test 3 clinical heart Flashcards
in ventricular rhythms
QRS complex will be ugly and P wave will likely be hidden or missing, atrial contraction often not present
premature ventricular complex is similar to ____- because
PAC and PJC because its an early/premature beat
what is a premature ventricular complex
an early beat when the signal comes from a cell in the ventricle
premature ventricular complexes are usually
very common, but not too dangerous unless they happen many times each minute
premature ventricular complexes are often felt by
felt by the person in palpitations
PVCs are much more common than
PACS or PJCs
PVC
premature ventricular complex
PVCs often come in
waves and patterns
what patterns can PVCs come in
- Bigeminy
- Trigeminy
- Quadrigeminy
- Idioventricular Rhythm
- Accelerated Idioventricular Rhythm
- Ventricular Tachycardia
- Ventricular Flutter
- Ventricular Fibrillation
- Asystole
Bigeminy
PVC happens every other beat
Trigeminy
PVC or irregular contraction happens every third beat
Quadrigeminy
irregular contraction every fourth beat
generally which PVCs come in waves
bigeminies, trigeminies, quadrigeminies come in waves then the heart returns to normal rhythm
idioventricular rhythym
an escape rhythm where electricity is generated by ventricular cells
idioventricular rhythm is very
very slow, below 40 bpm
all contractions in idioventricular rhythms are
wide N ugly
accelerated idioventricular rhythm
QRS complex are still wide and ugly, but the rate is between 40 bpm and 100 bpm
ventricular Tachycardia (V-tach)
like accelerated junctional rhythm but over 100 bpm
ventricular flutter
like atrial flutter, very rapid ventricular contractions
ventricular flutter often
descends into ventricular fibrillation
ventricular fibrillation (v-Fib)
like atrial fibrillation, but with more amplitude
ventricular fibrillations usually only
lasts a few seconds before falling to a flatline
it V-fib there is an absence of
of normal QRS complexes
Asystole
no electrical output and the patient is clinically dead
common rhythms
sinus
atrial
junctional
ventricular
the sinoatrial node is supposed to be the ______
pacemaker of the heart
when the sa node is the pacemaker of the heart
it is in sinus rhythm
normal sinus rhythm
all things normal, heart rate 60-100, rhythm is regular
sinus bradycardia
all things normal. heart rate is under 60 rhythm is regular
sinus tachycardia
all things normal, heart rate is is above 100, rhythm regular
how can you check bradycardia
more than 5 big boxes between each contraction, less than 60 bpm
how can you check tachycardia
less than 3 big boxes between each contraction, rate over 100
sinus arrythmia
all things normal w/ IRREGULAR CONTRACTIONS
sinus arrest
SA node and rest of heart does not contract for a span of time
how are sinus arrests reported
w/ a duration, such as sinus arrest, 3.5 sec delay
w/ each passing second of sinus arrest
blood pressure rapidly drops
when the SA node fails to be the pacemaker, then
other cardiomyocytes can take over
when other cardiomyocytes take over when the SA node fails to be the pacemaker (not just for one beat)
said t be an escape rhythm
the cells that release the new signal in an escape rhythm
ectopic pacemakers
escape rhythms occur in a variety of
shapes and sizes
when rogue atrial cells take over as the pacemaker for just one beat
premature atrial complex
how to distinguish a premature atrial complex
there will be one early beat w/ a modified P wave that is NOT inverted
wandering atrial pacemaker
escape rhythym where SA node fails to generate signal, so diff parts of atria create a signal to compensate
WAP
wandering atrial pacemaker
WAP is defined by
3 unique types of P waves across a strip
multifocal tachycardia
WAP (3 or more P wave morphologies) with heart rate over 100
where is multifocal tachycardia common
typically only seen in elderly patients with COPD
atrial flutter
atria rapidly contract, but QRS complexes happen normally
atrial fibrillation
similar to atrial flutter, but atria just quiver instead of rapidly contracting
both A-fib and A-flutter
happen unknowingly
what often happens in atrial flutter
electricity in atria forms a loop n causes continuous contraction. rhythm is thrombogenic but not life threatening if ventricles still readily contract
