class 10: cardio examination Flashcards
what is the flow of the conduction system of the heart
SA (pacemaker)
AV
bundle of his - bundle branches
purkinjie fibers
whta is the function of the AV node
pass depolarization to the ventricles
there is a brief delay to allow for ventricle filling
what is the function of the bundle fibers - where do they carry there depolrizatoin
To left and right ventricle
where do Purkinje fibers carry their depolarization
Throughout ventricles
what are the 4 parts of a ECG
P
QRS
T
what does the P wave represent
̶Atrial depolarization
what does the QRS complex represent
̶Ventricular depolarization and atrial repolarization
what does the T wave represent
̶Ventricular repolarization
what is the ST segment telling us
Ischemia or Infarction
how do we calcualte HR on a ECG
Six-second method
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.
what are the Classification of AV Heart Blocks
1st degree heart block
2nd degree heart block
3rd degree heart block
what is 1st degree heart block
Delay in conduction
what is 2nd degree heart block
Partially blocked conduction
what is 3rd degree heart block
Fully blocked conduction
what is 1st degree heart block - 2/2
AV nodal disease
1st degree heart block - PR interval
> 0.2 seconds (1 large box)
1st degree heart block - P wave
Each P is followed by a QRS
1st degree heart block - population
Seen also in athletes with increased vagal tone (activity)
1st degree heart block - progress of this condition
Generally, won’t progress, benign condition
what is another name for 2nd degree block
Mobitz
what is the characteristics of 2nd degree block
Increasing PR interval before the QRS is
dropped, then the cycle is repeated.
what causes 2nd degree block
One or more – but not all – of the atrial impulses fail to conduct to the ventricles
what are the two kinds of 2nd degree block
Type I/Wenckebach
Type II
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
