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EKG
CHAPTER 1
| Question | Answer |
|---|---|
| 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 |
| CONDUCTION PATHWAY | 1. SA NODE~ 2 ATRIAL DEPOLARIZATION ~3 AV NODE ~ 4 BUNDLE OF HIS ~ 5 RT & LT BUNDLE OF BRANCHES ~ 6 PURKINJE FIBERS ~7 VENTRICLE DEPOLARIZATION ~ 8 VENTRICLE REPOLARIZATION |
| During POLARIZATION ( RESTING) there are more positive electrolytes OUTSIDE THE MEMBRANE | and NEGATIVE ELECTOLYTES WITHIN THE CELL MEMBRANE |
| during DEPOLARIZATION (CONTRACTION) the GATES open and the THE POSITIVE ELETROLYTES PASS THROUGH AND | TURN THE NEGATIVE ELECTROLYTES within to POSITIVE |
| During REPOLARIZATION ( RELAXATION) the electrolytes return to their original position in the cell membrane | RETURNING THE POSITIVE ELECTROLYTES TO OUTSIDE OF THE CELL MEMBRANE AND THE NEGATIVE BACK TO THE INSIDE OF THE CELL MEMBRANE |
| 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 |
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Tbella
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