Term
| Muscular organ the size of a man’s closed fist |
|
Definition
|
|
Term
|
Definition
| Top of the heart is the ___, bottom is the ___ |
|
|
Term
Epicardium: Outermost layer, contains coronary arteries.
Myocardium: Middle, thickest layer
-Made of pure muscle and does the contracting
-Area of damage when someone has heart attack
Endocardium: Thin, innermost layer, forms the heart valves
-Is watertight to prevent leakage of blood out into the other layers
-The cardiac conduction system is found here |
|
Definition
| List/describe 3 layers of the heart |
|
|
Term
Double-walled sac that encloses the heart
Serves as support and protection
Pericardial fluid is found between the layers of the pericardium—it minimizes friction of the layers as they rub together with each heartbeat
Anchors the heart to the diaphragm and great vessels |
|
Definition
|
|
Term
|
Definition
| List the 4 chambers of the heart |
|
|
Term
|
Definition
Receives deoxygenated blood from the body.
SVC/IVC
Blood here has an O2 sat of only 60-75% and is colored blue/black
CO2 concentration is high |
|
|
Term
|
Definition
| Pumps blood to the lungs to get oxygenated |
|
|
Term
|
Definition
Receives oxygenated blood from the lungs
O2 sat of about 100%; CO2 concentration is very low
Bright red |
|
|
Term
|
Definition
| Pumps blood throughout the body |
|
|
Term
S1—closure of mitral and tricuspid valve—1st heart sound
Systole between S1 and S2
S2—closure of semi-lunar valves—2nd heart sound
Diastole between S2 and the next S1 |
|
Definition
|
|
Term
Pulmonic valve: Between right ventricle and pulmonary artery.
Aortic valve: Between left ventricle and aorta
-Aortic stenosis– usually in older people with bicuspid or calcification of the valve |
|
Definition
| Describe semi-lunar valves |
|
|
Term
Tricuspid valve: Between right atrium and ventricle.
Mitral valve: Between left atrium and ventricle |
|
Definition
|
|
Term
o Atria contract, squeezing remainder of blood into ventricles
o last 30% being pushed out… lose it—A fib |
|
Definition
|
|
Term
atrial depolarization
... might wanna know this one... just sayin... =) |
|
Definition
|
|
Term
| ventricular depolarization |
|
Definition
|
|
Term
| ventricular repolarization |
|
Definition
|
|
Term
|
Definition
o Mediated by NE from the adrenal gland
o Speeds up the heart rate, increases BP, dilates pupils, slows digestion
o Fight or flight |
|
|
Term
|
Definition
o Mediated by Ach secreted as a result of stimulation of the vagus nerve
o Slows the HR, decreases BP, enhances digestion
o Rest & digest
o Holding your breath and doing the valsalva maneuver can cause the HR to slow by vagal stimulation |
|
|
Term
o Phase 4: Cardiac cell at rest.
o Phase 0: Rapid Depolarization. (QRS Complex)
o Phases 1 & 2: Early repolarization. (ST segment)
o Phase 2: Plateau phase.
o Phase 3: Rapid repolarization. (T wave) |
|
Definition
|
|
Term
|
Definition
| Late ventricular repolarization. Not usually seen; you’ll see some but usually its some type of arrhythmia |
|
|
Term
| Flat line between P wave and QRS complex |
|
Definition
|
|
Term
| Flat line between QRS complex and T wave |
|
Definition
|
|
Term
|
Definition
Downward wave preceding an upward wave.
negative deflection that occurs before a positive deflection
There can be only one |
|
|
Term
|
Definition
Any upward wave.
Can be more than 1 |
|
|
Term
|
Definition
| Downward wave with no upward wave at all. |
|
|
Term
|
Definition
| Measure rhythm regularity |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Heart’s normal pacemaker. Inherent rate 60–100 beats per minute.
