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CVP > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

Intrinsic regulation

A

The heart beats all by itself.

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2
Q

Frank Starling’s mechanism of the heart

A

The greater the heart muscle is stretched during filling, the greater the force of contraction and the greater the quantity of blood pumped into the aorta

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3
Q

Length tension relationship

A

Cardiac muscle sarcomeres are naturally short and resist stretch more than skeletal muscle. The increase in length increases the number of functional cross bridges between actin and myosin, therefore greater force of contraction

The longer the sarcomere, the weaker it is. Therefore the cardiac muscle is strong

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4
Q

Right arterial stretch ______ (increases/decreases) heart rate by ________%

A

Increases

10-20%

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5
Q

Skipped heart beat causes next beat to be harder because

A

The myosin are overlapped

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6
Q

Mechanisms that work to match the venous return

A

Frank Starling’s mechanism and Right Atrial Stretch

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7
Q

Frank Starling’s Law

A

CO=VR

Cardiac output = venous return

If one drops, so does the othereventually.

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8
Q

Innervation of the heart via the autonomic nervous system. Tells the heart to speed up or slow down

A

Extrinsic regulation.

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9
Q

Increases heart rate

Increases force of contraction

A

Sympathetic

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10
Q

Decreases heart rate

Weakly decreases force of contraction

A

Parasympathetic

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11
Q

Sympathetic chain

A

Series of ganglia on each side of spine from the spine to the chain from the chain to the heart (?) Review this

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12
Q

Ability for parasympathetic to directly impact the heart rate is _____ (weaker/stronger) than the sympathetic

A

Weaker

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13
Q

Vagus nerve is cranial nerve

A

X

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14
Q

Maximum sympathetic stimulation:

A

Approx 24 L/min

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15
Q

Normal sympathetic stimulation

A

Approx 14 L/min

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16
Q

Other influences on heart function (3)

A

Potassium (Hyperkalemia, or too much K, slows heart rate, abnormal rhythms and potentially death)

Calcium ions (Too much is hypercalcemia causes spastic contractions)

Temperature (fever causes an increase in heart rate. The warmer you are, the faster your heart rate)

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17
Q

Natural pacemaker

Fastest heart rate of all cardiac tissue

A

Sinus node (SA node)

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18
Q

Conduction system

A

Specialized cardiac muscle cells

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19
Q

Location of the SA node

A

Superior posterolateral RA

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20
Q

Why does the SA node self-excitation and inherent rhythmicity?

A

It has a sodium leak, and it has a higher RMP (resting membrane potential)

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21
Q

SA node connects to the _____ muscle and ________ fibers

A

Atrial muscle and intermodal fibers

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22
Q

Fibers receives action potential from SA node

Connects to the AV node

A

Internodal fibers

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23
Q

Node that delays action potential (slow velocity through node, low # gap juncions to allow time for the atria to relax)
Located posterior RA

A

AV node

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24
Q

Purkinje System

A

Fibers lead from the AV node, through the AV bundle (Bundle of His), through the left and right bundle branches, then throughout the ventricular muscle.

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25
Q

Purkinje system has a very _____ (fast/slow) conduction velocity

A

Fast

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26
Q

Heart rate vs conduction velocity

A

All of heart has the same heart rate

Conduction velocity is the propagation, how long it takes from point A to point B is different. They start at the same time, but some take longer

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27
Q

Speed for conduction to go from SA node to AV node

A

moderately fast

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28
Q

Conduction rate from AV node to bundle

A

Slow

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29
Q

Conduction speed from bundle to ventricular muscle

A

Very fast

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30
Q

If SA node no longer works, what takes over as the pacemaker? Why?
What takes over after that?

A

AV node. It has the 2nd fastest firing rate. The heart rate would be slower.
After that would be Purkinje System

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31
Q

QRS Wave

A

Ventricular depolarization

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32
Q

T wave

A

Ventricular depolarization

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33
Q

P wave

A

Atrial depolarization

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34
Q

Developer of the ECG

A

Will EM Einthoven

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35
Q

Difference between ECG and action potential depends on

A

Where electrodes are placed, among other things

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36
Q

To record voltage change, need 2 electrodes. Explain the 2.

