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The heart is located In the media stinum ( space between the sternum/ anterior and vertebrae/posterior
The heart has 3 layers Endocardium ( innermost) Myocardium ( middle) Epicardium (outer layer)
The sac surrounding the heart is called Pericardial fluid sac
The heart has 2 upper chambers The two upper chambers are the right and left atria Functions as RECIEVING chambers
The heart has 2 lower chambers The two lower chambers are the right and left ventricles Functions as PUMPING chambers
The 4 valves in the heart act as doors Right side Right atrium to right ventricle = to tricuspid valve
The 4 valves in the heart act as doors Left side Left atrium to left valve = to bicuspid/ mitral valve
2/3 of the heart Is on the left side
1/3 of the heart Is on the right side
EKG Eletrocardiogram
EGG Electrocardiograph
EKG/ EEG Means the same thing It is a recording of electrical conduction system of the heart
The apex is At the 5th intercostal space by the left ventricle ( apical pulse is heard at 5 th ICS
The left and right side of the heart are separated by A thick muscular structure called the septum
The right atrium receives deoxygenated blood From the body through the superior and inferior vena cava
The right ventricle is pumping deoxygenated blood to the lungs Threw the pulmonary artery Taking blood away from the heart to the body
The left atrium receives the oxygenated blood from the Lung through the pulmonary veins
The left ventricle is pumping oxygenated blood To the body through the aorta
Myometrum muscle Is thicker on the left side because it pumps blood through the whole body
The left ventricle is the most Important chamber because it pumps blood through whole body
The 4 valves in the heart There purpose is to prevent backflow
1 Right side tricuspid valve Lies between the rt atrium and rt ventricle
2 bicuspid/ mitral valve Lies between the Lf atrium and Lf ventricle
3 pulmonary semi lunar valve PSLV Lies between the rt ventricle and the pulmonary artery
4 aortic semi lunar valve ASLV Lies between Lt ventricle and aorta ( does not allow blood to go back in)
Chordac tendinae and papillary muscles Are attached to valves which keeps them in place and helps in there function
Prolapse When valves lose there function to open and close
The the has heart 4 4 chambers
The heart has 4 valves
The chambers are divided by The spectum
This valve separates the RA and the RV Tricuspid valve
This valve separates the LA and the LV Bicuspid/mitral valve
The valve separates the RV and the PULMONARY ARTERIES PSLV
This valve separates the LV and the AORTA ASLV
Two types of myocardial cells are Electrical and mechanical
When the myocardial cells are in a "state of rest" we call it Polarization
When the ions of the myocardial cells are moving we call this Depolarization
When the ions of the myocardial cells ARE RETURNING BACK TO THE RESTING STATE we call this REPOLARIZATION
When the heart is CONTRACTING, it is in which phase ? Systole 120
When the heart is RESTING it is in which phase Diastole 80
The unique property that allows a myocardial cell to INITIATE AND MAINTAIN RHYTHIC heart activity is called automaticity
The unique property that allows a myocardial cell to RELAY AN IMPULSE TO A NEIGHBORING cell is called Conductivity
The unique property that allows a myocardial cell to RESPOND TO AN IMPULSE is called Excitability
The unique property that allows a myocardial cell to RESPOND to an IMPULSE with a PUMPING ACTION is called Contractility
1st pacemaker the hearts natural..... SA NODE 60-100 bpm
2nd pacemaker is AV ( atrial ventricular) 40-60 bpm
3rd pacemaker is Furkinje fibers 20-40 bpm
The SA NODE IS LOCATED Upper side of the RT ATRIUM
The gatekeeper of the heart is AV NODE
The impulse is then sent here ('after gatekeeper) Bundle of his
Then the bundle of his goes here RT AND LF BUNDLE BRANCHES
The bundle branches then go here Furkinge fibers
What does depolarization cause Contractions
Oxygen poor blood is called Deoxygenated blood
Deoxygenated blood enters which chamber of the heart RT ATRIUM
After the 1st chamber it flows through the Tricuspid valve
A waveform refers to a positive (upright deflection) or negative (downward deflection) from the isoelectric line.
The isoelectric line is the straight line seen on the ECG strip.
The waveforms produced on the ECG graphing paper correlate with the heart’s electrical activity
Baseline: This is a flat, horizontal line separating ECG cycles. The baseline (or isoelectric line) is used as a reference point when centering the tracing
The waves will deflect positively or negatively from the baseline. A positive deflection is characterized by an upward deflection above the isoelectric line as the electrical signal moves toward the electrode. . A negative deflection is characterized by a downward deflection below the isoelectric line as the electrical signal moves away from the electrode.
Segment: This is the space between two waves
Interval: : This includes a combination of one or more waves and a segment. This represents the length of a wave.
P wave 0.06–0.1 seconds Depolarization of the left and right atria
PR segment Represents the conduction time of the atrioventricular node, down the bundle of His and through the bundle branches. (Begins with the end of the P wave and finishes with the start of the Q wave.) Not really significant in disease.