A-Fib and A-Flutter generally
affect elderly people and come and go in waves
primary symptoms A-Fib/ A-Flutter
shortness of breath when lying down
Atrial rhythms
premature atrial complex wandering atrial pacemaker multifocal tachycardia atrial flutter atrial fibrillation
sinus rhythms
normal sinus rhythm sinus bradycardia sinus tachycardia sinus arrhythmia sinus arrest
when the AV node takes over as the pacemaker
junctional rhythm
PJC
premature junctional complex
what happens in PJC
AV node releases one signal quickly above another contraction
how to distinguish PJC
inverted p wave and early beat
all junctional rhythms have
inverted p wave
junctional escape beat
like PJC, one beat that is not premature, later than usual inverted p wave,
junctional escape rhythm
pacemaker long term, not just one beat and inverted p wave , below 60 bpm
accelerated junctional rhythm
like junctional escape rhythm, but from 60-100 bpm, still inverted p wave
atrial cells usually only create a signal
40-60 times per minute
junctional tachycardia
liek other junctional rhythms, but from 100-180 bpm, still inverted p wave
supraventricular tachycardia
when ur in tachycardia w/ a buried p wave
in supraventricular tachycardia
p wave is buried, you know signal is above ventricles but not from where
BP
blood pressure
blood pressure
the pressure blood exerts on walls of blood vessels
where is blood pressure normally measured
brachial artery in arm
blood pressure changes a lot depending on whether
the heart has just eaten or not
blood pressure is measured in what 2 numbers
systolic blood pressure, diastolic blood pressure
systolic blood pressure
the pressure at the peak of ventricular contraction
list junctional rhythyms
premature junctional complex junctional escape beat junctional escape rhythm accelerated junctional rhythm junctional tachycardia
diastolic blood pressure
the pressure when ventricles are relaxed
blood pressure are measured in
mmHg
what are blood pressures listed as
systolic/diastolic
normal blood pressure
around 120/80
what do u use to take blood pressure
a sphygmomanometer
how do u use a sphygmomanometer
- inflate slightly above expected range (140-160 mmHg)
- hold stethoscope or feel for pulse
- slowly deflate until a pulse is sensed
- continue deflating until a pulse is no longer sensed
systolic BP
number at which pulse is sensed
diastolic BP
the number at which pulse disapears
if blood pressure is too high
cuff totally blocks blood flow
just right blood pressure
cuff blocks blod flow unless heart has just pumped
too low blood pressure
cuff does not block blood flow
blood pressure should ideally fall where in adults
between 110-140/70-80
hypotension
a person with a resting systolic BP under 100
hypertension
a person with a resting systolic BP over 130
BP relies on what factors
- how big is the container (affects vasodilation/vasoconstriction)
- how much much stuff is in the container (how much water in blood)
- how fast/hard stuff is being pumped (cardiac output)
bigger the container
the lower the blood pressure
cardiac output is
heart rate times stoke volume
cardiac output formula
CO= HR x SV
one blood pressure reading is not
not enough to make a diagnosis of hypertension or hypotension
orthostatic hypotension
when you stand suddenly. blood falls to lower portion of the body and decreases flow to head. quickly vessels contract, increase BP, returning blood flow to body
another word for orthostatic hypotension
head rush
long term hypertension
especially dangerous, linked to CAD, CHF and other arterial diseases
CAD
coronary artery disease
CHF
congestive heart failure
hypertension makes the heart
work unnecessarily hard and puts extra strain on artery walls
with hypertension over time
the heart swells to large sizes and artery walls lose their elasticity
generally the ______ have a major role in regulating
kidneys, blood pressure
when BP is low, what does the kidneys do
release renin
what does renin do
initiates a cascade releasing angiotensin II
angiotensin II functions
- directly causing vasoconstriction (BP up)
- stimulates release of hormone aldosterone
aldosterone
causes kidneys to leave more sodium, causing water to enter blood through osmosis (BP ^)
