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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
Purkinje system has a very _____ (fast/slow) conduction velocity
Fast
26
Heart rate vs conduction velocity
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
27
Speed for conduction to go from SA node to AV node
moderately fast
28
Conduction rate from AV node to bundle
Slow
29
Conduction speed from bundle to ventricular muscle
Very fast
30
If SA node no longer works, what takes over as the pacemaker? Why? What takes over after that?
AV node. It has the 2nd fastest firing rate. The heart rate would be slower. After that would be Purkinje System
31
QRS Wave
Ventricular depolarization
32
T wave
Ventricular depolarization
33
P wave
Atrial depolarization
34
Developer of the ECG
Will EM Einthoven
35
Difference between ECG and action potential depends on
Where electrodes are placed, among other things
36
To record voltage change, need 2 electrodes. Explain the 2.
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
37
Action potential electrodes are placed: | ECG Electrodes are placed:
Deep to the axons Epidermis
38
Recording where RMP records a negative value, and records a positive value during AP
Action Potential recording
39
Recording where depolarizations and depolarizations are deflections from zero (isoelectric) lines
ECG recording
40
Recordings that are Monophysite
Action Potentials
41
Recordings that are biphasic
ECG
42
Recordings that only show amplitude of voltage changes as recorded at a point in a cell
Monophasic
43
Recordings of both amplitude and direction of waves of voltage changes through heart muscle. This is a ____.
Biphasic Vest or
44
Time between the beginning of the P wave to the beginning of the Q wave. 0.16 sec
P-R interval
45
Interval from 1 R wave to the next R wave
R-R interval
46
Time it takes from Q wave to end of T wave
Q-T interval
47
Time it takes from end of S to beginning of T wave
ST Segment
48
Very important segment to look at, as it is a presensitive indicator of cardiac eschimia
ST Segment
49
Reduction of blood flow, usually pathologically
Eschemia/hypoxia with eschemia
50
Deviations of the ECG (PQRST)
Isoelectric line
51
Vector rules for depolarization
A wave of depolarization moving towards a positive electrode records a positive deflection. Moving away from a positive electrode records a negative deflection
52
Vector rules for repolarization
A wave or repolarization moving towards a positive electrode records a negative deflection Moving away from a positive electrode records a positive deflection
53
What happens if a wave of depolarization/repolarization was moving at right angles to both electrodes?
Deflection would be 0
54
What would happen if a wave of depolarization was moving at an oblique angle to the electrodes?
Deflection would be positive, but not as large
55
How many electrodes are typically used in an ECG? How many leads?
10 electrodes 12 leads
56
Difference between lead and electrode
Electrode is the actual wire attached to the body Lead is the pathway
57
12 leads:
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
Standard bipolar limb leads
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
Standard bipolar limb leads, AKA:
Einthoven’s Triangle
60
Einthoven’s Law
In regards to the amplitude of the R wave: Lead II= Lead I + Lead III This is true for any accurate ECG
61
Augmented unipolar limb leads:
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
Precordial (chest) leads:
``` 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
Why use only 1 ankle instead of both for the ECG?
Use left bc it is in the path of the heart. | They do use an electrode on the right, but as the grounding
64
The trick to interpreting ECGs is to know:
Which vectors (directions) each lead is sensitive to, and from that figure out what the heart is doing electronically.
65
The ECG _______ the electrical activity that is happening at a particular time
Averages
66
Normal mean P wave vector represents:
The depolarization activity of the atria
67
Atrial T wave is normally obscured by:
The QRS complex
68
Repolarization usually follows :
the same direction that depolarization goes
69
The pattern of ventricular repolarization begins:
From the apex toward the base of the heart This explains why the T wave is positive (lead II)
70
Common theories for the cause of the U wave (very small sometimes seen wave) include:
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
Different stages of ventricular depolarization ins QR and S vectors
``` 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
Vector analysis used to determine the vector of depolarization through the heart
Hexaxial reference system
73
What does the hexaxial reference system concentrate on?
The mean QRS vector for the analysis
74
Precise way of vector analysis requires
Requires the use of any 2 of the 6 limb leads
75
Steps of the precise way for vector analysis
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
Normal vector axis determination
0-90 degrees
77
Vector axis determination, left axis deviation
QRS axis of 0 to -90 degrees
78
Right axis deviation of QRS vector axis
QRS axis of 90-180 degrees
79
Extreme axis of QRS vector axis determination
-90 to -180 degrees
80
Easy way for vector anazlysis: QRS can be estimated by:
Comparing the size of the QRS complexes of all 6 limb leads
81
In the easy method of vector analysis, the lead with the larges deviation from the isoelectric line can be used to:
Estimate the QRS vector in the heart.
82
Significance of an axis deviation for left axis
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
Significance of a right axis deviation
Tall, long-waist, lean build RV hypertrophy (pulmonary valve stenosis/regurgitation, interventricular septal defect., tetralogy of Fallot) R bundle branch black
84
Tetralogy of Fallot
4 problems 1- Interventricular septal defect 2- over-riding aorta 3- pulmonary stenosis 4- RV hypertrophy.
85
QRS voltages should be a sum of
I II and III = 2-4 mV
86
Individual normal BRS voltages
.5-2 mV
87
Increased QRS voltage is typically due to
Hypertrophy
88
Decreased QRS voltage could indicate
Damages heart muscle
89
Normal time frame of QRS
.04-.11 sec
90
Prolonged QRS would be due to
Bundle branch block or hypertrophy
91
Acute damaged heart muscle, like during an MI, does not:
Repolarization normal and therefore becomes a source of current. They cannot generate enough ATP to generate action potentials.
92
Heart muscle is injured, and there is some sort of current interference
Current of Injury
93
Resting heart rate faster than 110bpm
Tachycardia
94
Causes of tachycardia
Fever Certain toxins SNS activity
95
Resting heart rate slower than 60 bpm
Bradycardia
96
Potential causes of bradycardia
Athletes (typically endurance athletes) | Vagus nerve is over-stimulated.

CVP (4 decks)

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