ECG

Heart Beat Anatomy

SINUS NODE
Sinus Node (SA Node)

The Hearts Natural Pacemaker - 60-100 BPM at rest

Heart Beat Anatomy

AV NODE
Sinus Node (SA Node)

Receives impulse from SA Node Delivers impulse to the HisPurkinje System 40-60 BPM if SA Node fails to deliver an impulse

Atrioventricular Node (AV Node)

Heart Beat Anatomy

BUNDLE OF HIS
Sinus Node (SA Node)

Begins conduction to the Ventricles AV Junctional Tissue: 40-60 BPM

Atrioventricular Node (AV Node)

Bundle of His

Heart Beat Anatomy

THE PURKINJE NETWORK
Sinus Node (SA Node)

Atrioventricular Node (AV Node)

Bundle Branches Purkinje Fibers Moves the impulse through the ventricles for contraction Provides 20-40 BPM

Bundle of His Bundle Branches

Purkinje Fibers

Normal Sinus Rhythm

Impulse Formation In SA Node

Initiation of the cardiac cycle normally begins with initiation of the impulse at the SA (sinoatrial) node.

Atrial Depolarization

After the SA node fires, the resulting depolarization wave passes through the right and left atria, which produces the P-wave on the surface EKG and stimulates atrial contraction.

Delay At AV Node

Impulse proceeds to the AV node, slows impulse conduction, which allows time for the atria to contract and for blood to be pumped from the atria to the ventricles prior to ventricular contraction. Conduction time through the AV node accounts for most of the duration of the PR interval.

Conduction Through Bundle Branches

After the impulse passes through the bundle of His, it proceeds through the left and right bundle branches. A small portion of the last part of the PR interval is represented by the conduction time through the bundle branches.

Conduction Through Purkinje Fibers

Next the impulse passes through the Purkinje fibers (interlacing fibers of modified cardiac muscle). Conduction time through the Purkinje system is represented by a small portion of the last part of the PR interval.

Ventricular Depolarization

The impulse passes quickly through the bundle of His, the left and right bundle branches, and the Purkinje fibers, leading to depolarization and contraction of the ventricles. The QRS complex on the EKG represents the depolarization of the ventricular muscle mass.

Plateau Phase of Repolarization

The Plateau Phase lasts up to several hundred milliseconds.

Final Rapid (Phase 3) Repolarization

Repolarization of the ventricles generates a current in the body fluids and produces a T-wave. This takes place slowly, and generates a wide wave.

Normal EKG Activation

Atrial contraction

Atrioventricular node

Ventricular contraction

Ventricular relaxation

CARDIAC CYCLE
Atria contract simultaneously Atria relax, then ventricles contract Systole = contraction Diastole = relaxation

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The Cardiovascular System

REX KARL S. TEOXON, RN, MD

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HEART SOUNDS
1. S1- due to closure of the AV valves 2. S2- due to the closure of the semi-lunar valves

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Cardiac Output
Cardiac output (CO)
Amount of blood pumped by each side of the heart in one minute

CO = (heart rate [HR]) x (stroke volume [SV])

Stroke volume
Volume of blood pumped by each ventricle in one contraction
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The FrankStarling law

the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart when all other factors remain constant. The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully

CORONARY CIRCULATION
Blood in the heart chambers does not nourish the myocardium The heart has its own nourishing circulatory system
Coronary arteries Cardiac veins Blood empties into the right atrium via the coronary sinus
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The heart itself must receive enough oxygenated blood. Blood is supplied to the heart through the coronary arteries, two main branches which originate just above the aortic valve.

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The Cardiovascular System

The venous drainage of the heart 1. Cardiac veins 2. Coronary sinus

REX KARL S. TEOXON, RN, MD

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Heart attack (myocardial infarction or MI) Heart attack is when part of the heart muscle dies. This is usually caused by a blood clot (coronary thrombosis), which has blocked one of the coronary arteries supplying the heart and depriving the tissues of oxygen.
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Myocardial infarction

Death of myocardial tissue in regions of the heart with abrupt interruption of coronary blood supply
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VASCULAR SYSTEM
The vascular system consists of the arteries, veins and capillaries The arteries are vessels that carry blood away from the heart to the periphery The veins are the vessels that carry blood to the heart The capillaries are lined with squamos cells, they connect the veins and arteries

REX KARL S. TEOXON, RN, MD

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Blood Vessels: The Vascular System

Taking blood to the tissues and back
Arteries

Arterioles
Capillaries Venules Veins

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ANATOMY OF BV

Three layers (tunics) Tunic intima

Endothelium

Tunic media
Smooth muscle
Controlled by sympathetic nervous

system Tunic externa Mostly fibrous connective tissue

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The Vascular System

Figure 11.8b
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings REX KARL S. TEOXON, RN, MD

Slide 11.24
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Differences Between Blood Vessel Types

Walls of arteries are the thickest
Lumens of veins are larger

Skeletal muscle milks blood in veins toward the heart

Walls of capillaries are only one cell layer thick to allow for exchanges between blood and tissue
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MOVEMENT OF BLOOD THROUGH VESSELS

Most arterial blood is pumped by the heart Veins use the milking action of muscles to help move blood

Figure 11.9
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