Cardiac 15 Q Flashcards by K D

What does the P wave represent?

Atrial depolarization (and contraction)

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What does the QRS complex represent?

Ventricular depolarization (and contraction)

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Smallest divisions on an EKG graph paper are _ mm squares

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Each large square on an EKG measures _ mm

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

0.2

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

0.04

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The SA node normally paces the heart at a range of

60-100 bpm

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

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

1st degree

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Hypo or hyperkalemia? Wide QRS

Hyperkalemia

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Hypo or hyperkalemia? Prominent U wave

Hypokalemia

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Hyper or hypocalcemia? Prolonged QT

Hypocalcemia

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Beta blockers decrease _ and _

Heart rate and contractility

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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.

Vasodilation

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ACE inhibitors (-prils) cause vaso_

vasodilation

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

decreases PVR and increases CO

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4 things that may be used for symptomatic sinus bradycardia

Pacemaker, atropine, epinephrine, dopamine (BP support)

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

Pacemaker, epinephrine, atropine, dopamine

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2 txs for stable SVT

adenosine, CCB

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Treatment for unstable SVT

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

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Treatment for stable atrial fibrillation or flutter (2)

CCBs (primarily cardizem), digoxin

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What is the treatment for unstable afib or flutter

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

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What is the treatment for stable Vtach? (3)

cardioversion, amiodorone, lidocaine

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What is the tx for unstable vtach?

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

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What is the tx for Torsades?

Magnesium sulfate

What is the treatment for ventricular fibrillation?

amidorone, lidocaine, immediate defibrillation, CPR

What is the treatment for asystole?

CPR, pacemaker

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

Pressors dopamine, epinephrine, Norepinephrine, phenylephrine, vasopressin

When using pressors, remember that they can compromise perfusion to

distal extremities

Name 4 medications that cause vasodilation and decrease blood pressure

NTG, nipride, apresoline (hydralazine), nicardipine

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

Cardiogenic shock

What is the normal troponin?

0-0.1

PVCs are indicative of \_

Hypoxia

Normal PR interval

0.12-0.20 seconds (3-5 boxes)

Normal Size of QRS

Less than 3 boxes

Inherent rate of the purkinje system

20-40 bpm

Inherent rate of the AV node

40-60 bpm

Treatment of choice for VF and pulseless VT

defibrillation--most effective if done within 2 minutes of onset

Treatment of choice for VT with a pulse or SVT

synchronized cardioversion

Supplies the lateral wall of the LV

Left circumflex

Supplies the anterior wall of the left ventricle

left anterior descending

Name 2 classes of negative inotropes used to decrease contractility

Beta blockers, calcium channel blockers

Name 3 positive inotropes used to increase contractility

Digoxin, dobutamine, dopamine

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

Myocardial infarction

What 3 factors determine the severity of a MI

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

PCI within _ minutes for a STEMI

90 minutes

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

30-90 minutes

What rhythm is common after a CABG

afib--give beta blockers

Normal CKMB (specific to heart muscle)

0-3

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

Immediately

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

\>180; \>110

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

Intra Aoritc Balloon Pump

After IABP, monitor _ because the IABP destroys them

platelets

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

less than 15 degrees

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

1:3

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

arterial occlusion, gas embolism, infection, hemorrhage

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 \_

immobilized

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

diastole

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

Fill with blood

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

R intervals x 10

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

1500 example: 1500/20 boxes=75 bpm

What is the rhythm?

Sinus brady If symptomatic: pacemaker, atropine, epinephrine, dopamine

What is the rhythm?

Sinus tach

What rhythm?

Idioventricuar

What rhythm?

Sinus arrythmia

What rhythm

SVT If stable: give adenosine fast, CCB Unstable: same meds + cardiovert

What rhythm

AFib Stable: CCB (usually cardizem), Heprain, Dig Unstable: same meds + cardiovert

What rhythm?

PAC in the 3rd beat

What rhythm?

Asystole? CPR + Pacemaker

What rhythm?

Atrial flutter Stable: CCB-cardizem, dig Unstable: Meds + cardiovert w/ heparain before

What rhythm?

PJC 5th beat

What rhythm?

junctional escape

What rhythm?

NSR

What rhythm?

Vtach Stable: cardiovert, amiodorone, lidocaine Unstable: same meds + immediate defibrillation and CPR

What rhythm?

VFib CPR, defib, amiodorone, lidocaine

Myocardial Damage What area of the heart is affected if the RCA is involved? 3 Lead changes?

Inferior Lead changes: 2, 3, aVF

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

Posterior Leads: Reciprocal V1-V2

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

Septal Leads: V1-V2

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

Lateral Leads: I, AVL, V5-V6

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

Anterior Leads V2-V4

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

Anterior lateral Leads: 1, aVL, V1-V6

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

first degree

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

Weinkebach

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

Mobitz 2

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

3rd degree

6 step EKG interpretation (look at the steps)

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