Critical Care Test 1
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| The top of the heart | base
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| The bottom of the heart | apex
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| The outermost layer of the heart. The coronary arteries run along this layer. | epicardium
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| The middle and thickest layer. Made of pure muscle and does the work of contracting. Part that is damaged with a MI | Myocardium
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| The thin innermost layer that lines the heart's chambers and folds back onto itself to for the heart valves. Watertight to prevent leakage of blood into the other layers. The cardiac conduction system is found in this layer. | endocardium
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| A receiving chamber for deoxygenated blood returning to the heart from the body. O2 saturation of only 60%-75%, blood is a dark maroon color, and CO2 concentration is high. Delivers blood to the right ventricle. | right atrium
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| pumps the blood to the lungs for a fresh supply of O2. O2 saturation of 6-%-75%, blood is dark maroon, and CO2 concentration is high. | right ventricle
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| Receiving chamber for the blood returning to the heart from the lungs. O2 saturation is 100%, bright red in color, CO2 concentration is extremely low. Delivers blood to left ventricle. | left atrium
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| Job is to pump blood out to the entire body. Major pumping chamber of the heart. O2 is 100%, bright red color, and CO2 is low. | left ventricle
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| The heart is divided into left and right sides by | septum
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| The septum separating the atria is | interarterial septum
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| The septum separating the ventricles is | interventricular septum
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| The hearts two valves that prevent backflow of blood | semilunar valves and AV valves
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| separate a ventricle from an artery and have three half-moon-shaped cups. | Semilunar valves
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| This valve is located between the right ventricle and the pulmonary artery | pulmonic valve
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| located between the left ventricle and the aorta | aortic valve
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| Valves that are located between the atrium and ventricles | AV (atrioventricular) valves
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| located between the right atrium and ventricle, has three cusps | tricuspid valve
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| located between the left atrium and ventricle, it has two cusps | mitral or bicuspid valve
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| Between s1 and s2, the heart beats and expels blood. | systole
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| Between s2 and the nest s1, the hear rests and fills with blood | diastole
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| large vein that returns deoxygenated blood to the right atrium from the head, neck, upper chest, and arms | Superior vena cava (SVC)
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| large vein that returns deoxygenated blood to the right atrium from the lower chest, abdomen, and legs | inferior vena cava (IVC)
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| Large artery that takes deoxygenated blood from the right ventricle to the lungs to load up on oxygen and unload carbon dioxide | pulmonary artery
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| large veins that return oxygenated blood from the lungs to the left atrium | pulmonary veins
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| largest artery in the body. takes oxygenated blood from the left ventricle to the systemic circulation to feel all the organs in the body. | aorta
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| Blood flow through the heart | Blood enters the heart in the superior or inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta, into the body.
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| refers to the mechanical events that occur to pump the blood | cardiac cycle
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| the two phases of the cardiac cycle | diastole and systole
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| three phases of diastole | rapid-filling, diastasis, and atrial kick
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| first phase of diastole. Atria is full of blood, ventricles empty. Pressure differential causes AV valves to pop open and blood rapidly fills ventricles | rapid filling phase
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| Second phase of diastole. Pressure equalize between atria and ventricles, flow in ventricles slows. | diastasis
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| last phase of diastole. Atria contract to squeeze remainder of blood into the ventricles | atrial kick
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| four phases of systole | isovolumetric contraction, ventricular ejection, prodiastole, isovolumetric relaxation
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| first phase of systole. Ventricles contracting, no blood flow occurring because of the aortic and pulmonic valves are still close. Huge expenditure of myocardial o2 consumption. | isovolumetric contraction
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| second phase of systole. Valves open, blood pours out of ventricles into pulmonary artery and aorta | ventricular ejection
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| third phase of systole. Pressure equalize between ventricles and pulmonary artery and aorta, blood flow slows | prodiastole
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| last phase of systole. Ventricles relax and pulmonic and aorta valves closed | isovolumetric relaxation
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| Blood flow through the systemic circulation | leaves aorta and enters arteries, then arterioles, into each organs capillary bed, now deoxygenated blood enters venules, widen into veins, and back to the vena cava.
