CARDIAC

HEART
Sounds
S1 Tricuspid & Mitral Valve Closes
S2 Pulmonary & Aortic Valve Closes
S3 Ventricular Filling Complete
S4 Elevated Arterial Pressure (Atrial Kick)
WAVE REVIEW

P Wave: Atrial
depolarization
PR Segment: AV node
conduction
QRS Complex:
Ventricular
Depolarization
U Wave: Hypokalemia
creates U-wave
InDepth

ST Segment:
Ventricles depolarized
T Wave: Ventricular
repolarization

P Wave: Small upward wave indicating atrial depolarization

QRS Complex: initial downward deflection followed by large
upright wave, followed by small downward wave; represents
ventricular depolarization; masks arterial repolarization; enlarged
R portion- enlarged ventricles; enlarged Q portion may indicate probable heart attack
T Wave: Dome shaped wave; Indicates ventricular repolarization; flat when insufficient O2; elevated
when K levels
P-R Interval: Interval from beginning of P wave to R wave; represents conduction time from initial
excitation to initial ventricular excitation; Good diagnostic tool; usually normal <0.25

S-T Segment: Time from the end of S to beginning of T wave; represents time between end of
spreading impulse through ventricles and ventricular repolarization; in heart attack; with
insufficient oxygen
Q-T Interval: Time for singular depolarization and repolarization of the ventricles. Conduction
probs, myocardial damage, or congenital heart defects can prolong this.

ECG Changes with MI

T wave inversion
ST segment elevation
Abnormal Q waves
ECG Changes with Digitalis
Inverts T wave
QT segment shorter
Decreases ST segment
ECG Changes with Quinidine
Inverts T wave
Q segment longer
QRS segment longer
ECG Changes with K+
Hyperkalemia: Lowers P Wave; width of QRS
Hypokalemia: Lowers T wave; causes U
ECG Changes with Ca
Hypercalcemia: makes a longer QRS segment
Hypocalcemia: increases time of QT interval

Right Sided Heart Failure

Right Upper Quadrant Pain
Right Ventricular Heave
Tricuspid Murmur
Weight gain
Nausea
Elevated Right Atrial Pressure
Elevated Central Venous Pressure

Peripheral Edema
Ascites
Anorexia
Hepatomegaly

Left Sided Heart Failure

Left Ventricular Heave
Confusion
Paroxysmal Nocturnal Dyspnea
DOE
Fatigue
S3 Gallop
Crackles

Tachycardia
Cough
Mitral Murmur
Diaphoresis
Orthopnea

CONGESTIVE HEART FAILURE

Class I describes a patient who is not limited with normal physical activity by symptoms.
Class II occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms.
Class III is characterized by a marked limitation in normal physical activity.
Class IV is defined by symptoms at rest or with any physical activity.
Causes: CAD, Valvular heart disease, Cardiomyopathies, Endocarditis, Extracardiac infection, Pulmonary
embolus
Symptoms: Skin cold or cyanotic, Wheezing, Mitral valvular deficits, Lower extremity edema, Pulsus
alternans, Hypertension, Tachypnea

NEURO