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Semester 5 PMCP Exam 1 > Atrial ECG > Flashcards

Atrial ECG Flashcards

1
Q

key things about heart cells

A

rhythmicity
automaticity
refractory period
conductance

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2
Q

heart - on the right side from where to where

A

3rd to 6th costal cartilages

approx 10-15 cm from sternum

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3
Q

heart - on the left side from where to where

A

2nd to 5th intercostal space

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4
Q

heart - apex is found where in relation to sternum

A

9cm to the left of sternum in 5th intercostal space

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5
Q

where is the true heartbeat

A

in 5th intercostal space

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6
Q

heart mvmnt is most noticeable when

A

during deep inspirations

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7
Q

heart mvmnt with deep inspiration and why

A

descends down and to the right because central tendon from diaphragm inserts on pericardium and is pulling down

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8
Q

heart mvmnt with expiration

A

opposite of inspiration - move back up

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9
Q

atelectasis

A

collapsing of the lungs

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10
Q

atelectasis does what to the heart

A

shifts the heart to the same side

Trying to fill the space

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11
Q

with tension pneumothorax what happens to the heart

A

the positive pressure shifts the heart away from the side of the pathology

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12
Q

heart valves - name

A

Tricuspid, Mitral, Aortic, Pulmonic

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13
Q

Which valves are between the atria and ventricles

A

Tricuspid and Mitral

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14
Q

Cusps of the valves

A

Mitral (2)
Tricuspid (3)
When ventricles fill, the cusps are forced up into the closed position

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15
Q

Chordae tendinae prevent

A

the cusps from being forced into the atria

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16
Q

Dysfunction of cords can lead to

A

regurgitation from ventricle into atria

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17
Q

Cusps are relaxed when

A

in diastole to let blood flow freely into the ventricles from the atria

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18
Q

Pulmonic and aortic valves have how many cusps and where do they attach

A

3 - attach to root of aorta and pulmonary artery

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19
Q

Pulmonic and aortic valves - what happens at end of systole

A

blood in aorta and pulmonary artery force the cusps shut

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20
Q

Pulmonary and aortic valves can be

A

inverted so they can support the column of blood flowing into ventricles during diastole and with contraction of systole they can open to allow blood to flow in

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21
Q

artery supply - derived from

A

right and left coronary arteries - arise from aortic sinuses

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22
Q

Left coronary artery divides into

A

anterior descending and left circumflex artery

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23
Q

left coronary artery, ant descending, and left circumflex supply

A

most of left ventricle, left atrium, most of ventricular septum, and in 45% the SA node

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24
Q

Right coronary artery supplies

A

most of the right ventricle, AV node, and in 55% of people the SA node

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25
Q

Veins - three groups of veins

A

Coronary sinus and supplying veins
Anterior cardiac veins
Thebesian veins

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26
Q

Veins - coronary sinus and supplying veins - location

A

Most of the veins drain into here

Located on post aspect of coronary sulcus

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27
Q

Veins - coronary sinus and supplying veins - empties into

A

the right atrium between opening of IVC and tricuspid valve

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28
Q

Veins - anterior cardiac veins
Location -
Fed from -

A

Fed from anterior part of right ventricle

Originates in subepicardial tissue and cross coronary sulcus into right atrium

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29
Q

Veins - thebesian veins

Where most numerous

A

Tiny veins that enter into the cavities of the heart

Most numerous in right atrium and ventricle

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30
Q

Vena cava empties into

A

right atrium

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31
Q

Blood flows from right ventricle into

A

pulmonary artery - to capillaries - across alveoli for gas exchange - to pulmonary veins - to left atrium

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32
Q

which artery has deoxygenated blood

A

pulmonary artery

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33
Q

Systemic circulation - purpose

A

carries nutrition and oxygen throughout the body while carrying away waste products

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34
Q

driving force of systemic circulation

A

heart

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35
Q

Systole does what

A

forwards oxygenated blood away from the heart

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36
Q

Diastole does what

A

elastic recoil of vessels maintain the forward propulsion of blood between ventricular systoles

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37
Q

Innervations

A

balance between intrinsic automaticity and extrinsic nerves

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38
Q

Intrinsic innervation centers around the

A

SA node - it is the pacemaker of the heart

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39
Q

Without vagal influence - SA node inherent pulse

A

100-110 beats per minute

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40
Q

Vagal influence (extrinsic influence) on SA node - pulse

A

60-80 bpm

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41
Q

Extrinsic is regulated by the

A

medulla with input from hypothalamus during stress and activity

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42
Q

AV pulse

A

40-60 bpm if AV was in charge

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43
Q

Bundle of His pulse

A

20-40 bpm

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44
Q

upper thoracic nerves cause

A

1 acceleration of discharge rate of SA node
2 increase in AV nodal conduction
3 increase in contractile force of atria and ventricles

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45
Q

vagus nerve causes

A

cardiac slowing and decreased AV node conduction

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46
Q

Concentric waves of excitation of the SA node travel through the AV node with what