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| arise from the base of the aorta and course along the epicardial surface of the heart and then dice into myocardium to provide its blood supply | coronary arteries
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| a branch off of the left main coronary artery and supplies blood to the anterior wall of the left ventricle | left anterior descending coronary artery
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| a branch off of the left main coronary artery and feeds the lateral wall of the left ventricle | circumflex coronary artery
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| feeds the right ventricle and the inferior wall of the left ventricle | right coronary artery
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| The heart has two kinds of cells | contractile and conduction system cells
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| cause the heart muscle to contract, resulting in a heartbeat | contractile cells
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| create and conduct electrical signals to tell the heart when to beat. Without these electrical signals the contractile cells would never contract | conduction system cells
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| The hearts main function | pump enough blood to meet the bodys metabolic needs
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| a state of readiness, the cardiac cell if ready for electrical action | polarized state
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| cardiac cell is stimulated by an electrical impulse, a large amount of sodium rushed into the cell and a small amount of potassium leaks out, cause a discharge of electricity and becomes positively charged. Result in muscle contraction | depolarization
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| during cell recovery, sodium and potassium ions are shifted back to their original places by way of the sodium-potassium pump, and active transport system that returns the cell back to its negative charge. Result in muscle relaxation | repolarization
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| these are the myocardium's electrical stimuli | depolarization and repolarization
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| These are the myocadium's mechanical responses | Contraction and relaxation
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| There can be no heartbeat (mechanical response) without first having had | depolarization (the electrical stimulus)
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| Can the heart have an electrical stimulus without having an mechanical response? | Yes, but the heart will not pump
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| What happens to the cardiac cell when stimulated by electrical charge. 4 phases | action potential
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| Cardiac at rest. Corresponds with isoelectric line of EKG | phase 4
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| depolarization. Cell becomes positively charged. Corresponds with QRS complex on EKG | phase 0
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| Early repolarization. Calcium is released. Muscle contraction begins. Corresponds with ST segment on EKG | phase 1 and 2
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| rapid repolarization. Cell is returning to electrically negative state. Corresponds with T wave on EKG | phase 3
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| Cardiac cells resists responding to/ depolarizing from an impluse | refractory periods
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| Cardiac cell cannot respond to another impulse, no matter how strong, will not result in another depolarization | absolute refractory period
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| cell can respond only to very strong impulse and will result in depolarization | Relative refractory period
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| Cardiac cell is hyper, and will respond to very weak stimulus will cause depolarization | Supernormal period
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| on the EKG equals one heartbeat | P-QRS-T
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| atrial depolarization, small, rounded, upright on most leads | P wave
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| usually not seen, occurs same time as QRS, but atrial repolarization, | Ta wave
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| ventriclular depolarization, spiked upward and/or downward deflections | QRS
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| ventricular repolarization, broad, rounded, upright if the QRS is upright | T wave
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| represents late ventricular repolarization, not normally seen, shallow, broad, and rounded | U wave
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| The flat lines between the P wave and QRS, no electrical current | PR segment
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| the flat line between the QRS and T wave, no electrical current | ST segment
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| The flat line between T wave of one beat and the P wave of the next beat | baseline or isoelectric line
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| Atrial contraction occurs during the | P wave and PR segment
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| Ventricular contraction occurs during the | QRS and ST segment
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| When atria depolarizes | a P wave is written on EKG
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| A negative deflection that occurs before a positive deflection | Q wave
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| any positive deflection | R wave
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| there can be more than one R wave, a second on is called | R prime written R'
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| a negative deflection that follows an R wave | S wave
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| A negative deflection with no positive deflection at all | QS wave
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| A pathway of specialized cells whose job is to create and conduct the electrical impulses that tell the heart when to pump | conduction system
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| the area of the conduction system that initiates the impulses | pacemaker
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| conduction pathway of the heart | originates in the sinus node, through interarterial tracts, carry impulses to the atrial tissue, through the intranodal tracts, AV node, Bundle of His, to left and right bundle branches, purkinje fibers, and arrives at ventricles
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| Cardiac cells have several characteristics | automaticity, conductivity, excitability, and contractility
