CHAPTER 1
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| The heart is located | In the media stinum
( space between the sternum/ anterior and vertebrae/posterior
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| The heart has 3 layers | Endocardium ( innermost)
Myocardium ( middle)
Epicardium (outer layer)
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| The sac surrounding the heart is called | Pericardial fluid sac
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| The heart has 2 upper chambers | The two upper chambers are the right and left atria
Functions as RECIEVING chambers
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| The heart has 2 lower chambers | The two lower chambers are the right and left ventricles
Functions as PUMPING chambers
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| The 4 valves in the heart act as doors Right side | Right atrium to right ventricle = to tricuspid valve
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| The 4 valves in the heart act as doors Left side | Left atrium to left valve = to bicuspid/ mitral valve
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| 2/3 of the heart | Is on the left side
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| 1/3 of the heart | Is on the right side
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| EKG | Eletrocardiogram
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| EGG | Electrocardiograph
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| EKG/ EEG | Means the same thing
It is a recording of electrical conduction system of the heart
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| The apex is | At the 5th intercostal space by the left ventricle
( apical pulse is heard at 5 th ICS
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| The left and right side of the heart are separated by | A thick muscular structure called the septum
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| The right atrium receives deoxygenated blood | From the body through the superior and inferior vena cava
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| The right ventricle is pumping deoxygenated blood to the lungs | Threw the pulmonary artery
Taking blood away from the heart to the body
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| The left atrium receives the oxygenated blood from the | Lung through the pulmonary veins
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| The left ventricle is pumping oxygenated blood | To the body through the aorta
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| Myometrum muscle | Is thicker on the left side because it pumps blood through the whole body
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| The left ventricle is the most | Important chamber because it pumps blood through whole body
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| The 4 valves in the heart | There purpose is to prevent backflow
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| 1 Right side tricuspid valve | Lies between the rt atrium and rt ventricle
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| 2 bicuspid/ mitral valve | Lies between the Lf atrium and Lf ventricle
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| 3 pulmonary semi lunar valve PSLV | Lies between the rt ventricle and the pulmonary artery
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| 4 aortic semi lunar valve ASLV | Lies between Lt ventricle and aorta
( does not allow blood to go back in)
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| Chordac tendinae and papillary muscles | Are attached to valves which keeps them in place and helps in there function
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| Prolapse | When valves lose there function to open and close
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| The the has heart 4 | 4 chambers
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| The heart has | 4 valves
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| The chambers are divided by | The spectum
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| This valve separates the RA and the RV | Tricuspid valve
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| This valve separates the LA and the LV | Bicuspid/mitral valve
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| The valve separates the RV and the PULMONARY ARTERIES | PSLV
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| This valve separates the LV and the AORTA | ASLV
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| Two types of myocardial cells are | Electrical and mechanical
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| When the myocardial cells are in a "state of rest" we call it | Polarization
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| When the ions of the myocardial cells are moving we call this | Depolarization
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| When the ions of the myocardial cells ARE RETURNING BACK TO THE RESTING STATE we call this | REPOLARIZATION
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| When the heart is CONTRACTING, it is in which phase ? | Systole 120
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| When the heart is RESTING it is in which phase | Diastole 80
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| The unique property that allows a myocardial cell to INITIATE AND MAINTAIN RHYTHIC heart activity is called | automaticity
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| The unique property that allows a myocardial cell to RELAY AN IMPULSE TO A NEIGHBORING cell is called | Conductivity
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| The unique property that allows a myocardial cell to RESPOND TO AN IMPULSE is called | Excitability
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| The unique property that allows a myocardial cell to RESPOND to an IMPULSE with a PUMPING ACTION is called | Contractility
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| 1st pacemaker the hearts natural..... | SA NODE
60-100 bpm
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| 2nd pacemaker is | AV ( atrial ventricular)
40-60 bpm
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| 3rd pacemaker is | Furkinje fibers
20-40 bpm
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| The SA NODE IS LOCATED | Upper side of the RT ATRIUM
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| The gatekeeper of the heart is | AV NODE
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| The impulse is then sent here ('after gatekeeper) | Bundle of his
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| Then the bundle of his goes here | RT AND LF BUNDLE BRANCHES
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| The bundle branches then go here | Furkinge fibers
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| What does depolarization cause | Contractions
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| Oxygen poor blood is called | Deoxygenated blood
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| Deoxygenated blood enters which chamber of the heart | RT ATRIUM
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| After the 1st chamber it flows through the | Tricuspid valve
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| 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
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| During POLARIZATION ( RESTING) there are more positive electrolytes OUTSIDE THE MEMBRANE | and NEGATIVE ELECTOLYTES WITHIN THE CELL MEMBRANE
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| during DEPOLARIZATION (CONTRACTION) the GATES open and the THE POSITIVE ELETROLYTES PASS THROUGH AND | TURN THE NEGATIVE ELECTROLYTES within to POSITIVE
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| 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
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| A waveform | refers to a positive (upright deflection) or negative (downward deflection) from the isoelectric line.
