Term
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Definition
| occurs at beginning of ventricular systole; closure of AV valves; loudest at apex |
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Term
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Definition
| occurs at end of ventricular systole; closure of aortic and pulmonic valves; loudest at base (2nd intercostal space) |
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Term
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Definition
| occurs at end of rapid filling phase during ventricular diastole; can be physiologic or pathologic; caused by increased volume load on ventricles |
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Term
| Pathological reasons for S3 |
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Definition
Increased volume load on ventricles:
Mitral, tricuspid, aortic, or pulmonic regurgitation, dilated cardiomyopothy, left to right shunting (atrial septal defect, ventricular septal defect, patent ductus arteriosus |
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Term
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Definition
always pathologic; atrium contracts into a noncompliant ventricle
hypertension, acute MI, hypertrophic cardiomyopathy, aortic or pulmonary valve stenosis, dilated cardiomyopathy |
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Term
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Definition
| occurs only in pts w/ atrial septal defect: L->R shunt |
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Term
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Definition
| due to turbulent flow due to valve stenosis, valve regurgitation, or excessive flow |
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Term
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Definition
| during respiration, right heart gallops and murmurs become loader, whereas gallops and murmurs from the left side don't change |
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Term
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Definition
| begins after S1, stops before S2, has crescendo-decrescendo shape; may be innocent or due to ventricular outflow obstruction; late peaking is more serious |
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Term
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Definition
| occur w/ mitral or tricuspid regurgitation or ventricular septal defect |
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Term
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Definition
starts at S2 and ends before S1;
aortic or pulmonic regurgitation;
best heard at 3rd L intercostal space;
duration (not intensity) correlates w/ severity |
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Term
|
Definition
starts at S2 and ends before S1;
aortic or pulmonic regurgitation;
best heard at 3rd L intercostal space;
duration (not intensity) correlates w/ severity |
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Term
|
Definition
starts at S2 and ends before S1;
aortic or pulmonic regurgitation;
best heard at 3rd L intercostal space;
duration (not intensity) correlates w/ severity |
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Term
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Definition
after S2
increased flow or stenosis across AV valve
soft, low frequency |
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Term
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Definition
| atrial contraction across stenotic AV valve |
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Term
| patent ductus arteriousus murmur |
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Definition
best heard in left 2nd intercostal space
continuous, loud
begins in systole, peaks near S2 |
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Term
left anterior descending artery
originates from_____
in _____ groove
supplies _______ with _____ branches and _____ with _____ branches |
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Definition
originates from left coronary artery from left coronary cusp of aortic root
in anterior interventricular groove
supplies anterior 2/3 of interventricular septum w/ septal branches + anterior free wall of LV w/ diagonal branches |
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Term
Left circumflex coronary artery (LCX)
originates from____
in ______ groove
supplies _______ with _______ branches
may supply ______ |
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Definition
originates from left coronary artery
in left atrioventricular groom
supplies lateral and posterior LV w/ obtuse marginal branches
may supply posterior descending coronary artery |
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Term
Right coronary artery
originates _____
in ______ groove
supplies ____ w/ _____ branch
may supply _______ |
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Definition
originates in right coronary cusp of aortic root
in right atrioventricular groove
supplies RV w/ RV branch
may supply posterior descending coronary artery |
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Term
Right coronary artery
originates _____
in ______ groove
supplies ____ w/ _____ branch
may supply _______ |
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Definition
originates in right coronary cusp of aortic root
in right atrioventricular groove
supplies RV w/ RV branch
may supply posterior descending coronary artery |
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Term
posterior descending coronary artery
branch of _____
supplies _____ |
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Definition
branch of either left circumflex or right coronary artery (determines if heart is right or left sided)
in posterior interventricular groove
supplies posterior (inferior) 1/3 of interventricular septum |
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Term
| sinoatrial node supplied by ___ |
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Definition
| right coronary artery 55% or left circumflex artery 45% |
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Term
| atrioventricular node supplied by ___ |
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Definition
| right coronary artery 90% or left circumflex coronary artery 10% |
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Term
| bundle of His supplied by ___ |
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Definition
| septal branches of the left anterior descending coronary artery |
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Term
Action potential of heart muscle:
phase 0
phase 1
phase 2
phase 3
phase 4 |
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Definition
phase 0 - rapid Na into cell
phase 1 - brief minor repolarization
phase 2 - prolonged plateau
phase 3 - major repolarization
phase 4 - resting/reolarized |
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Term
| SA nodal depolarization on EKG |
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Definition
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Term
| atrial depolarization on EKG |
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Definition
P wave
depolarized by SA node
begins in RA -> R&LA - leftward and inferior |
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Term
| AV nodal depolarization on EKG |
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Definition
PR segment
slow impulse
from atria to bundle of His |
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Term
| His Bundle and Bundle Branch depolarization on EKG |
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Definition
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Term
| Ventricular depolarization on EKG |
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Definition