Normal sinus rhythm |
|
|
Term
|
Definition
Backup pacemaker
Inherent rate 40–60 beats per minute |
|
|
Term
|
Definition
A lower backup pacemaker
Inherent rate 20–40 beats per minute |
|
|
Term
|
Definition
Predominant pacemaker slows, lower pacemaker takes over at slower rate
Someone has bradycardia, 50 bpm, AV takes over |
|
|
Term
|
Definition
| Irritable lower pacemaker takes control and becomes new pacemaker at a faster rate |
|
|
Term
Lead I: Right arm to left arm
-Left arm is positive electrode
Lead II: Right arm to left foot
-Left foot is positive electrode
Lead III: Left arm to left foot
-Left foot is positive electrode |
|
Definition
| Describe leads I, II, and III |
|
|
Term
|
Definition
| formed by joining the lines representing Leads I, II, and III at the middle |
|
|
Term
|
Definition
| Formed by joining the lines representing leads I, II, III, AVR, AVL, and AVF at the middle |
|
|
Term
o Formed by joining the lines representing leads I, II, and III at their ends
o Lead I + Lead III = Lead II.
o Lead II should have the tallest QRS complex of the bipolar leads.
o I is big, II and III are small– leads/machine messed up…
o Right arm usually negative! |
|
Definition
| Describe Einthoven's triangle |
|
|
Term
AVR: On right arm.
AVL: On left arm.
AVF: On left foot |
|
Definition
| 3 augmented unipolar leads |
|
|
Term
V1: 4th intercostals space (ICS), Right Sternal Border (RSB)
V2: 4th ICS, LSB
V3: B/T V2 & V3
V4: 5th ICS, midclavicular line (MCL)
V5: 5th ICS, anterior axillary line (AAL)
V6: 5th ICS, midaxillary line (MAL) |
|
Definition
| Where do leads for V1-V6 go? |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| AVL and AVF qrs should be |
|
|
Term
|
Definition
|
|
Term
|
Definition
High-voltage shock that alows 110 volts to travel through skin.
Caused by: Inadequate grounding of electrical equipment (frayed/broken wires or cords, electrical outlet damage, or other).
Results in: Burns, neurologic damage, fatality. |
|
|
Term
|
Definition
Smaller shock that travels up a conduit into the heart (pacemaker, etc.)
Caused by: Frayed grounding wire or other.
Results in: Burns, neurologic damage, fatality |
|
|
Term
o Leads 1 and 2 are on limbs—show a lot
o V1 is on chest—not as much |
|
Definition
| Which leads show least and most artifact |
|
|
Term
|
Definition
| Most accurate way of calculating HR |
|
|
Term
If there are QRS complexes
The type of regularity
The heart rate
If there are P waves
The PR and QRS intervals |
|
Definition
| 5 steps to rhythm interpretation |
|
|
Term
o Narrow QRS complexes of uniform shape.
o Regularly spaced QRS complexes.
o Heart rate between 60–100.
o Upright rounded matching P waves “married to” the QRS.
o PR interval 0.12–0.20 secs (3-5 boxes), constant from beat to beat.
o QRS interval <0.12 secs. (less than 3 boxes) |
|
Definition
| Characteristics of normal QRS, PR intervals |
|
|
Term
o QRS complexes absent or abnormally shaped.
o P waves absent, multiple in number, or abnormally shaped.
o Abnormally shortened or prolonged PR intervals.
o Abnormally prolonged QRS intervals.
o Heart rate abnormally slow or fast.
o Irregular rhythm or a rhythm interrupted by premature beats or pauses |
|
Definition
| Dysrhythmia characteristics |
|
|
Term
Rate: 60–100.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs.
Cause: Normal.
Adverse effects: None.
Treatment: None |
|
Definition
|
|
Term
Rate: <60.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs
Cause: Vagal stimulation, MI, hypoxia, digitalis toxicity, well-trained athlete.
Adverse effects: Dizziness, pallor, weakness, syncope, diaphoresis, hypotension.
Treatment: Atropine if symptoms, oxygen, pacemaker, hold bradycardia-inducing medications |
|
Definition
|
|
Term
Rate: 101–160.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs.
Cause: Atropine, emotions, pulmonary embolus, MI, CHF, fever, vagus nerve inhibition, thyrotoxicosis.
Adverse effects: Decreased cardiac output.
Treatment: Treat cause. Consider beta-blockers |
|
Definition
|
|
Term
Rate: Varies with respiratory pattern.
Regularity: Irregular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant
QRS: <0.12 secs.
Cause: Heart disease, breathing pattern.
Adverse effects: Usually none.
