cardiovascular physiology and monitoring tariq alzahrani m.d assistant professor college of medicine...
TRANSCRIPT
![Page 1: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/1.jpg)
Cardiovascular Physiology and Monitoring Tariq Alzahrani M.DAssistant Professor College of Medicine King Saud University
![Page 2: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/2.jpg)
![Page 3: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/3.jpg)
Coronary Circulation Blood Supply RCA LCA
Conduction System SAN AVN
Coronary Perfusion Pressure (50-120mmHg)
ADBP – LVEDP
![Page 4: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/4.jpg)
Cardiac Cell Types• Electrical cells Generate and conduct impulses rapidly• SA and AV nodes• Nodal pathways• No contractile properties
• Muscle (myocardial) cells Main function is contraction• Atrial muscle• Ventricular muscle• Able to conduct electrical impulses• May generate its own impulses with certain types of stimuli
![Page 5: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/5.jpg)
PURKINJE FIBERS
BUNDLEBRANCHES
Sino-atrial(SA) node
Atrio-ventricular (AV) node
![Page 6: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/6.jpg)
INTERCALATED DISC (TIGHT JUNCTION)
![Page 7: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/7.jpg)
Nerve impulse Terminology• Resting state The relative electrical charges found on each
side of the membrane at rest • Net positive charge on the outside • Net negative charge on the inside
• Action PotentialChange in the electrical charge caused bystimulation of a neuron
![Page 8: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/8.jpg)
Action Potential Terms• DepolarizationThe sudden reversal of electrical chargesacross the neuron membrane, causing thetransmission of an impulse• Minimum voltage must be met in order to do this
• Repolarization Return of electrical charges to their originalresting state
![Page 9: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/9.jpg)
Automaticity (P Cells)• Prepotential, Resting Potential,
Diastolic Depolarization• Action Potential• Repolarization
Factors That Affect Automaticity:Sympathetic and parasympathetic outflow will affect the prepotential phaseTemperatureRA and SAN stretchHormonesDrugs
Distribution Of P Cells
![Page 10: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/10.jpg)
Conduction SpeedA-V nodal conduction:One way conductionA-V nodal Delay (0.1 sec)
Factors Affecting Conductivity:Sympathetic and vagal infuinceTemperatureHormonsIschemiaAcidosisDrugs
![Page 11: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/11.jpg)
MEM
BRAN
E P
OTE
NTI
AL (m
V)
-90
0
0
12
3
4
TIME
PHASE0 = Rapid Depolarization (inward Na+ current) 1 = Overshoot (outward K+ current)
2 = Plateau (inward Ca++ current)
3 = Repolarization (outward K+ current)
4 = Resting Potential
Mechanical Response
(outward K+ current)(inward Na+ current)
![Page 12: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/12.jpg)
MEM
BRAN
E P
OTE
NTI
AL (m
V) 0 0
-50 -50
-100 -100
SANVENTRICULULARCELL
ACTION POTENTIALS
0
12
3
4
4
0 3
![Page 13: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/13.jpg)
Cardiac MyocyteStructureCa++ ReleaseExcitation-Contraction
Coupling
![Page 14: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/14.jpg)
The Fibrous A-V Ring
![Page 15: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/15.jpg)
THE ANATOMY OF BLOOD VESSELS
• Layers:1. Tunica interna (intima)
2. Tunica media
3. Tunica externa (adventitia)
![Page 16: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/16.jpg)
Comparison of Veins and Arteries
Arteries: Veins:
![Page 17: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/17.jpg)
The Distribution of Blood
![Page 18: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/18.jpg)
Cardiac Output CO = SV x HR• The amount of blood ejected from theventricle in one minute• Stroke volume Amount of blood ejected from the ventricle inone contraction• Heart rateThe # of cardiac cycles in one minute
![Page 19: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/19.jpg)
Determination of Stroke Volume• Preload Amount of blood delivered to the chamber Depend upon venous return to the heart Also dependent upon the amount of blood delivered to the
ventricle by the atrium• Contractility The efficiency and strength of contraction Frank Starling’s Law• Afterload Resistance to forward blood flow by the vessel walls
![Page 20: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/20.jpg)
• End-diastolic volume (110-120 mL)• End-systolic volume (40-50 mL)• Stroke volume (70 mL)• Ejection fraction (60%)
![Page 21: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/21.jpg)
Pressure-Volume Loops
![Page 22: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/22.jpg)
