2) Cardiology Flashcards
Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:
= neutral/ground
= Negative
= Positive
Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:
= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)
1 Cause of Cardiogenic shock
Heart Attack / MI
Glucagon dynamics for Ca-blockers OD
= heart has Glucagon receptors on SA & AV, opens up Ca via upregulation cells to allow Ca inflex, as a work around to increase HR (Ca-Cl> then gluc)
P wave) morphology:
represents:
Limb Lead amplitude
Precordial “chest” Leads amplitude:
= + deflection in leads 1,2,&3 >Biphasic in V1
= Atrial depolarization
= <2.5
= <1.5
PVC) Bigeminy:
Trigeminy
Quadgeminy
= 2rd beat uni/PVC regularly “boom PVC” (1:1 pattern)
= 3rd beat is uni/PVC regularly “boom boom PVC)
= 4rd beat is uni/PVC regularly “boom boom boom PVC” 2-3x
PVC) Unifocal:
Multifocal:
= same fire site & shape
= dif fire spots & shape
Refractory periods) Absolute:
Relative:
= end of P to apex of T wave- cells absolute Beginning of repolarization
= “some really could happen” lot of cells repolar but not all so can throw out of rhythm Commodo cordis
T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
Fixed pacer:
Demand pacer:
=NONDEMAND PACER Fires continuously at preset rate, regardless of heart’s electrical activity, TC pacing nondemand
= non-fixed, Sensing device; fires only when natural HR drops
Atrial pacer:
Definers:
Treatment:
= paces only in atrium
=Atrial line w/ P wave following
= (ask PT for pacemaker card) Magnet donut, TCP, bradyC & asystole as any other PT
Ventricular pacer:
Definers:
Treatment:
= paces only in ventricle
= line before QRS complex & Wide QRS
= (ask PT for pacemaker card) Magnet donut, TCP, bradyC & asystole as any other PT
AV Sequential pacer:
Definers:
Treatment:
= paces in atrium & ventricle
= line before P wave & QRS, wide QRS
= (ask PT for pacemaker card) Magnet donut, TCP, bradyC & asystole as any other PT
Failure to capture pacer:
Definers:
Treatment:
= not shocking/pacing when supposed to
= Pacer Spikes are not before each beat
= (ask PT for pacemaker card) Magnet donut, TCP, bradyC & asystole as any other PT
1 cause of death when having a MI
is from a lethal dysarrhythmia
- (Cardiac Pharmacology)
- NA Channel Blockers:
- Beta-Blockers:
- Potassium Channel Blockers:
- Calcium Channel Blockers:
- Miscellaneous:
1= (Vaugh-Will) Classes: 1]Na, 2]Beta, 3]K, 4]Ca, Misc] Adenosine
2= (Procainamide & Lidocaine) both Widened QRS & Prolongs QT
3= (Propranolol) Prolonged PRI & Bradycardias
4= (Amiodarone) Prolonged QT
5= (Diltiazem & Verapamil) Prolonged QT & Bradycardias
6= (Adenosine & Digoxin) Prolonged QT & Bradycardias
1st line IV med in cardiac arrest
Epi
1st line med in cardiac arrest
oxygen
A patient calls 911 today because they are having some trouble breathing. The patient states for the last couple of days, they have had some on and off again chest pain with dyspnea, and today they started to notice some swelling in their ankles. Based off this history, you would suspect
The patient started with left ventricular failure that is now causing the right ventricle to fail as well
L-ventricular dysfunction S/S:
Dyspnea, Rales, Tachypnea “Left Lungs”
R-ventricular dysfunction would most likely present with:
Ascites, JVD, Peripheral edema “Right Tight (skin w/ edema)”
Abdominal Aortic Aneurysm (AAA):
S/S:
Ligament:
= Bulging of abdominal aorta.
