test 3 clinical heart Flashcards
1
Q
in ventricular rhythms
A
QRS complex will be ugly and P wave will likely be hidden or missing, atrial contraction often not present
2
Q
premature ventricular complex is similar to ____- because
A
PAC and PJC because its an early/premature beat
3
Q
what is a premature ventricular complex
A
an early beat when the signal comes from a cell in the ventricle
4
Q
premature ventricular complexes are usually
A
very common, but not too dangerous unless they happen many times each minute
5
Q
premature ventricular complexes are often felt by
A
felt by the person in palpitations
6
Q
PVCs are much more common than
A
PACS or PJCs
7
Q
PVC
A
premature ventricular complex
8
Q
PVCs often come in
A
waves and patterns
9
Q
what patterns can PVCs come in
A
- Bigeminy
- Trigeminy
- Quadrigeminy
- Idioventricular Rhythm
- Accelerated Idioventricular Rhythm
- Ventricular Tachycardia
- Ventricular Flutter
- Ventricular Fibrillation
- Asystole
10
Q
Bigeminy
A
PVC happens every other beat
11
Q
Trigeminy
A
PVC or irregular contraction happens every third beat
12
Q
Quadrigeminy
A
irregular contraction every fourth beat
13
Q
generally which PVCs come in waves
A
bigeminies, trigeminies, quadrigeminies come in waves then the heart returns to normal rhythm
14
Q
idioventricular rhythym
A
an escape rhythm where electricity is generated by ventricular cells
15
Q
idioventricular rhythm is very
A
very slow, below 40 bpm
16
Q
all contractions in idioventricular rhythms are
A
wide N ugly
17
Q
accelerated idioventricular rhythm
A
QRS complex are still wide and ugly, but the rate is between 40 bpm and 100 bpm
18
Q
ventricular Tachycardia (V-tach)
A
like accelerated junctional rhythm but over 100 bpm
19
Q
ventricular flutter
A
like atrial flutter, very rapid ventricular contractions
20
Q
ventricular flutter often
A
descends into ventricular fibrillation
21
Q
ventricular fibrillation (v-Fib)
A
like atrial fibrillation, but with more amplitude
22
Q
ventricular fibrillations usually only
A
lasts a few seconds before falling to a flatline
23
Q
it V-fib there is an absence of
A
of normal QRS complexes
24
Q
Asystole
A
no electrical output and the patient is clinically dead
25
common rhythms
sinus
atrial
junctional
ventricular
26
the sinoatrial node is supposed to be the ______
pacemaker of the heart
27
when the sa node is the pacemaker of the heart
it is in sinus rhythm
28
normal sinus rhythm
all things normal, heart rate 60-100, rhythm is regular
29
sinus bradycardia
all things normal. heart rate is under 60 rhythm is regular
30
sinus tachycardia
all things normal, heart rate is is above 100, rhythm regular
31
how can you check bradycardia
more than 5 big boxes between each contraction, less than 60 bpm
32
how can you check tachycardia
less than 3 big boxes between each contraction, rate over 100
33
sinus arrythmia
all things normal w/ IRREGULAR CONTRACTIONS
34
sinus arrest
SA node and rest of heart does not contract for a span of time
35
how are sinus arrests reported
w/ a duration, such as sinus arrest, 3.5 sec delay
36
w/ each passing second of sinus arrest
blood pressure rapidly drops
37
when the SA node fails to be the pacemaker, then
other cardiomyocytes can take over
38
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
39
the cells that release the new signal in an escape rhythm
ectopic pacemakers
40
escape rhythms occur in a variety of
shapes and sizes
41
when rogue atrial cells take over as the pacemaker for just one beat
premature atrial complex
42
how to distinguish a premature atrial complex
there will be one early beat w/ a modified P wave that is NOT inverted
43
wandering atrial pacemaker
escape rhythym where SA node fails to generate signal, so diff parts of atria create a signal to compensate
44
WAP
wandering atrial pacemaker
45
WAP is defined by
3 unique types of P waves across a strip
46
multifocal tachycardia
WAP (3 or more P wave morphologies) with heart rate over 100
47
where is multifocal tachycardia common
typically only seen in elderly patients with COPD
48
atrial flutter
atria rapidly contract, but QRS complexes happen normally
49
atrial fibrillation
similar to atrial flutter, but atria just quiver instead of rapidly contracting
