Pacemakers of Heart: ECG Analysis

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Questions and Answers

If a patient's heart rate is consistently measured at 50 bpm, which pacemaker of the heart is most likely generating this rate?

  • His-Purkinje Network
  • Bachman's Bundle
  • Atrioventricular (AV) Node (correct)
  • Sinoatrial (SA) Node

During a period of intense physical activity, the sympathetic nervous system's influence increases. How would this affect the firing rate of the sinoatrial (SA) node?

  • Stop firing completely
  • Increase to around 100 bpm (correct)
  • Decrease to below 60 bpm
  • Remain unchanged at 60 bpm

A patient's ECG indicates a heart rate originating from the ventricles. Which range would be the most probable firing rate?

  • <40 bpm (correct)
  • 60-100 bpm
  • 100-160 bpm
  • 40-60 bpm

Following a vagal maneuver, a patient's heart rate slows. This change is primarily mediated by which part of the autonomic nervous system?

<p>Parasympathetic nervous system (C)</p> Signup and view all the answers

A cardiologist observes that a patient's ECG shows normal atrial function but impaired ventricular contraction. Lesions in which structure are the most likely cause?

<p>Bundle of HIS (B)</p> Signup and view all the answers

After administering a sympathomimetic drug, what change in heart rate would you anticipate if the SA node is functioning as expected?

<p>Increase in heart rate (B)</p> Signup and view all the answers

A patient with a complete heart block has a very low heart rate. What pacemaker location is likely sustaining the heart's activity?

<p>His-Purkinje network (D)</p> Signup and view all the answers

During an ECG analysis, the absence of a P wave may suggest a malfunction in which area?

<p>SA node (A)</p> Signup and view all the answers

If the parasympathetic nervous system is inhibited, what effect would this have on the AV node's firing rate?

<p>Increase in firing rate (A)</p> Signup and view all the answers

In a patient with a history of atrial fibrillation, which anatomical structure is most likely contributing to the rapid and disorganized atrial activity?

<p>Bachman's Bundle (B)</p> Signup and view all the answers

A person is experiencing high levels of stress, leading to increased sympathetic tone. How would this likely affect the AV node's firing rate?

<p>Increase above 60 bpm (C)</p> Signup and view all the answers

A patient's ECG shows a ventricular rate of 30 bpm with wide QRS complexes. Which pacemaker is most likely responsible?

<p>His-Purkinje Network (C)</p> Signup and view all the answers

Following a heart transplant, the transplanted heart typically has a higher resting rate compared to a heart with intact vagal innervation. Why is this?

<p>The heart is denervated and lacks parasympathetic influence. (D)</p> Signup and view all the answers

A pharmacological agent blocks the activity of Bachmann's bundle. What direct effect would this have on cardiac function?

<p>Reduced interatrial conduction velocity (C)</p> Signup and view all the answers

In patients with sick sinus syndrome, the SA node's function is impaired. If the AV node takes over, what is the expected heart rate range?

<p>40-60 bpm (B)</p> Signup and view all the answers

A patient presents with an abnormally slow heart rate after starting a beta-blocker medication. Which pacemaker is most affected by this drug?

<p>SA node (D)</p> Signup and view all the answers

During a surgical procedure, the vagus nerve is inadvertently stimulated. What effect would this have on the heart's pacemakers?

<p>Decreased AV node conduction velocity (B)</p> Signup and view all the answers

If the SA node and AV node are both non-functional, what is the expected heart rate range, assuming the His-Purkinje Network takes over?

<p>&lt;40 bpm (A)</p> Signup and view all the answers

A patient with an atrial septal defect (ASD) is noted to have abnormal interatrial conduction. Which structure is most directly involved in this dysfunction?

<p>Bachmann's Bundle (D)</p> Signup and view all the answers

What effect does stimulating the sympathetic nervous system have on the AV node conduction velocity?

<p>Increased conduction velocity (D)</p> Signup and view all the answers

Which anatomical location typically initiates the electrical impulse that results in atrial contraction, as observed on an ECG?