= Pulsatile abdominal mass, back/ABDMN pain, hypoBP if ruptured
= Ligamentum arteriosum
According to AHA, when is Morphine or Fentanyl indicated for a patient presenting with chest pain After
admin of ASA & 3 Nitro doses
Adenosine & Digoxin class & indication
class misc> Adenosine 1st line med for stable narrow complex SVT,
Regular & monomorphic wide-complex tachyC thought to be from a reentry SVT (SVT w/ BBB) Does not convert A-fib/flutter
Afterload:
= resistance against which the heart must pump against afterload become increased w/ increased ventricular workload
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Normal T Wave in any chest lead should have max amplitude:
= 10 mm
Normal T Wave in any limb lead should have a max amplitude:
= 5 mm
ANP Atrial natriuretic peptide:
made, stored, & released by atrial M> cells in response to atrial distension & Sympathetic stim & counters RAAS system, Decreases afterload pressure
ECG Camera views) Anterior
Lead V3 V4
Aortic aneurysm:
S/Ss:
= weakness aorta wall can rupture, Dissecting aneurysm occurs when inner layers of aorta become separated
= Very sudden chest pain & full force, “Ripping/Tearing ” in nature, Pulse & BP deficit
Arteriosclerosis is
hardening of the blood vessels “AR h-AR-d”
Atherosclerosis is
buildup of plaque in-between arteries’ media & intima
“40% block = 60% of blood getting through” “ATh F-AT”
Atrial appendages:
(abnormal heart birth defect) pockets that form clots on either atrium from uterine dev/,
Axis quick ID
Lead 1,2,&3
Axis normal
Axis Path L
Axis QRSs) Lead 1 Up/+
lead 2 Up/+
lead 3 Up/+
Normal
Axis QRSs) Lead 1 Up/+
lead 2 Up/+
lead 3 2 Down/-
physcio L
Axis QRSs) Lead 1 Up/+
lead 2 2 Down/-
lead 3 2 Down/-
Patho Left
Axis QRSs) Lead 1 2 Down/-
lead 2 Up/+ or Down -
lead 3 Up/+
RIght
Axis QRSs) Lead 1 Down/-
lead 2 Down/-
lead 3 Down/-
Extreme Right
Axis Path L cause:
Anterior Hemiblock
Axis QRSs) normal axis leads & Degrees
= all Up) 0° to +90°
Axis QRSs) Pyscio Left leads & Degrees
= U, U, D) 0° to -30°
Axis QRSs) Patho Left leads & Degrees
= U,D,D) -30° to -90°
Axis QRSs) RIght axis leads & Degrees
= D, U/D, U) +90° to +180°
Axis QRSs) Extreme right leads & Degrees
=All down )+180° to -90°
Axis QRSs) all Up
Normal
Axis QRSs) U, U, D
physcio L
Axis QRSs) U, D, D
Patho Left
Axis QRSs) D, U/D, U
RIght
Axis QRSs) D, D, D
Extreme Right
Axis pys L
Benign Early Repolarization (BER) ECG changes:
Widespread concave ST elevation limited to precordial leads (usually V2-V5)
Absence of PR depression
Prominent T waves
Characteristic “fish-hook” appearance (often best in lead V4)
Pericarditis:
Usually presents w/:
S/S:
= inflammation of the pericardium, the sac structure w/ 2 layers of tissue that surrounds the heart (Pericardial friction rub)
= concave STE, PR Depression in multiple leads
Spodick’s Sign, rub @ ERb’s point
= Paroxysmal nocturnal dyspnea (PND), Hx of sick,
BNP Brain Natriuretic peptide:
secreted by ventricles in response to stress to excessive stretching of myocytes & Counter RAAS
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
Chordae Tendineae:
Heart regurgitation:
= connect valves’ leaflets to papillary-M.s to prevent valves from prolapsing into atria & allowing backflow during ventricle contraction
= papillary not working &/or valve doesn’t correctly opens so prolapse