what is also involved in BP regulations
temperature, sympathetic nervous system
how does temperature affect BP
the higher the temp the higher the BP
how does sympathetic nervous system affect BP
epinephrine release increases BP
final step in renin cascade
ACE turns inactive angiotensin I to active angiotensin II
ACE
angiotensin converting enzyme
popular way to treat hypertension
ACE inhibitors
normally the heart beats how much
60-100 times per min
skeletal muscle must be
stimulated by a nerve to contract
cardiac muscle can
generate its own signal to contract
any one cell along the electrical wiring of the cardiac muscle
can fire and send its signal to the rest of the heart
different parts of the heart contract on
own different intervals
arterial tissue contracts
50-60 times a minute
ventricular tissue will contract
20-40 times a minute
how are lub/dub contractions coordinated
the heart has a built in conduction system to pass signals
the conduction pathway is a series of
nerve-like, muscle like fibers called cardiomyocytes
what do cardiomyocytes do
carry the signal to make cardiac muscle contract
the signal to make cardiac muscle contract is normally generated by what
sinoatrial node (SA node)
where is SA node located
right atrium
how does the signal to make cardiac muscle contract travel from the SA node to Av node
runs across left and right atria, making them contract, captured by the AV node
AV node
atrioventricular node
how long are signals held in the AV node
.12 seconds
what happens after signal is held by Av node
passes through the Bundle of His
how does a signal travel through bundle of His
breaks into 2 bundle branches, which travel to apex of heart then run back up the outer walls
why 2 bundle branches
one for each ventricle
what do the bundle branches break into
small strands called purkinje fibers
what do purkinje fibers do
tell nearby heart muscle to contract
electrical pathway
SA node» AV node» Bundle of His» Bundle Branches» Purkinje Fibers
kno which part of pathway is lub and dub
ask at review
generally, cardiomyocytes have a ____ charge compared to enviroment
negative
how do cardiomyocytes transmit signals
by briefly changing charge fro negative to positive charge (DEPOLARIZATION0
can depolarization be measured
YES
EKG can also be called
electrocardiography or ECG
EKGs do what
detect and record depolarization of cardiac cells under the skin
in an EKG usually
10 electrodes placed around torso for different looks and summed into 1 signal
many leads on EKG lead to
many outputs
3.5 parts of an EKG
P wave, QRS complex, T wave, U wave
P wave
shows depolarization of atrial cells
QRS complex
shows depolarization of ventricular cells
T wave
shows repolarization of ventricular cells
U wave
unsure, probs repolarization of other cells in the heart , often absent
why is there a delay between the P wave and the QRS complex
there is a delay when the signal sits on the AV node
the SA is supplied w/ nerves by
sympathetic and parasympathetic nervous syetms
what does sympathetic nervous system affect SA node
influence how quick it can generate a signal
how does parasympathetic nervous system affect SA node
influence how slow it generates a signal
5 components of rhythm analysis
regulrity Rate P wave morphology PR interval QRS interval
regularity
should be even, fluctuation of 1.5 boxes or .3 sec is abnormal
Rate
how much heart beats in a minute
to calculate regular rate
1500 rule
1500 rule
1500/ # of small boxes
irregular rate
how many contractions in 6 second strip and mult by 10
what is a p wave morphology
the shape
usual p wave is usually
short, round, compact, no more than .1 sec
usual size of P wave
.5-2.5 small squares
changes to p wave
burial, inversion, notched, biphasic, flutter, after QRS, multiple
inversion p waves
P wave is upside down
notched p waves
p wave has multiple peaks
biphasic p waves
up and down or down and up
flutter waves
p waves happen very quickly
after QRS
P waves happen after QRS complex
multiple
many types of p waves present
PR interval
amount of time from beginning of p wave and beginning of QRS
PR interval should be
between .12 to .20 sec (3-5 small boxes )
measure PR interval
for every contraction on a strip
QRS duration
length of QRS complex
QRS should be between
.06 and .10 sec
