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Med Surg > Cardiac 15 Q > Flashcards

Cardiac 15 Q Flashcards

1
Q

What does the P wave represent?

A

Atrial depolarization (and contraction)

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2
Q

What does the QRS complex represent?

A

Ventricular depolarization (and contraction)

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3
Q

Smallest divisions on an EKG graph paper are _ mm squares

A

1

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4
Q

Each large square on an EKG measures _ mm

A

5

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5
Q

Amount of time represented by the distance between 2 heavy black lines is _ of a second

A

0.2

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6
Q

Each small division (measured horizontally between two fine lines) represents _ of a second

A

0.04

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7
Q

The SA node normally paces the heart at a range of

A

60-100 bpm

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8
Q

_ PVCs per minute is pathological and do not ignore this patient!

A

6

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9
Q

What type of block? PR interval is consistently prolonged the same amount in every cycle

A

1st degree

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10
Q

Hypo or hyperkalemia? Wide QRS

A

Hyperkalemia

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11
Q

Hypo or hyperkalemia? Prominent U wave

A

Hypokalemia

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12
Q

Hyper or hypocalcemia? Prolonged QT

A

Hypocalcemia

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13
Q

Beta blockers decrease _ and _

A

Heart rate and contractility

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14
Q

Calcium channel blockers (-pines) increase supply by _ and decrease demand (BP and SVR) so the heart doesn’t have to work as hard and more blood is supplied.

A

Vasodilation

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15
Q

ACE inhibitors (-prils) cause vaso_

A

vasodilation

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16
Q

hydralazine (Apresoline) is a vasodilator that decreases _ and increases _

A

decreases PVR and increases CO

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17
Q

4 things that may be used for symptomatic sinus bradycardia

A

Pacemaker, atropine, epinephrine, dopamine (BP support)

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18
Q

Watch heart blocks if they are asymptomatic. If symptomatic, what are 4 things used in tx?

A

Pacemaker, epinephrine, atropine, dopamine

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19
Q

2 txs for stable SVT

A

adenosine, CCB

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20
Q

Treatment for unstable SVT

A

Same meds as stable (adenosine, CCB) but also cardioversion

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21
Q

Treatment for stable atrial fibrillation or flutter (2)

A

CCBs (primarily cardizem), digoxin

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22
Q

What is the treatment for unstable afib or flutter

A

Same meds as stable (CCBs, dig) but also cardioversion Give anticoagulant prior to cardioversion

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23
Q

What is the treatment for stable Vtach? (3)

A

cardioversion, amiodorone, lidocaine

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24
Q

What is the tx for unstable vtach?

A

Same meds as stable (amidorone, lidocaine) + immediate difibrillation, CPR

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25
Q

What is the tx for Torsades?

A

Magnesium sulfate

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26
Q

What is the treatment for ventricular fibrillation?

A

amidorone, lidocaine, immediate defibrillation, CPR

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27
Q

What is the treatment for asystole?

A

CPR, pacemaker

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28
Q

What medications activate receptors in the SNS, causing vasoconstriction and increasing venous return to the heart –> increasing BP

A

Pressors dopamine, epinephrine, Norepinephrine, phenylephrine, vasopressin

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29
Q

When using pressors, remember that they can compromise perfusion to

A

distal extremities

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30
Q

Name 4 medications that cause vasodilation and decrease blood pressure

A

NTG, nipride, apresoline (hydralazine), nicardipine

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31
Q

State of inadequate tissue perfusion that impairs cellular function and may lead to organ failure. There is reduced cardiac output due to the inability of the heart to pump adequate blood in the presence of a normal blood volume

A

Cardiogenic shock

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32
Q

What is the normal troponin?

A

0-0.1

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33
Q

PVCs are indicative of _

A

Hypoxia

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34
Q

Normal PR interval

A

0.12-0.20 seconds (3-5 boxes)

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35
Q

Normal Size of QRS

A

Less than 3 boxes

36
Q

Inherent rate of the purkinje system

A

20-40 bpm

37
Q

Inherent rate of the AV node

A

40-60 bpm

38
Q

Treatment of choice for VF and pulseless VT

A

defibrillation–most effective if done within 2 minutes of onset

39
Q

Treatment of choice for VT with a pulse or SVT

A

synchronized cardioversion

40
Q

Supplies the lateral wall of the LV

A

Left circumflex

41
Q

Supplies the anterior wall of the left ventricle

A

left anterior descending

42
Q

Name 2 classes of negative inotropes used to decrease contractility

A

Beta blockers, calcium channel blockers

43
Q

Name 3 positive inotropes used to increase contractility

A

Digoxin, dobutamine, dopamine

44
Q

Severe chest pain that is not relieved by rest, position change, or nitrate administration is indicative of

A

Myocardial infarction

45
Q

What 3 factors determine the severity of a MI

A

Level of occlusion, length of time of occlusion, and presence/absence of collateral circulation

46
Q

PCI within _ minutes for a STEMI

A

90 minutes

47
Q

For STEMIs thrombolytic therapy (streptokinase, TPA, retavase) should be started within _ to _ minutes of arrival

A

30-90 minutes

48
Q

What rhythm is common after a CABG

A

afib–give beta blockers

49
Q

Normal CKMB (specific to heart muscle)

A

0-3

50
Q

A patient had an angioplasty and is now having chest pain (or EKG changes). should you report this?

