EKG

2011

cNa

iCaL cKto1

cK1 iNa iKto1

EPI 1, 2, 3; ACh 1, 2, 3

1. Slope of diastolic depolarization

2. Maximum diastolic potential 3. Threshold potential

P Wave = Depolarization of Atria PR interval = Depolarization of AV node QRS complex = Depolarization of Purkinje & Ventricular fibers, completed ST Segment = Plateau of ventricles (phase 2) T Wave = Repolarization of Ventricles, completed

FIGURE 20-6. Components of the electrocardiogram (ECG) recording.

Acute Myocardial Ischemia

ECF K transmembrane concentration gradient RMP nearer to threshold partial depolarization during phase 4 Lesser # fast Na channels opening during phase 0 as RMP Na influx amplitude of phase 0

1. Heart rate? 2. P waves? 3. Relationship of P

waves and QRS? 4. Mean QRS axis? 5. QRS shape (narrow, wide)? 6. ST segment? 7. PR, QRS, QT intervals? 8. Rhythm?

2:20

Heart Valves & Heart Sounds

Heart Sounds

S1

S2

Closure

of AV valves Low, loud and long Lub

Closure

of SL valves High, soft and short Dub

Heart Sounds

S3

S4

Vibration of blood on ventricular walls Low, loud Children; thin-walled Suggests heart failure Early diastole

Vibration of blood on ventricular walls Low, soft Elderly Suggests heart failure Late diastole

2:30

Mitral Valve Anomalies

Mitral Stenosis

Mitral regurgitation
Apex Systolic ZHHHH Poor forward flow

Apex Diastolic Lub-Dub-Brrr Inability to fill LV backward failure

Aortic Valve Anomalies

Aortic stenosis

Aortic regurgitation

Base Systolic sSSSHHHH Poor forward flow

Base Diastolic Lub-bhuu-Dub Poor forward flow