Chrontropy:
Inotropy:
Dromotropy:
= HR, + tropic +HR vice versa
= Contraction force
= Speed of impulse transmission, usually goes w/ Inotropy
(Electrolytes affects) Cl
Na
K
Ca
Mg
= Cl picks up Co2 (shift) to keep neutrality
= depolarizing myocardium
= depolarization & majority myocardial contractile
= influences repolarizations
= regulates contractility & rhythm
Congestive Heart Failure (CHF):
= Weakened heart unable to efficiently pump blood from L-ventricle
= May be acute or chronic, May occur suddenly, during an MI, Flash Pulmonary Edema
Contractility:
= ability of CM. cells to contract, or shorten (Actin Myosin)
Coronary Artery Bypass Graft (CABG):
Chest or leg blood vessel is sewn from the aorta to a coronary artery beyond the point of obstruction
When you cant pout a stent in blockage
By pass the blockage to coronary,
De Winter’s T Waves:
V2 V3 most commonly but can happen any lead
ST depression at the J-point & upsloping ST-segments w/ tall, symmetrical T- waves in the precordial leads (LMCA or LAD occlusion)
“Hyper T w/ STD”
Dotted line on ECG means
monitor not connected properly
ECG Camera views) Left Lateral view by which lead
Lead I, aVL, V6, V5
ECG Camera views) Septal view by which leads
Lead V1 V2
ECG Camera views) LMCA - 3 vessel disease view by which lead
Lead aVR
ECG Camera views) Posterior view by which leads
Lead V9 V8
ECG Camera views) Right view by which lead
Lead V4R
ECG Lead coronary arteries) Anterior view leads are feed by
(LAD) Left Anterior Descending
ECG Lead coronary arteries) Inferior view leads are feed by
(RCA) Right Coronary Artery
ECG Lead coronary arteries) Posterior view leads are feed by
(RCA) Right Coronary Artery &/or (LCX)
ECG Lead coronary arteries) Right view leads are feed by
(RCA) Right Coronary Artery
ECG Lead coronary arteries) Lateral view leads are feed by
(LCX) Left Circumflex
Coronary arteries) Lateral ECG leads to
(LCX) Left Circumflex
ECG Lead views) Lead aVR views what
LMCA - 3 vessel disease
ECG Lead views) Lead V5 V6 views what
Lateral
ECG Lead views) Lead V3 V4 views what
Anterior
ECG Lead views) Lead V1 V2 views what
Septal
ECG Lead views) Lead I, aVL, V4, V5 views what
Left Lateral
ECG Lead views) Lead V4R views what
Right
ECG Lead views) Lead V8 V9 views what
Posterior
Ejection Fraction (EF):
<45% usually indicates:
<30%:
= Ratio of blood pumped from the ventricle to the amount remaining @ the end of diastole/ %of blood pumped out from ventricle (60-70%)
=<45% usually indicates in or going to CHF
=<30% in CHF & chronic cardiac crip on oxy
EMD
Electrical Mechanical disassociation (same as PEA)
Fascicular Block (Hemiblock):
A block of 1 of the 2 fascicles of the left bundle
Heart Failure:
S/S:
= Weakened heart unable to efficiently pump blood from L-ventricle
= Dyspnea, Chest pain/pressure, Tachycardia, Pedal edema (swollen ankles), JVD, Pale & moist skin, AMS
Heart’s Endocrine hormones’:
ANP:
BNP:
= store & secretes 2 hormones released when somewhere in heart fail
= Atrial Natriuretic Peptide: made, stored, & released by atrial-M cells response to atrial distension & Sympathetic stim (counter RAAS & lessen afterload pressure)
= Brain Natriuretic peptide: secreted by ventricles response to stress to excessive stretching of myocytes & Counter RAAS
Heart’s 3 tissue layers:
= Endocardium, myocardium, & pericardium.
