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CVS > Lecture 11 > Flashcards

Lecture 11 Flashcards

1
Q

Fibrous ring

A

Dose connective tissue
4 - between atria and ventricles

Function:

Allows ventricles and atria to contract separately
Anchors the valves
Electrical insulator - bundle of His acts as passageway

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2
Q

Interventricular septum depolarisation

A

Left to right (left thicker)

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3
Q

P wave

A

Atrial depolarisation

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4
Q

PR interval

A

Start of P wave to start of Q wave

Beginning of atrial depolarisation to beginning of ventricular depolarisation

3-5 small boxes 0.12 - 0.2 seconds

Delay at AV node - isoelectric line
Bundle of His spread from atria to ventricles - isoelectric line

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5
Q

q wave

A

Depolarisation of the intervertebral septum (left to right)

Small downwards depolarisation - move obliquely away

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6
Q

R wave

A

Depolarisation of the free ventricular walls and apex

Large upwards deflection

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7
Q

S wave

A

Depolarisation spreads to ventricular bases

Downwards deflection

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8
Q

T wave

A

Ventricular repolarisation
From base to apex to positive electrode
Upwards deflection

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9
Q

No QRS complex

A

AV block - Heart block

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10
Q

QRS complex

A

Depolarisation of ventricles

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11
Q

ECG

A 
10 electrodes - 4 limb 6 chest 
12 views (leads)
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12
Q

C1 electrode

A

Right of sternum - Ruth intercostal space

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13
Q

C2 electrode

A

Midclavicular line - 4th intercostal space

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14
Q

C3 electrode

A

Halfway between V2 and V4

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15
Q

C4 electrode

A

Midclavicular line - 5th intercostal space

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16
Q

C5 electrode

A

Level with C4 at left anterior axillary line

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17
Q

C6 electrode

A

Level with C5 at left mid axillary line

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18
Q

V1 - V4

A

Antero-septal leads

LAD

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19
Q

V5-V6

A

Lateral leads

Circumflex

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20
Q

Leads for lateral left side of heart

A

Lead 1
V5-V6
AVL

Circumflex artery

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21
Q

Leads for inferior surface of heart

A

Lead II
Lead III
AVF

Right coronary artery

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22
Q

Right ventricle and septum

A

V1

V2

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23
Q

Apex and anterior surface of ventricles

A

V3 and V4

24
Q

V1 relationship to v6

A

Inverse

25
Q

Lead II relationship with AVR

A

Inverse

26
Q

5 large squares

A

1 second

27
Q

300 large squares

A

1 minute

28
Q

1 small square

A

1/25

0.04 seconds

29
Q

1 large square

A

1/5 - 0.2 seconds

30
Q

1 cardiac cycle

A

P wave to p wave

31
Q

QRS interval

A

Start of Q wave to end of S wave
Time takes for ventricular depolarisation

3 small boxes - 0.12 seconds

Widened QRS - depolarisation not via His-Perkinje fibres

32
Q

QT interval

A

Time taken for depolarisation and repolarisation of ventricles
Beginning of Q wave to end of T wave

9- 11 small boxes - 0.44 seconds

33
Q

ST interval

A

End of S to start of T
Isoelectric line

If raised or depressed - MI or ischaemia

34
Q

Sinus rhythm

A 
Regular rhythm
HR = 60 - 100bpm 
P wave present 
PR interval - 3 - 5 small boxes 
QRS complex - 3 small boxes 
Every P wave followed by QRS complex
35
Q

First degree heart block

A

Prolonged PR interval - 5+ small boxes

Delay in conductance between atria and ventricles via AV node and Bundle of His

Causes:

  • acute MI (transient)
  • fibrosis (permanent)
36
Q

Second degree heart block mobitz type 1 (Wenkebach)

A

Successfully longer PR interval until 1 QRS complex dropped

37
Q

Second degree heart block type 2

A

Sudden drop of QRS complex without PR interval elongation
High risk of progression to complete heart block
Prophylaxis pace maker

38
Q

Third degree heart block

A

Complete failure of AV conduction
Atria and ventricles contract independently

Regular P waves
No steady PR interval
Ventricular escape rythmn - ventricular pacemaker takes over
Wide QRS complex - myocytes to myocytes spread

P-P interval and R-R interval have different rates

Urgent pacemaker required

39
Q

Bundle branch block

A

Delayed conduction in the branches of the bundle of His
P wave and PR interval normal

Widened QRS complex as ventricular depolarisation takes longer

40
Q

atrial Fibrillation

A 
Supraventricular rhythms 
normal QRS complex - ventricle depolarisation intact. R-R interval intact 
Atrium - multiple atrial foci 
Rapid and Chaotic 
Wavy baseline - no P waves

Caused by multiple re-entrant circuits

41
Q

Ventricular arrythmia

A

Arise from ventricles
Widened QRS
Ventricle tachycardia

42
Q

Atrial fibrillation effect on haemodynamics

A

Atrial contraction lost - quiver
Ventricular contraction intact but irregular

Therefore:
Irregular heart rate
Irregular pulse

43
Q

Ventricular tachycardia

A

3 + consecutive ventricular ectopics
Broad complex
Persistent VT is dangerous as can lead to ventricular fibrillation and cardiac arrest

44
Q

Ventricular fibrillation

A

Fast, chaotic abnormal ventricular depolarisation
No coordinated contraction - quiver
No cardiac output
Cardiac arrest

45
Q

Narrow QRS complex tachycardia

A

Sinus tachycardia
AF
Supraventricular tachycardia

46
Q

Broad complex tachycardia

A

VF

VT

47
Q

Bradycardia can lead to what?

A

Heart block

Simple bradycardia

48
Q

STEMI

A

ST segment elevation - behaves as if abnormal current towards lead during repolarisation
Complete occlusion of coronary artery
complete myocardial thickness involved
Sub epicardium injury

Urgent reperfusion required

49
Q

STEMI progression

A
  1. Ischaemia- ST elevation
  2. Injury - smaller R wave and deeper Q wave
  3. Necrosis - T wave inversion and Q wave deeper (2+ small squares)

Recovery - ST and T wave normalised
Q wave persists

50
Q

Why is Q wave permanent

A

Necrosis of muscle causes no AP propagation so ECG leads look ‘through’ damaged area therefore more electrical forces from opposite side of lead

51
Q

Non - STEMI

A

ST depression
T wave inversion
Sub endocardial injury
Differentiated by blood test

52
Q

Differences between STEMI and Non - STEMI

A

ST depression

No pathological Q wave as no muscle necrosis

53
Q

Similarities between STEMI and Non - STEMI

A

T wave inversion

Unstable angina

54
Q

Stable angina

A

Pain during exercise - ST depression

Normal at rest

55
Q

Hyperkalaemia ECG

A

Early:
Tall peaked T wave - stronger repolarisation
Flattened p wave - less excitable
Longer PR - atrial depolarisation decreases

Later:
Widened QRS
ST segment merges with T wave
Sine wave

56
Q

Hypokalaemia

A

Low T waves - harder to repolarise
U wave
Low ST segment or depression

CVS (14 decks)

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