Electrocardiography Flashcards

1
Q

Pacemaker potential

A

1) Phase 4 depolarization: membrane potential slowly rises to potential
2) Depolarization: action potential begins when threshold is reached
3) Repolarization to resting potential

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2
Q

phase 4 depolarization – ionic basis

A

[membrane potential slowly rises to potential]

1) decrease in outward flux of K+, I(k) [[[slowly close K+ channels]]]
2) I(f), funny current: inward slow flux of Na+, thru nonspecific channels
3) gradual influx of Ca++ as threshold is approached I(Ca)

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3
Q

Depolarization (pacemaker potential) – ionic basis

A

Opening of voltage-gated L-type Ca++ channels

[[[influx of Ca++]]]

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4
Q

Repolarization (pacemaker potential) – ionic basis

A

Opening of voltage-gated K+ channels

[[[influx of K+]]]

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5
Q

hierarchy of pacemakers

A

1) SA node (60-100 bpm)
2) AV node (40-50 bpm)
3) His-Purkinje Fibers (20 bpm)

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6
Q

parasympathetic control of heart rate

A

Vagus nerve releases ACh to SA node.

Voltage gated K+ channels close more slowly. Hyperpolarize resting potential.

Decreased funny current.
Reduce slope of phase 4 depolarization to slow heart rate.

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7
Q

sympathetic control of heart rate

A

Cardiac plexus releases norepi to SA/AV nodes and myocardium.

Increases I(f) and I(Ca) in all myocardial cells.

Alters thrshold toward more negative voltage.

Increases heart rate and increases force of contraction (positive ionotropic effect).

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8
Q

non-pacemaker cell action potentials

A

resting potential: -90 mV

0) rapid depolarization
1) slight repolarization
2) plateau phase
3) repolarization
4) maintenance of resting potential

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9
Q

phase 0 of non-pacemaker cell AP

A

Rapid influx of Na+ through voltage gated channels.

Rapid depolarization.

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10
Q

phase 1 of non-pacemaker cell AP

A

Inactivation of Na+ channels.
Opening of outward K+ channel.

Starts depolarization.

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11
Q

phase 2 of non-pacemaker cell AP

A

Plateau phase.
Inward flux of Ca++ (L-type voltage gated channels).
Slow outward flux of K+.

Balance each other, stay close to 0 mV.

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12
Q

phase 3 of non-pacemaker cell AP

A

Repolarization.
Ca++ channels close.
Potassium efflux.
Membrane returns to resting potential.

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13
Q

phase 4 of non-pacemaker cell AP

A

Small fluxes of Na+ and K+ maintain resting potential.

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14
Q

Effective Refractory Period (ERP)

A

Phase 0-1 of non-pacemaker cell AP.
New AP cannot be elicited.
Allows cell to pump out blood and refill before the next beat.

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15
Q

Sequence of heart activation

A

1) SA node fires AP
2) Signal travels thru atrial muscle via gap junctions
3) Signal reaches AV node (tiny fibers –> slow velocity –> delays signal)
4) Signal enters bundle of His, then R/L bundle branches, then Purkinje fibers
5) Signal spreads cell to cell via gap junctions

septum –> apex –> base

endocardium –> epicardium

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16
Q

P wave

A

ECG
Atrial depolarization.
Triggers contraction of atria.

17
Q

QRS complex

A

ECG
Ventricular depolarization.
Triggers contraction of ventricles.

18
Q

T wave

A

Repolarization of ventricles.

19
Q

Wiggers Diagram

A

Pressure tracings.

1) Atrial systole
2) Isovolumetric contraction
3) Opening of Aortic valve
4) Reduction in ejection rate
5) Isovolumetric relaxation
6) Opening of mitral valve

20
Q

Wiggers Diagram – atrial systole

A

Triggered by P wave.
Small pressure rise in atrium squeezes blood into ventricle.
Tops off ventricle.

21
Q

Wiggers Diagram – isovolumetric contractions

A

Triggered by QRS complex.
Mitral valve closes.
Aortic valve closed.
Pressure rises rapidly.

22
Q

Wiggers Diagram – opening of aortic valve

A

Ventricular pressure exceeds aortic pressure.
Begins ejection phase.
Aortic pressure rises.

23
Q

Wiggers Diagram – reduction in ejection rate

A

Ventricle approaches end of contraction (T wave).
Outward flow declines.
Ventricular/aortic pressures begin to fall.

24
Q

Wiggers Diagram – isovolumetric relaxation

A

Movement of blood reverses, closing valves.
Ventricular pressure falls rapidly.
Atrial pressure rises as venous inflow fills atrium.
Aortic pressure falls as ejected blood drains away from heart.

25
Q

Wiggers Diagram – opening of mitral valve

A

Rapid filling of ventricle from blood accumulated in atrium.

Rapid filling then reduced filling from pulmonary veins.

26
Q

end diastolic volume (EDV)

A

Most full the ventricle will be for that beat.

Filled by atrial systole.

27
Q

End systolic volume (ESV)

A

Least full the ventricle will be during that beat.

Volume remaining in ventricle at end of ejection.

28
Q

stroke volume

A

SV = EDV - ESV

29
Q

S1 heart sound

A

Closure of mitral/tricuspid valves.
Sudden rise in ventricular pressure.
Turbulence of blood in ventricles.

30
Q

S2 heart sound.

A

Closure of aortic/pulmonary valves.

Vibrations of blood in the high pressure vessels.

31
Q

S3 heart sound

A

Rapid filling in some people.

Common in children

32
Q

S4 heart sound

A

Vibration of ventricular walls during atrial systole in some people.

33
Q

ejection fraction

A

ejection fraction = SV/EDV