Cardiac Flashcards
What is the sinus tachycardia formula?
The formula for maximal sinus rate is 220 - age= Classification Physiological sinus tachycardia. anything above this rate is SVT
What is the normal cardiac output?
4-8 PLM
Normal ranges for the SA node?
Normal ranges for the AV junction?
Normal ranges for the Purkinje fibers?
SA node = 60-100
AV junction = 40-60
Purkinje fibers= 15-40
EKG Cardiac Cycle.
Depolarization of the Atria?
Delay at the AV node to allow filling of the ventricle?
depolarization of the ventricles?
beginning of ventricle repolarizing?
repolarizing of the ventricles?
P wave
PR interval
Q, R, S complex
ST Segment
T wave
SVR Formula
[ (MAP-CVP)÷CO]X80
Where and what is the J point in reference to EKG?
The J (junction) point in the ECG is the point where the QRS complex joins the ST segment. It represents the approximate end of depolarization and the beginning of repolarization as determined by the surface ECG.
In reference to EKG timing.
1 large box vertically is _______mm?
1 small box is _______mm?
5mm vertical
1 mm
The right coronary artery supplies blood to the?
The right coronary artery supplies blood to the right ventricle and atrium of the heart as well as sinoatrial and atrioventricular nodes.
What is an OMI? Pertaining to cardiac
Occlusion Myocardial Infarction (OMI): A branch of the ACS algorithm representing near or total occlusion with insufficient collateral circulation causing active infarction Non-Occlusion Myocardial Infarction (NOMI): No occlusion, or sufficient collateral circulation to avoid active infarction
OMI location and artery in Leads
leads II III aVF =
I II aVF= Inferior RCA supplies blood to the SA, AV node, and right ventricle in 90% of the population.
OMI location and artery in Leads
VI V2 V3 V4
Anterior,Left main/ LAD supplies blood to the entire left side
OMI location and artery in Leads
I aVL V5 V6
I and aVL= high lateral/LCX feeds high lateral wall
V5 V6= LCX/ left marginal left diagonal. feeds the low lateral wall.
OMI location and artery in Leads
aVR
Left main insufficiency
Characteristics of a physiologic q wave
< 0.4 sec in with
< 2mm in depth
< 25% of R wave height
Physiological q wave is normal
Characteristics of a pathologic q wave
> 0.04
2mm in depth
25% of R wave
Indicates an old MI scarring does not allow electrical impulse so there is a delay
What are the ECG contiguous leads?
.Contiguous leads refers to leads that direct neighbors and reflect the same anatomical area; such as anterior leads (V1–V6), inferior leads (II, aVF, III) and lateral leads (I, aVL). For example, leads V3 and V4 are contiguous; V1 and V2 are also contiguous; aVL and I are also contiguous; V3 and V5 are not contiguous]
what are reciprocal leads?
Reciprocal change is a very important ECG finding, not only supporting the diagnosis of STEMI but also indicating a high-risk patient. Reciprocal change is defined as ST-segment depression occurring on an ECG which also has ST-segment elevation in at least 2 leads in a single anatomic segment.
In a 12 lead, the first lead you look at is?
What are you looking for?
V1 you are looking for a BBB is QRS< .12 or 120 Ms
aVL and lead III are _______ of each other
when ST elevation is in lead aVL look at lead III for reciprocal changes in opposite deflection
Recipical changes can only be seen on the ________wall and _________wall
High lateral wall I and aVL an inferior wall II III aVF
Will pericarditis show reciprocal changes on an EKG?
No there will be global STE and no reciprocal changes on the EKG this is a STEMI imposter
How do you identify LVH on an EKG?
look at AVL and Measure the R wave if it is > 11mm it is most likely LVH.
look at the R wave in V5 V6 and measure the height and add it to the S wave in lead 1 if > 35 LVH is likely. This is a STEMI imposter
How do you identify a (BER)
Bening early repolarization
seen in patients under 50 Y/O
STE everywhere with no reciprocal changes. There is a smily face at the J-point hook and the patient VS will be stable. There is a notch at the J-point. in leads II III aVF V4 V5 V6. STEMI imposter
Pertaining to axis deviation between -30 to +90 degrees is normal? True or False?