PR interval Time interval from SA node through internodal pathways to the ventricles. (Begins with the start of the P wave through the start of the QRS complex.) 0.12–0.2 seconds
QRS wave or complex Conduction of impulse from the bundle of His through the ventricles; represents ventricular depolarization. Widening may suggest a ventricular escape rhythm disorder or a bundle branch block. 0.13 seconds
ST segment The time at which the entire ventricle is depolarized; end of the S wave to the beginning of the T wave. An elevation may indicate a myocardial infarction or pericarditis; a depression may indicate ischemia.
QT interval The total time from ventricular depolarization to complete repolarization; Begins at the start of the Q wave and ends at the end of the T wave. An increase in length predisposes the patient to an increased risk of tachycardia arrhythmias such as V-tac
T wave Resting phase of cardiac cycle called ventricular repolarization. This can be peaked in hyperkalemia.
U wave Seldom seen and not really mentioned in most texts today. Its origin is unknown. May be seen in patients with hypokalemia or in patients with bradycardia.
PQRSTU cycle A complete cardiac cycle
Right arm Wire colors RA/ White
Left arm Wire colors LA/ Black
Right leg RL/ Green
Left leg Wire colors LL/ Red
Chest wire colors V1- Brown/red
Chest wire colors V2 - Brown/yellow
Chest wire colors V3- Brown/green
Chest wire colors V4- Brown/blue
Chest wire colors V5- Brown/orange
Chest wire colors V6- Brown/purple
The ECG paper is imprinted with two sets of squares. Each small square is 1 mm high and 1 mm wide, while each large square is 5 mm × 5 mm, and consists of 25 small squares Each large square is outlined in darker ink for easy counting. Each small square is equal to 0.04 seconds and each large square is equal to 0.2 seconds.
stylus (the wire that produces the tracing) moves in response to the patient’s heartbeat, it melts the plastic, resulting in a tracing.
The vertical measure the amplitude or how high the complex deflects,
the horizontal lines measure the timing of the impulses
The ECG paper normally runs through the machine at a rate of 25 millimeters per second (mm/sec). If the heart rate is elevated and the complexes are spaced too closely together for an accurate interpretation, the paper speed may be increased the paper speed may be increased to 50 mm/sec, which will spread the complexes farther apart. The change in paper speed is usually automatically indicated at the top or bottom of the tracing.
Electrodes, also known as sensors, are attached to the patient and designed to detect electrical activity coming from the heart
A standard ECG consists of a total of 12 leads; however, only 10 sensors and lead wires are attached to the patient’s body
Each lead transmits a recording of the electrical impulses coming from the heart at different angles.
Waves of depolarization moving TOWARDS a positive pole usually result in a positive deflection
waves of depolarization moving AWAY from a positive pole usually result in a negative deflection
If a particular lead produces a deflection other than what is anticipated , it could indicate heart pathology or a problem with the placement of the electrodes.
The limb electrodes are placed on the fleshy, nonbony part of the patient’s upper arms and lower legs
The tabs on the electrodes should be pointing downward on the arms and upward on the legs to reduce tension or pulling on the electrodes.
Electrode tabs on the chest should also be facing downward and placed on the wall of the chest at the appropriate spaces.
Leads I, II, and III are known as the “standard limb leads” and are often referred to as bipolar leads because they record the electrical activity from two limb electrodes at the same time. .These leads measure the electrical activity of the heart between a negative (–) pole and a positive (+) pole
Lead I records the difference in voltage between the RA (– pole) and LA (+ pole);
lead II records the difference in voltage between the RA (– pole) and LL (+ pole)
lead III records the difference in voltage between the LA (– pole) and LL (+ pole)
Note: The RL wire is used as a reference point or ground wire and is not part of the recording even though an electrode is placed on the right leg. Note: The RL wire is used as a reference point or ground wire and is not part of the recording even though an electrode is placed on the right leg.
The next three limb leads—aVR, aVL, and aVF— are known as the augmented leads and referred to as unipolar because only a single positive electrode is referenced against a “null point" (a point with little or no significant electronic variation) between the remaining limb electrodes
The aV stands for augmented voltage and is referred to as augmented because the electrical impulses from these three leads are very small and the ECG machine must augment or increase their size to make them readable.
The last letter in each of the augmented leads is an abbreviation that relates to the positive pole or electrode used in each lead.
Lead aVR (right arm) records the difference in voltage between the RA (the + pole) and a midpoint between the LA and LL (the negative reference point).
Lead aVL (left arm) records the difference in voltage between the left arm (+ pole) and a midpoint between the RA and LL (negative reference point).
Lead aVF (foot or left leg in this case) records the difference in voltage between the left leg (+ pole) and a midpoint between RA and LA (negative reference point).
The chest or precordial leads are the last six leads of the standard 12-lead ECG and do not require any amplification because of how close they are to the heart
V1: Fourth intercostal space at the right margin of the sternum
V2: Fourth intercostal space at the left margin of the sternum
V3: Midway between The V2 and V4 on the 5th rib
V4: Fifth intercostal space at the midclavicular line
V5: Same horizontal level as V4 at the left anterior axillary line
V6: Same horizontal level as V4 and V5 at the left midaxillary line
Created by: Tbella