Anatomy
Where is the moderator band located and what is its function
Right ventricle – transmits part of the right bundle branch to the anterior papillary muscle, enabling coordinated depolarisation of the right ventricle.
List the waves from start to finish of the ECG and what they represent
P-wave = Atrial depolarization
QRS Complex = Ventricular depolarization
T- wave = Ventricular repolarization
Describe the following
Paroxysmal nocturnal dyspnea
Orthopnea
(what are some good questions to ask on this topic)
Explain why these signs occur
Paroxysmal nocturnal dyspnea - waking at night SOB
Orthopnea - SOB when laying
Q. How many pillows do you sleep on, do you sleep in a chair
Redistribution of pulmonary oedema over the larger horizonal plain, also increased venous return when laying
What is the other name for the Epicardium
Visceral serous pericardium
What are the components of the intercalated disk
Desmosomes - structural
Gap junctions - electrical
What does the S-wave represent
Depolarization of the base of the left ventricle
List some signs for peripheral vascular disease
Thinning or hair and skin + shiny skin
Claudication
Cool temperature
What is the most common location for a atrial thrombus to from
Left atrial appendage
Outline the order of cardiac valves starting from RA
Tricuspid (AV)
Pulmonary (SL)
Mitral/tricuspid (AV)
Aortic (SL)
The ST-segment aligns with which phase of the AP
Phase 2 (the plateau)
What is the normal location of the apex beat
5th ICS MCL
Outline the filling of the coronary arteries and how rate related ischemia may occur as a result
Coronary arteries arise from the aortic root - Coronary arteries fill during diastole when column of blood retroflows, closes Aortic valve and is funneled into the sinuses.
High HR results in short diastolic period, reduces filling time and can result in rate related hypoperfusion which manifests as global myocardial ischemia
What electrically isolates the atria and ventricles
Fibrous Skellington
What are the 7 phases of the cardiac cycle
When assessing JVP, what position should the patient be in? What vessel are we looking for? Where do we expect it to be located?
Internal jugular vein
45 degree with slight rotation
Between the heads of the SCM just above the clavicle
Complete the equation
MAP =
MAP = SVR x CO
Outline the pathway of electricity in the heart
SA node
AV node
Bundle of HIS
Left and right bundle branches
Purkinje fibers
Factors influencing venous return (sorry I couldn't think of a hard ECG question)
1. Skeletal muscle pump and valves
2. Respiratory pump – decreased intrathoracic pressure during inspiration
3. Venoconstriction – venous smooth muscle constriction prevents peripheral pooling
4. Blood volume – increased volume = increased return
In what areas do we listen for specific valves when auscultating the precordium
RUSB - Aortic
LUSB - pulmonary
LLSB - tricuspid
Apex - mitral (over apex beat)
Explain the frank starling effect
An increase in end diastolic volume results in a greater stroke volume (to a certain degree) - optimized myosin/actin overlap