2444 Exam Flashcards
What indicates infarction/injury on a 12 lead?
ST elevation
What indicates ischemia on a 12 lead?
ST depression, inverted T waves
What indicates previous cardiac injury/cardiac tissue necrosis?
Deep Q waves. (⅓ of QRS wave is MI).
What leads represent the inferior portion of the heart?
II, II, AvF
What leads represent the lateral portion of the heart?
I, AvL, V5, V6.
What leads represent the anterior portion of the heart?
V3, V4
What leads represent the septal portion of the heart?
V1, V2
The right coronary artery is represented by what leads?
II, III, and AvF
The left anterior descending (LAD) artery is represented by what leads?
V1-V6
The left circumflex artery is represented by which leads?
I, AvL
What does a P wave represent?
Atrial depolarization
How long is a normal PRI?
0.12-0.20 or 3-5 small boxes
What does a prolonged PRI indicate?
The atria is holding the charge it received from the SA node for longer than it should. Not necessarily a problem with the SA node, but the AV node.
What is the speed measurement of EKG paper?
25mm/sec. One small box represents 0.04 seconds.
What is the normal width of the QRS?
0.08-0.12 or 2-3 small boxes
What does a wide QRS indicate?
slower spread of ventricular depolarization. It is taking longer for the ventricles to contract.
What does the QRS indicate?
Ventricular depolarization
What does the T wave indicate?
Ventricular repolarization.
BP, diet, exercise, stress, and sugar intake are all examples of ____ cardiac issues
modifiable
age, race, sex, and FMHx are all examples of ____ cardiac issues
non-modifiable.
Normal conduction rate for the SA node?
60-100
Normal conduction rate for the AV node?
40-60
Normal conduction rate for the perkinje fibers?
20-40
Sinus Bradycardia?
less than 60
Sinus Tachycardia
greater than 100
Junction escape rate?
40-60
Accelerated Junctional rate?
60-100
Junctional tachycardia rate?
greater than 100
What can cause a wide QRS?
BBB, Vtach, hypertrophy, SVT with a BBB.
Sudden onset, pain ripping or tearing sensation, pain radiating to the neck, back, shoulders, or abdomen. Stridor or hoarseness, two different BP, dysphagia are all S/S of what pathology?
Thoracic Aortic aneurysm.
Lower abdominal pain on the left side, palpable abdominal pulse, lower back/flank pain, unequal or absent distal pulses are all S/S of what pathology?
AAA
What is the pathway for a drop of blood through the heart?
Vena cava, RA, Tricuspid, RV, Pulmonary arteries, lungs, pulmonary veins, LA, bicuspid valve, LV, aortic arch.
Adenosine dose and indication?
6mg
12mg
12mg
SVT
Amiodarone HCL dose and indication
Vfib and Vtach w/o pulse
300mg
150mg
Vtach w/ pulse
150mg/10 min.
Atropine dose and indication
symptomatic bradycardia
0.5mg q 3-5 min max 3mg
Dopamine dose and indication
Symptomatic bradycardia and nonhypovolemic hypotension
2-20mcg/kg/min
effects start at 5-10 mcg/kg/min
Epi 1:10 dose and indication
CA
1mg IV q 3-5 min
Lebetalol dose and indication
Unstable angina, non q wave MI, AAA, SVT with RVR, Vtach refractory to lidocaine
5-10mg IV repeat to total of 20mg IVP. Goal of 115-130 mmHg diastolic BP
Levophed dose and indication
Neurogenic and cariogenic shock and septic shock. RSOC to achieve BP > than 90
BP <70
8-12mcg/min
Lidocaine dose and indication
CA from VT/VF
Maintenance infusion @ROSC associated w/ VT/VF
CA - 1-1.5mg/kg q 5-10 min to max of 3 mg.
ROSC - 1-4mg/min
Magnesium sulfate indication and dose?
Torsades
1-2g over 10 min.
Morphine indication and dose
Cardiac chest pain unrelieved by nitro
2-4mg q3-5 min to hypotension or respiratory depression
Nitroglycerine indication and dose
Chest pain of cardiac origin
0.4mg sublingual
Sodium bicarb dose and indication
prolonged CPR
1mEq/kg
Verapamil dose and indication
SVT, aflutter w/ RVR, afib, atrial tach, unstable angina
2.5-5mg repeat 5-10mg q15 min
Epinephrine dose for profound symptomatic bradycardia
2-10mcg/kg
What are signs/symptoms associated with cariogenic shock and how can it be treated?
dyspnea, rales, tachycardia with decreased BP, increased respirations, diaphoresis, arrhythmias, increased blood volume in lungs and liver due to pump failure (CHF).
Dopamine to increase BP 2-20mcg/kg/min
What are parasympathetic agents used to treat bradycardia?
Atropine, dopamine, and epi
How does atropine work?
reverses vagal tone
How does dopamine work?
increases rate and force of ventricles, high dose causes peripheral vasoconstriction.
How does Epi work?
alpha effects cause vasoconstriction, beta 1 causes increased HR..
What is the condition in which the arteries narrow and harden leading to poor circulation of blood throughout the body?
