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Physiology Exam 3

Electrical Activity of the Heart Action Potentials • Pacemaker Potentials (ex: SA Node) o Grad al de!olari"ation # oscillating $%P o $a!id de!olari"ation # &'ty!e (a)* channels o $e!olari"ation # +* channels (+* o t) • ,entric lar AP o Phases:  -e!olari"ation # fast Na* channels (Na* .N)  .nitial $a!id $e!olari"ation  Platea Phase # Slo/ (&'ty!e) (a)* channels (decreased Na* 0 +* cond ctance)  &ate ra!id re!olari"ation # +* channels (+* 123 fast 0 decreased (a)* cond ctance) o Atrial AP # (a)* channels are N13 o!en as long o (ond ctance (hanges  Na* • increases slo/ at first4 increases greatly d ring de!olari"ation • -ecreases d ring !latea !hase  (a)* • .ncreases d ring !latea !hase • -ecreases d ring re!olari"ation !hase  +* • -ecreased d ring !latea !hase • .ncreased greatly d ring re!olari"ation • AP 0 (ontractile $es!onse o $efractory !eriod is almost as long as AP d ration  S mmation 0 tetany cannot occ r in cardiac m scle • 1rigin 0 S!read of (ardiac Excitation o .m! lse origin (SA Node) 0 Atrial de!olari"ation  SA Node  s!read thr atria  A, node  A, nodal delay  o Se!tal -e!olari"ation   5 ndle of His  P rkin6e fi5ers  ventricles o A!ical 0 ,entric lar -e!olari"ation  -e!olari"ation s!reads from a!ex (7 5ottom) !/ard o &ate ,entric lar -e!olari"ation  S!reads !/ard to 5ase o $e!olari"ation  3ravels in o!!osite direction of de!olari"ation (from 5ase  a!ex)  8ase relaxes first so ventric lar filling can occ r Electrocardiogram • (haracteristics o Gra!h of variations in voltage !rod ced 5y the heart d ring vario s !hases of the cardiac cycle o 8ody fl ids s rro nding heart are salt sol tions 9 very good cond ctors of electricity  Allo/s s to meas re electrical activity /ith s rface electrodes o E(G is la5 test only # can hel! in clinical condiditions:  Arrhythmias 0 heart 5locks (a5normalities in rhythm or cond ction)  Extent4 location4 0 !rogress of ischemic damage after myocardial infarction  Hy!ertro!hy of the heart  Effect of certain dr gs (ex: digitalis 0 : inidine)  A5normal electrolyte meta5olism (es!; +* a5normalities)  Anatomical orientation of the heart o <hat yo can see from E(G:  Heart rate

3E directions .n ventricle # de!olari"ation 0 re!olari"ation are 5oth 2P<A$.>? sec@mm 9 $'$ time A>@$'$ time 9 H$ each mm on gra!h 9 >.entric lar -e!olari"ation &ate .entric lar $e!olari"ation &arge    2s ally small 0 !right 3ravels thro gh &eft 5 ndle 5ranch4 then $ight 5 ndle 5ranch . !ick ! 7 leads 9 B cm vertical deflection Dor di!ole going from (')  (*) across chest: Event $es lting di!ole P .Physiology Exam 3 • • •  $'$ distance in mm = >.entric lar -e!olari"ation .m! lse origin 7 SA Node Small /ave Same direction as (atrial de!olari"ation) lead  E Se!tal -e!olari"ation 1!!osite of leads /ave  $ /ave S /ave 3 /ave A!ical (Early) .soelectric line # entire ventricle is de!olari"ed (no voltage difference across leads) # flatline occ rs immediately 5efore 3 /ave B m.ncrease in myocardial mass 9 increase in voltage differences of excitation (higher $ /aves) • Hy!ertro!hy of a heart cham5er /ill increase the am!lit de of the de!olari"ation /ave for that cham5er  Pro5a5le anatomical !osition • &ead /ith the greatest am!lit de is the lead most !arallel to the mean electrical axis • ( rrent o!!osite from lead di!ole 9 negative@do/n/ard deflection • ( rrent !er!endic lar 9 no deflection or 5i!hasic /ave • ( rrent same as lead di!ole 9 !ositive@ !/ard deflection • %ean electrical axis for normal individ als 9 '3>°*B>C° o *A>° ' a!ex of heart !ointed slightly left of midline o left axis deviation ' co nter'clock/ise or '3>° # hy!ertension4 aortic stenosis4 ischemic heart disease o right axis deviation # clock/ise of B>C° ' (1P-4 ! lmonary hy!ertension  (ond ction se: ence !attern  %yocardial damage .>? sec o o o % scle mass • .deflections # meaning they occ r in 1PP1S.

