Cardiac 15 Q Flashcards
What does the P wave represent?
Atrial depolarization (and contraction)
What does the QRS complex represent?
Ventricular depolarization (and contraction)
Smallest divisions on an EKG graph paper are _ mm squares
1
Each large square on an EKG measures _ mm
5
Amount of time represented by the distance between 2 heavy black lines is _ of a second
0.2
Each small division (measured horizontally between two fine lines) represents _ of a second
0.04
The SA node normally paces the heart at a range of
60-100 bpm
_ PVCs per minute is pathological and do not ignore this patient!
6
What type of block? PR interval is consistently prolonged the same amount in every cycle
1st degree
Hypo or hyperkalemia? Wide QRS
Hyperkalemia
Hypo or hyperkalemia? Prominent U wave
Hypokalemia
Hyper or hypocalcemia? Prolonged QT
Hypocalcemia
Beta blockers decrease _ and _
Heart rate and contractility
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
ACE inhibitors (-prils) cause vaso_
vasodilation
hydralazine (Apresoline) is a vasodilator that decreases _ and increases _
decreases PVR and increases CO
4 things that may be used for symptomatic sinus bradycardia
Pacemaker, atropine, epinephrine, dopamine (BP support)
Watch heart blocks if they are asymptomatic. If symptomatic, what are 4 things used in tx?
Pacemaker, epinephrine, atropine, dopamine
2 txs for stable SVT
adenosine, CCB
Treatment for unstable SVT
Same meds as stable (adenosine, CCB) but also cardioversion
Treatment for stable atrial fibrillation or flutter (2)
CCBs (primarily cardizem), digoxin
What is the treatment for unstable afib or flutter
Same meds as stable (CCBs, dig) but also cardioversion Give anticoagulant prior to cardioversion
What is the treatment for stable Vtach? (3)
cardioversion, amiodorone, lidocaine
What is the tx for unstable vtach?
Same meds as stable (amidorone, lidocaine) + immediate difibrillation, CPR
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)
- Identify and examine P waves
- Measure PR interval (should be 0.12-0.20)
- Measure the QRS complex (0.06-0.12)
- Identify the rhythm
- Determine the heart rate
- Interpret the strip