A

.04 second delay

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47
Q

Why the delay in concentric waves of excitation of the SA node traveling the AV node

A

get blood out of atria and get it into the ventricles

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48
Q

What wave of depolarization gives rise to P-QRS-T

A

Wave of excitation passes through Bundle of His, down Bundle Branches, through Purkinje fibers, which then permeate the ventricles and cause them to contract

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49
Q

for the heart to work properly what has to occur first

A

electrical stimulation first followed by mechanical contraction

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50
Q

ECG is a graphic display of

A

the electrical event that is the stimulus for mechanical contraction

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51
Q

ECG records the

A

summation of action potentials of the mm cells in the atria and ventricles as P-QRS-T waveforms

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52
Q

AP is directly related to the difference between

A 
the outside (pos) and inside (neg) charges
NA out and K in
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53
Q

Depolarization is the

A

rapid change of polarity on the inside and outside of the cell during phase 0

54
Q

ECG records the

A

depolarization/muscle contraction

55
Q

In the atria - the AP correlates with

A

depolarization of the P wave

56
Q

PR interval represents

A

total time for depolarization and time required for the impulse to travel through the AV junction through bundle branches

57
Q

Why do we not see repolarization of the atria

A

buried in QRS

58
Q

In ventricles - depolarization correlates with

A

QRS complex of ECG

59
Q

QRS interval represents

A

time required to depolarize both ventricles

60
Q

ST segment represents

A

repolarization of ventricles

61
Q

T wave represents

A

the end of repolarization of the ventricles

62
Q

QT interval represents

A

total time required for both depolarization and repolarization of the ventricles

63
Q

each 5 mm block represents how many seconds

A

0.20

64
Q

1 second in time is represented by

A

5 larger blocks

65
Q

P wave time

A

0.08 - 0.10 s

66
Q

PR interval time

A

0.12 - 0.20 s

67
Q

QRS interval time

A

0.06 - 0.10 s

68
Q

QT interval time

A

less than or equal to 0.44 s

69
Q

12 lead ECG

A

6 in frontal plane

6 in transverse plane

70
Q

Frontal plane leads

A

3 standard limb leads

3 augmented limb leads (AVR, AVL, AVF)

71
Q

Transverse plane leads

A

V1-V6

72
Q

Standard limb leads - Lead 1

A 
traveling away (negative to positive) 
T might be inverted
73
Q

Standard limb leads - Lead 2

A

how the blood and contraction go through the heart - all are upright

74
Q

Augmented - AVR

A

All inverted, moving away from heart

75
Q

Augmented - AVL

A

All inverted

76
Q

Augmented - AVF

A

Should all be upright

77
Q

Calculating HR - 3 ways

A

1500 method
R-R method
6 second method

78
Q

1500 method

A

Most precise way
Count small squares btw QRS
Divide into 1500

79
Q

R-R method

A

Rs on dark line

300-150-100-75-60-50

80
Q

6 second method

A

least accurate

count QRS complexes in 6 second intervals and multiply by 10

81
Q

Info on EKG represents hearts ___ activity

A

electrical

82
Q

Myocardial contraction is caused by ___ of the myocytes, which records on the EKG

A

Depolarization

83
Q

The recovery phase that follows depolarization is known as ___

A

repolarization

84
Q

Procedure for systematic evaluation of an ECG

A 
Evaluate P wave
Evaluate PR interval
QRS complex
QRS interval
T wave
R-R interval
Observe patient
85
Q

P wave –>

A

Atria, SA node

86
Q

PR interval —>

A

Atria through AV node

87
Q

QRS complex —>

A

Ventricles

88
Q

QRS interval —>

A

ventricles

89
Q

T wave —>

A

we aren’t repolarizing - infarct

90
Q

R-R interval —>

A

rate

91
Q

Sinus rhythm includes (3)

A

P wave before each QRS
PR interval 0.12 - 0.20
QRS rate 60-100 bpm

92
Q

Dysrhythmias originating in SA node

A

Wandering Atrial Pacemaker
Sinus Tachycardia
Sinus Bradycardia
Sinus Arrhythmia

93
Q

Supraventricular Arrhythmias
What is it
May occur where
How categorized

A

Abnormality of the impulse above the level of the ventricles
May occur in atria or at level of AV junction
Categorized as sinus, atrial, junctional

94
Q

Sinus Arrhythmia (3)

A

P wave before QRS
PR interval 0.12 - 0.20, varies
QRS rate 40-100 bpm (less than .12 s)

95
Q

Respiratory Sinus Arrhythmia - common in

A

children and elderly

96
Q

Respiratory Sinus Arrhythmia - respirations increase rate with ___ decrease rate with ____

A

increase - inspiration

decrease - expiration

97
Q

Non respiratory arrhythmia - may be observed in people with

A

cardiac disease and myocardial infarction - especially in association with sinus bradycardia, digoxin therapy, or enhanced vagal tone

98
Q

Clinical signs and symptoms with sinus arrhythmia

A

irregular pulse

usually asymptomatic

99
Q

tx for sinus arrhythmia

A

treat underlying cause

100
Q

Sinud Bradycardia (3)