Treatment: Usually none required
Sinus arrhythmia is the only irregular rhythm from the sinus node and it has a pattern that is cyclic and usually corresponds w/ the breathing patternfaster w/ inspiration & slower w/ expiration |
|
Definition
|
|
Term
|
Definition
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by a pause.
-P waves: Normal before pause, may be different after.
-PR: 0.12–0.20 secs before pause, same or different after
-QRS: <0.12 secs on sinus beats; may be different if ventricular pacemaker takes over after pause.
-Cause: Sinus node ischemia, hypoxia, digitalis toxicity, medications.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, oxygen if symptoms, hold bradycardia-inducing medications |
|
|
Term
|
Definition
| pause that occurs when the regularly firing sinus node suddenly stops firing for a brief period |
|
|
Term
|
Definition
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by a pause.
-P waves: Upright, matching, married to QRS.
-PR: 0.12–0.20 secs, constant.
-QRS: <0.12 secs.
-Cause: Meds, hypoxia, vagal stimulation.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, oxygen if symptoms, hold bradycardia-inducing medications |
|
|
Term
|
Definition
| pause that occurs when the sinus node fires its impulse on time, but the impulse’s exit from the sinus node to the atrial tissue is blocked (the beat that the sinus node propagated is not conducted anywhere) |
|
|
Term
|
Definition
| If any rhythm from the sinus node has a QRS of 0.12 or wider, there is a |
|
|
Term
|
Definition
Usually are rapid rhythms that usurp the sinus.
Occasionally will be slow.
Treatment aimed at returning to sinus rhythm |
|
|
Term
|
Definition
|
|
Term
|
Definition
| NO P WAVES!!!! and regular |
|
|
Term
| Wandering Atrial Pacemaker |
|
Definition
Rate: <100 (usually 50-60’s)
Regularity: Irregular.
P waves: At least three different shapes.
PR: Varies.
QRS: <0.12 secs.
Cause: Medications, hypoxia, MI, vagal stimulation.
Adverse effects: Usually none ill effect.
Treatment: Usually none needed. |
|
|
Term
|
Definition
| These occur when the pace-making impulse has originated from at least 3 different foci in the atria that will make their own unique P wave |
|
|
Term
| Premature atrial complexes |
|
Definition
Rate: Can occur at any rate.
Regularity: Regular but interrupted by premature beats.
P waves: Shaped differently from sinus Ps.
PR: 0.12–0.20 secs.
QRS: <0.12 secs.
Cause: Stimulants, hypoxia, heart disease.
Adverse effects: Can lead to other dysrhythmias, can be a sign of early CHF.
Treatment: Digitalis, quinidine, oxygen; omit stimulants. |
|
|
Term
|
Definition
These are premature beats that are fired out early by irritable atrial tissue before the next sinus beat is due.
(Early firing d/t stimulants, caffeine, tobacco, etc.)
They may or may not be followed by a QRS |
|
|
Term
| Paroxysmal Atrial Tachycardia (PAT) |
|
Definition
Is a sudden burst of 3 or more PAC’s in a row
In order to be dx the 1st PAC that started it must be seen
Rate: 160–250.
Regularity: Regular (but it interrupts a slower rhythm).
P waves: Different from sinus Ps.
PR: 0.12–0.20 secs.
QRS: <0.12 secs.
Cause: Same as PAC.
Adverse effects: Decreased cardiac output.
Treatment: Digitalis, calcium channel blockers, beta-blockers, sedation, amiodarone, adenosine, oxygen. |
|
|
Term
|
Definition
| It is simply a sudden burst of 3 or more PAC’s in a row that usurps the underlying rhythm and then becomes its own rhythm for just a period of time |
|
|
Term
|
Definition
Rate: Atrial—250–350, ventricular—varies depending on conduction.
Regularity: Regular or irregular.
P waves: None. Flutter waves instead. 2 or more “flutters” to each QRS
PR: Not applicable.
QRS: <0.12 secs.
Cause: Pulmonary embolus, valvular heart disease, lung disease, thyrotoxicosis.
Adverse effects: Decreased cardiac output.
