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Endocardium

The innermost layer of the heart, it forms the lining and folds back onto itself to form the four valves. It is in this layer that the conduction system is found

Myocardium

Muscular layer of the heart

Epicardium

The outermost layer of the heart. It is actually the inner layer of the pericardium

Right atrium

Receives deoxygenated blood returning to the heart from the body via the superior vena cav which carries blood from the upper body and the inferior vena cava which carries blood from the lower body.

Right ventricle

Receives deoxygenated blood from the right atrium which pumps to the lungs for oxygenation through the pulmonary artery (trunk) to the right and left pulmonary arteries

Left atrium

Receives oxygenated blood returning from the lungs via the right and left pulmonary veins.

Left ventricle

Receives the oxygenated blood from the left atrium and pumps it to the body through the aorta, the largest artery of the body.

The two semilunar valves

Pulmonic valves and aortic valves

Heart Sounds S1

First heart sound is due to the closure of the mitral and tricuspid valves

Heart Sounds S2

Second heart soudn is due to closure of the aortic and pulmonic valves

Coronary arteries

The arteries supplying the heart with blood

Sympathetic Nervous System

Affects both the ventricles and atrium by increasing heart rate, conduction and irritability

Parasympathetic Nervous System

Affects the atria only by decreasing heart rate, conduction and irritability

Automaticity

This is the ability of the cardiac cells to stimulate their own electrical impulse without being stimulated from another source

Excitability

Irritability, shared by all cardiac cells and it the ability to respond to external stimulus; electrical, chemical and mechanical

Conductivity

This is the ability of all cardiac cellls to receive and electrical stimulus adn transmit the stimulus ot the other cardiac cells

Contractility

This is the ability of the cardiac cells to shorten and cause cardiac muscle contraction in response to an electrical stimulus

SA node

Primary pacemaker of the heart, instrinisc rate of 60 -100 beats per minute

AV node

Located at the posterior septal wall of the right atrium, just above the tricuspid valve. There is a 1/10th of a second delay of electrical activity at this level to allow the blood to flow from the atria to the ventricles. Intrinsic rate of 40-60 beats per minute

Bundle of His

Found at the superior portion of the interventricular septum, it is the pathway that leads to the SA node. Intrinsic rate 40-60 beats per minute.

Bundle Branches

Located at the interventricular septum. The bundle of His divides into the right and left bundle branches. The function is to conduct the electrical impulse to the purkinje fibers.

Purkinje Fibers

Found within the ventricular endocardium. Instrinsic rate is 20-40 beats per minute.

Unipolar Precordial Leads

V1,V2,V3,V4,V5 and V6

25mm/sec

The normal running speed of the EKG

1 MV will produce a deflection of

10mm

Waveform

Refers to the movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection

Segment

Line between two waveforms

Interval

Waveform plus segment

Complex

Several waveforms

P wave

atrial depolarization

QRS complex

Ventricular Depolarization

T wave

Ventricular Repolarization

U wave

Late repolarization, a prominent one could indicate hypokalemia

RR interval

The interval between two Rs

PR interval measurement

0.12-.20 second

QRS interval measurement

0.06-.12 second

Somatic tremors

Artifact - Patient tremors or shaking the wires can produce jittery patterns on the EKG tracings.

Wandering baseline

Sweat or lotion on the patients skin or tension on the electrode wires can interfere with the signal going to the ekg apparatus causing the baseline of the tracing to move up and down on the ekg paper

60 cycle interference

Can produce deflections occuring at a rapid rate that may mimic atrial flutter. This is caused by electrical appliances or apparatus being used nearby while the tracing

Broken Recording

The stylus goes up and down trying to find the signal. This can be caused by loose electrode or cables or by frayed or broken wires

Indications for Stress Testing

Evaluation of Chest pain in patient with normal EKG. Evaluation of patient who has recently had a myocardial infarction. Diagnosis and Treatment of arrythymias

Standardization

1mv should produce a deflection of 1 cm (10mm)

Indications for Stopping Stress Test

Chest pain, Shortness of breath (SOB), dizziness, and blood pressure abnormalities

Target Heart Rate

220 minus patient age.

Heart rate for valid Stress test

85% of 220 minus patient age

Indications for pharmalogic stress test

patients with physical limitations.

Arrhythmias of sinus origin

Where electrical flow follows the usual conduction pathway but it too fast, too slow or regular.

ectopic rhythms

Electrical impulses originate from somewhere else other than the sinus node

conduction blocks

Electrical impulses go down the usual pathway but encounter blocks and delays.

Preexcitation Syndrome

The electrical impulses bypass the normal pathway and instead go down an accessory shortcut.

Ischemia

Occurs when there is a decrease in the amount of blood flow to a section of the heart. This is usually experienced as chest pain and discomfort and is called angina

Four elements of negligence

duty, derelict, direct cause and damage.To

Tort

A wrongful act that results in injury to one person by another.

