Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
23Activity
0 of .
Results for:
No results containing your search query
P. 1
Cardio Notes

Cardio Notes

Ratings:

4.0

(2)
|Views: 505|Likes:
Published by api-3744683
about the heart....
about the heart....

More info:

Published by: api-3744683 on Oct 15, 2008
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

03/18/2014

pdf

text

original

CARDIOVASCULAR SYSTEM
NCM104 LEC
KARLEEN L. JARO
BSN 4-Q
Action Potential
Cardiac Conduction
\u2022
Sinoatrial (SA) node \u2013 Fires at 60\u2013100
beats/minute
\u2022
Intranodal pathway
\u2022
Atrioventricular (AV) node \u2013 Fires at 40-60
beats/minute
\u2022
Atrioventricular bundle of His
\u2013

Ventricular tissue fires at 20-40
beats/minute and can occur at this
point and down

\u2022
Right and left bundle branches
\u2022
Purkinje fibers
Cardiac Output/Index
\u2022
Cardiac output
\u2013
CO = HR (beats/minute) X SV
(liters/beat)
\u2013
Normal adult: 4-8 liters/minute
\u2022
Cardiac index
\u2013
CI = CO(liter/minute)/Body surface area
(m2)
\u2013
Normal adult: 2.8-4.2 liter/minute/m2
\u2013
Normalizes liter flow to body size
Stroke Volume
\u2022
The amount of blood ejected by the left
ventricle
\u2022
Preload
\u2013
The amount of stretch placed on the
cardiac muscle just prior to systole
\u2013
Starling\u2019s Law
\u2022
Afterload
\u2013
The force or pressure at which the
blood is ejected from the ventricle
\u2013
Equated with systemic vascular
resistance (SVR)
\u2022
Contractility
Patient Assessment: Cardiovascular System
Physical Exam
\u2022
Inspection
\u2013
General appearance
\u2013
Jugular venous distension (JVD)
\u2013
Skin
\u2013
Extremities
\u2022
Palpation
\u2013
Pulses
\u2013
Point of maximal impulse (PMI)
\u2022
Percussion
\u2022
Auscultation
\u2013
Good stethoscope
\u2013
Positioning
\u2013
Normal tones \u2013 S1/S2
\u2013
Extra tones \u2013 S3/S4
\u2013
Murmurs
\u2013
Rubs
6
CARDIOVASCULAR SYSTEM
NCM104 LEC
KARLEEN L. JARO
BSN 4-Q
Murmurs
\u2022
Timing
\u2022
Location
\u2022
Transmission
\u2022
Pitch
\u2022
Quality
\u2022
Intensity
Grading
\u2022
Grade 1 \u2013 Barely audible
\u2022
Grade 2 \u2013 Clearly audible
\u2022
Grade 3 \u2013 Moderately loud
\u2022
Grade 4 \u2013 Loud with a thrill
\u2022
Grade 5 \u2013 Very loud with an easily palpable
thrill
\u2022
Grade 6 \u2013 Very loud, no stethoscope needed,
palpable and visible thrill
Important Cardiac Labs
\u2022
Coagulation studies \u2013 PTT and PT/INR
\u2022
Electrolytes \u2013 Potassium, magnesium, and
calcium
\u2022
Lipid studies \u2013 Cholesterol, triglycerides
\u2022
Enzymes \u2013 CK, CK-MB, LDH
\u2022
Troponin
Invasive Tests
\u2022
Coronary angiography
\u2022
Electrophysiology studies
Steps to reading ECGs
\u2022
What is the rate? Both atrial and ventricular if
they are not the same.
\u2022
Is the rhythm regular or irregular?
\u2022

Do the P waves all look the same? Is there a P
wave for every QRS and conversely a QRS for
every P wave?

\u2022
Are all the complexes within normal time
limits?
\u2022
Name the rhythm and any abnormalities.
Rate\u2022

Look at complexes in a 6-second strip and
count the complexes; that will give you a rough
estimate of rate

\u2022
Count the number of large boxes between two
complexes and divide into 300
\u2022
Count the number of small boxes between two
complexes and divide into 1500
Estimate rate by sequence of numbers
Normal Timing
\u2022
PR interval \u2013 0.12 to 0.20 seconds
\u2022
QRS interval \u2013 less then 0.12
\u2022

QT interval \u2013 varies with rate. It is usually less
then \u00bd the R-to-R distance on the preceding
waves

