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Cardiac index
CI = CO(liter/minute)/Body surface area (m2)
Normal adult: 2.8-4.2 liter/minute/m2
Normalizes liter flow to body size
Stroke Volume
Preload
Afterload
Contractility
Stroke Volume
Preload
The amount of stretch placed on the cardiac muscle just prior to
systole (the amount of the ventricle at end diastole)
Diastole : filling stage of cardiac cycle.
Afterload
The force or pressure at which the blood is ejected from the
left ventricle
Equated with systemic vascular resistance (SVR)
Contractility is a term used to denote the force
generated by the contracting myocardium under any given
condition
HEART SOUNDS
The normal heart sounds, S1 and S2, are produced primarily by
the closing of the heart valves. The time between S1 and S2 corresponds to
systole This is normally shorter than the
time between S2 and S1 (diastole). As the heart rate increases diastole
shortens.
S1—First Heart Sound. Closure of the mitral and tricuspid valves
creates the first heart sound (S1),
Cardiac catheterization
Coronary angiography
Cardiac Electrophysiology
57
ST segment : the isoelectric line between the end of
QRS and the beginning of T wave
QT interval : the interval between the beginning of
Q wave and the end of T wave , it measures ( 0.32 –
0.40 ) second
58
Normal Timing
PR interval – 0.12 to 0.20 seconds
QRS interval – less then 0.12
QT interval – varies with rate. It is usually less then ½
the R-to-R distance on the preceding waves
Steps to reading ECGs
What is the rate? Both atrial and ventricular if they are not
the same.
Is the rhythm regular or irregular?
Do the P waves all look the same? Is there a P wave for every
QRS and conversely a QRS for every P wave?
Are all the complexes within normal time limits?
Name the rhythm and any abnormalities.
Rate
Look at complexes in a 6-second strip and count the
complexes; that will give you a rough estimate of rate
Count the number of large boxes between two
complexes and divide into 300
Count the number of small boxes between two
complexes and divide into 1500
Estimate rate by sequence of numbers.
Normal Sinus Rhythm
Rate is between 60 and 100 beats/minute
The rhythm is regular
All intervals are within normal limits
There is a P for every QRS and a QRS for every P
The P waves all look the same
Sinus Tachycardia
Rate above 100 beats/minute
The rhythm is regular
All intervals are within normal limits
There is a P for every QRS and a QRS for every P
The P waves all look the same
Caused by fever, stress, caffeine, nicotine, exercise, or by
increased sympathetic tone
Treatment is to take care of the underlying cause
Sinus Bradycardia
Rate is lower than 60 beats/minute
The rhythm is regular
All intervals are within normal limits
There is a P for every QRS and a QRS for every P
The P waves all look the same
Caused by beta-blocker, digitalis, or calcium channel blockers.
Normal for athletes
Don’t treat unless there are symptoms. Can use pacing or
atropine
Sinus Arrhythmia
Rate is between 60 and 100 beats/minute
The rhythm is irregular. The SA node rate can increase or
decrease with respirations
All intervals are within normal limits
There is a P for every QRS and a QRS for every P
The P waves all look the same
More common in children and athletes
Ask the patient to stop breathing and the rate will become
regular
Premature Atrial Contraction
(PAC)
Occur when an ectopic atrial focus discharge an
impulse before the next anticipated sinus node
activation , these ectopic Ps have a bizarre
appearance and can be pointed , inverted or
notched
CAUSES :
1- Acute myocardial infarctions .
2- digoxin toxicity .