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| The ability to create an impulse without outside stimluation, electrical | automaticity
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| the ability to pass this impluse along to neighboring cells,electrical | conductivity
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| the ability to respond to this stimulus by depolarizing, electrical | excitability
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| the ability to contract to do work, mechanical | contractility
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| Three types of pacemakers | sinus node, AV junction, ventricle
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| pacemaker that's 60-100 beats per minute | sinus node
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| pacemaker that's 40-60 beats per minute | AV junction
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| pacemaker that's 20-40 beats per minute | ventricle
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| has the fastest inherent rate of all the potential pacemaker cells. | the sinus node
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| true or false: the fastest pacemaker at any given moment is the one in control | true
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| predominant pacemaker slows down; lower pacemaker takes over at its slower inherent rate and results in a slower heart rate than before | escape
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| beat that comes in after a pause longer than normal R-R interval. life saver | escape beat
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| series of escape beats | escape rhythm
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| lower pace maker becomes hyper; fires in at an accelerated rate, stealing control away from slower predominant pacemaker and results in a faster hear rate than before | usurpation
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| pattern of successive heart beats | heart rhythm
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| abnormal heart rhythm | arrhythmia
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| a printout of the heart's electrical activity viewed from 12 different angles as seen in 12 different leads | 12-lead-EKG
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| an electrocardiographic picture of the heart's electrical activity | lead
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| a printout of one or two leads at a time and is done to assess the patent's heart rhythm | rhythm strip
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| on EKG each small block is | 0.04
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| on EKG each big block is | 0.20
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| counting horizontally measures | intervals in secs
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| counting vertically measures | amplitudes in mm
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| enable a determination of the heart's efficiency at transmitting its impulses down the pathway | interval measurements
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| time traveling from atrium to ventricle. 0.12-0.20. measuring from beginning of P wave to the beginning of the QRS | PR interval
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| measures the time it takes to depolarize the ventricles. <.012 usually 0.06-0.10. beginning of QRS to the end of the QRS | QRS interval
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| measures depolarization and repolarization time of the ventricles. less than or equal to half of R-R interval. beginning of the QRS to the end of the T wave | QT interval
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| three methods for calculating the heart rate | the 6-second strip method, the memory method, and the little block method
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| the least accurate of all the methods. count the number of QRS complexes and multiply by 10 which will tell the mean rate | the 6-second strip method
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| Since the 6-second strip method can be misleading, it makes more sense to provide | a range of the heart rates
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| this is the fastest method. count the number of big blocks between consecutive QRS complexes and divide that number into 300 | the memory method
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| count the number of little blocks between QRS complexes and divide into 1500. | the little block method
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| is concerned with the spacing of the QRS complexes | rhythm regularity
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| count the number of little blocks between QRS complexes to compare | R-R intervals
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| three types of regularity | regular, regular but interrupted, irregular
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| rhythm is which the R-R intervals vary by only one or two little blocks. the QRS complexes usually look alike | regular rhythm
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| regular rhythm that is interrupted by either a premature beat or pause. the beats that interrupt this otherwise regular rhythm may look the same as the surrounding regular beats or may look quit different. | regular but interrupted rhythm
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| beats that arrive early, before the next normal beat is due | premature beats
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| rhythm in which the R-R intervals vary, not just because of premature beats or pauses, but because the rhythm is intrinsically chaotic. | irregular rhythm
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| Calculate the heart rate by choosing any two successive QRS complexes and using the little block or memory method. calculating one heart rate | Calculating for regular rhythms
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| Calculate the mean rate by using 6-sec strip method, and then calculate the heart rate range using the little block or memory method. calculating the range slowest to fastest, plus mean rate | calculating for irregular rhythms
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| ignore premature beats and calculate the heart rate, using little block or memory method, on an uninterrupted part of the strip. calculating one heart rate | calculating for regular rhythms but interrupted by premature beats
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| calculate the heart rate range slowest to fastest, along with the mean rate | calculating regular rhythms but interrupted by pauses
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| five steps to rhythm interpretation | QRS complexes? are they the same shape? regularity? heart rate? P waves? are they the same shape? in the same place or relative to the QRS? are any P waves not followed by a QRS? what are the PR and QRS intervals?
