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CP Test 1 > B4-089 The Electrocardiogram > Flashcards

B4-089 The Electrocardiogram Flashcards

1
Q

fast response cardiac action potential occurs in

A
  • cardiomyocytes
  • purkinje fibers
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2
Q

slow response cardiac action potential occur in

A
  • SA node
  • AV node
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3
Q

use 3 electrodes on both arms and left leg

A

limb leads

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4
Q

configure Einthove’s triangle, with heart at center

A

limb leads

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5
Q
  • bipolar leads
  • recording made between any two vertices of the triangle
A

limb leads

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6
Q

use same 3 limb electrodes, but compare 2 leads vs. the third

A

augmented limb leads

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7
Q
  • unipolar leads
  • called “aV”
A

augmented limb leads

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8
Q

both limb and augmented limb leads are in the […] plane

A

coronal

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9
Q

6 unipolar leads that lie on the perpendicular to others (transverse plane)

A

chest leads

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10
Q

positioned as spokes of a wheel to intersect at a point

A

hexaxial system

limb/augmented limb

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11
Q

movement of a depolarization wave toward the positive end of a lead produces a […] deflection

A

positive

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12
Q

movement of a repolarization wave toward the positive end of a lead produces a […] deflection

A

negative

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13
Q

the height of a wave relects the […] of the current

A

magnitude

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14
Q

the length of a wave reflects its

A

duration

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15
Q

the sum of segments and waves

A

intervals

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16
Q

which interval shows the rate?

A

R-R

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17
Q

atrial depolarization

A

p wave

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18
Q

P wave + PR segment

A

PR interval

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19
Q

ventricular depolarization

A

QRS complex

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20
Q

corresponds to phase 2 of ventricular action potential

A

ST segment

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21
Q

ventricular repolarization

A

T wave

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22
Q

QRS complex + ST segment + T wave

A

QT interval

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23
Q

firing of the SA node intiates

A

atrial depolarization

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24
Q

specialized conduction paths to rapidly conduct the impuls from the SA node to the AV node and left atrium

A

internodal pathways

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25
Q

atrial depolarization is dependent on […] current

A

sodium

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26
Q

if the sodium current is reduced, the P wave will be

A

wider and have lower amplitude

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27
Q

the impulse is delayed in the AV node which allows the atria to

A

contract before the ventricles depolarize

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28
Q

highest conduction velocity in heart

A

purkinje fibers

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29
Q

the conduction impulse spreads between myocytes via

A

gap junctions

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30
Q

why will the QRS complex appear different on each lead?

A

as depolarization spreads through the ventricles, it changes magnitude and direction

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31
Q

sequence of ventricular depolarization

A
  1. depolarize atria
  2. depolarize septum from left to right
  3. depolarize anteroseptal region of myocardium toward apex
  4. depolarize bukl of ventricle myocardium, from endocardium to percardium
  5. depolarize posterior portion of the base of the left ventricle
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32
Q
  • corresponds to phase 2 of the ventricular action potential
  • recorded along isoelectric line of the ECG
A

ST segment

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33
Q

represents ventricular repolarization

A

T wave

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34
Q

represents the entire time required from the onset of ventricular depolarization to repolarization

A

QT interval

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35
Q

Ca+ current and K+ current

A

ST segment

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36
Q

average orientation and magnitude of a dipole representing the most intense phase of ventricular depolarization

A

mean electrical axis MEA

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37
Q

if the QRS is positive in both leads I and aVF, the MEA is

A

normal

38
Q

conditions that change MEA

A
  • pregnancy
  • ventricular hypertrophy
  • infarct
39
Q

ECG is used to

A
  1. measure cardiac function
  2. detect electrolyte imbalance
  3. evaluate effective treatment
40
Q

parasympathetic system […] heart rate

A

decreases

41
Q

sympathetic system […] heart rate

A

increases

42
Q

mediated by adrenergic receptors

A

sympathetic

43
Q

increases heart rate, conduction, and contractility

A

sympathetic

44
Q

mediated via cholinergic receptors

A

parasympathetic

45
Q

decreases heart rate, conduction, contractility

A

parasympathetic

46
Q

increased sympathetic nerve firing to the heart increases

A
  • funny sodium current
  • calcium current
  • potassium current

norepinephrine

47
Q

sympathetic activity makes MDP more […] and phase 4 […]

A

positive
steeper

48
Q

increased sodium current will cause

A

contractions to be stronger and briefer

49
Q

increased potassium current will cause

A

repolarization to be increased and occur faster

50
Q

does sympathetic nerve activation change the P wave or QRS complex?