Treatment: Digitalis, calcium channel blockers, beta-blockers, adenosine, cardioversion. |
|
|
Term
|
Definition
| results when 1 irritable atrial focus fires out regular impulses at a rate so rapid that a flutter pattern is produced instead of P waves |
|
|
Term
|
Definition
Rate: Atrial—350–700, ventricular—varies depending on conduction.
Regularity: Irregularly irregular. UNPREDICTABLE
P waves: None. Wavy baseline between QRSs instead.
PR: Not applicable.
QRS: <0.12 secs.
Cause: MI, lung disease, valvular heart disease, hyperthyroidism.
Adverse effects: Decreased cardiac output, blood clots causing stroke or pulmonary embolus |
|
|
Term
If duration <48 hours:
--Digitalis, calcium channel blockers, beta-blockers, amiodarone, cardioversion.
If duration >48 hours:
--Non-emergent: Anticoagulation for 2–3 weeks, then cardioversion.
In emergencies: Heparin, transesophageal echo to rule out atrial clots, then cardioversion. |
|
Definition
| Tx and time frames for A-fib |
|
|
Term
|
Definition
| when there are hundreds of atrial impulses from different locations all firing off AT THE SAME TIME |
|
|
Term
| Supraventricular tachycardia |
|
Definition
Rate: 130 or higher.
Regularity: Regular.
P waves: Not seen.
PR: Not measurable
QRS: <0.12 secs.
Cause: Stimulants, hypoxia, heart disease.
Adverse effects: Decreased cardiac output.
Treatment: Digitalis, ibutilide, calcium channel blockers, beta-blockers, oxygen. |
|
|
Term
|
Definition
| You know that the impulse originated in the atria because the following QRS is ___. (Impulses that originate in the ventricle will have a ___) |
|
|
Term
DIG!
... this might be a test question... ;) |
|
Definition
| drug related with junctional tachycardia |
|
|
Term
| Premature junctional complex |
|
Definition
Premature beats that originate in the AV junction before the next sinus beat is due. Caused by irritable tissue in the AV junction usurping the sinus node for that beat.
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by premature beat.
-P waves: Inverted or absent.
-PR: 0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Stimulants, hypoxia, heart disease, nicotine.
-Adverse effects: Usually none.
-Treatment: Treat the cause. |
|
|
Term
|
Definition
HR slower than normal. A higher pacemaker has failed & the AV junction has to escape to save the pts life
-Rate: <40.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Vagal stimulation, hypoxia,
sinus node ischemia, heart disease.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, pacemaker, oxygen.
Hold bradycardia-inducing medications. |
|
|
Term
|
Definition
originates in the AV junction at its inherent rate of 40-60. It is usually an Escape rhythm.
-Rate: 40–60.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Vagal stimulation, hypoxia,
sinus node ischemia, heart disease.
-Adverse effects: Potential for decreased
cardiac output at slower heart rates.
-Treatment: Atropine; consider oxygen; hold bradycardia-inducing medications |
|
|
Term
| Accelerated junctional rhythm |
|
Definition
THIS IS AS FAST AS THE SINUS NODE
-Rate: 60–100.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Heart disease, stimulants, caffeine.
-Adverse effects: Usually none.
-Treatment: Usually none needed
(remove the cause). |
|
|
Term
|
Definition
***know that a cause of this is DIGITALIS TOXICITY!!!
-Rate: >100.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Digitalis toxicity, heart disease,
stimulants.
-Adverse effects: Decreased cardiac
output at faster heart rates.
-Treatment: Beta-blockers, calcium channel blockers, adenosine; consider oxygen |
|
|
Term
|
Definition
o Heart rate ranges from zero to >250.
o The most lethal of all rhythms.
o Most will cause symptoms of decreased cardiac output, if not frank cardiac standstill |
|
|
Term
|
Definition
regular but interrupted by premature beat
Rate: Can occur at any rate.
Regularity: Regular but interrupted by premature beat.
P waves: Usually not seen.
PR: Not applicable.
QRS: Wide and bizarre in shape; >0.12 secs wide.
T wave: Opposite QRS.
Cause: Heart disease, hypokalemia, hypoxia, hypomagnesemia, stimulants, caffeine, stress.
Adverse effects: Can progress to lethal rhythms.