<p>Sinoatrial Node (B)</p> Signup and view all the answers

A patient presents with a heart rate of 110 bpm. If the SA node is controlling the heart rate, what nervous system influence could be responsible?

<p>Increased sympathetic activity (C)</p> Signup and view all the answers

In a patient with a junctional rhythm, which pacemaker site is initiating the heart's electrical activity?

<p>Atrioventricular (AV) Node (C)</p> Signup and view all the answers

After undergoing a cardiac ablation procedure that targets the AV node, what compensatory mechanism might the heart employ to maintain cardiac output?

<p>His-Purkinje network pacing (A)</p> Signup and view all the answers

During periods of rest, how does the parasympathetic nervous system primarily influence the firing rate of the SA node?

<p>Decreases firing rate (C)</p> Signup and view all the answers

What is the typical firing rate of the ventricles when the His-Purkinje network acts as the primary pacemaker?

<p>Less than 40 bpm (D)</p> Signup and view all the answers

Which component of the heart’s electrical conduction system transmits impulses directly from the atria to the ventricles?

<p>Atrioventricular (AV) node (C)</p> Signup and view all the answers

How does the autonomic nervous system influence the atrial kick, a phenomenon related to the final phase of atrial contraction?

<p>Sympathetic stimulation enhances atrial kick. (C)</p> Signup and view all the answers

A patient’s ECG reveals a rate of 45 bpm, and further analysis suggests the SA node is not functioning. Which secondary pacemaker is most likely controlling the heart rate?

<p>Atrioventricular (AV) Node (A)</p> Signup and view all the answers

What is the effect of blocking muscarinic receptors on the SA node's activity?

<p>Increased firing rate (B)</p> Signup and view all the answers

Flashcards

Heart's Pacemakers

Pacemakers of the heart include the Sinoatrial Node, Atrioventricular Node, and HIS-Purkinje Network.

Sinoatrial Node Location

Located at the junction of the Superior Vena Cava (SVC) and Right Atrium (RA).

Atrioventricular Node Location

Located at the Right Atrium at the level of the septal leaflet and tricuspid valve.

HIS-Purkinje Network Location

Located in Ventricular conduction tissue

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Sinoatrial Node Firing Rate

The firing rate is typically 60-100 bpm.

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Atrioventricular Node Firing Rate

The firing rate is typically 40-60 bpm.

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HIS-Purkinje Network Firing Rate

The firing rate is less than 40 bpm.

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Sinoatrial Node Innervation

Sympathetic innervation at 100 bpm; Parasympathetic innervation less than 60 bpm.

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Atrioventricular Node Innervation

Sympathetic innervation greater than 60 bpm; Parasympathetic innervation less than 40 bpm.

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HIS-Purkinje Network Innervation

Sympathetic innervation greater than 40 bpm; Parasympathetic innervation not available.

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Sinoatrial Node Info

Includes Bachman's Bundle.

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Atrioventricular Node Info

Includes the Bundle of HIS and Atrial kick.

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HIS-Purkinje Network Info

Includes 2 major bundle branches.

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Study Notes

  • ECG Analysis (Part 2) by Richard P. Wilson, DNAP, CRNA, FAANA, CSPA Expert Consultant

Pacemakers of Heart

  • Sinoatrial Node location: Junction of SVC and RA
  • Sinoatrial Node firing rate: 60-100 bpm
  • Sinoatrial Node ANS Innervation: Sym = 100 bpm, Para = <60 bpm
  • Sinoatrial Node Misc Info: Bachman's Bundle
  • Atrioventricular Node location: RA level of septal leaflet and tricuspid valve
  • Atrioventricular Node firing rate: 40-60 bpm
  • Atrioventricular Node ANS Innervation: Sym = >60 bpm, Para = <40 bpm
  • Atrioventricular Node Misc Info: Bundle of HIS, Atrial kick
  • HIS-Purkinje Network location: Ventricular conduction tissue
  • HIS-Purkinje Network firing rate: <40 bpm
  • HIS-Purkinje Network ANS Innervation: Sym = >40 bpm, Para = N/A
  • HIS-Purkinje Network Misc Info: 2 major bundle branches

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