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| The normal sinus rhythm originating from the sinus node if | sinus rhythm
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| normal sinus rhythm consists of | narrow QRS, uniform shape, regular, HR 60-100, upright P waves and married to QRS, PR interval 0.12-0.20, QRS interval <0.12
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| arrhythmias consists of | QRS absent or abnormally shaped, absent P waves or multiple numbers or abnormal shape, abnormal PR and QRS intervals, HR abnormally slow or fast, irregular rhythm or rhythm with interruptions
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| inherent rate of the sinus node is 60-100 but this rate can go higher or lower if the sinus node is acted on by the | SNS or the PNS
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| heart rates that are too fast or too slow can cause symptoms of | decreased cardiac output (inadequate blood flow to the body)
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| criteria that must be met for the rhythm to be sinus in origin | upright matching P waves in Lead II followed by a QRS, PR intervals constant, and HR < or = 160 at rest
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| in lead II are considered sinus P waves until proven otherwise | all matching upright P waves
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| in sinus rhythm QRS is normally | narrow and <0.12 sec
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| if conduction through the bundle branches is altered QRS can be | wide and >0.12 secs
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| impulse is born in the sinus nose and heads down the conduction pathway to the ventricle. every P wave is married to a QRS complex, HR is the normal 60-100. regular rhythm P waves upright, PR= 0.12-0.20sec QRS= <0.12 secs | Sinus Rhythm
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| slower than normal rhythm from the sinus node, impluse originated in the sinus nose and travels the conduction system normally. HR <60 regular P wave upright, shaped the same, and married to QRS, PR= 0.12-0.20 secs QRS= <0.12 secs | Sinus Bradycardia
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| Causes of Sinus brady | vagal stimulation, MI, hypoxia, dig toxcity, athlete, other meds (beta blocker, opiods)
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| a slow heart rate can cause signs of | decreased cardiac output
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| treatment for brady | none unless pt symptomatic, atropine, O2, pacemaker, epi and dopamine (if in shock),
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| the sinus node fires at a heart rate faster than normal, impulse originates in the sinus node and travels down the conduction pathway normally. HR 101-160, regular, P wave upright, same shaped, and married to QRS, PR= 0.12-0.20 secs QRS= <0.12 secs | Sinus tachycardia
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| causes of sinus tach | atropine or bronchodilators, emotional upset, pulmonary embolus, MI, CHF, fever, inhibition of vagus nerve, hypoxia, thryotoxicosis
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| sinus tach can cause | increased cardiac workload and decreased cardiac output
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| treatment for sinus tach | meds for fever, sedation for anxiety, beta blockers for MI, O2
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| only irregular rhythm from sinus node, pattern that is cyclic and usually corresponds with breathing pattern, rate varies with resp., irregular or repetitive, R-R interval exceeds the shortest by >or=0.16secs | Sinus arrhythmia
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| P wave upright and same shape, married to QRS, P-P interval is irregular, PR= 0.12-0.20 secs QRS= <0.12 secs | Sinus arrhythmia
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| causes of sinus arrhythmia | breathing pattern, but can be caused by heart disease
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| Treatment for sinus arrhythima | usually none required
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| a pause that occurs when the regularly firing sinus node suddenly stops firing for a brief period, one or more P-QRS-T sequences will be missing, escape beat from lower pacemaker may take over for one or more beats | sinus arrest
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| the sinus node may resume after missing or the lower pacemaker may continue as pacemaker, creating a new escape rhythm, not multiple of previos R-R intervals | sinus arrest
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| can occur at any HR, regular but interrupted (pause), normal sinus P waves and normal or different P waves ending the pause. P-P is regular before pause and vary after. | sinus arrest
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| PR= 0.12-0.20 secs before and shorter or absent after pause, QRS= <0.12 secs but on escape beat may be narrow <0.12secs or wide >0.12secs depends on which pacemaker resumes after pause | sinus arrest
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| causes of sinus arrest | sinus node ischemia, hypoxia, dig toxicity, excessive vagal tone, med side effects
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| treatment for sinus arrest | may not cause a problem (no ill effects), meds to be stopped that's causing arrest, atropine and/or pacemaker, O2
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| very long sinus arrest can cause | decreased cardiac output
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| 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. results in one or more P-QRS-T sequences being missing, creating a pause, the length depends on how many missed | Sinus block
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| when conduction of the regularly firing sinus impulses resumes, the sinus beats return on time at the end of the pause. the pause will be a multiple of R-R intervals (2 or more R-R cycles) | Sinus block
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| can occur at any rate, regular but interrupted (pause), normal sinus P waves before and after and same shape, PR= 0.12-0.20secs QRS= <0.12secs | Sinus block
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| causes of sinus block | med side effects, hypoxia, strong vagal stimulation
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| frequent or very long sinus blocks can cause | decreased cardiac output
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| treatment for sinus block | may not cause a problem (no ill effects), stop med causing block, atropine and/or pacemaker, O2
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