A

Immediately

51
Q

SBP > _ and/or DBP > _ is hypertensive crisis

A

>180; >110

52
Q

Procedure that increases coronary blood flow to the heart muscle, decreases cardiac workload, and leads to improved CO

A

Intra Aoritc Balloon Pump

53
Q

After IABP, monitor _ because the IABP destroys them

A

platelets

54
Q

After IABP, logroll only!! Also, keep HOB < _

A

less than 15 degrees

55
Q

After IABP, initial inflation is 1:1 (one inflation per one beat) then weaned to 1:2 then _

A

1:3

56
Q

4 complications of IABP. (the longer the patient stays on IABP the > the risk of hemorrhage)

A

arterial occlusion, gas embolism, infection, hemorrhage

57
Q

IABP is for short term use only to buy time for reversing LV failure, reversing cariogenic shock, and providing support until surgery. Baseline distal pulses are priority. Afterwards the patient will be confined to bed and _

A

immobilized

58
Q

With an IABP, inflation of the balloon occurs during _ when the aortic valve closes

A

diastole

59
Q

The faster the heart rate, the less time the ventricles have to _

A

Fill with blood

60
Q

Calculate rate on an *irregular* EKG by counting the number of _ intervals in a 6 second strip x 10

A

R intervals x 10

61
Q

Calculate rate on a *regular* EKG by counting the number of small squares between 2 consecutive R waves and dividing into _

A

1500 example: 1500/20 boxes=75 bpm

62
Q

What is the rhythm?

A

Sinus brady

If symptomatic: pacemaker, atropine, epinephrine, dopamine

63
Q

What is the rhythm?

A

Sinus tach

64
Q

What rhythm?

A

Idioventricuar

65
Q

What rhythm?

A

Sinus arrythmia

66
Q

What rhythm

A

SVT

If stable: give adenosine fast, CCB

Unstable: same meds + cardiovert

67
Q

What rhythm

A

AFib

Stable: CCB (usually cardizem), Heprain, Dig

Unstable: same meds + cardiovert

68
Q

What rhythm?

A

PAC in the 3rd beat

69
Q

What rhythm?

A

Asystole?

CPR + Pacemaker

70
Q

What rhythm?

A

Atrial flutter

Stable: CCB-cardizem, dig

Unstable: Meds + cardiovert w/ heparain before

71
Q

What rhythm?

A

PJC 5th beat

72
Q

What rhythm?

A

junctional escape

73
Q

What rhythm?

A

NSR

74
Q

What rhythm?

A

Vtach

Stable: cardiovert, amiodorone, lidocaine

Unstable: same meds + immediate defibrillation and CPR

75
Q

What rhythm?

A

VFib

CPR, defib, amiodorone, lidocaine

76
Q

Myocardial Damage

What area of the heart is affected if the RCA is involved?

3 Lead changes?

A

Inferior

Lead changes: 2, 3, aVF

77
Q

What area of the heart is involved in the left circumflex or RCA is involved?

Lead changes?

A

Posterior

Leads: Reciprocal V1-V2

78
Q

What is the area of the heart affected if the LAD is involved?

Leads?

A

Septal

Leads: V1-V2

79
Q

What area of the heart is affected if the left circumflex is involved?

Leads?

A

Lateral

Leads: I, AVL, V5-V6

80
Q

What area of the heart is affected if the LAD (widowmaker0 is involved?

Leads?

A

Anterior

Leads V2-V4

81
Q

What area of the heart is affected if the left main coronary artery is involved?

Leads?

A

Anterior lateral

Leads: 1, aVL, V1-V6

82
Q

Poem: If the R is far from P then you have a

A

first degree

83
Q

Poem: longer, longer, longer drop then you have a

A

Weinkebach

84
Q

Poem: If some Ps dont get through then you have a

A

Mobitz 2

85
Q

Poem: If Ps and Qs dont agree then you have a

A

3rd degree

86
Q

6 step EKG interpretation

(look at the steps)

A
  1. Identify and examine P waves
  2. Measure PR interval (should be 0.12-0.20)
  3. Measure the QRS complex (0.06-0.12)
  4. Identify the rhythm
  5. Determine the heart rate
  6. Interpret the strip

Med Surg (19 decks)

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