4 0 .. is largest4 lead ..? sec (J'B> mm) $S'3 Segment (S3 segment) • Drom end of E$S  onset of 3 /ave isoelectric • E(G &eads o Einthoven leads  . 5lock o Premat re Systoles .. # left arm4 right arm4 0 left leg  EinthovenFs la/: .f P'$ H >.nterval P'$ ... is largest4 lead . * . • 8ased on +irchoffFs la/ # s m of all !otential differences in a closed circ it is "ero o %ean electrical axis  Heart normally sits 7 A>° ' lead .nterval .nterval %eas res: -istance 5@t ) s ccessive $ /aves Normal .aries /@ H$ &ong E3 syndrome: genetic !ro5lem /@ voltage'gated +* channelsK can s ddenly go into fi5rillation (arrhythmia) S3 elevation@de!ression: S3 segment moves a5ove@5elo/ 5aselineK indicates damage to heart tiss e A'. 9 .Physiology Exam 3 E(G .B sec E'3 .?) sec >.. is largest de!olari"ation4 lead .ntervals $'$ . is do/n/ard (ardiac Arrhythmias o Sin s rhythms (normal 0 a5normal)  8radycardia (G A> 5!m)  3achycardia (H B>> 5!m) o A.)> sec (3'C mm) E$S .4 ..B)'>. 5lock  3rd degree A.. 3ransmission 5locks  Bst degree A.. is do/n/ard  &eft axis shift ' >° ' lead . 5lock  )nd degree A..3'>.ration of electrical systole Drom onset of E /ave  end of 3 /ave 8elo/ >. (ond ction time Drom onset of P /ave  5eginning of E$S com!lex >. is smallest4 all !/ard deflections  $ight axis shift ' B)>° ' lead .) sec  Bst degree heart 5lock Short P'$  PA( or PI( (P /ave is s ally 5i!hasic or inverted) Narro/ /ave d e to s!eed of P rkin6e fi5ers (indicated sin s or s !raventric lar origin) <ide indicates ventric lar origin % lti!le !eaks indicates 5 ndle 5ranch 5lock .nterval 3otal ventric lar de!olari"ation time Drom onset of E /ave (or $ /ave)  termination of S /ave 2!!er limit 9 >.al es 7 a reg lar ventric lar rhythm: A> sec@$'$ interval (sec) 9 H$ (!er min) Dor !a!er 7 )Cmm@sec: H$9 (BC>> mm@min)@$'$ interval (mm) slo/er H$ 9 longer P'$ interval ..

Physiology Exam 3 o  Premat re ventric lar contraction (P.() Di5rillation  (irc s movement  Ecto!ic foc s .

Supraventricular Rhythms Physiology Sin s 8radycardia Exam 3 Sin s 3achycardia Sin s Arrhythmia H$ (haracteristics (a se Result from pacemakers above the ventricle.entric lar myocardi m is !acemaker o tside P rkin6e system) 8locked 7 5 ndle 5ranch or P rkin6e E$S is /ide and notched () or more !eaks) .e to ischemia or myocardial infarction 8locks P rkin6e fi5ers into $ or & ventricle 3rd degree A.) sec A. Delay or block passage of e!citation "aves from atria into ventricles.. 5lock ' high 5lock L ?C 5!m ' lo/ 5lock 8 ndle 8ranch 8lock Esca!e rhythm 9 )>'?> 5!m Ventricular Rhythms Premat re . (<encke5ach) ' %o5it" .entricles may 5e excited a5o t only every 3rd D /ave D /ave may not 5e visi5le if ventricle res!onse is ra!id $'$ intervals are reg lar 8aseline is irreg lar  smooth (looks like noise) Early excitation $'$ interval shorter than !receding se: ence P /ave (if !resent) a!!ears 5i!hasic or inverted P /ave is s ally not !resent $ /aves are narro/ (excitation !asses thr P rkin6e system) Narro/ E$S Atrial Dl tter Atrial $ates 9 ))>'3>> 5!m 1ften a !henomena of children H$ increases near the end of ins!iration 0 slo/s near the end of ex!iration # d e to vagal infl ences of SA node . Driven by SA Node. 5lock ' %o5it" .3) or Atrial fi5rillation or atrial fl tter Altered conduction through AV Node Bundle of His or bundle branches. ?>'A> 5!m BA>'))> 5!m -amage to SA Node (not driven 5y SA node) Atrial or A. nodal cond ction is delayed to the !oint that some excitations do not reach ventricles ?:3 ratios %ore common P'$ intervals get longer4 then ski! one A. node Premat re Atrial (PA() or I nctional (PI() (om!lex I nctional (A. node is !acemaker $eg lar P /aves (atria 5eat on their o/n) Atria 0 ventricles have ) different rhythms $eg lar4 5 t slo/er E$S /aves (dissociated from P /aves) <ide E$S /aves (slo/ cond ction . Nodal) $hythm S !raventric lar 3achycardia Heart Block Bst degree A. P'$ interval H Dixed4 5 t !rolonged P'$ intervals -elayed cond ction thr A. node or 6 nction !ro5lem E$S com!lex (cond ction is 5locked) (onstant ski! 2s ally from myocardial infarction P$ ratios are ):B or 3:B -angero s P$ intervals donFt lengthen4 s ddenly dro! %ay !roceed to 3rd degree heart 5lock E$S (om!lete 5lockage (nothing gets from atria  ventricle) .e to large atrial reentry !ath/ays Atrial Di5rillation $andom /aves of excitation circling thr atria 0 im!inging randomly on A. H$ G A> 5!m H$ H B>>'BC> 5!m P /ave may 5e s !erim!osed on the last !art of the 3 /ave <aves are normal4 5 t irreg lar P /aves are !resent 0 vary /ith re!iratory activity . 5lock )nd degree A.entric lar E$S H >.entricles develo! a se!arate !acemaker (an lead to hy!otension@ nconscio sness $andom P'$ intervals &o/er !ortion of A.B) sec (3mm) /ide 3 /aves inverted (di!ole is on o!!osite direction of excitation) <ide /aves /@ greater than normal am!lit de Ecto!ic !acemakers s ally donFt se P rkin6e system # excitation is cond cted more slo/ly Arise from ischemic or irritated myocardi m -e!olari"ation 0 re!olari"ation are . node >. node reentry (PS.

Physiology Exam 3 A5normal E(G • 3hings that ca se fi5rillation o &ong !ath/ay # dilated heart o -ecreased rate of cond ction # P rkin6e 5lock4 ischemia4 high 5lood M+*N o Shortened refractory !eriod # dr gs4 e!ine!hrine4 re!etitive electric stim lation .