3.1.4. Basis of the Surface ECG Flashcards

(37 cards)

1
Q

What is neuronal input within the heart responsible for?

A

Modulating activity (electrical signal originates within the heart itself)

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2
Q

How many APs per contraction (heart beat)?

A

1

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3
Q

Why do APs take on different morphologies in different parts of the heart?

A

It is a reflection of the ion channel population in each cell and its function

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4
Q

Where does cardiac Ap originate?

A

Specialized cardiac myocytes that exhibit pacemaker activity (SA node)

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5
Q

What nerve is responsible for parasympathetic innervation and what does it do?

A

Vagus. Slows down HR via ACh

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6
Q

What nerve is responsible for sympathetic innervation and what does it do?

A

T1-4 Spinal Nerves. Speeds up HR via Norepinephrine

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7
Q

Why does excitation start in the SA node?

A

Because it is the fastest pacemaker
SA: 70-80 APs/min
AV: 40-60
Purkinje: 15-40

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8
Q

What is the significance of atrial contraction?

A

Provides a “kick” to fill the ventricle

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9
Q

What is the Frank-Starling mechanism?

A

Strength of contraction is proportional to the end diastolic volume/ pressure

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10
Q

How is AP conducted to the ventricle?

A

Slowly (allows complete emptying of atrial contents), through the AV node.

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11
Q

What is the most important difference b/w fast- and slow-response cardiac APs

A

The ion responsible for the phase 0 upstroke:

Fast-response AP = fast inward Na+ current
Slow-response AP = slow inward Ca current

This is why conduction is slow in the AV nodes, but fast in the His-Purkinje system

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12
Q

Which ventricle is excited first?

A

Both, simultaneously

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13
Q

Where is AP conducted from in terms of the heart’s anatomy?

A

Base to Apex, then back Basal after reaching the Ventricles

Endocardium to the Epicardium

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14
Q

How does repolarization occur?

A

Epicardium to Endocardium

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15
Q

In which layer of the heart is the AP the shortest?

A

Epicardium

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16
Q

The total time from impulse initiation in the SA node to

repolarization of the ventricles

17
Q

What is an ECG?

A

An extracellular recording of the mean cardiac vector over time

18
Q

Does the ECG measure heart contraction?

A

No. Only electrical activity

19
Q

Which part of the body serves as the ground electrode?

20
Q

Which leads provide frontal plane information?

21
Q

Which leads provide horizontal plane information?

22
Q

Why does the R wave increase in amplitude for chest leads?

A

Because the left ventricle is larger than the right

23
Q

What is the zone of transition?

A

The lead where R- and S-wave amplitudes are roughly the same

24
Q

Which ECG intervals and durations are important to look out when determining if the heart in functioning properly?

A

PR interval
QRS duration
ST segment
QT interval

25
What does a shortened PR interval mean?
Wolfe-Parkinson-White Syndrome Signals are entering from other areas than the AV node
26
What does a widened QRS duration mean?
Slow conduction in Purkinje fibers and/pr ventricular muscles
27
What is someone at greater risk for who has shortened or increased QT intervals?
Cardiac arrhythmias
28
What does Bazett's correction account for?
The heart's affect on the AP duration
29
What is the normal axis of the apex?
-30 to 90 degrees
30
What does the ST segment reflect?
AP plateau (changes = ischemia)
31
What happens when the heart becomes ischemic?
An ATP-sensitive K+ channel opens after sensing the metabolic distress. This causes the AP to shorten dramatically in ischemic cells.
32
What is atrial flutter?
Back to back P waves; creates a sawtooth appearance on the ECG
33
What will you see on the ECG of patients with hypokalemia or bradycardia?
a U-wave (small bump after the T wave)
34
What can irregularly spaces QRS be a sign of?
Atrial fibrillation (no discernible P wave)
35
Medications that can prolong QT
Sotalol, Risperidone (antipsychotics), Macrolides, Chloroquine, Protease Inhibitors, Quinidine, Thiazides
36
Congenital long QT syndrome
1. Inherited disorder of myocardial repolarization 2. Romano-Ward Syndrome 3. Jarvell and Lange-Nielsen Syndrome (deafness) 4. Predisposes patients to Torsades de pointes (polymorphic ventricular tachycardia)
37
What is ventricular fibrillation?
Completely erratic rhythm. It is fatal w/o immediate CPR and defibrillation