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Conduction sequence
electrical impulse travels from the SA node to the AV node then down the bundle of His. The electrical impulse will then go down the L and R BB and then the purkinje fibers
what allows the ventricles time to fill?
The AV node slows the impulse down to allow the atria to fill the ventricles with blood
why is coordination of ventricle contraction important?
in order to have enough pressure within the chambers to eject blood
Name two important processes for the heart to pump properly
Impulse generation and impulse conduction
examples of abnormal SA node impulse generation
paroxysmal atrial contraction and atrial tachycardia
What sort of foci can occur during coronary ischemia? How does it happen?
PVCs in the ventricles, the foci must have high excitability to cause ectopic impulses
Default gain standard for ECGs
1mV/10mm or 0.1mV/1mm
what should be noted about heart rhythm in holter scanning?
the underlying rhythm
any alternate rhythms
variations in conduction like AV block or intermittent nocturnal wenckebach block
how can you determine the origin of an impulse?
by looking at its polarity, patterns and time intervals compared to other waves
the first step in determining abnormalities in heart beats
try to find the P waves
QRS origin of impulse
AV: normal QRS, either inverted or no P wave
Ventricles: Wide QRS, no P, inverted polarity
pacemaker: pacer spike
difference between sinus pause and SA block
sinus pause is a delay in impulse conduction and SA block is cause by a conduction defect
SA impulse generation defects
aging
ischemia
inflammation
drug effects
where is afib often generated?
in cells within the opening of the pulmonary veins
aflutter atrial rate
300-500bpm
Idioventricular rate
30-45bpm
what is ventricular pre-excitation?
when the AV delay is shorter which allows the ventricles to be stimulated earlier than normal
what may be the cause of a shift in AV delay?
overstimulation of SNS or a decrease in PNS
how is a delta wave created?
when the impulse travels down the bundle of Kent and partially depolarizes the ventricles before another impulse travels down the AV node
there is an increased incidence for WPW in:
MVP
tricuspid malformation
cardiomyopathy
WPW and other pre-excitation syndromes are at increased risk of developing what?
a re-entrant circuit that can initiate paroxysmal tachycardia
when is 2nd and 3rd degree AV block considered more serious?
when its caused by degenerate or acute conditions like
MI
direct ischemia of AV node
sclerosis or fibrosis of AV node or bundle of His
where may wenckebach occur?
in the AV node or SA node as a form of exit block
what is Stokes-Adams syndrome?
when someone experiences syncope before the escape rhythm is initiated
when does the RBB branch off?
when it reaches the distal portion of the septum and apex of right V
what are the two branches of the LBB called?
the anterior-superior and posterior-inferior
normal depolarization is completed in how many seconds?
less than 0.12sec
lesions in His-purkinje system causing delays may be caused by:
ischemia
inflammation
hypoxia
drugs
conduction defects may occur in what 5 sites of the bundle branches?
common bundle
right bundle
left main branch
anterior-superior branch
posterior-inferior branch
ECG characteristics of RBBB
tall and wide QRS in V6 and lead I
prolonged QRS
slurred S in V6 and lead I
prominent S in V1 and AVR
ECG characteristics in LBBB
polarization the opposite of normal
slurred R in V6, lead I
Q wave or small R with deep S wave in V1, AVR
wide QRS >0.12 sec
T wave and ST segment deviations
anterior hemiblock characteristics
normal QRS
Large positive R wave in Lead I, negative S wave in Lead III
QRS axis -45 or more (left axis deviation)
posterior hemiblock characteristics
normal QRS
large positive R wave in lead III, negative S wave in Lead I
QRS axis +120 or more (right axis deviation)