A

One is the reference (negative) electrode
One is the recording (positive) electrode

For Action Potential AND ECG

A signal is detected by the recording device (oscilloscope) when there is an electrical difference

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37
Q

Action potential electrodes are placed:

ECG Electrodes are placed:

A

Deep to the axons

Epidermis

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38
Q

Recording where RMP records a negative value, and records a positive value during AP

A

Action Potential recording

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39
Q

Recording where depolarizations and depolarizations are deflections from zero (isoelectric) lines

A

ECG recording

40
Q

Recordings that are Monophysite

A

Action Potentials

41
Q

Recordings that are biphasic

A

ECG

42
Q

Recordings that only show amplitude of voltage changes as recorded at a point in a cell

A

Monophasic

43
Q

Recordings of both amplitude and direction of waves of voltage changes through heart muscle. This is a ____.

A

Biphasic

Vest or

44
Q

Time between the beginning of the P wave to the beginning of the Q wave. 0.16 sec

A

P-R interval

45
Q

Interval from 1 R wave to the next R wave

A

R-R interval

46
Q

Time it takes from Q wave to end of T wave

A

Q-T interval

47
Q

Time it takes from end of S to beginning of T wave

A

ST Segment

48
Q

Very important segment to look at, as it is a presensitive indicator of cardiac eschimia

A

ST Segment

49
Q

Reduction of blood flow, usually pathologically

A

Eschemia/hypoxia with eschemia

50
Q

Deviations of the ECG (PQRST)

A

Isoelectric line

51
Q

Vector rules for depolarization

A

A wave of depolarization moving towards a positive electrode records a positive deflection.
Moving away from a positive electrode records a negative deflection

52
Q

Vector rules for repolarization

A

A wave or repolarization moving towards a positive electrode records a negative deflection
Moving away from a positive electrode records a positive deflection

53
Q

What happens if a wave of depolarization/repolarization was moving at right angles to both electrodes?

A

Deflection would be 0

54
Q

What would happen if a wave of depolarization was moving at an oblique angle to the electrodes?

A

Deflection would be positive, but not as large

55
Q

How many electrodes are typically used in an ECG? How many leads?

A

10 electrodes

12 leads

56
Q

Difference between lead and electrode

A

Electrode is the actual wire attached to the body

Lead is the pathway

57
Q

12 leads:

A

3 standard bipolar limb leads
3 augmented unipolar limb leads
6 precordial chest leads

Each lead assigns one electrode as the positive electrode and 1 or more as the negative ones

58
Q

Standard bipolar limb leads

A

One positive and one negative on each one

Lead 1: Negative electrode on the right wrist/chest. Positive on the left wrist/chest. Wave moves horizontal and towards the left.

Lead 2: Use same negative electrode as lead 1 on right wrist. Positive electrode on left ankle

Lead 3: Use same positive electrode as lead 2 on left ankle, and same negative electrode as lead 1 on left wrist.

59
Q

Standard bipolar limb leads, AKA:

A

Einthoven’s Triangle

60
Q

Einthoven’s Law

A

In regards to the amplitude of the R wave:

Lead II= Lead I + Lead III

This is true for any accurate ECG

61
Q

Augmented unipolar limb leads:

A

3 electrodes

Each lead has 1 positive and 2 negatives

aVR (Right wrist): Positive electrode on right wrist. Negative electrodes are left wrist and left ankle. Line goes towards middle of left wrist and left angle

AVL (left wrist): Positive on left wrist. Negative electrodes are right wrist and left ankle. Line goes towards right rest and left ankle

AVF (Left ankle) Positive on left ankle. Negative on right and left wrists. Line goes straight up

62
Q

Precordial (chest) leads:

A 
V1: 4th intercostal space to the Rt of the sternum 
V2: 4th ICS to the left of the sternum
V3: Between V2 and V4
V4: 5th ICS, left mid-clavicular line
V5- 5th ICS, L anterior axillary line
V6- 5th ICS, left mid-axillary line
63
Q

Why use only 1 ankle instead of both for the ECG?

A

Use left bc it is in the path of the heart.

