Cardiology: Reimert’s Strategies

Functions of the Heart

• Three key functions of the heart:

  • Volume: Blood circulation in the body within one minute (drop of blood completes a cardiac cycle).

  • Pump: The heart as a muscle function.

  • Electrical Conduction System: Coordinates heartbeats and keeps the rhythm.

Electrical Activity of the Heart

• Sinoatrial Node (SA Node): The pacemaker firing at an intrinsic rate of 60-100 bpm.

  • Origin of a normal sinus rhythm, characterized by P waves followed by QRS complexes.

• Atrioventricular Node (AV Node): Acts as a gatekeeper, allowing and regulating impulses between atria and ventricles.

Cardiac Cycle Overview

1. Firing of SA Node

2. PR Interval: Time taken for atria to contract and fill ventricles.

3. QRS Complex: Ventricular contraction (systole).

4. T Wave: Ventricular repolarization.

Common Cardiac Rhythms

• Normal Sinus Rhythm: Regular rhythm originating from SA Node.

• Bradycardia and Tachycardia: Definitions based on heart rate; bradycardia (<60 bpm) and tachycardia (>100 bpm).

• Pacemakers:

  • PAC (Premature Atrial Contraction): Fired from atria without ventricular squeeze.

  • PVC (Premature Ventricular Contraction): Fired from ventricles, results in wide and bizarre rhythms.

Importance of Patterns in Cardiology

• Emphasize recognizing less common patterns, which can simplify rhythm recognition and diagnosis.

• Example: Identify rhythms based on widths and rates to categorize them faster.

Utilizing Color in Learning

• Use of Color: Aids recall of cardiac components.

  • Example: Red for arteries, blue for veins, and specific colors for different phases of the cardiac cycle.

Key Points in Arrhythmia Recognition

1. Narrow vs. Wide:

   • Narrow QRS = Originating from atria.

   • Wide QRS = Originating from ventricles.

2. Fast vs. Slow: Distinguishing based on rate can narrow down potential rhythms effectively.

3. Regularity of Rhythms: Understand whether the rhythms are regular or irregular, which can also aid in diagnosis.

Summary of Common Rhythmic Patterns

• Wide and Fast: May indicate V-Tach or V-Fib (deadly rhythms).

• Narrow and Fast: His-purkinje or junctional rhythms; can also indicate SVT or atrial flutter.

• Importance of naming the underlying cause instead of memorizing complex algorithms (e.g., 27 rules).

Practical Tips for Identification

• Approach the monitoring of rhythms in phases; identify broad categories first, then refine:

  • Fast vs. slow

  • Narrow vs. wide

• Always be on the lookout for the presence of P waves to further narrow down arrhythmia types.

Final Thoughts

• The goal is to reframe learning strategies to accommodate different learning styles and ensure a solid understanding of fundamental cardiac functions and rhythms.