Term
| Phase 0 (__________ __________) __________ moves __________ __________ cell and __________ moves __________ __________ cell. |
|
Definition
| (Rapid Depolarization) Sodium, rapidly into, calcium, slowly into |
|
|
Term
Phase 1 (__________ __________)
__________ channels __________. |
|
Definition
| (Early Repolarization) Sodium, close |
|
|
Term
Phase 2 (__________ __________)
__________ continues to flow in. __________ flows out of the cell. |
|
Definition
| (Plateau Phase) Calcium, Potassium |
|
|
Term
Phase 3 (__________ __________)
__________ channels __________ and __________ flows __________ __________. |
|
Definition
| (Rapid Repolarization) Calcium, close, Potassium, out rapidly |
|
|
Term
| Phase 4 (__________ __________) __________ transport via the __________-__________ __________ begins restoring __________to the __________ of the cell and __________ to the __________ of the cell. Cell membrane is __________ to __________ and __________ moves __________ the cell. |
|
Definition
| (Resting Phase) Active, sodium-potassium pump, potassium, inside, sodium, outside, impermeable, sodium, potassium, into |
|
|
Term
Which phase does this describe and what is the voltage range?
Depolarization begins when the cell membrane is stimulated allowing Sodium to rapidly flow into the cell, and Calcium to slowly flow into the cell from negative to positive and triggers myocardial contraction. |
|
Definition
|
|
Term
Which phase does this describe and what is the voltage range?
After the rapid influx of Sodium, a brief period of partial repolarization occures. Sodium stops flowing into the cell and the electrical charge becomes more negative. |
|
Definition
|
|
Term
Which phase does this describe and what is the voltage range?
At about the same amount of Calcium enter the cell as Potassium leaves it creating a plateau effect. The cell is now supersaturated with ions and can't accept any stimulus as the point no matter how strong. |
|
Definition
|
|
Term
Which phase does this describe and what is the voltage range?
Calcium and Sodium stop entering the cell, and large amounts of Potassium exit the cell. Together these processes make the cell more negative. During the last half of this phase, the cell can respond only to a stimulus that's stronger than normal. |
|
Definition
|
|
Term
Which phase does this describe and what is the voltage range?
Adenosine Triphosphate (ATP) actovates the Sodium/Potassium pump, which removes the exscess Sodium that entered the cell during depolarization an move Potassium into the cell. This returns the intacellular cdoncentration of Sodium and Potassium to pre-depolarization levels. The cell can receive an electrical stimulus once again. |
|
Definition
|
|
Term
| If you encounter a patient in Ventricular Fibillation (V-fib), what should your response be? |
|
Definition
| Initiate Emergency Response System and begin performing cardiopulmonary resuscitation (CPR), Defibrillation as early as possible, adminsiter cardiac medications (RN only). For reoccuring episodes, an Automatic Implantable Cardioverter/Defibrillator (AICD) should be implanted. |
|
|
Term
| What is a PVC and how can you recognize one? |
|
Definition
| Premature Ventricular Contraction is a ventricular rhythm that comes early in the rhythm and has a wide and bizzare QRS Complex. |
|
|
Term
| What is the difference between a unifocal and multifocal PVC? |
|
Definition
| A unifocal PVC has one irratable focus outside the normal conduction pathway; where as, a multifocal has two or more foci outside the normal conduction pathway. |
|
|
Term
| How should the rate of an irregular rhythm be calculated. |
|
Definition
| Count the number of normal QRS complexes in a 6-second interval and multiply by 10. When recording the rate, the calculated value must have 'quotes' around the numbers. |
|
|
Term
| What is Ventricular Fribrillation (V-fib) and is it a life-threating rhythm? |
|
Definition
| V-fib is a very life-threating rhythm and needs immediate intervention. You can tell that the patient is in V-fib because the patient will have no LOC, will be pulseless, and not breathing. The heart rhythm will have multiple foci in ventricles firing impulses haphazardly with chaotic muscular activity, no dicernible PQRST, and no cardiac output. If not attended to immediately, the patient will die! |