Hypothermia affect on heart:
= Osborn waves (J waves), <90 core usually, So irritable will/can throw to AFIB
Imitators of Infarct:
LVH, LBBB, Ventricular beats, Pericarditis, BER
Intercalated discs:
Discs speed Vs standard cell membrane:
Syncytium:
= Special tissue bands inserted between myocardial cells that increase the rate(400x) in which AP is spread from cell-cell thus Syncytium
= 400x faster than standard cell membrane drom/Inotropy
= Group of cardiac cells physiologically function as a unit, “working together in sync” “top in syncytium to bottom”
Isolated Dextrocardia:
Abdominal situs Inversus:
Situs Inversus Totalis:
= Heart on right side/flipped “Right = Left” so mirror leads, AEDs
= Spleen & Liver flipped but H normal
= “EVERYTHING WRONG” H right side
Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
Side of heart has most myocardium:
Epicardium makes what & how:
Pericardium holds what, w/ what color & Fn.:
= L side of heart (muscle)
= folds over self to make pericardium
= holds 25-50mLs straw color fluid to reduce friction, 150mL = heart can squeeze,
Leads aVR, aVL, aVF are what type of leads
as Augmented leads.
Left Anterior Fascicle (LAF):
Pathway of conducting impulses:
= THIN Located in the anterior & superior portion of the left ventricle
= Conducts impulses to the anterior and lateral walls of the L-ventricle
Left Posterior Fascicle (LPF):
Pathway of conducting impulses:
= THICK Found in the posterior & inferior portion of the left ventricle
= Conducts impulses o the inferior & posterior walls of the L-ventricle
Left Ventricular Failure:
S/S:
Fluid backs up from the left ventricle to the lungs
= Rales, orthopnea, pink frothy sputum, crackles.
Left Ventricular Hypertrophy (LVH)
How to Recognize LVH:
= Enlargement & thickening of the L-ventricle
= Take the tallest R wave in V5 or V6 + the S wave in V1 = > 35mm –R in aVL > 11mm
Lown-Ganong) definer:
Pathway name & path:
= has short PRI interval
= Bundle of James connects posterior internodal pathway to bundle of his
Mahaim Syndrome
Accessory connects to Below bundle of his (wide QRS) looks like VTach
Match the Labels
H= Aorta
I= Pulmonary Artery
J= Left Pulmonary Veins
K= Left Atrium
L= Bicuspid Valve
M= Aortic Valve
N= Left Ventricle
O= Papillary Muscle
Match the Labels
A= SA Node
B= AV Node
C= Interventricular Septum
D= Right Bundle Branch
E= Purkinje System
F= Purkinje Fibers
G= Left Bundle Branch
H= Bundle of His
I= AV Junction
J= Internodal Pathways
K= Bachmann’s Bundle
Match the labels
A= Superior Vena Cava
B= Pulmonary Valve
C= Right Pulmonary Veins
D= Right Atrium
E= Tricuspid Valve
F= Chordae Tendineae
G= Right Ventricle
H= Inferior Vena Cava
Mirror Criteria
V1&2 leads (v2 most sensitive w/ R): ST depression w/ big R wave (accompany 15-20% inferior or lateral STEMI)
Muscle tremors, shivering, and loose electrodes can cause deflections on the ECG called:
Artifact
Nitroglycerin is administered to a patient having chest pain because it:
Dilates the blood vessels which lowers the afterload pressure.
only condition A-Fib has cadence:
Afib w/ 3rd degree In rhythm “Gandalf dead so Atriums & Ventricles doing own thing
P Wave Asystole:
P waves ventricles dont pick up b/c 3rd degree HB (type of PEA)
Percutaneous Transluminal Coronary Angioplasty (PTCA):
tiny balloon inflated inside a narrowed coronary artery“Cath”
If balloon doesnt fix then gets stent (metal sheath)
Prinzmetal Angina:
= Coronary Spasm causing pain from Stimulants
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
Right Ventricular Failure:
S/S:
= Fluid backs up from the R-ventricle to the systemic circulation
= +JVD kussmaul’s sign, peripheral edema, ascites, hepatomegaly, Orthopnea
S3 is heard when
S4 is heard when
S3 after S2
S4 before S1
Sgarbossa criteria 2:
Concordant ST depression ≥ 1 mm in V1-V3.