Battery

Unprivileged touching of one person by another

Invasion of privacy

This is the release of medical records without the patient's knowledge and permission

Libel

Written defamation of character

slander

Spoken defamation of character

Chain of Infection ( in order)

Agent, portal of exit, mode of transmission, portal of entry and susceptible host

Medical Asepsis

the destruction of pathogenic organisms after they leave the body

The pulmonary arteries

Carry deoxygenated blood to the lungs.

The pulmonary veins

carry oxygenated blood from the lungs to the heart

veins

carry deoxygenated blood back to the heart

arteries

carry oxygenated blood away from the heart

Septum

separates the heart into two halves

Lead I ( negative and positive)

right arm - and left arm+

Lead II (negative and positive)

right arm- and left leg +

Lead III (negative and positive)

left arm - and left leg +

Limb leads

Leads I, II and III

Augmented leads

AVr, AVL and AvF

Frontal leads

bipolar and augmented
Lead I, II and III, AVR, AVL and AVF

AVR (positive)

right arm

AVL (positive)

left arm

AVF

postive left leg

oxygen

should be given to all patients with acute chest pain that may be due to cardiac ischemia. Prompt treatment of the hypoxemia may prevent cardiac arrest.

Isoproterenol (Isuprel)

An overall increase in heart rate and myocardial contractility, but never agents have replaced in most clinical settings. It is contraindicated in routine treatment of cardiac arrest.

Beta Blockers

Reduces heart rate, blood pressure, myocardial contractility, and myocardial oxygen consumption with make them effective in the treatment of angina pectoris and hypertension. They preventing atrial fibrillation, atrial flutter, and parosysmal supra-ventricular tachycardia.

Dopamine

This is indicated for significant hypotension in the absence of hypovolemia. Significant hypotension is present when systolic blood pressure is less than 90mmHg with evidence of poor tissue perfusion, oliguria and changes in mental status. It should be used at the lowest dose that produces adequate perfusion of vital organs

Lidocaine

This is the drug of choice for the suppression of ventricular ectopy, including ventricular tachycardia and ventricular flutter. Excessive doses can produce neurological changes, myocardial depression, Neurological toxicity is manifested as drowsiness, disorientation, decreased hearing ability, parethesia, and muscle twitching, and eventual seizures.

Verapamil

Is the treatment of paroxysmal supraventricular tachycardia (PSVT)effective in terminating more than 90% of episodes of PSVT in adults and infants.

Digitalis

Increases the force of cardiac contraction as well as cardiac output. Toxicity is common with an incidence of up to 20%. Patients require constant monitoring for signs and symptoms of toxicity such as: yellow vision, nausea, vomiting, and drowsiness.

Morphine Sulfate

This is the traditional drug of choice for pain and anxiety associated with acute myocardial infarction. In high doses may cause respiratory depression. It is a controlled substance and has a tendency for abuse and addiction.

Nitroglycerin

Is a powerful smooth muscle relaxant effective in relieving angina pectoris. It is effective for both exertional and rest angina. Headache is common following the administration of this drug. Hypotension may occur and patients should be instructed to sit down or lie down while taking nitroglycerin.

Infomed consent

This is consent given to the patient who is made aware of any procedure to be performed, its risks, expected outcomes and alternatives

4 elements of negligence

Duty- Duty of care
Derelict- Breach of duty of care
Direct Cause- Legally recognizable injury occurs as a result of the breach of duty of care
Damage- Wrongful activity must have caused the injury or harm that occured.

Battery

The basis of tort in this case is the unprivileged touching of one person by another. When a procedure is performed the patient must givve consent in full knowledge.

Invasion of privacy

This is the release of medical records with the patient's knowledge and permission

Defamation of character

This consists of injury to another person's reputation, name, or character.

slander

Spoken defamation of character

Libel

Written defamation of character

Chain of Infection (Order)

Agent-Portal of Exit-Mode of Transmission_Portal of Entry-Susceptible Host

Medical Asepsis

The destruction of pathogenic microorganisms after they leave the body.

Handwashing

Most important means of preventing the spread of infection

Barrier Protection

Also called PPE Masks, gloves, face shields, and respirator

Standard Precautions

Infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices. These include wearing gloves, wearing face shields when there is danger for splashing on mucous membranes and disposing of all needles and sharp object in puncture proof containers without recapping.

Contact Precautions

Designed to reduce the risk of transmission of microorganisms by direct or indirect contact. Involves skin to skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person.

Airborne Precautions

Designed to reduce the risk of airborne transmission of infectious agents. Special air handling and ventilation are required to prevent airborne transmission.

Droplet Precautions

Designed to reduce the risk of droplet transmission of infectious agents. Droplet transmission involves contact with the mucous membranins of the nose or mouth of a susceptible person with large particle droplets generated from the source person through coughing, sneezing, or talking. Usually travel only three feet.

Tricuspid valve

Located between the right atrium and right ventricle. It has three cusps.

Mitral valve

Located between the left atrium and left ventricle. It has two cusps. Also called biscuspid valve

Latex sensitivity

An emerging and important problem in the heatlh field.

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