Volume Load ►
Pressure Load ►
![Page 23: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/23.jpg)
Regulation of Cardiovascular System
• Neural Mechanisms–Vasoconstriction
–Vaosdilation
–Baroreceptors
–Chemoreceptors
![Page 24: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/24.jpg)
Nerve Supply of the Conduction System
SANReceives right vagal and right sympathetic supply
AVNReceives left vagal and left sympathetic supply
The rest of the conduction system receive sympathetic supply (like ventricle)
![Page 25: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/25.jpg)
![Page 26: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/26.jpg)
HORMONAL REGULATION
• Epinephrine & Norepinephrine– From the adrenal medulla
• Renin-angiotensin-aldosterone– Renin from the kidney– Angiotensin, a plasma protein– Aldosterone from the adrenal cortex
• Vasopressin (Antidiuretic Hormone-ADH) _ ADH from the posterior pituitary• ANP from RA
![Page 27: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/27.jpg)
BP (Kidney) Renin
Angiotensinogen (renin substrate)
Angiotensin
Aldosterone
Kidney
sodium & water retention
Vasoconstriction
Venoconstriction
RENIN-ANGIOTENSIN-ALDOSTERONE MECHANISM
![Page 28: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/28.jpg)
HypothalamicOsmoreceptors
BP via Posterior Pituitary Vasopressin (ADH)
Vasoconstriction WaterVenoconstriction Retention
VASOPRESSIN(ANTIDIURETIC HORMONE)
![Page 29: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/29.jpg)
![Page 30: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/30.jpg)
![Page 31: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/31.jpg)
![Page 32: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/32.jpg)
How To interpret ECG?
1. Rate?
2. QRS Duration?
3. Stability?
![Page 33: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/33.jpg)
ECG limb leads
![Page 34: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/34.jpg)
![Page 35: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/35.jpg)
Normal ECG
![Page 36: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/36.jpg)
• P wave corresponds to depolarization of SA node
• QRS complex corresponds to ventricular Depolarization
• T wave corresponds to ventricular repolarization
• Atrial repolarization record is masked by the larger QRS complex
![Page 37: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/37.jpg)
Measurements
Small square = 0.04 sec.
Large square = 5 small square = 0.2 sec.
One second = 5 large square.
One minute = 300 large square.
![Page 38: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/38.jpg)
P duration = 3 small sqs = 0.12 sec.
P height = 3 small sqs = 0.12 sec.
QRS duration=3 small sq=0.12 sec.
P-R interval = 5 small sq = 0.2 sec.
Remember This 3, 3, 3 and 5
![Page 39: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/39.jpg)
Right ventricular hypertrophy (precordial leads)
![Page 40: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/40.jpg)
Left ventricular hypertrophy (precordial leads)
![Page 41: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/41.jpg)
QRS voltage decrease
• Myocardial infarction (decrease of excitable myocardium mass)• Fluids in the pericardium (short-circuits of currents within pericardium)• Pulmonary emphysema (excessive quantities of air in the lungs)
![Page 42: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/42.jpg)
J-point:
ST-segment shift –sign of current ofinjury
-Time point of completeddepolarization (zero reference)-The junction of the QRS and the ST segment
![Page 43: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/43.jpg)
Injury currents: constant source
• Mechanical trauma• Infectious process• Ischemia
![Page 44: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/44.jpg)
• Ischemia= ST depression or T-wave inversion Represents lack of oxygen to myocardial tissue
![Page 45: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/45.jpg)
• Injury = ST elevation -- represents prolonged ischemia; significant when > 1 mm above the baseline of the segment in two or more leads
![Page 46: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/46.jpg)
• Infarct = Q wave — represented by first negative deflection after P wave; must be pathological to indicate MI
![Page 47: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/47.jpg)
What part of the heart is affected ?II, III, aVF =
Inferior Wall
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
![Page 48: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/48.jpg)
Which part of the heart is affected ?
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
• Leads V1, V2, V3, and V4 =
Anterior Wall MI
![Page 49: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/49.jpg)
What part of the heart is affected ?