50
both A-fib and A-flutter
happen unknowingly
51
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
52
A-Fib and A-Flutter generally
affect elderly people and come and go in waves
53
primary symptoms A-Fib/ A-Flutter
shortness of breath when lying down
54
Atrial rhythms
```
premature atrial complex
wandering atrial pacemaker
multifocal tachycardia
atrial flutter
atrial fibrillation
```
55
sinus rhythms
```
normal sinus rhythm
sinus bradycardia
sinus tachycardia
sinus arrhythmia
sinus arrest
```
56
when the AV node takes over as the pacemaker
junctional rhythm
57
PJC
premature junctional complex
58
what happens in PJC
AV node releases one signal quickly above another contraction
59
how to distinguish PJC
inverted p wave and early beat
60
all junctional rhythms have
inverted p wave
61
junctional escape beat
like PJC, one beat that is not premature, later than usual inverted p wave,
62
junctional escape rhythm
pacemaker long term, not just one beat and inverted p wave , below 60 bpm
63
accelerated junctional rhythm
like junctional escape rhythm, but from 60-100 bpm, still inverted p wave
64
atrial cells usually only create a signal
40-60 times per minute
65
junctional tachycardia
liek other junctional rhythms, but from 100-180 bpm, still inverted p wave
66
supraventricular tachycardia
when ur in tachycardia w/ a buried p wave
67
in supraventricular tachycardia
p wave is buried, you know signal is above ventricles but not from where
68
BP
blood pressure
69
blood pressure
the pressure blood exerts on walls of blood vessels
70
where is blood pressure normally measured
brachial artery in arm
71
blood pressure changes a lot depending on whether
the heart has just eaten or not
72
blood pressure is measured in what 2 numbers
systolic blood pressure, diastolic blood pressure
73
systolic blood pressure
the pressure at the peak of ventricular contraction
74
list junctional rhythyms
```
premature junctional complex
junctional escape beat
junctional escape rhythm
accelerated junctional rhythm
junctional tachycardia
```
75
diastolic blood pressure
the pressure when ventricles are relaxed
76
blood pressure are measured in
mmHg
77
what are blood pressures listed as
systolic/diastolic
78
normal blood pressure
around 120/80
79
what do u use to take blood pressure
a sphygmomanometer
80
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
81
systolic BP
number at which pulse is sensed
82
diastolic BP
the number at which pulse disapears
83
if blood pressure is too high
cuff totally blocks blood flow
84
just right blood pressure
cuff blocks blod flow unless heart has just pumped
85
too low blood pressure
cuff does not block blood flow
86
blood pressure should ideally fall where in adults
between 110-140/70-80
87
hypotension
a person with a resting systolic BP under 100
88
hypertension
a person with a resting systolic BP over 130
89
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)
90
bigger the container
the lower the blood pressure
91
cardiac output is
heart rate times stoke volume
92
cardiac output formula
CO= HR x SV
93
one blood pressure reading is not
not enough to make a diagnosis of hypertension or hypotension
94
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
95
another word for orthostatic hypotension
head rush
96
long term hypertension
especially dangerous, linked to CAD, CHF and other arterial diseases
97
CAD
coronary artery disease
98
CHF
congestive heart failure
99
hypertension makes the heart
work unnecessarily hard and puts extra strain on artery walls
100
with hypertension over time
the heart swells to large sizes and artery walls lose their elasticity
101
generally the ______ have a major role in regulating
kidneys, blood pressure
102
when BP is low, what does the kidneys do
release renin
103
what does renin do
initiates a cascade releasing angiotensin II
104
angiotensin II functions
- directly causing vasoconstriction (BP up)
| - stimulates release of hormone aldosterone
105
aldosterone
causes kidneys to leave more sodium, causing water to enter blood through osmosis (BP ^)
106
what is also involved in BP regulations
temperature, sympathetic nervous system
107
how does temperature affect BP
