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Telemetry: Mid-Term > Module 1 > Flashcards

Module 1 Flashcards

1
Q

What are normal heart sounds? And how do you auscultate them?

A
  • S1 & S2

- Diaphragm

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2
Q

What is occurring during S1?

A

the atrioventricular values (Mitral and tricuspid) close at the beginning of systole

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3
Q

What is occurring during S2?

A

produced at the end of systole, when the semilunar values close (pulmonic and aortic)

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4
Q

What are the four major value areas that are listen to during S1 and S2?

A
  • Mitral value (5th ICS +MCL)
  • Tricuspid area (4th ICS and L sternal boarder)
  • Pulmonic area (2nd ICS and L sternal boarder)
  • Aortic area (2nd ICS and R sternal boarder)
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5
Q

What are the extra heart sounds? And how should they be assculatated

A

S3 and S4

-With a bell

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6
Q

What could be happening during S3?

A

“Ventriclular gallop”

  • To much fluid entering the ventricle at the begining of diastole due to volume overload
  • Occurs after S2
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7
Q

What could be happening during S4?

A

“atrial gallop”

  • It occurs at the end of diastole (just before S1) when the ventricle is full
  • It is the sound of the atrial contraction against a distended ventricle
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8
Q

What is the formula for cardiac output?

A

CO= Heart rate X Stroke Volume

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9
Q

What is stroke volume?

A

Is the amount of blood ejected from the heart with each contraction

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10
Q

What can effect the stroke volume?

A
  • Preload and afterload of the heart

- Contractility of the heart (less contractility, less stroke volume)

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11
Q

What is preload?

A

It is the volume of blood in the ventricles at the end of diastole

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12
Q

What determines the amount of volume in the ventricles at the end of diastole?

A

Venous return

Poor venous return can lead to poor preload volume

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13
Q

What is afterload?

A

It is the force or the restiance, against which the bentricles have to pump in order to eject the blood

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14
Q

What happens if there is high restiance

A

Ventricles must contract more forcefully to maintain a normal stroke volume

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15
Q

What can happen to the workload of the heart with increased resitance?

A

Increase in O2 demands and if the heart is unable to contract strong enough, then the amount of blood being ejected from the heart is less

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16
Q

What are the primary determinant of afterload

A

The diameter of the arteries and arterioles

-The tone of the atrial system

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17
Q

Increases in arterial vascular tone or vasoconstriction will decrease what?

A

The diameter of the vessels and increase afterload

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18
Q

What hormones are released in response to increase in afterload?

A

Catecholamines

  • Epinephrine
  • Epinephrine
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19
Q

What will physiological effects will decrease afterload?

A

Increase in arterial vessel diameter and a decrease in vascular tone

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20
Q

What causes this decrease in afterload?

A

Hypothermia and multiple other drugs

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21
Q

What determines the heart contractility?

A
  • preload (as explained by Starling’s Law)
  • the stimulatory effect of the sympathetic nervous system, and
  • external factors that affect the amount of calcium in the myocardial cell.
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22
Q

What can decrease contractility of the heart?

A
  • inadequate O2 supply to myocarial tissue
  • Negative inotropic drugs
  • Electrolyte imbalance
23
Q

What can increase the contractility of the heart

A
  • Some electrolyte imbalance
  • circulating catecholamines
  • positive inotropic drugs (digoxin, dopamine, dobutamine)
24
Q

What are the two types of cardiac cells?

A

Myocardial cells (mechanical cells) and the cells of the electrical conduction system (electrical cells)

25
Q

What is the job of the mechanical cells?

A

To contract

26
Q

Where is the majority of mechaincal cells found in the heart?

A

Musculature of the heart

27
Q

What makes these cells contract?

A

The electrical stimulus sent from the electrical cells

28
Q

What is the specific property that mechanical cells have that allow them to shorten and return to their original length?

A

contractility

29
Q

What is another name for the electrical cells?

A

Pacemaker cells

30
Q

What do the electrical cells do?

A

Form a stimulus or impulse to ensure that i passes along a specialised route, the conduction system

31
Q

What are the 5 electrical cell properties?

