Week 1 Flashcards
What are the phases of a cardiac action potential?
- Phase 0: Rapid Na+ influx through open fast Na+ channels
- Phase 1: Transient K+ channels open and K+ efflux returns TMP to 0mV
- Phase 2: Influx of Ca2+ through L-type Ca2+ channels is electrically balanced by K+ efflux through delayed rectifier K+ channels
- Phase 3: Ca2+ channels close but delayed rectifier K+ channels remain open and return TMP to -90mV
- Na+, Ca2+ channels closed, open K+ rectifier channels keep TMP stable at -90 mV
What is electro-mechanical coupling?
Electrical events cause mechanical events and their
inter-relationship in the heart is important for function
What do we measure with ECG?
Electrical signal. It’s relationship to mechanical and
functional properties of the heart is what makes it a valuable component of the cardiac exam
What does an electrocardiogram do?
Captures the electrical activity produced by the heart’s contraction cycle.
What forms the basis for an electrocardiogram?
The detection of current electrical impulses generated from the flow of charged particles along this pathway that are detectable
on the surface of the skin
Where are the electrodes of an ECG in reference to the body?
The negative is on the right arm and the positive electrode is usually on the left leg
ECG leads capture signal going from where to where?
From the negative terminal to the positive terminal
What end of the ECG captures/receives the signal?
The positive terminal
What do ECG bipolar leads utilize?
A negative and positive electrode and record the electrical activity between them.
What do ECG unipolar leads utilize?
Utilize a single positive recording electrode and a combination of the other electrodes to serve as a composite negative electrode
Where do the bipolar leads go?
Limb: Right arm, left arm, left leg
Where do the unipolar leads go?
- Precordial (Chest)
* Unipolar (Augmented)
Where do the precordial (Chest) leads go?
- V1: 4th IC space to the right of the sternum (Septal)
- V2: Forth IC space to the left of the sternum (Septal)
- V3: between V2 and V4 (Anterior wall)
- V4: midclavicular line, 5th IC space (Anterior Wall)
- V5: anterior axillary line @ level of V4 (Lateral Wall)
- V6: midaxillary line @ level of V4 (Lateral Wall)
Primarily on the left side
Why are augmented leads termed as unipolar leads?
Because there is a single positive electrode that is referenced against a combination of the other limb electrodes.
What portion of the heart does augmented lead: aVF(augmented vector foot) look at?
The inferior portion of the heart
What portion of the heart does augmented lead: aVL(augmented vector lateral/left arm) look at?
The lateral wall of the heart
What portion of the heart does augmented lead: aVR(augmented vector right arm) look at?
It looks at the heart backwards, so its signal is flipped.
Called the orphan lead
What is the most basic ECG?
The 3 lead ECG. It uses 3 electrodes. (RA, LA and LL)
The 3 lead ECG is able to obtain a signal for the ____ leads
The 3 lead ECG is able to obtain a signal for the bipolar limb leads
What is the 3 lead ECG used for?
Basic monitoring and Research
purposes
Where are the lead placements for the 5 lead ECG?
RA, RL, LA, LL and Chest
What is displayed on the monitor of the 5 lead ECG?
The bipolar leads (I, II and III) AND a single chest/precordial lead
- (depending on position of the brown chest lead (positions V1–6)
In what setting is the 5 lead ECG commonly used?
In Acute Care
What are the characteristics of the 12 lead ECG?
• 10 electrodes. • Electrodes on all 4 limbs - (RA, LL, LA, RL) • Electrodes on precordium - (V1–V6) • Monitors 12 leads - (V1–V6), (I, II, III) and (aVR, aVF, aVL)
What does a 12 lead ECG allow?
Allows interpretation of specific areas of the heart
What is a 12 lead ECG used for?
Diagnostics, stress testing
What is the location and coronary artery of a V1, V2 lead?
Location: Anterior
Coronary artery: LAD
What is the location and coronary artery of a V3, V4 lead?
Location: Apical- septal
Coronary artery: LAD
What is the location and coronary artery of a II, III, and avF lead?
Location: Interior
Coronary artery: PDA( 80% RCA, 20% LCx)
What is the location and coronary artery of a I, V5, V6, and avL lead?
Location: lateral
Coronary artery: LCx
What do the thin lines on an ECG paper mean?
1 mm intervals or 0.04 sec
What do the thick lines on an ECG paper mean?
5 mm intervals or .2sec
What do the 1 thick lined box (5 boxes) on an ECG paper mean?
.20 sec or 5mm
What do the 5 thick lined box (25 boxes) on an ECG paper mean?
= 1 second
What do the tick marks on rhythm strip on an ECG paper mean?