I, aVL, V5 and V6 Lateral wall of left
ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
![Page 50: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/50.jpg)
• I, aVL, V5 + V6 = Lateral Wall = Circumflex Artery Blockage
![Page 51: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/51.jpg)
RateIf regular: Divide 300/ number of large squares between 2 Rs = HR
If irregular: count number of complexes in 6 sec. and multiply by 10
- Normal 60 -100
- Bradycardia < 60
- Tachycardia > 100
P = Sinus
No P = Non sinus
![Page 52: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/52.jpg)
Rate > 100.
QRS: Narrow.
Stable or unstable.
Rate < 60.
QRS: Narrow.
Stable or unstable.
Sinus tachycardia.
PSVT.
Atrial flutter.
Atrial fibrillations.
Sinus bradycardia.
1st degree HB.
2nd degree HB.
Complete HB.
Supraventricular Rhythm
![Page 53: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/53.jpg)
Supraventricular Rhythm: Tachycardia
Sinus Tachycardia
![Page 54: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/54.jpg)
Paroxysmal SVT
Supraventricular Rhythm: Tachycardia
![Page 55: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/55.jpg)
Atrial Flutter
Supraventricular Rhythm: Tachycardia
![Page 56: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/56.jpg)
Atrial Fibrillations
Supraventricular Rhythm: Tachycardia
![Page 57: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/57.jpg)
Supraventricular Rhythm: Bradycardia
Sinus Bradycardia
Normal Sinus Rhythm
![Page 58: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/58.jpg)
Supraventricular Rhythm: Bradycardia
1st Degree HB
![Page 59: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/59.jpg)
Supraventricular Rhythm: Bradycardia
2nd Degree HB: Mobitz 1 Wenckebach.
Progressive lengthening of the P-R interval with intermittent dropped beat.
![Page 60: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/60.jpg)
Supraventricular Rhythm: Bradycardia
Sudden drop of QRS without prior P-R changes
2nd Degree HB: Mobitz 2
![Page 61: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/61.jpg)
Supraventricular Rhythm: Bradycardia
3rd Degree HB
![Page 62: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/62.jpg)
The right bundle brunch block (precordial leads)
![Page 63: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/63.jpg)
Left bundle branch block (precordial leads)
![Page 64: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/64.jpg)
Characteristics of PVCs• QRS prolongation due to slower conduction in
the muscle fibers• QRS high amplitude due to lack of synchrony of excitation of RV and LV which causes partial neutralization of their contribution to the ECG• QRS and T-wave have opposite polarities, again
due to slow conduction which causes repolarization to follow depolarization.
![Page 65: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/65.jpg)
Ventricular Rhythm
Idioventricular Rhythm.
![Page 66: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/66.jpg)
Ventricular Rhythm
Accelerated Idioventricular Rhythm.
![Page 67: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/67.jpg)
Ventricular Rhythm
![Page 68: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/68.jpg)
Ventricular Rhythm
![Page 69: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/69.jpg)
Pacer Rhythm
Ventricular Rhythm
![Page 70: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/70.jpg)
Stability
* Stable patient: think of drug therapy.
* Unstable patient: think of electric therapy.
![Page 71: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/71.jpg)
Treatment
Supraventricular Rhythm:
Stable = Drugs
Adenosine.
B blocker.
Ca channel blocker.
Digoxin.
Unstable = Electric
DC, Synchronized
![Page 72: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/72.jpg)
Treatment
Ventricular Rhythm:
Stable = Drugs
Amiodarone.
Lidocaine.
Procainamide.
Unstable = Electric
DC, Non Synchronized
![Page 73: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/73.jpg)
![Page 74: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/74.jpg)
Normal Venous Tracing
a ► Atrial Contraction
c ► Isometric (V) Contraction
x ► Mid-Systole
v ► Venous Filling (Atrial)
y ► Rapid Filling (Ventricular)
![Page 75: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/75.jpg)
![Page 76: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/76.jpg)
![Page 77: Cardiovascular Physiology and Monitoring Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University](https://reader035.vdocuments.site/reader035/viewer/2022062517/56649f325503460f94c4e8e7/html5/thumbnails/77.jpg)
THANK YOU