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

Physiology Exam 3

$'$ distance in mm = >;>? sec@mm 9 $'$ time A>@$'$ time 9 H$ each mm on gra!h 9 >;>? sec

o o o

% scle mass .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 .n ventricle # de!olari"ation 0 re!olari"ation are 5oth 2P<A$- deflections # meaning they occ r in 1PP1S.3E directions .soelectric line # entire ventricle is de!olari"ed (no voltage difference across leads) # flatline occ rs immediately 5efore 3 /ave B m, !ick ! 7 leads 9 B cm vertical deflection

Dor di!ole going from (') (*) across chest: Event $es lting di!ole P .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) ,entric lar -e!olari"ation &ate ,entric lar -e!olari"ation ,entric lar $e!olari"ation &arge

2s ally small 0 !right 3ravels thro gh &eft 5 ndle 5ranch4 then $ight 5 ndle 5ranch

Physiology Exam 3

E(G .ntervals $'$ .nterval P'$ .nterval %eas res: -istance 5@t ) s ccessive $ /aves Normal ,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 .f P'$ H >;) 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 ,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', (ond ction time Drom onset of P /ave 5eginning of E$S com!lex

>;B)'>;)> sec (3'C mm)

E$S .nterval

3otal ventric lar de!olari"ation time Drom onset of E /ave (or $ /ave) termination of S /ave

2!!er limit 9 >;B sec

E'3 .nterval

- ration of electrical systole Drom onset of E /ave end of 3 /ave

8elo/ >;?) sec >;3'>;? 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 .4 ..4 0 ... # left arm4 right arm4 0 left leg EinthovenFs la/: .. 9 . * ... 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 .. is largest de!olari"ation4 lead . is smallest4 all !/ard deflections $ight axis shift ' B)> ' lead ... is largest4 lead . is do/n/ard &eft axis shift ' > ' lead . is largest4 lead ... 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, 3ransmission 5locks Bst degree A, 5lock )nd degree A, 5lock 3rd degree A, 5lock o Premat re Systoles

Physiology Exam 3

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. Driven by SA Node. 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 ,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 - e to large atrial reentry !ath/ays

Atrial Di5rillation

$andom /aves of excitation circling thr atria 0 im!inging randomly on A, node

Premat re Atrial (PA() or I nctional (PI() (om!lex I nctional (A, Nodal) $hythm S !raventric lar 3achycardia Heart Block Bst degree A, 5lock )nd degree A, 5lock ' %o5it" . (<encke5ach) ' %o5it" .. ?>'A> 5!m BA>'))> 5!m

-amage to SA Node (not driven 5y SA node)

Atrial or A, node reentry (PS,3) or Atrial fi5rillation or atrial fl tter Altered conduction through AV Node Bundle of His or bundle branches. Delay or block passage of e!citation "aves from atria into ventricles. P'$ interval H Dixed4 5 t !rolonged P'$ intervals -elayed cond ction thr A, node >;) sec 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 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) ,entricles develo! a se!arate !acemaker (an lead to hy!otension@ nconscio sness $andom P'$ intervals &o/er !ortion of 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$S /aves (slo/ cond ction ,entric lar myocardi m is !acemaker o tside P rkin6e system) 8locked 7 5 ndle 5ranch or P rkin6e E$S is /ide and notched () or more !eaks) - e to ischemia or myocardial infarction 8locks P rkin6e fi5ers into $ or & ventricle

3rd degree A, 5lock ' high 5lock

L ?C 5!m

' lo/ 5lock 8 ndle 8ranch 8lock

Esca!e rhythm 9 )>'?> 5!m

Ventricular Rhythms Premat re ,entric lar

E$S H >;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

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