|
|
Term
| What is Atrial Fribrillation (A-fib) and is it a life-threating rhythm? |
|
Definition
| Many irritable foci in atria intiating impulses with intermittent conduction throught the AV node. Ventricular rate varies. |
|
|
Term
| What is the difference between Controlled A-fib versus Uncontrolled A-fib? |
|
Definition
| Controlled has a ventricular rate of 100 or less; where as, uncontrolled has a ventricular rate of >100. |
|
|
Term
| What is the clinical significance of Sinus Bradycardia (SB)? |
|
Definition
| This slow and regular rhythm which typically can have a decreased cardiac out (CO) may progress to a more serious rhythm |
|
|
Term
| What is the characteristics and clinical significance of Bradycardia with Ventricular Escape Beats (VEB)? |
|
Definition
| The underlying rhythm is slow and the escape beats may have a wide QRS that appears to be a PVC. These beats appear late in a rhythm after a long pause. Do not suppress the compensatory mechanism (junctional or ventricular pacemaker); instead, correct airway problems then raise the underlying rate (bradycardia). |
|
|
Term
| What is the clinical significance of Sinus Tachycardia (ST)? |
|
Definition
| Increased heart rate leads to increased myocardial oxygen consumption. Treat the cause not the rhythm. |
|
|
Term
| What is the clinical significance of Sinus Arrhythmia? |
|
Definition
|
|
Term
| What is the clinical significance of Atrial Tachycardia (AT) or Paroxysmal Atrial Tachycardia? |
|
Definition
| With this rapid rhythm, the coronary arteries are unable to fill due to the short diastolic filling time. Also, the shortened ejection time with decreased cardiac output may progress to heart failure, shock, or even death. Increased heart rate causes increased myocardial oxygen consumption (MVO2), especially with myocardial infarction (MI). |
|
|
Term
| What is Atrial Flutter (A-flutter) and is it a life-threating rhythm? |
|
Definition
| An irritable focus in the atrium initiating 250-350 bpm with an occasional intermittent conduction through the AV node. This rhythm is not primarily life threatening, but can lead to secondary problems that can be life threatening. |
|
|
Term
| What is Supraventricular Tachycardia (SVT)? |
|
Definition
| It is a rapid rhythm with a normal QRS complex and T wave but no dicernable P wave. It is considered "supra"ventricular because there is no hard evidence that the rhythm is either sinus or junctional because the rate is so fast, the possible P wave could be buried within the previous T wave. |
|
|
Term
| What is the intrinsic sinus rate? |
|
Definition
|
|
Term
| What is the normal atrial foci pacemaker rate? |
|
Definition
|
|
Term
| What is the intrinsic normal rate for the atrioventricular (AV) node? |
|
Definition
|
|
Term
| What is the normal intrinsic HIS-Purkinje fibers (ventricular) rate? |
|
Definition
|
|
Term
| How do you know that you have a "junctional" beat from a "high site"? |
|
Definition
| The P wave will be retrograde (going backwards), therefore, it will reach the atria before the ventricals and it will be inverted, less than 0.12 and in front of the QRS complex. |
|
|
Term
| How do you know that you have a "junctional" beat from a "mid site"? |
|
Definition
| There will be no P wave because the impulse has reached the atria and ventricles simultaneously, therefore, hidden within the QRS complex that is <0.12 seconds and have a ventricular rate of 40-60 bpm. |
|
|
Term
| How do you know that you have a "junctional" beat from a "low site"? |
|
Definition
| The AV impulse is farther away from the atrium and goes retrograde (backwards)intothe atria and will reach the atria after the ventricles depolarize; therefore, the P wave will be inverted and after the QRS complex within the ST segment and have a ventricular rate of 40-60 bpm. |
|
|
Term
| What is the clinical significance of a juctional rhythm? |
|
Definition
| This slow and regular rhythm produces a decreased cardiac output and may progress into a more serious rhythm such as an idioventricular rhythm or ventricular tachycardia. |
|
|
Term
| What is the clinical significance of a Premature Junctional Contraction (PJC)? |