Arteriosclerosis
What is a specific kind of arteriosclerosis that involves the thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery? Risk factors may include HLD, HTN, smoking, DM, obesity, physical activity.
Atherosclerosis.
What is the difference between stable and unstable angina?
Stable angina is relieved with nitro or when hard works stops. Unstable angina does not respond to to cessation of activity or administration of nitro,
What does an inverted or absent P wave indicate?
junctional rhythm.
How do inotropic drugs work?
increases the force of cardiac contraction.
How do chronotropic drugs work?
increases the HR
How do dromotropic drugs work?
increases conduction velocity/speed through the conduction tissues of the heart. (rate of conduction through the AV node.)
What cardiac rhythms can be sync-cardioverted?
aflutter, afib, SVT, torsades w/ pulse, Vtach w/ pulse.
What cardiac rhythms are defibrillated?
Vfib and Vtach w/o pulse.
What does the loss of oxygen, blood, and sugar in the heart do?
stimulates epi and will cause alpha constriction/vasoconstriction steals red warm oxygen from extremities.
Sympathetic stimulation causes:
fight or flight. Cardiac increase
Parasympathetic stimulation causes
relaxation. Cardiac decrease.
What is stroke volume?
The volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction.
What is the average stroke volume of a 70kg male?
70mL
Not all of the blood that fills the heart by the end of diastole can be ejected from the heart during systole. Thus the volume left in the heart at the end of systole is the ____
end systolic volume
SV= ??? - ????
EDV - ESV
What is cardiac output?
the blood volume the heart pumps through the systemic circulation over a period measured in LPM.
What is the formula for cardiac output?
CO = SV x HR
??= SV x HR x peripheral vascular resistance
Blood pressure
dyspnea, rales, tachycardia, chronic atrial arrhythmias, pink frothy sputum, PE, orthopnea, increased BP are all signs and symptoms of ???.
CHF/right sided heart failure
What are treatments for CHF/right sided heart failure?
O2, nitro, morphine, CPAP
How do you treat chest pain (cardiac)
O2, nitro, aspirin, morphine
The pressure in the filled ventricle at the end of diastole.
Preload
The amount of pressure that the heart needs to exert to eject the blood during ventricular contraction is called?
Afterload
If a patient is taking a Ca channel blocker and nothing else, they likely have a history of ___ or ___?
HTN, or AFIB
If a patient takes a beta blocker or ACE inhibitor, they likely have a hx of ___?
HTN
How is pediatric SVT treated?
Reduced dose of adenosine.
What is the biggest risk factor for cardiovascular disease?
other than parents with CVD, it is diabetes.
Dobutamine drip is the cousin of dopamine but does not have the ???? effects with BP around 90.
chronotropic (increased HR)
____ is the synthetic version of dopamine.
Dobuatimine.
How is unstable VTach or SVT treated?
Cardioversion
what causes peaked T waves on an EKG?
Hyperkalemia
What arrhythmia can hyperkalemia cause?
Torsades
What is the most common cause of hyperkalemia?
Renal failure and the kidneys can’t eliminate water.
What temperature do you aim for if a patient has ROSC?
32-36 degrees C
____ from NVD need to be looked at during H/T’s.
Electrolyte imbalances.
____ are more likely to have atypical heart attacks (w/o chest pain)
females
Other s/s for a female having an acute MI include:
jaw pain, weakness, nausea
When a person requires ____, the sooner it is done, the greater the chance for survival.
defibrillation.
____ is pressure being pushed throughout the body.
systolic pressure
_____ is pressure in the arteries when the heart is at rest.
diastolic pressure.
What is the most common cause of PEA?
hypoxia secondary to respiratory failure.
_____ and _____ are the 2 most common underlying and potentially reversible causes of PEA?
Hypovolemia and Hypoxia
What are the H/T’s?
hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia
tension pneumo, tamponade, toxin, thrombosis pulmonary/coronary.
_____ is also known as the stretch law. The more the myocardial muscle is stretched, the greater the force of the contraction. Example is stretching a rubber band and letting it go.
Starling’s law
_____ is also known as pipe law. The blood flow through a vessel is directly proportional to the fourth power of the vessels radius. The bigger the hose the more water but the less pressure.
Poiseuille’s law
Decreases in preload mean ___ in afterload
decreases
____ angina is angina that is lasting longer and pain is getting worse.
unstable
Cardioversion is used for ___ rhythms.
Tachycardic arrhythmias
Pacing is used for ___ rhythms
bradycardia arrhythmias.
What rhythms are not defibrillated?
PEA and asystole
Parasympathetic interphase through the SA node will cause ____?
bradycardia
for testing purposes, what is the rate of the ventricles/purkinje fibers?
15-40
What is the main criteria for determining whether or not a patient is stable?
BP <90
When T wave gets 50% or more higher than the QRS, it can put the patient into ____
torsades
If a patient has sinus tachycardia, treat the _____
underlying cause
what are common underlying causes for sinus tachycardia?
dehydration, anxiety, hypovolemia
What is automaticity?
the individual cells of the conductive system in the heart can depolarize without any impulse form outside sources.
V1 and V2 are placed:
between rib 4 and 5
V3 is placed
right of the nipple line
