PET 4551 Study Guide Final PET4551 Professor Mia Newlin 1 Please know material from previous study guides 2 Know how to use the metabolic equations See Previous Guides 3 Know terms for isometric eccentric concentric isokinetic isotonic muscular strength muscular endurance and flexibility Know the physiological mechanisms of how strength increases over time See Previous Guides Isometric means the same length so an example would be using a handgrip test or pushing against a wall The muscle is staying at the same length throughout the whole contraction Eccentric is the lengthening of the muscle So it would be the down part of a bicep curl the muscle is becoming straight Ideally this motion should be 3 4 sec Concentric is the shortening of the muscle So it would be the curl part of the bicep curl Ideally this motion should be 2 3 sec Isokinetic means the same velocity The only machines that produce this motion are therapy machines and are very expensive Isotonic means the same tension So free weights would be called isotonic the tension does not change Muscular strength is the maximum force you can produce It s your 1 RM Muscular endurance is the ability for your muscles to lift at submaximal about for an extended duration Flexibility is simply the ability to move your muscle through it ROM PET4551 Professor Mia Newlin 4 Know conduction blocks First Degree Second Degree Mobitz Type I or Wenckebach Block Mobitz Type II Third Degree Heart Block For Reference you should have already memorized this Conduction blocks Any obstruction or delay of the flow of electricity along the normal pathways of electrical conduction First Degree Characterized by a prolonged delay in conduction at the AV node or His bundle Depolarization is held up in the AV node longer than usual Requires that the PR interval be longer than 0 2 seconds P wave relationship to QRS 1 1 R R interval are regular or follows P P interval Consistent length between QRS complexes but longer Slow conduction but no missed beats PET4551 Professor Mia Newlin Second Degree Wenckebach block Mobitz Type I Block within the AV node Each successive atrial impulse is delayed until one impulse fails to make it through Progressive lengthening of PR interval until one P wave fails to conduct Not every atrial impulse goes through the ventricles Longer and longer delay of AV node until conduction does not go through at all usually after 3 or 4 beats Progressively longer PR interval then a dropped beat P wave present but no QRS PET4551 Professor Mia Newlin Mobitz Type II AV block Block is below the AV node in the bundle of His lengthening does not occur Not all atrial impulses are transmitted to the ventricles Diagnosis requires the presence of a dropped beat without progressive lengthening of the PR interval EKG shows normal PR and QRS with a dropped beat This condition may require a pacemaker PET4551 Professor Mia Newlin Third Degree Complete heart block No atrial impulses make it through to activate ventricles PET4551 Professor Mia Newlin Ventricles respond by generating an escape beat at 30 45 bpm Atrial normal around 60 100 bpm QRS complex is wide because of ventricular origin P wave and QRS are consistent but not connected AV dissociation any circumstance in which the atria and ventricles are being driven by independent pacemakers P waves at normal rate No association with the QRS complex QRS complex is wide and bizarre Arrows are pointing at the P waves they are consistent independently of the QRS PET4551 Professor Mia Newlin 5 Know what the right and left bundle branch blocks look like Know characteristics Bundle branch block conduction block in one or both of the ventricular bundle branches Conduction block in either the left or right bundle branches Diagnosed by looking at the width and configuration of the QRS complexes Right Bundle Branch block When the conduction occurs through the right side after the left side depolarizes Obstruction of electrical conduction in right bundle branch causing a delay in RV depolarization QRS is greater than 0 12 sec in duration Unique QRS configuration in leads V1 and V2 RSR pointy rabbit ears Left lateral leads 1 aVL V5 and V6 have deep S waves Right precordial leads will show ST segment depression and T wave inversion PET4551 Professor Mia Newlin PET4551 Professor Mia Newlin Left Bundle Branch block Delay in ventricular depolarization QRS complex is wider than 0 12 sec in duration Lateral left leads I aVL V5 and V6 have marked prolongation in R waves which have broad or notched tips QRS in the left ventricle leads will have tall R waves which are broad on top or notched ST segment of depression and T wave inversion in left lateral leads QRS in the right ventricle leads will show reciprocal broad deep S waves Left axis deviation occurs PET4551 Professor Mia Newlin PET4551 Professor Mia Newlin 6 Know all of the arrhythmias including the two pre excitation conditions and the stages of a myocardial infarction Know how to diagnose a Myocardial Infarction What tests do we do MI Myocardial Infarction occlusions of the coronary artery Symptoms The most common is severe chest pain The pain may spread down the left shoulder and arm to other areas such as the back jaw neck or right arm Get aspirin for someone with pain Women and diabetics don t have classical symptoms pain in upper belly Other symptoms o Pain in the upper belly often mistaken for heartburn o Sweating o Nausea and vomiting o Trouble breathing o A feeling that their heart is racing pounding palpitations o Feeling weak or very tired o Feeling dizzy or fainting o Perfuse sweating Women are more likely to have the other symptoms particularly SOB have more back and jaw pain nausea and vomiting 3 ways to determine or diagnose a MI 1 History and Physical examination 2 Cardiac Enzymes o Creatine Kinase MB 6hrs PET4551 Professor Mia Newlin o Troponin I or T 2 3hrs 3 EKG Goes through 3 stages 1 T wave peaking followed by T wave inversion indicates ischemia not infarction o T wave inversion symmetrical o These reflect myocardial ischemia o Will revert back to normal when blood flow is restored unless myocardial cell death has occurred 2 ST segment elevation indicates injury 3 Appearance of new Q waves indicates irreversible myocardial cell death Acute infarction ST elevation PET4551 Professor Mia Newlin Old infarction just Q waves elevated Don t need to tell anterior lateral wall or posterior How to determine normal Q waves from abnormal ones indicates
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