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APEX > Cardiac Monitors > Flashcards

Cardiac Monitors Flashcards

1
Q

Order of the electrical system of the heart

A

SA node
Internodal Tracts
AV node
Bundle of His
Bundle Branches
Purkinje fibers

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2
Q

List the Internodal Tracts that travel from the SA node to the AV node

A

Anterior internodal tract
Middle internodal tract (Wenckebach tract)
Posterior internodal tract (Thorel tract)

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3
Q

What is the conduction velocity?

A

Quantifies how fast an electrochemical impulse propagates along a neural pathway

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4
Q

What is the conduction velocity of the SA and AV nodes?

A

0.02-0.1 m/sec (slow conduction)

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5
Q

What is the conduction velocity of myocardial muscle cells?

A

0.3-1 m/sec (intermediate conduction)

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6
Q

What is the conduction velocity of His bundle, bundle branches, and Purkinje fibers?

A

1-4 m/sec (fast conduction)

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7
Q

Conduction velocity is a function of:

A
  1. Resting membrane potential
  2. Amplitude of the action potential
  3. Rate of change in membrane potential during phase 0
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7
Q

Conduction velocity is affected by:

A

ANS tone
Hyperkalemia induced closure of fast Na channels
ischemia
acidosis
antiarrhythmic drugs

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8
Q

The AV node is the only _____

A

electrical pathway between the cardiac chambers
Think of the AV node as the “gatekeeper” of electrical transmission between the atria and the ventricles

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9
Q

James fiber is an ____ and connects ____

A

Accessory pathway
Connects atrium to AV node

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10
Q

Atrio-hisian fiber is an ____ and connects ____

A

Accessory pathway
Connects atrium to His bundle

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11
Q

Kent’s bundle is an ____ and connects ____

A

Accessory pathway
Connects atrium to ventricle

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12
Q

Mahaim bundle is an ____ and connects ____

A

Accessory pathway
Connects AV node to ventricle

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13
Q

List the conduction velocities of the cardiac conduction pathway from slowest to fastest.

A

AV node, SA node, myocardial muscle cells, His Bundle, Bundle branches, Purkinje fibers

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14
Q

Phase 0

A

Event: Depolarization
Ion Movement: Na moves in
Key EKG Events: QRS

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15
Q

Phase 1

A

Event: Initial Repolarization
Ion Movement: Chloride in and Potassium out
Key EKG Events: QRS

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16
Q

Phase 2

A

Event: Plateau
Ion Movement: Calcium moves in and Potassium moves out
Key EKG Events: ST segment

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17
Q

Phase 3

A

Event: Final Repolarization
Ion Movement: Potassium moves out
Key EKG Events: T wave

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18
Q

Phase 4

A

Event: Resting phase
Ion Movement: Potassium leak
Key EKG Events: End of T wave to next QRS

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19
Q

The absolute refractory period means ___

A

that no stimulus (no matter how strong) can depolarize the myocyte

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20
Q

The relative refractory period means ____

A

that a larger than normal stimulus is required to depolarize the myocyte

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21
Q

P wave (electrical event)

A

depolarization begins in the atria

22
Q

PR interval (electrical event)

A

depolarization complete in the atria

23
Q

QRS (electrical event)

A

repolarization of atria
depolarization begins in the ventricle

24
Q

ST segment (electrical event)

A

Depolarization is complete in the ventricle

25
Q

T wave (electrical event)

A

Repolarization begins in the ventricle

26
Q

After the T wave (electrical event)

A

Repolarization is complete in the ventricle

27
Q

Biphasic P waves (lead II) suggest ___

A

LA enlargement (think mitral stenosis)

28
Q

Tall P waves suggest ___

A

RA enlargement (think about cor pulmonale)

29
Q

the PR interval would be prolonged with ___

A

1st degree heart block

30
Q

PR interval depression suggests ___

A

viral pericarditis
atrial infarction

31
Q

P wave and PR internal duration

A

P wave: 0.08-0.12 second
PR internal: 0.12-0.2 second

32
Q

Q wave and QRS complex duration

A

Q wave: <0.04 second
QRS complex: <0.1 second

33
Q

What abnormality in the Q wave would make you think about an MI?

A

If the amplitude is greater than a third of the R wave
If the duration is greater than 0.04 seconds
If the depth is greater than 1mm

34
Q

If the QRS complex is increased, consider:

A

LCH, bundle branch block, ectopic beat, WPW

35
Q

Normal QTc interval

A

In women: < 0.47 seconds
In men: < 0.45 seconds

36
Q

If the ST segment elevation or depression is greater than 1 mm, consider:

A

1) MI
but can also be caused by hyperkalemia or endocarditis

37
Q

Usually, the T wave points ______

A

in the same direction as the QRS complex

38
Q

The T wave points in the opposite direction of the QRS if ________

A

repolarization is prolonged by:
- myocardial ischemia
- bundle branch block

39
Q

Peaked T waves are caused by ___

A

myocardial ischemia, LVH, or an intracranial bleed

40
Q

The U wave is _____

A

Usually absent.
If it is > 1.5 mm, then consider hypokalemia

41
Q

The Osborn wave is ___

A

Usually absent. It is a small positive deflection immediately after the QRS complex (At the beginning of the ST segment) and may occur with hypothermia.

42
Q

Where do you measure ST changes from?

A

The PR segment because it is an isoelectric line
*As a general rule, changes greater than +1 or -1 are significant

43
Q

The J point is ____

A

where the QRS complex ends and the ST segment begins

44
Q

List the EKG changes seen with hyperkalemia (in order of early to late)

A

Narrow and peaked T waves
Short QT
Wide QRS
Low P amplitude
Wide PR
Nodal Block
Sine wave fusion of QRS and T which leads to VF or asystole

45
Q

EKG changes with hypokalemia

A

U wave
ST depression
Flat T wave
Long QT interval

46
Q

EKG changes with hypercalcemia

A

Short QT

47
Q

EKG changes with hypocalcemia

A

Long QT

48
Q

EKG changes with hypermagnesemia

A

Not significant unless VERY HIGH:
heart block or cardiac arrest

49
Q

EKG changes with hypomagnesemia

A

Not significant unless very low:
Long QT

50
Q

A positive deflection occurs when ___

A

the vector of depolarization travels toward the positive electrode

51
Q

A negative deflection occurs when ___

A

the vector of depolarization travels away from the positive electrode

52
Q

A biphasic deflection occurs when ____

A

the vector of depolarization travels perpendicular to the positive electrode

APEX (2 decks)

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