|
Definition
| This irregular beat comes early in a normal rhythm and could possibly deteriorate into A-fib, A-flutter, or PAT. |
|
|
Term
| What rate is considered accelerated and tachycardic for a juntional rhythm? |
|
Definition
| Remember, the intrinsic rate for the AV node is 40-60 bpm. If the junctional rate is >60 but <100, it is considered accelerated and if the junctional rhythm is >100, then it is considered junctional tachycardia. |
|
|
Term
| What is the clinical significance of Accelerated Junction Rhythm or Juntional Tachycardia? |
|
Definition
| Less than 100 bpm is often asymptomatic; however, greater than 100 bpm may decrease cardiac output and coronary artery filling time. Juctional Tachycardia may be paroxysmal or could deteriorate into V-tach or V-fib. |
|
|
Term
| When a premature ventricular contraction does not disturm the sinus rhythm (regular R-R interval), but merely takes the place of a conducted beat, this is called a __________ __________. However, should the PVC occur within the regular R-R interval, this is called __________. |
|
Definition
| Compensatory pause, interpolated |
|
|
Term
| What is the clinical significance of premature ventricular contractions (PVC)? |
|
Definition
| May lead to V-fib or V-tach. It can lower cardiac output. |
|
|
Term
| When can PVCs be considered most dangerous? |
|
Definition
| When there are more than 6 PVCs per minute. When there is bigiminal or trigiminal PVCs. When there are couples, or runs of PVCs. Probably the most dangerous PVC is the R-on-T phenomenon. This occurs when the ventricles are at their most vulnerable state due to the relative refractory period of the action potential. This can instantly put the patient into the life-threatening V-tach rhythm. |
|
|
Term
| What is the clinical significance of V-tach? |
|
Definition
| A potentially lethal arrhythmia. Usually produces poor cardiac output because it does not perfuse (loss of stroke volume). May lead to V-fib if untreated. |
|
|
Term
| What is the clincial significance of idioventricular rhythm? |
|
Definition
| Focus is ventricular, therefore, wide complexes and typically slow rates. If a pulse is present, thiere is little perfusion and if the pulse is absent, it is called "electrical mechanical dissociation" (rhythm on monitor but no cardiac muscle activity). CPR must be started immediately! |
|
|
Term
| What is the clincial significance of ventricular standstill? |
|
Definition
| Near asystole, start CPR! |
|
|
Term
| What is the clincial significance of asystole? |
|
Definition
| unconscious, pulseless, apneic...near death! |
|
|
Term
| If you encounter a patient in asystole, what should your response be? |
|
Definition
| Initiate Emergency Response System and begin performing cardiopulmonary resuscitation (CPR), Defibrillation as early as possible, adminsiter cardiac medications (RN only). For reoccuring episodes, an Automatic Implantable Cardioverter/Defibrillator (AICD) should be implanted. |
|
|
Term
|
Definition
A. SA Node
B. AV Node
C. Bundle of HIS
D. Left Bundle Branch
E. Right Bundle Branch
F. Left Anterior Division
G. Purkinje Fibers
H. Left Posterior Division
I. Bachman's Bundle |
|
|
Term
[image]
Phase 0 (__________ __________) __________ moves __________ __________ cell and __________ moves __________ __________ cell.
Phase 1 (__________ __________)
__________ channels __________.
Phase 2 (__________ __________)
__________ continues to flow in. __________ flows out of the cell.
Phase 3 (__________ __________)
__________ channels __________ and __________ flows __________ __________.
Phase 4 (__________ __________) __________ transport via the __________-__________ __________ begins restoring __________to the __________ of the cell and __________ to the __________ of the cell. Cell membrane is __________ to __________ and __________ moves __________ the cell. |
|
Definition
(Rapid Depolarization) Sodium, rapidly into, calcium, slowly into
(Early Repolarization) Sodium, close
(Plateau Phase) Calcium, Potassium
(Rapid Repolarization) Calcium, close, Potassium, out rapidly
(Resting Phase) Active, sodium-potassium pump, potassium, inside, sodium, outside, impermeable, sodium, potassium, into |
|
|