They do use an electrode on the right, but as the grounding

64
Q

The trick to interpreting ECGs is to know:

A

Which vectors (directions) each lead is sensitive to, and from that figure out what the heart is doing electronically.

65
Q

The ECG _______ the electrical activity that is happening at a particular time

A

Averages

66
Q

Normal mean P wave vector represents:

A

The depolarization activity of the atria

67
Q

Atrial T wave is normally obscured by:

A

The QRS complex

68
Q

Repolarization usually follows :

A

the same direction that depolarization goes

69
Q

The pattern of ventricular repolarization begins:

A

From the apex toward the base of the heart

This explains why the T wave is positive (lead II)

70
Q

Common theories for the cause of the U wave (very small sometimes seen wave) include:

A

Delayed repolarization of purkinje fibers
Prolonged repolarization of mid-myocardial M-cells
After-potentials resulting from mechanical forces in the ventricular wall
The repolarization of the papillary muscle

71
Q

Different stages of ventricular depolarization ins QR and S vectors

A 
Septal activation (A)- Q wave
Apical activation (B)- R peak (most significant)
Left ventricular activation (C) - R wave return 
Late left ventricular activation (D)- S wave
72
Q

Vector analysis used to determine the vector of depolarization through the heart

A

Hexaxial reference system

73
Q

What does the hexaxial reference system concentrate on?

A

The mean QRS vector for the analysis

74
Q

Precise way of vector analysis requires

A

Requires the use of any 2 of the 6 limb leads

75
Q

Steps of the precise way for vector analysis

A

The direction and magnitude of the QRS vector is plotted from two of the 6 limb leads

Right angles are drawn from the points of the vectors

Where they intersect is the AXIS OF VENTRICULAR DEPOLARIZATION.
This angled is measured with a protractor

76
Q

Normal vector axis determination

A

0-90 degrees

77
Q

Vector axis determination, left axis deviation

A

QRS axis of 0 to -90 degrees

78
Q

Right axis deviation of QRS vector axis

A

QRS axis of 90-180 degrees

79
Q

Extreme axis of QRS vector axis determination

A

-90 to -180 degrees

80
Q

Easy way for vector anazlysis: QRS can be estimated by:

A

Comparing the size of the QRS complexes of all 6 limb leads

81
Q

In the easy method of vector analysis, the lead with the larges deviation from the isoelectric line can be used to:

A

Estimate the QRS vector in the heart.

82
Q

Significance of an axis deviation for left axis

A

Short stock build, obesity
LV hypertrophy (hypertension- systemic, aortic valve stenosis, aortic valve regurgitation (something going from where is is to where it shouldn’t be))
Left bundle branch block (causes cardiac cycle to go slower)

83
Q

Significance of a right axis deviation

A

Tall, long-waist, lean build

RV hypertrophy (pulmonary valve stenosis/regurgitation, interventricular septal defect., tetralogy of Fallot)

R bundle branch black

84
Q

Tetralogy of Fallot

A

4 problems

1- Interventricular septal defect
2- over-riding aorta
3- pulmonary stenosis
4- RV hypertrophy.

85
Q

QRS voltages should be a sum of

A

I II and III = 2-4 mV

86
Q

Individual normal BRS voltages

A

.5-2 mV

87
Q

Increased QRS voltage is typically due to

A

Hypertrophy

88
Q

Decreased QRS voltage could indicate

A

Damages heart muscle

89
Q

Normal time frame of QRS

A

.04-.11 sec

90
Q

Prolonged QRS would be due to

A

Bundle branch block or hypertrophy

91
Q

Acute damaged heart muscle, like during an MI, does not:

A

Repolarization normal and therefore becomes a source of current.

They cannot generate enough ATP to generate action potentials.

92
Q

Heart muscle is injured, and there is some sort of current interference

A

Current of Injury

93
Q

Resting heart rate faster than 110bpm

A

Tachycardia

94
Q

Causes of tachycardia

A

Fever
Certain toxins
SNS activity

95
Q

Resting heart rate slower than 60 bpm

A

Bradycardia

96
Q

Potential causes of bradycardia

A

Athletes (typically endurance athletes)

Vagus nerve is over-stimulated.

CVP (4 decks)

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