abnormalities of the conduction system elizabeth dugan - [email protected] olamide odubogun -...
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Abnormalities of the Conduction SystemElizabeth Dugan - [email protected]
Olamide Odubogun - [email protected]
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Rhythm Of The Heart
The Heart is Like an Orchestra.It has a conducting system that is directed by a conductor.
This conductor is the “Natural Pacemaker” of the Heart
Conducting System:-SA node (Primary Pacemaker)-AV node -Bundle of His-Purkinje Fibers
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•Sino-Atrial node (SA Node)
-Origination and dissemination of electrical signals to BOTH atria
-Causes BOTH atria to contract
•Atrioventricular Node (AV Node)
-Transmits signal to ventricles by going through interventricular septum
-Causes intentional delay, to allow atria to complete pumping
•His Purkinje System
-Electrical signal flows through the His-Purkinje system and causes the ventricles to contract SIMULTANEOUSLY
Conducting System
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SA node fires electrical
signal spreads through the
Right and left atria Right and
Left atria contract (blood moves from atria to ventricles)
AV Node fires electrical signal
spreads through His-Purkinje
System Right & Left Ventricles
Contract (blood moves from ventricles into aorta and pulmonary a.)
Electrical Signal
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The Electrocardiogram (EKG or ECG)
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WHAT does an EKG measure?•Measures electrical signals from heart.
This consists of: •Atrial contraction - P Wave•Ventricular contraction – QRS complex•Ventricular Relaxation – T Wave
HOLD ON!!!!!
What about Atrial Relaxation?
HOW does it do this?Your body is a conductor of electricity
•The electrical signal generated in the heart is detected by the leads placed on the surface of the body
EKG Mechanics
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Atria contract P Wave
Ventricles contract QRS complex
Ventricles Relax T Wave
Main EKG Waves
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Normal EKG:1. Regular Rate –heart rate of 60-100 bpm2. Regular Rhythm – P – QRS – T – P – QRS – T – P – QRS – T - etc3. The height of the wave – related to the mass of the muscle generating the wave
- the ventricles have more mass than the atria:
- large ventricles (ventricular hypertrophy) more muscle creating a stronger signal when the ventricles contract:
Normal EKG
QRS
P PPP
QRS QRSQRS
T T T TP
P wave is smaller than QRS complex
taller QRS complex
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Ventricular Hypertrophy (Large Ventricle)
Normal EKG
Causes of a Large QRS Complex
Increased mass in:1. One ventricle2. Both ventricles3. Portion of the ventricle
NOTICE the very large QRS complex in the EKG
QRS
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Ventricular Fibrillation
1. Ventricular Fibrillation – disordered electrical activity
The ventricles "flutter" rather than beat and pump little or no blood.
2. In minutes, collapse and sudden cardiac death will follow
Medical help is needed immediately
3. Treatment - defibrillator
ARRHYTHMIA
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-Disease of the myocardium
-Portion of the myocardium is thickened (hypertrophied, aka, the opposite of atrophy)
-Individual muscle fibers are disorganized abnormal conduction + arrhythmias
Hypertrophy is asymmetric The interventricular septum (muscle b/w
the 2 ventricles) is usually enlarged much more than the rest of the ventricle
Hypertrophic Cardiomyopathy
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The ventricle is hypertrophiedWhat happens to the following:Relaxation?Filling?Pressure?Forward Flow?What does all this cause?
ALLARE
DECREASED!
Difficulty breathing!
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Outflow ObstructionOutflow tract obstruction – (the outflow tract is the path from the LV into the aorta)
Increased velocity!
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Normal FlowNormal Velocity, Low Pressure
Outflow ObstructionFast Velocity, High Pressure
When flow is obstructed, you need to build more muscle so that you can pump harder! This equals hypertrophy!
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Mitral Regurgitation- Narrowed outflow tract =
faster flow- Faster flow of blood pulls
the mitral valve open- Blood goes back into the
atria from the ventricle during systole mitral regurgitation Left
Ventricle
AorticValve
Mitral Valve
Regurgitation
SHOW VIDEOHOW WE FIX MITRAL REGURG?
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HCM Symptoms
• Average age presentation : mid 20s• Wide range symptoms/severity• Difficulty breathing (dyspnea)
–WHY?• Angina
–WHAT DOES ANGINA MEAN?• Syncope (fainting)
–FROM WHAT?–WHY WOULD FAINTING BE BENEFICIAL?
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Interesting Facts– What is the most common cause of cardiac death in athletes?
• Hypertrophic Cardiomyopathy
– How many people does this affect?• 1/500
– Is everyone at risk for this? • Inherited (genetic) disorder: autosomal dominant, know
your genetics and be careful if you are a possible carrier!
– Does everyone with HCM have the same symptoms and outlook?
• There are different forms of the disease and some are more severe than others incomplete penetrance
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Physical Exam
• Often are normal• Extra heart sounds
– Fourth heart sound – this is heard before the “Lub” instead of “lub-dub” you here “da-lub-dub”
• Systolic Murmur – Due to Turbulent (noisy) flow through the outflow tract (LV to Aorta)
• Systolic Murmur– Due to regurgitation of blood through the mitral valve
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HCM and Arrhythmias
Normal Myocardium :
Linear arrangement
HCM: Disarray!
Physiology 101: Structure = Function
Thus, Abnormal Structure=…
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During Vfib
-The ventricles are like bowl of jelly
- Inefficient pump
-Muscle cells malaligned
“Myocardial Disarray”
MYOCARDIAL DISARRAY
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HHOW DO YOU SOLVE THIS PROBLEM??
1) Defribillators e.g. ICD
2) Pacemakers (artificial)
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Implantable Cardioverter Defibrillator (ICD)An ICD is used in patients at risk for:1. Ventricular tachycardia (>100 bpm) 2. Ventricular fibrillation3. Sudden cardiac death caused by arrhythmiasAn ICD is made up of two parts:1. Pulse generator – battery plus circuits 2. One or two leads (wires)How the ICD Works:1. Leads monitor your heart rate2. ventricular tachycardia or fibrillation detected controlled burst of impulses (called "overdrive" pacing)3. If that does not work, the ICD "shocks" the heart to restore a normal rhythm. Newer ICD devices can also work like a pacemaker if a slow heart rate (bradycardia) occurs.
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What does it Look Like???
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An ICD is like a pacemaker in some ways, but it can use higher energy electrical pulses to treat certain dangerous types of arrhythmia.
Pacemakers are used to treat:1.Abnormal rates
Bradycardia/ Tachycardia2.Abnormal rhythms
ArrhythmiaAtrial fibrillation
Goals:1.Coordinate the electrical signaling between the upper and lower chambers of the heart2.Coordinate the electrical signaling between the ventricles
Pacemaker
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The End