Treatment: Supplemental potassium, oxygen, amiodarone, procainamide |
|
|
Term
|
Definition
| causes prolongation of QT—can cause TDP |
|
|
Term
|
Definition
Premature beats that originate in Irritable ventricular tissue before the next sinus beat is due
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by premature beat.
-P waves: Usually not seen.
-PR: Not applicable.
-QRS: Wide and bizarre in shape; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Heart disease, hypokalemia, hypoxia,
hypomagnesemia, stimulants, caffeine, stress.
-Adverse effects: Can progress to lethal rhythms.
-Treatment: Supplemental potassium, oxygen, amiodarone, procainamide. |
|
|
Term
|
Definition
A very irregular rhythm in which the severely impaired heart is only able to “cough out” an occasional beat from its only remaining pacemaker, the ventricle (will be doing CPR here)
-Rate: <20.
-Regularity: Irregular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Profound cardiac or other damage.
-Adverse effects: Profound shock, unconsciousness, death.
Treatment: Atropine, epinephrine, dopamine, pacemaker, oxygen, CPR |
|
|
Term
| Idioventricular rhythm (IVR) |
|
Definition
rhythm originating in the ventricle at its inherent rate: Higher Pacemakers have failed, so the ventricle escapes to save the pt’s life
-Rate: 20–40.
-Regularity: Regular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Hypoxia, massive cardiac or other damage.
-Adverse effects: Decreased cardiac output, cardiovascular collapse.
-Treatment: Atropine, epinephrine, pacemaker, oxygen, dopamine, CPR if pulseless |
|
|
Term
| Accelerate idioventricular rhythm |
|
Definition
rhythm originating in the ventricle, w/ a HR faster than the Ventricle’s normal. It can result from Escape OR Usurption (The common cause here is reperfusion after thrombolytics…meaning that the heart is once again getting blood flow after a period of no flow)
-Rate: 40–100.
-Regularity: Usually regular, but can be a bit irregular.
-P waves: Usually not seen.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs
-T wave: Opposite QRS.
-Cause: MI, reperfusion after thrombolytics. -Adverse effects: Usually none as rhythm usually self-limiting.
-Treatment: Oxygen; atropine if rate slow and symptoms. |
|
|
Term
|
Definition
An irritable focus in the ventricle has usurped the sinus node to become the pacemaker & is firing very rapidly. *** may be tolerated for short bursts, but prolonged runs can cause profound shock, unconsciousness, and death ***
-Rate: >100.
-Regularity: Usually regular but can be a bit irregular.
-P waves: Usually none; dissociated if present.
-PR: Variable if Ps present.
-QRS: Wide and bizarre; >0,12 secs wide.
-T wave: Opposite QRS.
-Cause: Heart disease, hypoxia, hypokalemia, hypomagnesemia, stimulants.
-Adverse effects: Shock, unconsciousness, death.
-Treatment: Amiodarone, lidocaine, procainamide, cardioversion or defibrillation, supplemental potassium, oxygen. |
|
|
Term
|
Definition
form of V-Tach recognized by its classic shape of oscillations around an axis w/ the QRS complexes pointing up, then becoming smaller, then rotating around until they point down. It often deteriorates into ventricular fibrillation
-Rate: >200.
-Regularity: Regular or irregular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0,12 secs wide
-T wave: Usually not seen due to rapidity of rhythm.
-Cause: Antiarrhythmic medications, hypokalemia, hypoxia, hypomagnesemia, heart disease.
-Adverse effects: Shock, unconsciusness, death.
-Treatment: Supplemental magnesium, cardioversion, oxygen |
|
|
Term
|
Definition
Hundreds of impulses in the ventricle are firing off, each depolarizing its own little piece of territory. As a result, the ventricles wiggle instead of contract. The heart’s electricle system is in chaos, and the resultant rhythm looks like static. (The pt. is functionally dead here)
-Rate: Cannot be counted.
-Regularity: Not applicable.
-P waves: None
-PR: Not applicable.
-QRS: None; wavy or spiked baseline.
-T wave: None.
-Cause: MI, hypoxia, hypokalemia, hyperkalemia, drowning, drug overdose, accidental electric shock.
-Adverse effects: Death if untreated.
-Treatment: Defibrillation, amiodarone, lidocaine, procainamide, oxygen, CPR, epinephrine |
|
|
