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What is the pacemaker of the heart
SA node
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The bundle of tissue that gathers the electricity that has spread throughout the heart after the SA node has initiated electricity
AV Junction/Node
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The AV node releases the electricity to travel down
The Bundle of His
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If there is a bundle branch block the _____ will be _____ on an EKG
- QRS will be fat
- (not dangerous..."a bundle branch block doth not an arrhythmia make")
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EKG can tell about:
- Electrical Function
- (Rhythm disturbances, Conduction disturbances- bundle branch block)
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EKG cannot tell about:
- Mechanical Function
- (Structural Disorders-- valve disorders, Perfusion Disorders)
**An EKG can't show you low ejection fraction or that a heart isn't pumping well...only electrical)
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EKG can reflect electrical activity, not mechanical activity. To evaluate mechanical function assess:
BP, Urinary Output, LOC, Capillary Refill, and Peripheral Pulses
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Depolarization of the heart means it is:
Stimulating the heart muscle
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Repolarization of the heart means that the heart muscle is:
- Resting
- (if anything interrupts the heart during repolarization [resting], it gets irritable!)
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If you are dehydrated your sodium levels will:
- GO UP!!!
- (sodium and potassium levels are critical to life)
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Atrial Depolarization makes a ____ wave on the EKG...shows stimulation of the atrium
P wave
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Place on the EKG where the AV node has gathered all of the electricity
PR interval (from beginning of P to the QRS complex)
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We can tell if the heart is healthy based on the _______ on the EKG
PR interval
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Place on the EKG that shows stimulation (depolarization) of the ventricles
QRS complex
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A normal QRS complex should be ___ because both ventricles should be stimulated fast
Skinny
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After the ventricles are stimulated (as marked by the QRS) they need to rest and repolarize...this is indicated on an EKG as:
- T wave
- (time of electrical ventricular rest/repolarization)
...this is the vulnerable part of the cycle because if anything interupts this rest, it irritates the muscle
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Vulnerable part of cardiac electrical cycle, if anything interrupts this part the heart becomes irritable:
T wave (repolarization)
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Each cardiac Cycle should produce a
Pulse
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Inherent Rate of Sinus Node
60-100
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Inherent Rate of AV Junction
40-60 bpm
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Inherent rate of Ventricle
20-40 bpm
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Sinus Tachycardia is treated by:
Treating the cause!! (ie: taking a test, exercising, infection)
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Example of something that could kill of SA node:
Inferior MI that affects coronary artery
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Always check ____ before Digoxin
Apical Pulse
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If the SA node is killed off, the ____ picks up
AV node
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If the AV node is killed off, the _____ pick up
ventricles
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Pacemaker Rule:
Pacemaker site with the fastest rate will generally control the heart
(SA node > AV node > Ventricles)
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Sympathetic Branch increases:
- Heart Rate
- Conduction
- Irritability
(Works as accelerator! Epinephrine is released)
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Parasympathetic branch decreases:
- Heart Rate
- Conduction
- Irritability
(slows everything down....ie: Digoxin)
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On EKG paper, from "notch" to "noctch" is how long:
3 seconds
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Each tiny little box on an EKG is how long
.04 seconds
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Each big block on EKG (made of 5 little boxes) is how long?
.2 seconds
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Normal PR interval
.12-.20
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Normal QRS duration is:
.06-.12
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Explain Normal Sinus Rhythm on an EKG
- Impulse is coming from the SA node.
- HR is between 60-100
- There is a P wave for every QRS
- The PR interval is between .12-.20 seconds
- Skinny QRS complexes between .06-.12
- Each QRS is equal
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Treatment for Normal Sinus Rhythm:
There is NONE
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When do you treat for Sinus Bradycardia
Only if there are symptoms of sinus bradycardia
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How do you treat Sinus Tach
Treating the cause
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