3 secs
10 mm on an ECG paper is equal to ___
1 mV
What does the P wave on an ECG represent?
Atrial Depolarization
What are the normal ranges for a P wave on an ECG?
- Duration: < 0.12s OR 3 small boxes)
* Amplitude: < 2.5mm OR 2.5 small boxes)
What does the P-R interval on an ECG represent?
The propagation of the cardiac
action potential from the atria through the AV node into the ventricles.
What are the normal ranges for a P-R interval on an ECG?
- Duration: 0.12- 0.2s OR 3-5 small boxes
* Will shorten during exercise as heart rate increases
What does the QRS complex on an ECG represent?
Ventricular Depolarization
What are the normal ranges for a QRS complex on an ECG?
- Duration: 0.06- 0.10s OR 1.5-2.5 small boxes,
* Some healthy patients may have wider QRS (0.10-0.12s), but the absolute cut off is 0.12s
What is the amplitude for a QRS complex on an ECG?
• >0.5 mV in at least one standard lead (5 small
boxes)
• >1.0 mV in at least one precordial lead (10 small boxes)
• Upper limit 2.5 – 3.0 mV (25 small boxes)
What does the S-T segment on an ECG represent?
The interval between ventricular depolarization and repolarization.
What are the normal ranges for a S-T segment on an ECG?
• A discrete ST segment distinct from the T wave is usually absent.
• Often at higher heart rates (exercise) the ST-T segment is a smooth, continuous line
beginning at the J-point (end of QRS), slowly rising to the peak of the T-wave
What does the T wave on an ECG represent?
Ventricular repolarization
What are the normal ranges for a T wave on an ECG?
• It’s deflection should be the same direction as the largest component of the QRS wave complex (usually the R wave
- Ie, if the R wave is positive the T wave should be positive.
- Ex; in lead aVR it is normal for the T wave to be negative, since the QRS is also negative
What does the R-R Interval on an ECG represent?
- The duration between subsequent “heart beats”.
* This is duration is used to calculate heart rate.
What are the normal ranges for the R-R Interval on an ECG?
• Should be regular and consistent,
- Especially at rest.
• Will shorten during exercise as heart rate increases.
What does the Q-T Interval on an ECG represent?
- It represents the time taken for ventricular depolarization and repolarization.
- Shortens during faster heart rates, lengthens during slower heart rates
What are the normal ranges for the Q-T Interval on an ECG?
• Duration:
- Men 0.4- 0.44s OR 10-11 small boxes
- Women: 0.44- 0.46s OR 11-11.5 small boxes.
Why is the corrected QT (QTc) interval more often used?
Since the duration of QT varies inversely with the heart rate, the raw QT interval is often not used
How is the corrected QT (QTc) calculated?
QTc = measured QT interval
divided by
square root of R-R interval
What is the normal value for the corrected QT (QTc)?
< 0.44 sec
What does the J point on an ECG represent?
• The initiation of ventricular
repolarization
• Junction between the termination of the QRS complex and the beginning of the ST segment
What are the normal ranges for the J point on an ECG?
Should be in line with the isoelectric line
What is the R wave progression?
Small R waves begin in V1/V2 and progress in size to V4/V5.
• The R in V6 is usually smaller than R in V5.
What occurs at leads V3 or V4?
The transition from S>R to R>S
Where do s-waves begin when in reverse?
In reverse, the s-waves begin in V6 or V5 and progress in size to V2.
• The S in V1 is usually smaller than the S V2.
What is the QRS axis?
The direction of the mean QRS vector in the frontal plane
Normally all QRS segments are positive, except for ___
aVR
What are the characteristics of the Left Axis Deviation LAD of the QRS axis?
- QRS is positive (dominant R wave) in leads I and aVL
* QRS is negative (dominant S wave) in leads II and aVF
What are the characteristics of the Right Axis Deviation LAD of the QRS axis?
- QRS is negative (dominant R wave) in leads I and aVL
* QRS is positive (dominant S wave) in leads II or III and aVF
What are the components of the systematic analysis of an ECG?
• Rate
- Is the rate fast or slow
• Rhythm
- Regular or irregular
• Are a P wave and QRS complex with each cycle
• Do the P waves look alike
• Is there a P wave preceding every QRS
• Is the PR interval within normal limits
• Is the QRS duration within normal limits
• Does the rhythm come from the SA Node, AV node, or the ventricles
• Does the atrial rate = ventricular rate
What should the atrial rate to ventricular rate of an ECG be?
Should be 1:1
What does it mean when the rhythm of an ECG comes from the AV Node or above (SA, AV, atria, nodal tracts)?
The QRS is narrow