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Lecture 11 Flashcards

1
Q

Fibrous ring

A

Dose connective tissue
4 - between atria and ventricles

Function:

Allows ventricles and atria to contract separately
Anchors the valves
Electrical insulator - bundle of His acts as passageway

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2
Q

Interventricular septum depolarisation

A

Left to right (left thicker)

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3
Q

P wave

A

Atrial depolarisation

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4
Q

PR interval

A

Start of P wave to start of Q wave

Beginning of atrial depolarisation to beginning of ventricular depolarisation

3-5 small boxes 0.12 - 0.2 seconds

Delay at AV node - isoelectric line
Bundle of His spread from atria to ventricles - isoelectric line

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5
Q

q wave

A

Depolarisation of the intervertebral septum (left to right)

Small downwards depolarisation - move obliquely away

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6
Q

R wave

A

Depolarisation of the free ventricular walls and apex

Large upwards deflection

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7
Q

S wave

A

Depolarisation spreads to ventricular bases

Downwards deflection

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8
Q

T wave

A

Ventricular repolarisation
From base to apex to positive electrode
Upwards deflection

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9
Q

No QRS complex

A

AV block - Heart block

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10
Q

QRS complex

A

Depolarisation of ventricles

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11
Q

ECG

A 
10 electrodes - 4 limb 6 chest 
12 views (leads)
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12
Q

C1 electrode

A

Right of sternum - Ruth intercostal space

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13
Q

C2 electrode

A

Midclavicular line - 4th intercostal space

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14
Q

C3 electrode

A

Halfway between V2 and V4

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15
Q

C4 electrode

A

Midclavicular line - 5th intercostal space

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16
Q

C5 electrode

A

Level with C4 at left anterior axillary line

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17
Q

C6 electrode

A

Level with C5 at left mid axillary line

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18
Q

V1 - V4

A

Antero-septal leads

LAD

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19
Q

V5-V6

A

Lateral leads

Circumflex

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20
Q

Leads for lateral left side of heart

A

Lead 1
V5-V6
AVL

Circumflex artery

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21
Q

Leads for inferior surface of heart

A

Lead II
Lead III
AVF

Right coronary artery

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22
Q

Right ventricle and septum

A

V1

V2

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23
Q

Apex and anterior surface of ventricles

24
Q

V1 relationship to v6

25
Lead II relationship with AVR
Inverse
26
5 large squares
1 second
27
300 large squares
1 minute
28
1 small square
1/25 | 0.04 seconds
29
1 large square
1/5 - 0.2 seconds
30
1 cardiac cycle
P wave to p wave
31
QRS interval
Start of Q wave to end of S wave Time takes for ventricular depolarisation 3 small boxes - 0.12 seconds Widened QRS - depolarisation not via His-Perkinje fibres
32
QT interval
Time taken for depolarisation and repolarisation of ventricles Beginning of Q wave to end of T wave 9- 11 small boxes - 0.44 seconds
33
ST interval
End of S to start of T Isoelectric line If raised or depressed - MI or ischaemia
34
Sinus rhythm
``` Regular rhythm HR = 60 - 100bpm P wave present PR interval - 3 - 5 small boxes QRS complex - 3 small boxes Every P wave followed by QRS complex ```
35
First degree heart block
Prolonged PR interval - 5+ small boxes Delay in conductance between atria and ventricles via AV node and Bundle of His Causes: - acute MI (transient) - fibrosis (permanent)
36
Second degree heart block mobitz type 1 (Wenkebach)
Successfully longer PR interval until 1 QRS complex dropped
37
Second degree heart block type 2
Sudden drop of QRS complex without PR interval elongation High risk of progression to complete heart block Prophylaxis pace maker
38
Third degree heart block
Complete failure of AV conduction Atria and ventricles contract independently Regular P waves No steady PR interval Ventricular escape rythmn - ventricular pacemaker takes over Wide QRS complex - myocytes to myocytes spread P-P interval and R-R interval have different rates Urgent pacemaker required
39
Bundle branch block
Delayed conduction in the branches of the bundle of His P wave and PR interval normal Widened QRS complex as ventricular depolarisation takes longer
40
atrial Fibrillation
``` Supraventricular rhythms normal QRS complex - ventricle depolarisation intact. R-R interval intact Atrium - multiple atrial foci Rapid and Chaotic Wavy baseline - no P waves ``` Caused by multiple re-entrant circuits
41
Ventricular arrythmia
Arise from ventricles Widened QRS Ventricle tachycardia
42
Atrial fibrillation effect on haemodynamics
Atrial contraction lost - quiver Ventricular contraction intact but irregular Therefore: Irregular heart rate Irregular pulse
43
Ventricular tachycardia
3 + consecutive ventricular ectopics Broad complex Persistent VT is dangerous as can lead to ventricular fibrillation and cardiac arrest
44
Ventricular fibrillation
Fast, chaotic abnormal ventricular depolarisation No coordinated contraction - quiver No cardiac output Cardiac arrest
45
Narrow QRS complex tachycardia
Sinus tachycardia AF Supraventricular tachycardia
46
Broad complex tachycardia
VF | VT
47
Bradycardia can lead to what?
Heart block | Simple bradycardia
48
STEMI
ST segment elevation - behaves as if abnormal current towards lead during repolarisation Complete occlusion of coronary artery complete myocardial thickness involved Sub epicardium injury Urgent reperfusion required
49
STEMI progression
1. Ischaemia- ST elevation 2. Injury - smaller R wave and deeper Q wave 3. Necrosis - T wave inversion and Q wave deeper (2+ small squares) Recovery - ST and T wave normalised Q wave persists
50
Why is Q wave permanent
Necrosis of muscle causes no AP propagation so ECG leads look ‘through’ damaged area therefore more electrical forces from opposite side of lead
51
Non - STEMI
ST depression T wave inversion Sub endocardial injury Differentiated by blood test
52
Differences between STEMI and Non - STEMI
ST depression | No pathological Q wave as no muscle necrosis
53
Similarities between STEMI and Non - STEMI
T wave inversion | Unstable angina
54
Stable angina
Pain during exercise - ST depression | Normal at rest
55
Hyperkalaemia ECG
Early: Tall peaked T wave - stronger repolarisation Flattened p wave - less excitable Longer PR - atrial depolarisation decreases Later: Widened QRS ST segment merges with T wave Sine wave
56
Hypokalaemia
Low T waves - harder to repolarise U wave Low ST segment or depression

CVS (14 decks)

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