

A

3:2, 3 P waves for every 2 QRS

63
Q

look at the second degree AV block type 2 (Mobitz II block) ECG example (H)

A

done

64
Q

what are QRS intervals like in second degree AV block type 2 (Mobitz II block)?

A

regular

65
Q

second degree AV block type 2 (Mobitz II block) heart block type

A

2:1, 2 P waves for every QRS

66
Q

look at third degree AV block (complete heart block) ECG (I)

A

done

67
Q

what are QRS complexes like in third degree AV block (complete heart block)?

A

regular

68
Q

what are P waves like in third degree AV block (complete heart block)?

A

P wave doesn’t precede QRS every time, not dependent on each other

69
Q

look at the ECG example of sinus arrest (J)

A

done

70
Q

sinus arrest is (3)

A

failure of sinus node to discharge, absence of depolarisation, ventricular asystole

71
Q

look at ECG of brady-tachy syndrome (K)

A

done

72
Q

Brady-Tachy syndrome

A

intermittent episodes of slow and fast rates from SA node or atria

73
Q

sinus bradycardia treatment (4)

A

beta-blockers, calcium channel blockers, digoxin, conservative

74
Q

heart block is caused by

A

slow/blocked conduction through AV node

75
Q

heart block bradycardia treatment (2)

A

IV atropine, underlying cause

76
Q

look at the ECG os left and right bundle branch block (L)

A

done

77
Q

left bundle branch block (2)

A

assess LV function, bad prognostic

78
Q

right bundle branch block (3)

A

benign, with lung disease, maybe right ventricle strain

79
Q

tachycardia ECG questions after “are the QRS complexes regular and <120msec wide?”

A

if yes, supraventricular tachycardia, look for P wave, if <120bpm = sinus tachycardia, if >140bpm SVT

80
Q

tachycardia ECG questions after “are the QRS complexes regular and >120msec wide?”

A

if yes assume VT

81
Q

tachycardia ECG questions if the QRS complexes are irregular (2)

A 
<120msec = AF
>120msec = probs AF, VT if pts ill
82
Q

if unsure whether it’s SVT or VT (2)

A

inject adenosine, adenosine blocks AV node so rate should slow if SVT

83
Q

causes of sinus tachycardia (5)

A

hyperthyroidism, anxiety, heart failure, hypovolaemia, septicaemia

84
Q

stable SVT treatment (3)

A

IV adenosine, no digoxin, may revert spontaneously

85
Q

stable VT treatment (2)

A

IV amiodarone, electrical cardioversion, correct hypokalaemia

86
Q

look at ECG of atrial tachycardia (SVT)

A

done

87
Q

atrial flutter often degenerates to

A

atrial fibrillation

88
Q

look at the ECGs of atrial flutter (M)

A

done

89
Q

atrial flutter treatment (3)

A

anticoagulate, external electrocardioversion, electrophysiological ablasion

90
Q

AF risk increases 4-fold after

A

stroke

91
Q

in AF, ECG is

A

irregularly irregular

92
Q

look at the ECGs of rapid ventricular response and controlled ventricular response rate (N)

A

done

93
Q

atrial fibrillation treatment (3)

A

rhythm control, ventricular rate control, anti-thrombotic (NOT aspirin)

94
Q

look at the ECG example of ventricular tachycardia (N)

A

done

95
Q

look at ECG of ventricular fibrillation (O)

A

done

96
Q

in ventricular fibrillation (4)

A

rate is 0, no QRS, no pattern, needs defibrillating

97
Q

Torsades de Pointes treatment

A

magnesium

98
Q

Torsades de Pointes is exacerbated by (2)

A

low K+, low Mg2+

99
Q

Torsades de Pointes occurs in (2)

A

drugs, existing bradycardia

Block 13 - The Development of Cardiorespiratory Disease (14 decks)

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