Sgarbossa criteria 1:
Concordant ST elevation ≥ 1 mm in leads w/ a positive QRS.
Sgarbossa criteria 3:
Discordant ST elevation > 5 mm in leads w/ a negative QRS.
Sgarbossa smith modified criteria 3:
Discordant ST elevation > .20 QRS amp in leads w/ negative QRS
ST/QRS #= 0.12
Spodick’s Sign, or downsloping of the TP segment on an ECG is usually associated with
Pericarditis
Spodick’s Sign:
Downsloping of P wave
ST elevation leads criteria:
V2 & V3 females criteria:
V2 & V3 Males <40 criteria:
V2 & V3 Males>40 criteria:
STEMI criteria:
= > 1mm in all leads except V2 & V3
= 1.5 mm or more
= 2.5 mm or more
= 2 mm or more
= leads’ criteria in 2 or more contiguous leads
Stable & symptomatic doesnt always mean
medicate; ex vagal is all that is needed
Stable Angina:
= Predictable chest pain w/ exertion, relieved by rest or nitroglycerin.
J waves on a 12-lead ECG w/ PT who is not hypothermic is usually associated w/:
(BER) Benign early repolarizarion
The term “collateral circulation” refers to:
An alternative path for blood flow in case of blockage
admin/ing NGL to PT suspected of having an acute MI has therapeutic effect b/c
1 Increased coronary artery perfusion through vasodilation 2 Decrease in cardiac afterload pressure from peripheral vasodilation
Thoracic Aortic Aneurysm (TAA) aka :
S/S:
Ligament & fixation point:
= Bulging of thoracic aorta. DeBakey Tear
= “TEARING PAIN INTO BACK”, SOB, hoarseness, dysphagia
= Ligamentum arteriosum, fixed between aorta & pulmonary artery.
Thoracic Aortic Aneurysm aka:
Definers:
ECG changes:
= Debakey Tear
= Pulse & BP deficit, Acute “Rip/Tearing” pain, Hetero-perfusion
= ST Elevation in aVR and Posterior Leads
Time interval markings on ECG paper are placed at:
3-second intervals.
Unstable Angina:
= Unpredictable, occurs at rest, more severe, precursor to MI.
VT vs SVT w/ aberrancy) 1st Criteria/ (ERAD):
= up aVR, V6 down (99.9% evident) w/ all 3) all 3= VT
VT vs SVT w/ aberrancy) 2nd Criteria
Fusion P waves is from what:
= Fusion P waves present?
= SA trying to take over ventricles
VT vs SVT w/ aberrancy) 3rd Criteria:
Josephson’s Sign:
Nadir:
= Josephson’s Sign
= Notching near the nadir of the S-wave
= deepest/most distal point of depression
w/ A/V Sequential regain:
atrial kick
Wellen’s wave type A:
Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower
Highly specific for for a critical blockage of the LAD
Wellen’s wave type B:
DEEP inverted T waves V2 or V3,
What occurs for cardiogenic shock to be present:
Intrinsic:
Extrinsic:
= Pump failure; heart can’t supply sufficient blood
= “Inside” MI, PE, ect
= “Outside” Pericardial tamponade, Tension Pneumo/, ect
When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?
= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular
Which coronary artery feeds the anterior wall of the left ventricle?
Left Anterior Descending (LAD)
Which coronary artery feeds the inferior wall of the heart?
Right Coronary Artery (RCA)
Which coronary artery feeds the left lateral wall of the heart?
Left Circumflex (LCX)
Which ion has the greatest influence on muscular contraction:
= Calcium
WPW) Orthodromic loop;
Antidromic loop:
Treatmeats:
= Clockwise reentry w/ narrow complex
= Counterclockwise reentry w/ wide QRS
= procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion
Most lethal type of MI
Anterior
Most Common type of MI
Inferior
