Cardio II New Flashcards
p-wave
atrial depolarization
right and left atrial action potentials
Length of p-wave
0.08 sec
What represents ventricular depolarization on an ECG?
QRS
What represents ventricular repolarization on an ECG?
T-wave
What interval represents atrial contraction?
PR interval
Length of PR interval
0.2 sec
What do long PR intervals indicate
heart block
Why is the ECG isoelectric during the PR interval?
annulus fibrosus breaks the electrical circuit
A - SA node
B - Atrial cell
C - Venricular cell
What causes the t-wave to be upright?
subepicardial myocytes have ~3x mroe repolarizing iK channels than subendocardial, so they repolarize first
[repolarization occurs in reverse sequence to depolarization]
Why does atrial repolarization not register on an ECG?
it is asynchronous and slow
Length of QRS
0.1 sec
Lead II
left leg (+) to right arm (-)
angle of view = 60o
Lead III
left leg (+) to left arm (-)
angle of view 120o
aVL
left arm to + terminal
angle of view -30o
aVR
right arm to + terminal
angle of view -150o
looks into the inside of the ventricles
aVF
foot to + terminal
angle of view 90o
records the inferior surface of the heart
Where does the first depolarization occur
left side of the interventricular septum
activated by the left bundle branches
electrical axis of the heart
direction of largest dipole in the frontal plane
Can be determined by comparing the height of the R wave in leads I and aVF:
- if the largest R wave is in lead II, the electrical axis is closer to 60o
- the lead with the smallest QRS complex, with R and S waves of nearly equal height, must be at 90o angle to electrical axis
Shift of electrical axis in left ventricular hypertrophy
shifts to the left
(left axis deviation)
shift of electrical axis in right ventricular hypertrophy
right axis deviation
When is dipole the largest
midway through excitation
roughly half the wall is negative and half positive
Which lead displays the biggest R wave
Lead II
aligned at 60o, it is roughly in line with the biggest dipole
Sinus arhythmia
normal, regular, physiological slowing of the heart during expiration and speeding up during inspiration
fall in left ventricular SV during inspiration
fall in LV filling during inspiration
First-degree heart block
lengthening of the PR interval
( > 0.2sec)
caused by slowing of conduction between the AV node and the ventricle
Second-Degree Heart Block
intermittent failure of excitation to pass from the atria to the ventricles
Wenkebach Phenomenon
PR interval lengthens with each beat until a transmission fails completely
Third-Degree Heart Block
(complete)
atria and ventricles beat independently and at different rates
Stokes-Adams attacks
sudden and temporary syncope due to heart block
Wolff-Parkinson-White Syndrome
episodes of paroxysmal tachycardia (palpitations) resulting from a re-entry pathway (accessory bundle of Kent)
Bundle of Kent
extra electrical connection across the annulus fibrosus, additional to the bundle of His
- Seen in WPW syndrome
- produces a self-perpetuating circus pathway
Pharmalogical therapy for Re-Entry dysrhythmias
Disrupt the timing of re-entry using:
- Ca2+ channel blocker
- verapamin
- K+ channel activator
- Adenosine
- Na+ channel blocker
- Procainamide or quinidine
Delayed afterdepolarization (DAD)
can reach threshold, triggering an action potential and poorly co-ordinated ectopic beat (extra systole)
When is the “vulnerable period”
in the later half of the T-wave
readily triggers re-entry based arrhythmias
ECG of myocardial infarct
elevated ST segment
later on, Q and T-waves invert
Size (mV) of an EKG
1 mV
12-Lead EKG
recording of small potential differences in the frontal plane (3 bipolar limb leads and three unipolar limb leads) and transverse plane (6 precordial leads)
Lead I
left arm to right arm
horizontal (0o)
Intracellular Potential of Ventricular Myocyte
- 0 - rapid inflow of Na+
- 1 - transiently outward K+
- 2 - inward Ca2+
- L-type calcium channels
- Na/Ca exchanger
- K efflux
- 3 - K+ outflow
- 4 - resting membrane between -80 to -90mV
Automaticity
ability of a cell to depolarize itself
Examples: SA node and automaticity foci
First 1/3 of p-wave
caused by right atrial activation
what does the PR interval reflect?
delay of condution by the AV node
What does the t-wave represent on a ventricular myocyte graph?
phase 3 - repolarization
QT interval
measures the action potential duration
time in which the ventricles depolarize and repolarize
Bazett’s formula
QTc = QT/sqrt(RR)
What does each large box on an EKG represent?
0.20 seconds
Normal P-wave length
0.08-0.12 seconds
PR Interval length
0.12-0.20 seconds
QRS length
0.06-0.11 seconds
Frontal Plane leads
I, II, III, and aVR, aVL, and aVF
Horizontal plane leads
V1-V6
View the heart as if the body were cut in half