class 10: cardio examination Flashcards by VB VB

what is the flow of the conduction system of the heart

SA (pacemaker)

bundle of his - bundle branches

purkinjie fibers

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whta is the function of the AV node

pass depolarization to the ventricles

there is a brief delay to allow for ventricle filling

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what is the function of the bundle fibers - where do they carry there depolrizatoin

To left and right ventricle

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where do Purkinje fibers carry their depolarization

Throughout ventricles

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what are the 4 parts of a ECG

QRS

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what does the P wave represent

̶Atrial depolarization

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what does the QRS complex represent

̶Ventricular depolarization and atrial repolarization

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what does the T wave represent

̶Ventricular repolarization

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what is the ST segment telling us

Ischemia or Infarction

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how do we calcualte HR on a ECG

Six-second method

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what is the Six-second method

Count off 30 large boxes = 6 seconds (remember 1 large box = 0.2
seconds, so 30 large boxes = 6 seconds).

Then, count the number of R waves in six seconds and multiply
by 10.

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what are the Classification of AV Heart Blocks

1st degree heart block

2nd degree heart block

3rd degree heart block

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what is 1st degree heart block

Delay in conduction

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what is 2nd degree heart block

Partially blocked conduction

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what is 3rd degree heart block

Fully blocked conduction

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what is 1st degree heart block - 2/2

AV nodal disease

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1st degree heart block - PR interval

> 0.2 seconds (1 large box)

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1st degree heart block - P wave

Each P is followed by a QRS

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1st degree heart block - population

Seen also in athletes with increased vagal tone (activity)

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1st degree heart block - progress of this condition

Generally, won’t progress, benign condition

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what is another name for 2nd degree block

Mobitz

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what is the characteristics of 2nd degree block

Increasing PR interval before the QRS is
dropped, then the cycle is repeated.

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what causes 2nd degree block

One or more – but not all – of the atrial impulses fail to conduct to the ventricles

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what are the two kinds of 2nd degree block

Type I/Wenckebach

Type II

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type 1 2nd degree block - also called

“Wenckebach” or “Mobitz type I”

type 1 2nd degree block - characteristics

PR interval gets progressively longer each beat until finally a QRS is “dropped”

type 1 2nd degree block - due to

Disease of the AV node

2nd degree block - Type 2: also called

“Mobitz type II”

2nd degree block - Type 2: characteristics

PR intervals are constant and a QRS is “dropped” intermittently * No pattern can be discerned

2nd degree block - Type 2: 2/2

Disease of the Bundles of His and Purkinje fibers

3rd degree block - character

The atrial rate is independent of the ventricular rate (P wave and QRS march out separately) No relationship at all, of the P-R intervals QRS is usually wide and bizarre because it is ventricular origin

what does S-T Segment Depression on the Electrocardiogram indicate

Myocardial Ischemia heart attack

ECG of Myocardial Ischemia and what is it

* Decreased blood supply * ST segment depression * T wave flattened or inverted

ECG of Myocardial Infarction and what is it

* Complete occlusion of blood supply and cell death * ST segment elevation

Supraventricular Arrhythmias - 4 types

* Premature Atrial Contractions * Atrial Tachycardia * Atrial Flutter * Atrial Fibrillation

Atrial Tachycardia - rate

̶Atrial Rate: 100-250 bpm

Atrial Flutter - rate

̶Atrial Rate: 250-350 bpm

Atrial Fibrillation - rate

̶Atrial Rate: 400-600 bpm

Premature Atrial Contractions - character

the contraction occurs before it should the P wave bumps up with the T wave no 911 - continue exercise

Atrial Tachycardia - character

the atria (p wave) beat 2-3 time prior to the start of the QRS no 911 - continue exercise

Atrial Flutter - character

the atria (p wave) beat 5 times prior to the start of the QRS sawtooth no 911- sym stop exerise

Atrial Fibrillation - character

the atrial is shivering - beating a lot before the QRS cannot count no 911 - stop exercise

Premature Ventricular Contraction (PVC) - character

Heartbeat initiated by the Purkinje fibers: skipped beat or palpitations Ventricles contract before the atria: cannot be filled optimally

Premature Ventricular Contraction (PVC) - strip character

̶No P, wide bizarre QRS

what is ventricular tachycardia

̶PVCs that occur three (3) or more in a row

PVC - Bigeminy

1 normal beat followed by 1 PVC

PVC - Trigeminy

2 normal beats followed by 1 PVC

PVC - Multifocal PVC

More than 1 PVC is present and 2 do not appear similar in configuration

what do we do when we see a Multifocal PVC

STOP Exercise and immediately refer (call 911)

PVC - Couplet

2 consecutive PVCs together with no normal beat between them

if pt presents with Couplet what does we do

STOP Exercise ̶If 2 or more couplets, immediately refer (call 911)

PVC - what is then name when there is 3 PVS in a row

V tach

PVC - VTach what should we do

STOP and call 911

S3 what condition

CHF

what is another name for S3

ventricular gallop

what is the S4 conditions

HTN hypertrophy

what is another name for S4 heart stops

artial gallop

what part of the cardiac cycle does S1 and S2 heart sounds occur

systole

what part of the cardiac cycle does S3 and S4 heart sounds occur

diastole 3 - early 4- late

what does QT interval represent

the time it takes for the heart muscle to contract and relax ventricles

is 2nd degree heart block an emergency

type 1 - do not call 911 type 2 - stop exercise, no 911

is 3rd degree heart block an emergency

yes - 911

biventricular heart failure

a combination of left-sided and right-sided heart failure

right sided heart failure

has peri edema the purpose of the right side of the body is to collect blood form the body SOB and cough

left sided heart failure

no peri edema the purpose of the left side of the heart is to send blood to the rest of the body SOB and cough

what is cor pulmonale

a condition that causes the right side of the heart to fail Shortness of breath: Often the first symptom, especially during activity Chest pain: Usually in the front of the ches t Swelling: In the feet, ankles, legs, or belly

how much elevation and depression for ST wave changes

2 mm = depression 1 mm = elevation

is 911 needed for any of the artial conditions

no because the the ventricle is still contracting at the proper rate