QRS complex
endocardium -> epicardium
rapid, but not as rapid as His-Purkinje |
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Term
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Definition
T wave
necessary for subsequent depolarization |
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Term
| Causes of low stroke volume |
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Definition
1. inadequate ventricular filling = low end diastolic volume
2. impaired ejection
3. ineffective cardiac flow |
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Term
| causes of inadequate ventricular filling |
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Definition
intravascular volume depletion (hemorrage, GI losses, renal losses, 3rd spacing, inadequate intake)
pericardial constraint (pericardial effusion w/ cardiac tamonade, constrictive pericarditis)
stiff ventricular chambers (decreased compliance - thick ventricular wall, stiff wall such as fibrosis)
obstruction to ventricular inflow (AV valve stenosis)
inadequate time for ventricular filling (rapid heart rate) |
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Term
| Causes of impaired ejection |
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Definition
Poor cardiac myocyte function
- toxic or infectious injury
- congenital muscle abnormality
- ischemic damage (CAD)
- prolonged tachycardia
- prolonged hemodynamic overload
Excessive pressure load ov ventricular chamber
- hypertension (excessive arterial resistance)
- semilunar valve (aortic or pulmonic) stenosis |
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Term
| Causes of ineffective flow |
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Definition
Valve regurgitation w/ effective stroke volume being reduced
Cardiac shunts (ASD, VSD, PDA)
Systemic vascular shunts (AV fistula) |
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Term
| systemic vascular resistance = |
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Definition
SVR = (MAP-CVP)/CO
normal SVR is 15 mmHg/L/min
elevated SVR: systemic arterial vasoconstriction
low SVR: vasodilation |
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Term
|
Definition
| larger EKG deflections during depolarization |
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Term
| Left atrial enlargement on EKG |
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Definition
P wave has large negative deflection in V1 (atrial forces increased in leftward and posterior direction)
P wave duration is increased, often w/ notch in lead II (time for atreal depolarization is prolonged) |
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Term
| Right atrial enlargement on EKG |
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Definition
| P wave is tall and peaked in lead II and has tall positive deflection in V1 (atrial forces increased in inferior and slightly rightward and anterior direction) |
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Term
| Right atrial enlargement on EKG |
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Definition
| P wave is tall and peaked in lead II and has tall positive deflection in V1 (atrial forces increased in inferior and slightly rightward and anterior direction) |
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Term
| left ventricular hypertrophy on EKG |
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Definition
ventricular forces are increased toward left and inferior and posterior - large S waves in lead V1 and large R waves in leads I and aVL and V5-V6,
often associated w/ left atrial enlargement,
often repolarization (ST segment and T wave) is abnormal, directed opposite from QRS complex |
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Term
| right ventricular hypertrophy on EKG |
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Definition
ventricular forces are increased toward the right and inferiorly and anteriorly - large R wave in lead V1 and large S wave in lead I and V5-V6
may be associated w/ right atrial enlargement |
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Term
| ischemia and injury on EKG |
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Definition
changes in T waves or ST depression
T wave inversion (opposite direction from QRS)
ST depression doesnt' localize |
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Term
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Definition
ST elevation or Q wave formation
ST elevation = acute ongoing muscle infarction - requires immediate action! |
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Term
| Cause of myocardial ischemia |
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Definition
Excessive demand (severe hypertension or tachycardia)
Inadequate supply (atherosclerosis) |
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Term
| Prolonged P wave duration |
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Definition
| intra atrial conduction abnormality |
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Term
Prolonged PR interval
1st degree -
2nd degree -
3rd degree - |
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Definition
AV block
1st degree - PR inerval prolonged and constant w/ each P wave producing a QRS complex
2nd degree - PR interval can be long or normal, consistant or variable, some P waves produce QRS complexes, and some don't conduct through the AV node
3rd degree - PR interval is variable and no P waves conduct to the ventricle (PR interval randomly changes from beat to beat; QRS complexes produced by intrinsic activity of ventricle or lower AV node and are regular) |
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Term
|
Definition
due to slow conduction of impulse through the ventricle
left or right bundle branch block
intraventricular conduction delay
hyperkalemia
ventricular origin beat
Wolff-Parkinson-White pattern of ventricular pre-excitation |
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Term
|
Definition
due to prolonged cellular action potential due to abnormal function of myocyte cell membrane ion channel population
increase risk for suddent death
caused by antifungals, congenital malformations |
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Term
|
Definition
atrial rate is slow (<60 bpm)
normal P wave before each QRS |
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Term
|
Definition
atrial rate is faster than ventricular rate
P-P interval is shorter than R-R interval |
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Term
|
Definition
ventricular rate is slow w/ no clear P no clear P waves preceding QRS complexes; narrow QRS
rhythm originates in AV node rather than SA node |
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Term
|
Definition
no clear P waves preceding QRS complex
wide QRS complex
rhythm originates from ventricular myocardium rather than SA or AV nodes |
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Term
|
Definition
| fast atrial rate w/ normal P wave preceding each QRS |
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Term
| supraventriculartachycardia |
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Definition
fast ventricular rate
no normal P wave preceding QRS
fast and regular rhythm
narrow QRS |
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Term
ventricular tachycardia
aka
wide-complex tachycardia |
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Definition
fast ventricular rate
no normal P wave preceding QRS
rate is fast and regular
QRS is wide |
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Term
atrial fibrillation
or
atrial flutter
or
multifocal atrial tachycardia |
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Definition
fast and irregular ventricular rate
no normal P preceding QRS |
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