A

no

51
Q

effect of increased funny sodium current

A

increased heart rate

52
Q

effect of increased L-type calcium current

A
  • increased depolarization
  • increased conduction velocity through AV node
  • increased contraction strength
53
Q

effect of increased delayed rectifier potassium current

A

decreased action potential duration

54
Q

effect of decreased funny sodium current

A

slowed depolarization and heart rate

55
Q

effect of decreased calcium current

A

reduced depolarization and heart rate

56
Q

effect of decreased postassium current

A

extends phase 3 repolarization
slows heart rate

57
Q
  • increased HR
  • MDP less negative
  • faster phase 4 depolarization
  • decreased action potential duration
A

sympathetic effects (NE) on SA Node

58
Q
  • decreased heart rate
  • MDP more negative
  • slower phase 4 depolarization
  • increased action potential duration
A

parasympathetic effects (ACh) on SA node

59
Q
  • increased conduction velocity
  • faster phase 0 depolarization
A

sympathetic effects (NE) on AV node

60
Q
  • decreased conduction velocity
  • slower phase 0 depolarization
A

parasympathetic effects (ACh) on AV node

61
Q
  • phase 2 becomes more positive
  • action potential duration increases
  • contraction strength increases
A

sympathetic effects (NE) on ventricles

62
Q

heart rate > 100 bpm

A

tachycardia

63
Q

heart rate slower than 60 bpm

A

bradycardia

64
Q

group of conditions in which heartbeat is irregular

A

arrhythmia

65
Q

limits time of filling between beats

A

tachycardia

66
Q

inadequate to support proper cardiac output

A

bradycardia

67
Q

causes of arrythmias

A
  • disorders of impulse formation
  • disorders of impulse conduction
  • both
68
Q

symptoms of arrhythmias

A
  • palpitations
  • lightheadness
  • syncope
  • SOB
  • chest pain
69
Q

normal sinus rhythm

A
  • rate of 60-100 bpm
  • each QRS preceded by P wave
  • normal shape of QRS, duration < 120 ms
  • no additional waves
  • PR < 200 ms
  • QT interval less than half the R-R
70
Q
  • originates in SA node
  • more bpm than normal
  • regular rhythm
  • P waves similar
  • QRS normal
A

sinus tachycardia

71
Q

rapid regular tachycardia that occurs with reentrant activity

A

paroxysmal tachycardia

72
Q
  • heart rate in 200-350 bpm range
  • sinus tachycardia
A

atrial flutter

73
Q
  • suppression of sinus node
  • normal P waves
  • normal PR
  • normal QRS
  • rate <60 bpm
A

sinus bradycardia

74
Q

occurs in:
* well conditioned athletes
* during sleep
* hypothyroidism
* vagal stimulation
* medications

A

sinus bradycardia

75
Q

signal originates from group of cells outside the SA node

A

ectopic focus

76
Q

abnormal action potentials are triggered by a preceding action potential and can result in tachycardia

A

triggered activity

77
Q
  • “afterdepolarizations”
  • occur during phase 2, 3, or 4
A

triggered activity

78
Q
  • occur during late phase 2/early phase 3
  • associated with slow rates of phase 3 repolarization (long QT syndrome)
A

early afterdepolarizations

EAD

79
Q
  • occur in phase 4 of ventricular myocytes
  • high heart rates
  • high Ca+ concentrations
A

delayed afterdepolarizations

DAD

80
Q

EADs and DADs are secondary to high […]

A

calcium levels

81
Q

abnormal depolarization triggers an action potential to spread through myocytes repeatedly

A

reentrant loop

82
Q

single depolarization triggered by abnormal depolarizations

A

premature ventricular depolarization

83
Q

three requirements for reentry:

A
  1. abnormal electical circuit
  2. slow conduction
  3. unidirectional block
84
Q

reentrant loops are more likely when

A
  1. conduction velocity is decreased
  2. duration of action potential is increased
85
Q

results from the development of multiple reentry loops

A

fibrillation

86
Q
  • no p waves on ECG
  • ventricular rate irregular
  • 300-500 bpm
  • “bag of worms”
A

atrial fibrillation

87
Q

sawtooth baseline

A

atrial flutter

88
Q
  • prolonged PR interval
  • every P waves causes QRS
  • caused by reduced conduction velocity
A

first degree AV block

89
Q
  • multiple P waves precede each QRS
  • QRS looks normal
  • PR interval progressively lengthens
A

2nd degree heart block

90
Q
  • P waves not causing QRS complex
  • QRS looks normal, indicates ectopic focus
  • atrial and ventricular rate completely independent
A

third degree AV block

91
Q

AV block
a-fib
atrial flutter

classified as

A

supraventricular

92
Q

v tach
branch block
prolonged QT
v fib

classified as

A

ventricular

CP Test 1 (16 decks)

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