Heart, leads, sinus rhythm Flashcards
initiate and conduct impulse. the hearts wiring is called?
electrical cells
contract in response to electrical stimulation; pumping action is called?
mechanical cells
if the heart is in a resting or polarized (poolarized) state how would the cardiac cell look?
positive (+) on the outside
negative (-) on the inside
if a cardiac cell is depolarized how would the cell look?
negative (-) on the outside
positive (+) on the inside
we see this first as a P-wave on ECG monitor
how would the cardiac cell look in the recovery state called repolarization?
positive on the outside
negative on the inside
what is the dominant controller or pacemaker of conduction system?
SA node
the SA node pumps a normal range of ______ bpm?
60-100
the AV node pumps at _____ bpm?
40-60
the ventricle (purkinje fibers) pumps at _____bpm?
20-40
when the upper pacemaker fails the next in line will step in is known as the______?
escape mechanism
clump of heart cells become irritable and take over the SA node is called?
irritability mechanism
the heart is influenced by autonomic nervous system called _____ and ______?
sympathetic and parasympathetic
increased irritability, increased rate, increased force of contraction is what autonomic system?
sympathetic
decreased irritability, decreased HR, decreased force of contraction is what autonomic system?
parasympathetic
______ stimulation of the heart must occur before mechanical contraction, but electrical activity can occur without _______ contraction?
electrical
mechanical
how do we asses mechanical activity?
pulse, BP, cardiac output
how do we asses electrical activity?
electrocardiogram (ECG) monitor
electrical activity travel form the base to the _____ in a natural direction called a vector, which would start in the atria and move to the ________?
apex
ventricle
The “Key” electrode is the positive, negative, or ground lead?
positive electrode
if the current is heading toward the positive electrode this will produce a ____ deflection on the oscilloscope ?
upward (+)
if the current is heading away from positive electrode this will produce a _____ deflection on the oscilloscope?
downward (-)
why do we not use only one pattern of leads?
different arrangements give different view of the heart
right arm (-) left arm (+) what limb lead?
lead 1
right arm (-) left leg (+) what limb lead?
lead 2
left arm (-) left leg (+) what limb lead?
lead 3
hint right arm is always (-) left leg always (+) that leaves left arm with a (-) and a (+) !!!
do the motions and talk it out !!!
what lead is the vector? most common monitoring lead or viewpoint
lead 2
you put all the lead together this makes a _______ triangle?
Einthoven
_____ leads are created by making a single limb positive and all other limbs negative (6 limb leads total)
augmented leads
offer vertical and horizontal views of the heart (12 limb leads) is known as?
precordial leads
what limb leads can tell if myocardial infarction and where MI is located?
precordial leads
true or false? pregeled electrodes can use both contact gel and KY
false only contact gel
friction of electrode wires with sheets and bedrails, loose connections, muscle movement can cause what?
artifacts
lead colors green is ___
white is ____
black is _____
ground
negative
positive (more test come up positive!!!)
what is the paper speed in a ECG recorder?
25mm/sec
Millivolt (Mv) is on the __ axis?
y-axis (vertical)
time is on the ___ axis?
x-axis ( horizontal)
tic marks are made on the ECG paper every ___ seconds?
3
on the y-axis 1 MV = ___ large boxes or 10mm ___ small boxes?
2 large boxes or
10 small boxes
on the x-axis (time) how many large boxes = 1 second?
5 large boxes = 1 sec
30 large boxes would = how many seconds?
6 seconds
if we want to find out the _____ count the R-R in 6 seconds X 10
heart rate
1 small box = ___ mm
1 mm
1 small box = ___ seconds
0.04 sec
one large box = __ mm
5 mm
one large box = __ seconds
0.20 sec
what wave represents the depolarization of the right and left atria
P- wave
the P-wave is ___ to ___ mm in amplitude?
0.5 to 2.5 mm
the P-wave should be no more than ____ seconds in duration?
0.11 seconds
the area from the end of the P wave to the beginning of the QRS complex is known as the what?
PR segment
remember PR “segments” isoelectric or a
flat line
___ segment represents a delay in conduction through the AV junction spread through the bundle of his and purkinjie fibers before contraction?
P-segment
The P-wave added to the PR segment is called the ______?
