Chronic Disease and Obesity

slightly widened QRS complex after P'

slightly widened QRS complex, INVERTED P WAVE

VERY WIDE QRS, great amplitude

SAWTOOTHED P Wave

• NO DISCERNABLE P WAVE
• Irregular R to R intervals

• Rhythm is extremely irregular
• 1 of 2 SHOCKABLE RHYTHMS(other is pulse-less V-Tach)

• PR Interval greater than 0.2 seconds(5 blocks or more)
• The PR Interval stays the same elongated length

PR Interval increasingly prolonged until QRS complex is dropped

PR Interval unchanged, QRS Complex SUDDENLY MISSING

• P Wave normal, but NOT associated with QRS complex
• Atrial rate faster than Ventricular rate

"BUNNY EARS" in V1 or V2

"BUNNY EARS" in V5 or V6

Right Atrial Hypertrophy - large diphasic P Wave with tall initial component

Left Atrial Hypertrophy - large diphasic P Wave with wide terminal component

• Underweight: < 18.5
• Normal: 18.5 to 24.9
• Overweight: 25.0 to 29.9
• Obesity Class 1: 30.0 to 34.9
• Obesity Class 2: 35.0 to 39.9
• Obesity Class 3: > 40

Overweight 66.2%


Obese 32.9%

Encompasses many disease states, general disease of the heart

Any disease of the vascular system

Natural hardening of the arteries

Process of fatty substances, cholesterol, cellular waste products, calcium and fibrin building up on the inner lining of an artery

It is an inflammatory disease

• Hyperinsulenemia; Hypertension; Hyperlipidemia; Smoking
• Endothelial Injury
• Inflammatory Response
• LDL oxidized
• Macrophages adhere to intima
• Macrophages turn into FOAM CELLS
• FOAM CELLS turn into FATTY STREAKS

• Promote cholesterol efflux
• Inhibit oxidation of LDL

Key Point - Every mg. of HDL increase, there is a lowering of CHD by 2 to 3%

MAP = CO x Peripheral Resistance

MAP = SV x HR x PR

• Nervous System
• SNS
• Constricts blood vessels(NE or Epi)
• Humoral
• Renin-Angiotensin System (kidneys)
• Aldosterone
• Increases SODIUM reabsorption and POTASSIUM secretion by kidneys

Low plasma sodium and low blood pressure cause kidneys to release Renin, which aids in forming Angiotensin 2, a potent vasoconstrictor

ACE Inhibitors - block Angiotensin Converting Enzyme, which converts Angiotensin 1 to Angiotensin 2. Angiotensin 2 is a potent vasoconstrictor, which means blood pressure would decrease

Calcium Channel Blockers - slow the heart rate, thus dropping blood pressure

Remember: BP = SV x HR x PR

Diabetes Mellitus - Fasting Blood Glucose > 126 mg/dL

Impaired Fasting Glucose - 100 -125 mg/dL "Pre-diabetic"

Impaired Glucose Tolerance - Glucose between 140 and 199 mg/dL two hours after taking an OGTT

• Excessive thirst
• Excessive hunger
• Fatigue
• Increase Urine production
• Weight loss
• Blurred vision
• Sores that won't heal

• Headache
• Shaking
• Sweating
• Feeling tired
• Weakness
• Hunger

Measure of 3 month level of blood glucose level

Once insulin attaches to its receptors, GLUT 4 translocates to cell membrane, which allows glucose to enter into the cell

Key Point: exercise makes 1. more GLUT 4 cells, and 2. GLUT 4 translocates to cell membrane w/o insulin

• Microvascular
• Retinopathy
• Neuropathy - diabetic foot
• Nephropathy - kidney failure

• Macrovascular
• CAD
• Peripheral Vascular Disease

Only diet to show reversal of Atherosclerosis

• Must have 3 or more of the following:
• Abdominal obesity: men > 40, women >35 inches at waist
• Triglycerides > 150 mg/dL
• HDL men < 40, women < 50
• Blood Pressure > 130 / > 85 mmHg
• Fasting Glucose > 110 (ACSM says > 100)

Inverted T Wave that is also symmetrical

ST Segment Depression

Significant Q Wave is at least 1mm wide or Q Wave is 1/3 the amplitude or more of the QRS Complex

Acute Injury, MI is happening RIGHT NOW

SA Node 60 - 100 bpm

Atrial Foci 60 - 80 bpm

Junctional Foci 40 - 60 bpm

Ventricular Foci 20 - 40 bpm

Large Box - 300, 150, 100, 75, 60, 50...

6 Second Strip - # R Waves multiplied by 10

• Small Box - (rhythm MUST be REGULAR), count # of small boxes between 2 R's then divide 1500 by the number of small boxes.
• aka 1500 Method

Look for AVF and Lead I to determine axis by looking at QRS Complex

• Both negative = ERAD
• Both positive =Normal
• Lead I negative, AVF positive = RAD
• Lead I positive, AVF negative = LAD

• P Wave .08 - .12 = 2 to 3 blocks
• PR Interval .12 - .20 = 3 to 5 blocks
• QRS Complex .06 - .10 = 11/2 to 21/2 blocks
• ST Segment .12 = 3 blocks
• T Wave .16 = 4 blocks
• QT Interval .36 - .44 = 9 to 11 blocks

• Is the source the SA Node?
• if not, what is the source?
• Does the R to R Interval look regular?
• P before every QRS
• QRS after every P
• Check PR and QRS Intervals
• Does the P Wave look normal

• Right Ventricular Hypertrophy
• R Wave > S in V1

• Left Ventricular Hypertrophy
• S Wave in V1 + R Wave in V5 > 35 mm.

Also, Inverted T Wave