striated muscle

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striated muscle heart muscle smooth
muscle
excitation contraction coupling
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Description of curves
P Impulse spread through atria PQ neutral
(isoelectric) line after depolarisation of all
atria myocardium QRST ventricle complex Q
negative oscillation beginning of ventricle
depolarisation in septum R continue of
depolarisation wave through the ventricle S
 negative oscillation activation of last part
of ventricle myocardium in left ventricle base
ST neutral (isoelectric) line after ventricle
depolarisation (plató phase in action
potential) T repolarisation from epicardium to
endocardium
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According to the amplitude, lower or upper case
is usedgt 5 mm - Q, R, Slt 5 mm - q, r, s
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-90o
aVF
-60o
-120o
III
-30o
-150o
aVL
I
0o
180o
aVR
150o
30o
II
120o
60o
90o
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Action potential
SA node
Myocardium
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Examples of pathological ECG
Sinusoidal rhythm and fibrilation of atria AV
block
Heart attack
Fibrilation of ventricles
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AV block
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1. Blokáda levého raménka Tawarova (BLRT)
(synonymum LBBB - left bundle branch block)
According to the QRS interval      -complet
block - QRS gt 0,12s      -incomplet - QRS lt
0,11s Incidence heart attack (congenital LBBB
extremely rare. aortal stenosis or diphteria)
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Blokáda pravého raménka Tawarova (BPRT) (RBBB -
right bundle branch block)
Incidence RBBB heart attack, chronic cor
pulmonale, atrium septal defect. incomplete RBBB
normal in cyclist and boaters (volume load to
right ventricle).
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extrasystole
supraventricular
ventricular
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reentry
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ECG leads
R On the right arm, avoiding bony prominences RED
L In the same location that RA was placed, but on the left arm this time YELLOW
G On the right leg, avoiding bony prominences BLACK (ground)
LL In the same location that G was placed, but on the left leg this time GREEN
V1 In the fourth intercostal space (between ribs 4 5) just to the right of the sternum (breastbone).
V2 In the fourth intercostal space (between ribs 4 5) just to the left of the sternum.
V3 Between leads V2 and V4.
V4 In the fifth intercostal space (between ribs 5 6) in the mid-clavicular line (the imaginary line that extends down from the midpoint of the clavicle (collarbone).
V5 Between leads V4 and V6
V6 Horizontally even with V4 and V5 in the midaxillary line. (The midaxillary line is the imaginary line that extends down from the middle of the patient's armpit.)
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Leads and electrodes
Thoracic
Limb
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Evaluation of the ECG

• Pulse regular, irregular
• Rhythm sinusoidal or other (nodal from AV
  node)
• Frequency Normal 60-90 pulses/min
• Heart electrical axis inclination normal (the
  same way), to left (outside), to right (inside)
  just generally from limb leads I and III. Exactly
  by using Einthovens triangle.
• Description of waves, their duration and
  intervals.

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Frequency

• Heard frequency 72 pulses/min, pulse interval
  0.83 s
• During relaxation the frequency changes based of
  the respiration (RESPIRATION ARYTMIA)
  inspiration - increased frequency, expiration
  decreased frequency.
• Bradycardia fysiological deep long-term
  inspiration, deep forward bend and knee band
  reflex changes of vagal tonus.
• Tachycardia fysiological swallow (decrease of
  vagal tonus), change of position from lying or
  sitting to standing (ORTOSTATIC REACTION).

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Examples of pathological ECG
Sinusoidal rhythm and fibrilation of atria AV
block
Heart attack
Fibrilation of ventricles
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reentry
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Electric expression of heart action
Ganong Physiology

• Record of summary electric activity of hear is
  called electrocardiogram (ECG).
• ECG curve is summary potential that is a result
  of all action potentials of myofibers.
• Beginnings of QRS complex and action potentials
  of ventricles are the same and ending of
  ventricle action potentials is the same as the
  end of wave T.

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heart electrical axisaverage (largest)
electrical heart vector)
if positive in the lead aVF (above left) and
positive in the lead I (right) then must lie
where overlap (right)
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Lead I positive amplitude
Lead I negative amplitude
-90o
aVF
-60o
-120o
III
-30o
-150o
aVL
I
0o
180o
aVR
150o
30o
II
120o
60o
90o
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Heart electrical axis inclination

• Each myocyte produce dipole during action
  potential - vector with specific dimension and
  direction.
• Cell vector head from depolarised to polarised
  part, i.e. in direction of action potential
  spread.
• If the cell is completely depolarised (plató
  phase) or polarised (resting phase), vector is
  neutral.
• Electrical heart vector is a summary of all
  cells vectors in one time point

Normal value is -30 až 105 Shift of the axis
to right above 105 hypertrophy of RV or long
and slim Shift of the axis to left below -30
hypertrophy of LV or obese people