Discussion Question

Discussion Question

Cardiac Conduction System

Controls the rate and direction of electrical impulse conduction in the heart

Impulses are generated in the SA node, which has the fastest rate of firing, and travel to the Purkinje system in the ventricles.

 

In certain areas of the heart, the myocardial cells have been modified to form the specialized cells of the conduction system.

 

The conduction system maintains the pumping efficiency of the heart.

 

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Phases of Cardiac Potentials

Phase 0: rapid upstroke of the action potential

 

Phase 1: early repolarization

 

Phase 2: plateau

 

Phase 3: final repolarization period

 

Phase 4: diastolic repolarization period

 

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Refractory Periods #1

Absolute Refractory Period

No stimuli can generate another action potential.

Includes phases 0, 1, 2, and part of phase 3.

The cell cannot depolarize again.

 

Relative Refractory Period

Greater than normal stimulus response

Repolarization returns the membrane potential to below the threshold, although not yet at the resting membrane potential.

 

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Refractory Periods #2

Begins when the transmembrane potential in phase 3 reaches the threshold potential level

Ends just before the terminal portion of phase 3

 

Supernormal Excitatory Period

A weak stimulus can evoke a response.

Extends from the terminal portion of phase 3 until the beginning of phase 4

Cardiac arrhythmias develop.

 

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Electrocardiography

Twelve leads

Diagnostic ECG

Each providing a unique view of the electrical forces of the heart

Diagnostic criteria are lead specific.

Improper lead placement can significantly change the QRS morphology.

Misdiagnosis of cardiac arrhythmias or the presence of conduction defects can be missed.

 

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Goals of Continuous Bedside Cardiac Monitoring

Shifted from simple heart rate and arrhythmia monitoring to

Identification of ST segment changes

Advanced arrhythmia identification

Diagnose

Provide treatment

 

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Question #1

Is the following statement true or false?

 

The electrocardiogram is a reflection of cardiac muscle contraction. You can directly diagnose specific defects in muscle activity.

 

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Answer to Question #1

False

 

Rationale: The electrocardiogram is a reflection of cardiac muscle contraction. You can directly diagnose specific defects in muscle activity.

 

 

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Types and Causes of Disorders of the Cardiac Conduction System

Types

Disorders of rhythm

Disorders of impulse conduction

Causes

Congenital defects or degenerative changes in the conduction system

Myocardial ischemia and infarction

Fluid and electrolyte imbalances

Effects of drug ingestion

 

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Types of Arrhythmias #1

Sinus Node Arrhythmias

Sinus bradycardia

Sinus tachycardia

Sinus arrest

 

Arrhythmias of Atrial Origin

Paroxysmal supraventricular tachycardia

Atrial flutter

Atrial fibrillation

 

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Types of Arrhythmias #2

Junctional Arrhythmias

Disorders of Ventricular Conduction and Rhythm

Long QT Syndrome and Torsades de Pointes

Ventricular Arrhythmias

Premature ventricular contractions

Ventricular tachycardia

Ventricular flutter and fibrillation

 

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Types of Arrhythmias #3

Disorders of Atrioventricular Conduction

First-degree AV block

 

Second-degree AV block

 

Third-degree AV block

 

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Diagnostic Methods

Signal-averaged electrocardiogram

 

Holter monitoring

 

Exercise stress testing

 

Electrophysiologic studies

 

QT dispersion

 

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Pharmacologic Treatment of Arrhythmias

Class I drugs: act by blocking the fast sodium channels

Class II agents: β-adrenergic–blocking drugs that act by blunting the effect of sympathetic nervous system stimulation on the heart

Class III drugs: act by extending the action potential and refractoriness

Class IV drugs: act by blocking the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2

 

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Correction of Conduction Defects, Bradycardias and Tachycardias

Electronic pacemaker

Temporary

Permanent

Cardioversion

Defibrillation

Synchronized

Ablation

Surgical interventions

 

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Question #2

Sinus arrhythmias will have a greater affect on the total heart than atrial arrhythmias because________.

they will not be different, and each is equally harmful

the sinus node will directly cause a fibrillation

the sinus node will stimulate the rest of the heart directly into a new rhythm

the sinus node will not activate the atrioventricular node

 

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Answer to Question #2

C. the sinus node will stimulate the rest of the heart directly into a new rhythm

 

 

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Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

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Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

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Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

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I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

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The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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