the higher the temp the higher the BP
108
how does sympathetic nervous system affect BP
epinephrine release increases BP
109
final step in renin cascade
ACE turns inactive angiotensin I to active angiotensin II
110
ACE
angiotensin converting enzyme
111
popular way to treat hypertension
ACE inhibitors
112
normally the heart beats how much
60-100 times per min
113
skeletal muscle must be
stimulated by a nerve to contract
114
cardiac muscle can
generate its own signal to contract
115
any one cell along the electrical wiring of the cardiac muscle
can fire and send its signal to the rest of the heart
116
different parts of the heart contract on
own different intervals
117
arterial tissue contracts
50-60 times a minute
118
ventricular tissue will contract
20-40 times a minute
119
how are lub/dub contractions coordinated
the heart has a built in conduction system to pass signals
120
the conduction pathway is a series of
nerve-like, muscle like fibers called cardiomyocytes
121
what do cardiomyocytes do
carry the signal to make cardiac muscle contract
122
the signal to make cardiac muscle contract is normally generated by what
sinoatrial node (SA node)
123
where is SA node located
right atrium
124
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
125
AV node
atrioventricular node
126
how long are signals held in the AV node
.12 seconds
127
what happens after signal is held by Av node
passes through the Bundle of His
128
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
129
why 2 bundle branches
one for each ventricle
130
what do the bundle branches break into
small strands called purkinje fibers
131
what do purkinje fibers do
tell nearby heart muscle to contract
132
electrical pathway
SA node>> AV node>> Bundle of His>> Bundle Branches>> Purkinje Fibers
133
kno which part of pathway is lub and dub
ask at review
134
generally, cardiomyocytes have a ____ charge compared to enviroment
negative
135
how do cardiomyocytes transmit signals
by briefly changing charge fro negative to positive charge (DEPOLARIZATION0
136
can depolarization be measured
YES
137
EKG can also be called
electrocardiography or ECG
138
EKGs do what
detect and record depolarization of cardiac cells under the skin
139
in an EKG usually
10 electrodes placed around torso for different looks and summed into 1 signal
140
many leads on EKG lead to
many outputs
141
3.5 parts of an EKG
P wave, QRS complex, T wave, U wave
142
P wave
shows depolarization of atrial cells
143
QRS complex
shows depolarization of ventricular cells
144
T wave
shows repolarization of ventricular cells
145
U wave
unsure, probs repolarization of other cells in the heart , often absent
146
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
147
the SA is supplied w/ nerves by
sympathetic and parasympathetic nervous syetms
148
what does sympathetic nervous system affect SA node
influence how quick it can generate a signal
149
how does parasympathetic nervous system affect SA node
influence how slow it generates a signal
150
5 components of rhythm analysis
```
regulrity
Rate
P wave morphology
PR interval
QRS interval
```
151
regularity
should be even, fluctuation of 1.5 boxes or .3 sec is abnormal
152
Rate
how much heart beats in a minute
153
to calculate regular rate
1500 rule
154
1500 rule
1500/ # of small boxes
155
irregular rate
how many contractions in 6 second strip and mult by 10
156
what is a p wave morphology
the shape
157
usual p wave is usually
short, round, compact, no more than .1 sec
158
usual size of P wave
.5-2.5 small squares
159
changes to p wave
burial, inversion, notched, biphasic, flutter, after QRS, multiple
160
inversion p waves
P wave is upside down
161
notched p waves
p wave has multiple peaks
162
biphasic p waves
up and down or down and up
163
flutter waves
p waves happen very quickly
164
after QRS
P waves happen after QRS complex
165
multiple
many types of p waves present
166
PR interval
amount of time from beginning of p wave and beginning of QRS
167
PR interval should be
between .12 to .20 sec (3-5 small boxes )
168
measure PR interval
for every contraction on a strip
169
QRS duration
length of QRS complex
170
QRS should be between
.06 and .10 sec
