Slow resting heart rate. Less than 60 BPM
Fast resting heart rate. Above 100 BPM
Normal PR interval
Normal QRS interval
Less than or equal to 0.12 seconds
Normal jugular vein distention (JVD)
Less than 3cm at 30 degrees head elevation
Order of assessment
Insepction, Palpation, Percussion, Auscultation
Normal PR Interval
0.12-0.20 seconds which is 3-5 small boxes
Normal QRS Interval
Less than or equal to 0.12 seconds which is 3 boxes or less
First heart sound. Soft "Lubb"
Occurs at the end of the QRS interval. The ventricles depolarize, causing them to contract and the M & T valves to snap shut. Happens during Systole.
Second heart sound. Sharp "Dubb"
Occurs during the T wave when the ventricles relax and the A & P valves snap shut. Happens during diastole
Normal characteristics for pulses
Normally 2+, equal bilaterally, with 0 meaning absent and 4+ being strong and bounding
Pulse counted for 1 minute at the 5th intercostal mid clavicular line
Normal Characteristics of the Carotid Arteries
Pulses equal in rate, rhythm, and strength bilaterally; unchanged by inspiration, expiration, or rotation of the neck
Normal characteristics of heart sounds
Regular intervals between each sequence of beats with a distinct pause between the two sounds. AKA lub dub, each lub dub counting as one heart beat.
Normal characteristics of jugular veins
3cm or less above the sternal angle is considered normal (angle of Louis)
Point of Maximum Impulse (PMI)
Point where apex of the heart is closest to the surface in the thorax (usually 5th intercostal mid clavicular line)
Sustained lifts of chest wall that can be seen or palpated
Cardiac cell makeup
Cell is normally negative and more potassium is inside while sodium is outside. When the cell depolarizes, the cell becomes more positive and sodium rapidly enters the cell. Repolarization is the cell slowly going back to it's normal state.
Used to evaluate the cardiovascular response to physical stress (not used with pacemakers)
What can be a cause of juglar vein distention?
Right sided heart failure
Orthostatic BP normal results
Normal reduction from supine - standing is 20mm Hg and the HR should not increase more than 20 BPM
What is the difference between BP taken in the lower extremities VS upper extremities?
BP taken in the lower extremities can be expected to be 10 mm Hg higher than in the upper extremities
Normal Capillary Refill time
Less than 2 seconds
Used for: conduction abnormalities, cardiac dysrhythmias, cardiac hypertrophy, pericarditis, myocardial ischemia, site and extent of MI, pacemaker performance, effectiveness of drug therapy
Ambulatory ECG Monitoring
Diagnostic info over greater amount of time than resting ECG
Event Monitor/Loop Recorder
Patient starts it when they experience symptoms
Ejection of blood from ventricles when ventricles contract.
Represented by QRS on ECG tracing
Relaxation of ventricles and refilling of chambers
Represented by T wave on ECG
Where is S1 best heard at?
Where is S2 best heard at?
How many seconds does each small horizontal box represent (ECG)?
How many seconds does each large box represent (ECG)?
Use tangent light
Look for apical impulse - 5th intercoastals mid-clavicular
Alternate position - sit up, lean forward
Point of maximal impulse (apical)
Base of heart (thrills)
Match PMI with carotid pulse
- Sites: aortic, pulmonic, 2nd pulmoic (3rd intercostal), tricuspid (4th intercostals), mitral (5th intercostal)
- Patient may lean forward
- Check rhythm and rate
- Listen S1 while palpating carotid - begins systole
- Listen S2 - begins diastole
- Sound at apex S1>S2
- Sound at base S2>S1
- Neck Auscultation (listen for bruit)
Sinoatrial (SA) Node
Located in the upper right atrium
Initiates atrial depolarization and thus contraction
The natural pacemaker
Inherent rate of 60-100
Atrioventricular (AV) Node
Slows the electrical impulse to give ventricles time to fill
Considered the 2nd pacemaker
Inherent rate of 40-60
Begins conduction of the impulse to the ventricles
Bundle Branches and the Purkinje Fibers
Inherent rate of 20-40 if the SA and AV node stop
Ventricular depolarization and contraction
Any alteration in this conduction system is called a dysrhythmia/arrhythmia
Area on a normal ECG strip that is electrically neutral
Nothing is happening in the heart at this time (electrically)
Normal characteristics of P Waves
Upright position in Lead II
One for every QRS
All same shape and size
Normal P waves indicate that the electrical impulse originated in the SA node and atrial depolarization occurred
Normal characteristics of PR Interval
The time it takes for the electrical impulse to leave the SA node and travel through to the Bundle of His
Measured from the beginning of the P wave to the beginning of the QRS complex
A normal PR interval measures 0.12-0.2 seconds or 3-5 small boxes
Normal characteristics of QRS complex
Represents the time it takes for the electrical impulse to depolarize the ventricles
The QRS is measured as the first wave leaves the baseline to where the last wave of the complex begins to flatten out
A normal QRS measures 0.12 (3 boxes or less)
Normal characteristics of T wave
The final phase of ventricular repolarization
Normal T waves are round, upright in lead II, smaller than QRS
How to measure heart rate from ECG
Refers to the ventricular rate. Count the number of R waves in a 6 second strip and multiply by 10
How to measure rhythm using an ECG
Measure from P to P and R to R - is it regular or irregular? use calipers or a peice of paper
Analyzing P waves ECG
Look at the P waves- is there one for each QRS, are they nearly identical?
Analyzing PR interval ECG
Measure the PR interval - is it normal, between 0.12-0.2 seconds?
Analyzing the QRS complex
Is each QRS preceded by a P wave? Do they all look nearly identical and is the complex less than or equal to 0.12 seconds?