Normal Sinus Rhythm
\u2022
Rate is between 60 and 100 beats/minute
\u2022
The rhythm is regular
\u2022
All intervals are within normal limits
\u2022
There is a P for every QRS and a QRS for every
P
\u2022
The P waves all look the same
Sinus Tachycardia
\u2022
Rate above 100 beats/minute
\u2022
The rhythm is regular
\u2022
All intervals are within normal limits
\u2022
There is a P for every QRS and a QRS for every
P
\u2022
The P waves all look the same
\u2022
Caused by fever, stress, caffeine, nicotine,
exercise, or by increased sympathetic tone
\u2022
Treatment is to take care of the underlying
cause
Sinus Bradycardia
\u2022
Rate is lower than 60 beats/minute
\u2022
The rhythm is regular
\u2022
All intervals are within normal limits
\u2022
There is a P for every QRS and a QRS for every
P
\u2022
The P waves all look the same
\u2022
Caused by beta-blocker, digitalis, or calcium
channel blockers. Normal for athletes
\u2022
Don\u2019t treat unless there are symptoms. Can
use pacing or atropine
Sinus Arrhythmia
\u2022
Rate is between 60 and 100 beats/minute
\u2022
The rhythm is irregular. The SA node rate can
increase or decrease with respirations
\u2022
All intervals are within normal limits
\u2022
There is a P for every QRS and a QRS for every
P
6
CARDIOVASCULAR SYSTEM
NCM104 LEC
KARLEEN L. JARO
BSN 4-Q
\u2022
The P waves all look the same
\u2022
More common in children and athletes
\u2022
Ask the patient to stop breathing and the rate
will become regular
Premature Atrial Contraction (PAC)
\u2022
Can occur at any rate
\u2022
The rhythm is irregular because of the early
beat but is regular at other times
\u2022
All intervals can be within normal limits
\u2022
There is a P for every QRS and a QRS for every
P
\u2022
The P waves all look the same except the P in
front of the PAC will be different
Paroxysmal Supraventricular Tachycardia
(PSVT)
\u2022
Rate is between 150 and 250 beats/minute
\u2022
The rhythm is regular
\u2022
QRS intervals can be within normal limits
\u2022

There can be a P wave, but more likely it will be
hidden in the T wave or the preceding QRS
wave

\u2022
Starts and stops abruptly
\u2022
Treat with Valsalva maneuver or adenosine IV
Atrial Flutter
\u2022
Atrial rate is between 250 and 350
beats/minute. Ventricular rate can vary
\u2022
The rhythm is regular or regularly irregular
\u2022
There is no PR interval. QRS may be normal
\u2022
2:1 to 4:1 f waves to every QRS
\u2022
There are no P waves; they are now called
flutter waves
\u2022

Problem: Loss of atrial kick and ventricular
conduction is too fast or too slow to allow good
filling of the ventricles

Atrial Fibrillation
\u2022
Atrial rate is between 350 and 600
beats/minute; ventricular rate can vary
\u2022
The rhythm is irregular
\u2022
There is no PR interval; QRS may be normal
\u2022
There are many more f waves then QRSs
\u2022

Unlike flutter where the f wave will appear the same, in fib the f waves are from different foci so they are different

Multifocal Atrial Tachycardia (MAT)
\u2022
Rate is greater then 100 beats/minute
\u2022
The rhythm is irregular
\u2022
PR interval may vary depending on how close
the foci is to the AV node; QRS may be normal
\u2022
There usually is a P for every QRS and a QRS
for every P wave
\u2022
The P waves appear different because they are
coming from different foci
\u2022
There needs to be at least 3 different P waves
to be classified as MAT
Junctional Arrhythmia
\u2022
Rate is between 40 and 60 beats/minute
\u2022
The rhythm is regular
\u2022
There is a P for every QRS and a QRS for every
P
\u2022
The P wave can be in three possible places
\u2013

Retrograde conduction to atria before
ventricle; P wave would be upside
down before the QRS

\u2013

If both atria and ventricle receive
stimulus at the same time, the P would
be buried in the QRS

\u2013
If the ventricle was stimulated first, the
P would be located just after the QRS
Junctional Rhythms
\u2022
Junctional bradycardia
\u2013
Rate less than 40 beats/minute
\u2022
Accelerated junctional
\u2013
Rate 60-100 beats/minute
\u2022
Junctional tachycardia
\u2013
Rate is greater then 100 beats/minute
\u2022
Premature junctional contractions (PJC)
\u2013
Early beats in the cycle that have
junctional P wave morphology
Premature Ventricular Contractions (PVC)
\u2022
Early beat that is wide (>0.12)
\u2022
Originates the ventricles
\u2022
No P wave
\u2022
Compensatory pause
\u2022

Can be defined by couplet or triplet; anything
more would be considered ventricular
tachycardia

\u2022
Monomorphic or polymorphic
Ventricular Tachycardia
\u2022
Rate is between 100 and 200 beats/minute
\u2022
The rhythm is regular, but can change to
different rhythms
\u2022
No PR interval; QRS is wide and aberrant
\u2022
There may be a P wave, but it is not related to
the QRS
Torsades De Pointes
\u2022
Polymorphous ventricular tachycardia
\u2022

Caused by long QT syndrome. This is an
inherited condition or caused by antiarrhythmic
drugs

\u2022
Cannot be converted by defibrillation
\u2022
Magnesium is the drug of choice
\u2022
Overdrive pacing may work also
Ventricular Fibrillation
\u2022
Rapid, irregular rhythm made by stimuli from
many different foci in the ventricula
\u2022
Produces no pulse, blood pressure, or cardiac
output
\u2022
Can be described as fine or coarse
\u2022
Most common cause of sudden cardiac death
First\u2013Degree AV Block
6

Activity (23)

You've already reviewed this. Edit your review.
1 hundred reads
1 thousand reads
Mark Leo Samoy liked this
ashphoenix32 liked this
aysheslocum liked this
SITET liked this
Simran Sukhija liked this

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->