A

P wave before each QRS
PR interval .12-0.20
QRS less than 60 bpm, regular
Not often below 40

101
Q

Common etiology - sinus bradycardia

A

Damage to SA node
Inc parasympathetic tone
Hypoxemia
Normal in conditioned athletes

102
Q

Clinical signs and sx - sinus bradycardia

A

seldom symptomatic

may lead to blocks or escape rhythms

103
Q

Tx for sinus bradycardia

A

drug therapy

pacemakers

104
Q

Sinus tachycardia (3)

A

P wave before each QRS
PR interval 0.12 - 0.20
QRS rate - greater than 100 (usually 100-140)

105
Q

Sinus tachycardia common etiology

A 
Pain
fever
hypoxemia
CHF/pulmonary edema
Shock
Agitation
Illicit drugs
Caffeine
Nicotine
106
Q

Clinical signs and sx - sinus tachycardia

A 
Very with rate
Rapid, regular pulse
Palpitations
Dyspnea
Asymptomatic 
with MI - might have ischemia and/or CHF
107
Q

Tx for sinus tachycardia

A

Beta blockers and Ca channel blockers to slow heart

Elimination of underlying cause

108
Q

Wandering atrial pacemaker (3)

A

P wave present but vary in configuration
PR interval - vary but within normal limits
QRS rate - identical and within 0.04-0.10 s

109
Q

Common etiology with wandering atrial pacemaker

A

irritable foci

Injury to SA node, CHF, increased vagal firing

110
Q

Signs and sx with wandering atrial pacemaker

A

rhythm that is irregular and without consistant pattern

usually doesnt cause sx

111
Q

Tx for wandering atrial pacemaker

A

no tx necessary unless rhythm develops into atrial fibrillation

112
Q

Dysrhythmias originating in the atria

A

Atrial Fibrillation
Atrial Flutter
Atrial Tachycardia
Atrial Premature Beat

113
Q

Atrial premature beat (3)

A

P wave - premature P may have diff configuration
PR interval - might be less than .12 or more than .2
QRS rate - if APC is conducted a premature QRS is present

114
Q

Common etioloty of atrial premature beat

A

Atrial stretch (valve disease, liver disease, lung hypertension, drugs)
Hypoxemia
Atrial stimulation (pacemaker, catheter)
Frequent PACs may precede atrial flutter, a fib, or SVT

115
Q

Clinical signs and sx - atrial premature beat

A

irregular pulse

116
Q

atrial premature beat - tx

A

not usually indicated unless signs and sx present

if drug therapy is indicated, quinidine, procainamide, disopyramide

117
Q

Atrial tachycardia (3)

A

P wave before each QRS, might be hidden
PR interval - might be less than .12 or more than .2
QRS rate - more than 100 - 200

118
Q

atrial tachycardia - common etiology

A 
Atrial stretch
Inc sympathetic tone
Hypoxemia
Digitalis toxemia
Atrial stimulation
119
Q

Atrial tachycardia - clinical signs and symptoms

A

Rapid, regular pulse
May exhibit signs and sx of dec CO or CHF
Extremely dangerous in MI (inc O2 consumption, inc workload)

120
Q

Treatment for atrial tachycardia

A

Withhold digoxin
Treat underlying heart disease
B blockers or verapamil

121
Q

Atrial flutter (3)

A

P wave - saw toothe baseline, 250-350 bpm
PR interval - constant or variable
QRS rate - 75 to 250 bpm, regular or irregular

122
Q

Common etiology for atrial flutter

A 
Inc sympathetic tone
Atrial stimulation
Hypoxemia
Valvular disease
Hyperthyroidism
123
Q

Clinical signs and symptoms - atrial flutter

A

Depend on ventricular rate
maybe palpitations, angina, dyspnea
may cause ischemia and/or CHF

124
Q

Tx for atrial flutter

A

Slow ventricular rate by blocking conduction through AV node with digoxin, beta blockers, Ca channel blockers
Class 1 or 3 anti-dysrhythmic agents to convert atrial futter to sinus rhythm
Cardioversion 10 - 50 watts

125
Q

Atrial fibrillation (3)

A

P wave - irregular, undulant baseline, 300 or more
PR interval - variable
QRS - 50 to 250, irregular

126
Q

Atrial fibrillation etiology

A 
Inc sympathetic tone
ASHD
Hypoxemia
Hyperthyroidism
Valvular disease
127
Q

Atrial fibrillation signs and sx

A 
Irregular pulse
diff btw apical and atrial pulse
palpitations, angine, dyspnea
dec CO
Ischemia/CHF
May develop emboli from atrial wall thrombus formation
128
Q

Tx for atrial fibrillation

A

same as for atrial flutter

newly dx tx with anticoagulants

129
Q

Atrial foci have the inherent rate of ___ bpm

A

60-80

130
Q

Ventricular focu have the inherent rate of ___ bpm

A

20-40

Semester 5 PMCP Exam 1 (6 decks)

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