PET 4551 Study Guide for Final Please know material from previous study guides Know how to use the metabolic equations Previous guide 1 2 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 Previous guide 4 Know conduction blocks First Degree Second Degree Mobitz Type I or Wenckebach Block Mobitz Type II Third Degree Heart Block First degree block o P wave relationship to QRS 1 1 o PR interval 0 20 s prolonged o R R interval are regular or follows P P interval o Consistent length between QRS complexes but longer o Slowed conduction but no missed beats o Second degree AV block o Mobitz type I Wenckebach 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 o Mobitz type II Block below the AV node lengthening does not occur EKG shows normal PR and QRS with a dropped beat This condition may require a pacemaker Third degree heart block o No atrial impulses make it to active ventricles o Ventricles create an escape beat at 30 45 bpm Atria is normally around 60 100 bpm o QRS complex is wide because ventricular origin o P wave and QRS are consistent but not connected o QRS Arrows are pointing at the P waves they are consistent independently of the 5 Know what the right and left bundle branch blocks look like Know characteristics Right BBB o When the conduction occurs through the right side after the left side depolarizes o QRS 0 12 s o V1 and V2 have RSR pointy rabbit ears o Lateral leads 1 aVL V5 and V6 have deep S waves o Left BBB o QRS 0 12 s o Lateral left leads I aVL V5 and V6 have marked prolongations in R waves which have broad or notched tips o Leads over R ventricles have deep S wave o Left axis deviation occurs o 6 Know all of the arrhythmias including the two preexcitation conditions and the stages of a myocardial infarction Know how to diagnose a Myocardial Infarction What tests do we do MI occlusion of the coronary artery o Symptoms Most common is chest pain May spread down the left shoulder and arm others such as back jaw neck or right arm Get aspirin for someone with pain Women and diabetics don t have classical symptoms pain in upper belly Others o Women are more likely have the other symptoms have more back pain nausea and Sweating Nausea and vomiting Breathing trouble Feel like heart is racing or pounding Feel weak dizzy or tired Feeling dizzy or fainting vomiting o Three way to determine MI History and physical exam Cardiac enzymes Creatine kinase MB 6 hrs Troponin I or T 2 3 hrs EKG Goes through 3 stages 1 T wave peaking followed by T wave inversion indicates ischemia not infarction lack of blood flow get unsymmetrical 2 ST segment elevation never comes back to the line indicates injury 3 Appearance of new Q waves indicates irreversible myocardial cell death Acute infarction ST elevation And old infarction just Q waves elevated Don t need to tell anterior lateral wall or posterior o How to determine normal Q waves from abnormal ones indicates old infarctions o If artery is blocked can perform an angioplasty with a small balloon that can be inflated Q wave greater than 0 04 s in duration Depth of Q wave is at least 1 3 the size of the R wave Never use aVR Will have a negative inflection to open the artery o Small wire mesh tube stent o Coronary artery bypass surgery o Three PVCs but also infarction In the setting of acute MI Can take veins from their legs or other places 3 or more in a row R wave hitting the T wave o Example if all of these are present HR not the same between atria and ventricles Escape beat Less than 30 bpm P waves regular but more P than QRS 3rd degree AV block Pre excitation syndromes o This is when conduction is generated quicker than usual o Wolf Parkinson White syndrome Bypass called the Bundle of Kent PR interval is less than 0 12 seconds wider than normal QRS complex is wide and sloped the wave is called the Delta Wave o Lown Ganong Levine syndrome Accessory Pathway is intranodal James Fibers PR interval is shortened Can cause arrhythmias such as Paroxysmal supraventricular tachycardia Atrial fibrillation 7 Why do we have pacemakers What do the different rhythms look like with the different pacemakers For those with 3rd degree AV block who need part of their heart jumpstarted when the contraction does not flow properly through the heart Help lessen the degree of an AV block or bradycardia Can help if there is a sudden development of AV and bundle branch blocks during an acute MI Fixed pacemaker Demand pace makers pacemaker o Can be on the SA node ventricles or on atria and ventricles o On an EKG will see a line drop down rise up before the P wave it is an atrial o On EKG if line drops down before the QRS complex then it is a ventricular pacemaker Seen in V1 here 8 Know what happens to the cardiovascular and muscular system with aerobic and strength training in other words what are the mechanisms behind the physiological improvements Strength Increased recruitment of muscle fiber by motor neurons and increased utilization o Increase in strength o Increase in muscle mass Increase in cross sectional area hypertrophy o Increase resistance to injuries and falls Better muscle coordination More resistant muscles Aerobic o Decrease in heart rate Increased vagal tone o Increased stroke volume Greater cardiac contractility o Frank Starling Increases to compensate for lower HR Increase in plasma and blood volume 9 Know the components of physical fitness Physical fitness a dynamic state of energy and vitality that enables one to carry out daily tasks to engage in active leisure time pursuits and to meet unforeseen circumstances without undue fatigue Physically fit people have a decreased risk of hypokinetic diseases and are more able to function at the peak of intellectual capacity while experiencing joy in their lives Components o Body comp o Cardio Any exercise that uses longer muscle groups running cycling walking safe for older people soccer dancing etc o Flexibility o Muscular strength and endurance 10 Know the components of an exercise program how long should you spend on each component Warm up 5 10 mins o Active warm up o Stretching Aerobic 20 30 mins Strength 20 30 mins Cool down 5 mins o Active cool down o Stretching Aerobic
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