A
  1. Automaticity: The ability to generate an electrical impulse spontaneously, without external stimulation.
  2. Excitability: The ability of the cardiac cell to depolarize in response to an electrical stimulus.
  3. Refractoriness: The period of time when cardiac electrical cells are unresponsive to any stimulus regardless of strength.
  4. Rhythmicity: The ability of cardiac pacemaker cells to fire at regular intervals.
  5. Conductivity: The spread of electrical activity from one specialized cardiac cell to another.
32
Q

What and where is the SA node?

A

Sinoartical node

Its located in the superior portion of the right atrium

33
Q

What is another name for the SA? What is the normal rate of the SA node?

A

Primary pacemaker

60-100 BPM

34
Q

What is a SA node dysrhythmia?

A

When the SA node fires at a faster rate than normal

Beats exceeding between 100-180 BPM tachycardia

35
Q

How do you know the rhythm is not coming from the SA?

A

When the rate is greater than 180 BPM

36
Q

What is the AV node? And where is it located?

A

Atrioventricular node

It is located on the floor of the right atrium

37
Q

What happens if the SA node fails?

A

The junctional pacemaker cells can take over as a secondary or backup pacemaker site
This rate is 40-60 BPM

38
Q

Where is the bundle of his located?

A

The bundle of His arises from the junction and passes into the interventricular septum, where it divides into the right and left bundle branches.

39
Q

Where is the right bundle branch located?

A

The right bundle branch travels down the right side of the interventricular septum and then branches over the right ventricle. It terminates in the Purkinje fibres on the endocardial surface of the right ventricle.

40
Q

Where is the left bundle branch located?

A

The left bundle branch travels down the left side of the interventricular septum and divides into two branches or fascicles, the superior and the inferior branches of the left bundle. These branches terminate in the Purkinje fibres permeating the left ventricle

41
Q

What do the purkinje cells do?

A

Scattered throughout the Purkinje network are pacemaker cells that possess impulse-forming properties. These will function as pacemakers should both the SA node and the junctional tissue pacemaker sites fail.

42
Q

What is the flow of the electrical impulse?

A
  • Impulses arise in the SA node and follow to the AV node.

* Impulses flow to the bundle of His through the bundle branches, finally terminating at the Purkinje fibres.

43
Q

What is polarization?

A

Polarization is the resting state during which no electrical activity occurs in the cardiac cells. The inside of the cell is more negative than the outside of the cell

44
Q

What iions are involved in this?

A

The ions responsible for this are Na+, K+, and Ca+. Na+ and Ca++ have a strong positive charge and K+ has a relatively weak positive charge.

45
Q

What is depolarization?

A

When the cardiac cell receives a stimulus, depolarization begins.
• stimulus can be electrical, chemical, or mechanical

46
Q

What is the ion flow during depolarization?

A

In depolarization, sodium ions (Na+) rush through the open membrane channels, across the cell membrane and into the cell. Next, calcium ions (Ca++) follow through the slow calcium channels to the inside of the cell. As the positive ions enter the cell, the inside of the cell becomes positive and the outside becomes negative, resulting in stimulation of the cell.

47
Q

What is the property of being able to depolarize from one cell to another?

A

Conducitivity

48
Q

The SA node has the ability to generate its own wave of depolarization (impulse) without an external stimulus, what is this property called?

A

Automaticity

49
Q

What happens when the depolarization wave travels through the muscle fibres?

A

Contraction of the chambers of the heart

50
Q

What occurs during repolarization?

A

The cell returns to its resting sate
The sodium/potassium pump mechanism pumps the Na+ and Ca++ ions out of the cell and pumps the K+ ions into the cell, which re-establishes the negative electrical charge across the cell membrane. That is, the cell is ready to be depolarized again

51
Q

What is the refractory period?

A

Unresponsiveness to a stimuli

52
Q

What is the absolute refractory period?

A

This is a protective mechanism that prevents the cell from responding to any type of stimulus regardless of strength
-The absolute refractory period occurs during depolarization and early repolarization.

53
Q

What is the relative refractory period?

A

During this phase, the cell can respond to a stimulus, but that stimulus needs to be very strong. This phase occurs at the end of ventricular repolarization.

54
Q

What is the supernormal or vulnerable period?

A

During this phase a minimal stimulus can cause a response. The vulnerable period exists during the middle phase of repolarization and extending.

Telemetry: Mid-Term (5 decks)

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