True Normal Axis = QRS axis between -30° and +90°
Pertaining to axis deviation
Right axis deviation is between——– and ————?
+91 to +180
Left axis physiological deviation is between________ and ________.
Physiological meaning?
0 and -30 degrees
Physiological meaning normal function.
left axis pathological deviation is between_______ and ________
pathological meaning?
-30 to -90
pathological meaning disease if the heart
What leads are looked at to determine axis deviation?
V1 l and lll
in axis deviation.
In lead, l look for a primary impulse is it _______ or _______deflection
positive or negative deflection
In axis deviation when lead l is a positive deflection and lll is a negative deflection, you have a _________?
Pathologic left axis deviation
In axis deviation when lead I is in a negative deflection and lead III is a positive deflection you have a _________ axis deviation.
right axis deviation
In left axis deviation, how can you confirm if it is pathologic?
lead ll will show a negative deflection
QRS complex wider than ________ is considered a BBB.
> 0.12 seconds. this is a slow conduction through the QRS complex.
Causes for right axes deviation.
RVH, COPD, pulmonary emboli, Trycyclic overdose, lateral wall MI,
in a 12 lead with depression in V2 V3 V4, you should suspect
posterior wall MI and do a right-sided 12 lead.
In a bifascicular block which medications are contraindicated?
amiodarone lidocaine and procainamide sodium channel blockers. SLAP.
Left axis deviation is most commonly associated with a?
Anterior fascicular block
Right axis deviation is most commonly associated with a?
posterior fascicular block.
Wallen’s syndrome characteristics.
inverted or biphasic T waves in leads V2-V3, patient are pain-free, normal cardiac enzymes.
In Anterior depression from V2-V6 and aVR is elevated as high as V1 you should consider ________
left-main insufficiency
3 vessel disease process.
Left BBB diagnosis= In V1 the QRS complex is greater than_______? And the QRS complex has a primary __________ deflection
.12 or 120ms
primary QS inverted deflection
Right BBB diagnosis= In V1 the QRS complex is greater than_______? And the QRS complex has a primary __________ deflection
.12 or 120ms
Primary R wave positive deflection.
Explain the Scgabossa Criteria
Three points or more may indicate an OMI.
Posterior wall MI is a common occurance with Inferior wall MI? T/F
Posterior wall myocardial infarction occurs when circulation becomes disrupted to the posterior heart. It commonly occurrence with inferior or inferolateral MI,
Esmolol Indications?
Esmolol dosage?
SVT, HTN
500 mcg/kg/min over 1 min bolus
then begin infusion at 50 mcg/kg/min
Labetalol indications?
Labetalol dosage?
Antihypertensive
10-20 mg every 10 min
infusion mix 200 in 250ml adm 1-2 mg/min
Nicardipine ( cardene) indications?
Dosage?
HTN
5mg/hr IV
Dopamine Indications?
Dosage?
Increase CO and contractility
5-10 mcg/kg/min
Norepinephrine ( Levophed) Vasopressor Indications?
Dosage?
Neurogenic, vasogenic and septic shock.
4Mg into 250ml give 2-12 mcg/min until BP goal adult.
Pedi 01/mcg/kg/min
What does the RCA supply blood to?
SA, AV R-Atrium, and R- Ventricle, and Inferior/posterior wall.
Left Main Artery (LCA) is often referred to as the________. Because if blocked will occlude the ______ and _______
Widowmaker
LCX and LAD
The _________ artery branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the outer side and______________
circumflex
back of the heart
Leads II III AVF refers to which artery?
Leads I, AVL, V5, V6 refer to which artery?
aVR refers to which artery
V1,V2,V3,V4 refers to which artery
RCA feeds the SA, AV, R ventricle R atrium, and inferior/posterior wall.
I aVL ( High Lateral) LCx branch and V5, V6 are LCx and left marginal and left diagonal.
Left main insufficiency
Left Main LAD