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| The isoelectric line | is the straight
line seen on the ECG strip.
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| The waveforms produced | on the ECG graphing paper correlate with the heart’s electrical activity
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| 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
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| 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.
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| Segment: | This is the space between two waves
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| Interval: | : This includes a combination of one or more waves and a segment. This represents the length of a wave.
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| P wave |
0.06–0.1 seconds
Depolarization of the left and right atria
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| 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.
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| 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
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| 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
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| 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.
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| 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
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| T wave |
Resting phase of cardiac cycle called ventricular repolarization. This can be peaked in hyperkalemia.
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| 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.
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| PQRSTU cycle | A complete cardiac cycle
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| Right arm Wire colors |
RA/
White
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| Left arm Wire colors | LA/
Black
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| Right leg |
RL/
Green
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| Left leg Wire colors |
LL/
Red
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| Chest wire colors | V1-
Brown/red
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| Chest wire colors | V2 -
Brown/yellow
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| Chest wire colors | V3-
Brown/green
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| Chest wire colors | V4-
Brown/blue
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| Chest wire colors | V5-
Brown/orange
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| Chest wire colors | V6-
Brown/purple
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| 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.
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| stylus (the wire that produces the tracing) | moves in response to the patient’s heartbeat, it melts the plastic, resulting in a tracing.
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| The vertical | measure the amplitude or how high the complex deflects,
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| the horizontal lines | measure the timing of the impulses
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| 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.
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| Electrodes, also known as sensors, | are attached to the patient and designed to detect electrical activity coming from the heart
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| A standard ECG consists of a total of 12 leads; | however, only 10 sensors and lead wires are attached to the patient’s body
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| Each lead transmits | a recording of the electrical impulses coming from the heart at different angles.
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| Waves of depolarization moving TOWARDS a positive pole usually | result in a positive deflection
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| waves of depolarization moving AWAY from a positive pole usually | result in a negative deflection
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| 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.
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| The limb electrodes are placed on the | fleshy, nonbony part of the patient’s upper arms and lower legs
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| 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.
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| Electrode tabs on the chest should also be facing downward | and placed on the wall of the chest at the appropriate spaces.
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| 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
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| Lead I records the difference in voltage | between the RA (– pole) and LA (+ pole);
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| lead II records the difference in voltage | between the RA (– pole) and LL (+ pole)
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| lead III records the difference in voltage | between the LA (– pole) and LL (+ pole)
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| 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.
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| 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
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| 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.
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| The last letter in each of the augmented leads is an abbreviation | that relates to the positive pole or electrode used in each lead.
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| 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).
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| 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).
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| 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).
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| 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
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| V1: Fourth intercostal space at the | right margin of the sternum
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| V2: Fourth intercostal space at the | left margin of the sternum
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| V3: Midway between | The V2 and V4 on the 5th rib
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| V4: Fifth intercostal | space at the midclavicular line
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| V5: Same horizontal level as V4 | at the left anterior axillary line
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| V6: Same horizontal level as V4 and V5 | at the left midaxillary line
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