PR interval
begins with the onset of the P wave and ends with the onset of the QRS complex?
PR interval
The PR interval measures ___ to ___ seconds?
0.12 to 0.20 seconds
a long PR interval > 0.20 seconds indicates delay to long through AV junction. < 0.12 seconds indicate impulse originates at the ___ junction?
AV junction
The QRS complex represents ______ depolarization ?
ventricular
Q wave is the first (-) deflection and represents depolarization of the ________ septum?
interventricular
The R and S wave represents depolarization of the right and left ______?
ventricles
what is the normal duration of the QRS complex?
0.06 to 0.10 seconds for simplicity anything < 0.12 is normal
A QRS > 0.12 is a partial or incomplete bundle branch ______?
block
ventricular repolarization after the QRS happens in the isoelectric or flat portion of the ____ segment ?
ST segment
ventricular repolarization after the S wave and before the T wave is known as the _____ segment?
ST segment
an ST segment depression is suggestive of myocardial ______?
ischemia
a more than 1 to 2 mm elevation in ST segment is suggestive of an acute myocardial _______?
infarction
ventricular repolarization is represented by the ___ wave?
T wave
the absolute refractory period is present during the _____ of the T wave?
beginning ( you want you absolute vodka first)
At the peak of the T wave the _____ refractory period has begun?
relative ( have the vodka first cause your relatives are peaking you nerves )
the normal T wave is not higher than __ mm in amplitude ?
5mm
an inverted T wave my represent myocardial ____?
ischemia
a peak in the T wave are commonly seen in patients with _______?
hyperkalemia
rate- 60-100 bpm rhythm- P-P and R-R regular P wave- positive (up right) PR interval - 0.12 to 0.20 seconds QRS < 0.10 seconds this is known as what kind of rhythm?
sinus rhythm
SA node fires at slower rate than normal is known as what rhythm?
sinus bradycardia
rate- < 0.10 seconds
ST segment- depression
this is known as what kind of rhythm?
sinus bradycardia
the normal heartbeat is the result of an electrical impulse that starts in the SA node is known as what kind of rhythm?
sinus rhythm
this rhythm occurs during sleep, in well conditioned athletes?
sinus bradycardia
If the SA node fires faster than normal what sinus rhythm is this?
sinus tachycardia
rate-101-180 bpm rhythm- P-P and R-R regular P wave- positive (upright) PR interval - 0.12 to 0.20 seconds QRS-
sinus tachycardia
A very fast rate may be hard to tell difference between P wave and T wave?
sinus tachycardia
the SA node fires irregularly is know as what sinus rhythm?
sinus arrhythmia
associated with the phases of respiration and changes in intrathoracic pressure is known as ?
respiratory sinus arrhythmia
what sinus arrhythmia is not related to the respiratory cycle?
non respiratory sinus arrhythmia
rate- 60-100 bpm may be slower or faster rhythm- irregular phasic with respiration. heart rate increase with inspiration (R-R shorten) heart rate decreases with expiration ( R-R lengthen) P wave- positive (upright) PR interval- 0.12 to 0.20 seconds QRS-
sinus arrhythmia
how do we treat sinus bradycardia?
- oxygen
- Iv
- atropine
what medications cause sinus bradycardia?
- calcium blockers - amiodarone
- digitalis -sotalol
- beta blockers
what medications cause sinus tachycardia?
- epinephrine
- atropine
- dopamine
- dobutamine
- vagal stimulation
- hypothermia
- increased ICP
- post heart transplant
- hypothyroidism
- OSA
causes of sinus bradycardia
treatment for sinus tachycardia?
- fluid replacement
- pain relief
- removal of offending medications
- reducing fever or anxiety
- exercise -dehydration
- fever -pulmonary emboli
- pain -caffeine
- fear/anxiety -nicotine
- infection -cocaine
- shock
causes of sinus tachycardia
what causes sinus arrhythmia In respiratory?
phases of respiration and changes in intrathoracic pressure commonly seen in children and adults < 30 years
what causes non- respiratory sinus arrhythmia?
- seen in older individuals with heart disease
- common after MI
- Increased ICP
- medications- digitalis
- morphine
what treatment would we use for sinus arrhythmia?
doesn’t require treatment unless slow rate causes hemodynamic compromise; in that case treat with IV atropine
