3. Heartbeat & ECG Flashcards Preview

Year 1 - Term 2: Carriage of Oxygen > 3. Heartbeat & ECG > Flashcards

Flashcards in 3. Heartbeat & ECG Deck (25):
1

 

Where is the SAN?

 

Wall of R atrium, near entrance of superior vena cava

2

Where is the AVN?

 

On the inter-atrial septum

3

 

Give the conduction pathway

 

Pacemaker cells in SAN -> electrical impulse -> AVN -> 60ms delay before AVN transmits to ventricles via bundle of His -> purkinje fibres -> contracts apex up

 

NB. delay = "weak link"

4

 

Where does the SAN usually receive blood from?

What does this mean?

 

RCA

 

If MI occludes RCA there has to be a good anastamosis for the LCA or else cell death will stop SAN triggering heartbeat.

5

 

How long is a cardiac mucle AP?

 

200 milliseconds

6

 

Describe how pacemaker cells work

 

Constant Na+ in at rest and K+ out so current balance at -70mv.

K+ out decays with time and depolarises cell (-40mv) causing AP.

K+ is reset to high level again.

Thus HR depends on rate of K+ out.

7

 

What is the SAN innervated by?

 

Parasympathetic vagal fibres inhibit K+ channel closure via muscarinic cells

Sympathetic cardiac plexus fibres increase K+ channel closure via beta-adrenoreceptors

(NB. blood-bourne adrenaline acts on beta receptors throughout myocardium)

8

 

What is first degree AV block?

 

PR interval is lengthened beyond 200ms (prevalence in normal young pop of 1%), so cardiac output limited.

9

 

What is happening at A, B & C in this ventricular muscle AP?

Q image thumb

 

A: Na+ enters cell, depolarisation

B: Ca2+ enters cell, contraction initiation

C: K+ exits cell, repolarisation

10

 

What is the plateau in a ventricular muscle AP due to?

Why is there such a long refractory period?

 

 

Late prolonged entry of Ca2+ which helps muscle contract longer than skeletal muscle. Ca2+ enter through slow L type channels on cardiac cell membranes.

To keep cells synchronous

11

 

How does amylodapine work?

 

Blocks Ca2+ channels on cardiac cell membranes and thus reduces force of ventricular contraction and work/O2 demand of heart. 

12

 

What happens if cardiac cells get out of synchronisation?

How does a defibrilator work?

 

Fibrillation - different parts of ventricle contracting at different times and ventricular pressure does not rise enough to generate any cardiac output -> death

It shocks all muscle and makes it contract simultaneously, then the cells all go into refractory period together and rhythm is restored. 

13

 

What do the P,Q,R,S, and T waves show?

Q image thumb

P: atrial depolarisatin

QRS: ventricular depolarisation

T: due to differences in time of ventricular repolarisation

 

14

 

What are the ECG leads and where do they go?

 

3 limb leads show I, II, III

3 augmented leads show aVR, aVL, aVF (unipolar - virtual reference point in middle of chest)

6 chest leads show V1-V6

A image thumb
15

Which lead is the standard ECG recorded from?

How long should the QRS complex last?

How long should the PR interval be? (And what does higher values indicate?)

When do you hear the first heart sound?

II

<100ms

120-200ms, heart block

QRS

16

What could a notched/peaked P wave indicate?

What is one small box on ECG trace?

How does the Q wave appear on lead II?

What are ST segment changes important for diagnosing?

COPD, CHF

40ms

Small/absent

Acute MI (STEMI)

 

17

 

What are the normal appearances of aVR and aVL?

Where is V1 placed?

How are V1-V6 described?

aVR = large Q wave and small/non-existant R wave, aVL = v. small

4th intercostal space to right of sternum

V1 = mainly -ve, V5,6 = mainly +ve, transition between -ve and +ve

18

What leads would you look at for the following views of the herart:

Inferior

Lateral

Anterior

Septal

 

I,III,aVF

I,aVL,V5,V6

V3,V4

V1,V2

19

 What does this ECG show and why?

Q image thumb

No P wave - atrial fibrillation (pacemaker cells firing at different times = asynchronised and no electrical activity)

20

What does this ECG show and why?

Q image thumb

 

Extra P waves - atrial flutter (look at V1), often due to poor blood supply to SAN

21

What does this ECG show and why?

Q image thumb

 

S-T elevation = acute ischaemia (but most common cause = AMI)

22

What does this ECG show and why?

Q image thumb

S-T depression, can be sign of chronic ischaemia

23

What can you see in leads II and III?

Q image thumb

S-T elevation

24

What does this ECG show and why?

Q image thumb

Ventricular fibrillation - grossly abnormal ECG with no clear QRS complexes

25

What is the electrical axis of the heart?

How do you calculate the electrical axis of the heart?

How does the axis deviate with damage?

Electrical vector showing different depolarisation in different parts of the heart at the same time.

Measure size of QRS complex (R height - S height) on two leafds and draw them to scale on a triangle. 

If R ventricle damaged = L axis deviation and vice versa. (Swings TOWARDS HYPERTROPHIC tissue and AWAY from DAMAGED tissue).

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