Cardiac Flashcards
What are the three signs of Beck’s triad for identification of cardiac tamponade?
Hypotension, jugular venous distention, muffled heart sounds
When attempting to delineate between cardiac emergencies, your history and physical exam reveals recent chest pain that improves when leaning forward and a pericardial friction rub on auscultation. Which cardiac emergency do you believe the patient is suffering from?
Pericarditis
How does the lead placement vary in a 15-lead ECG?
- Acquire standard 12-lead
- V4 to V4R on corresponding R anterior chest
- V5 to V8 at 5th intercostal space posterior left back midscapular line
- V6 to V9 at 5th intercostal space posterior left back, paraspinal line next to V8
- Run another 12-lead. Relabel V4 > V4R, V5 > V8, and V6 > V9
What are the definition and equation that represent cardiac output?
Amount of blood pumped by the heart in one minute: CO (cardiac output) = SV (stroke volume) X HR (heart rate)
The method of mechanically restoring perfusion to blocked or constricted coronary arteries is know as?
Percutaneous transluminal coronary angioplasty (PTCA)
Why are patients with atrial fibrillation or flutter with a rapid ventricular response often hypotensive?
Decreased atrial kick and cardiac output
Why are nitrates and opioids used with caution in patients with right ventricular infarction?
Nitrates and opioids may reduce preload which will ultimately diminish pulmonary perfusion and left-sided cardiac output, thus dropping blood pressure
When attempting to treat malignant hypertension, what is the target when reducing blood pressure?
The initial blood pressure should not be reduced by more than 10-15%
What is the relationship between the QRS complex and the ejection fraction?
The greater the width of the QRS complex the lower the ejection fraction
Where is the infarction if ST elevation occurs in leads II, III, and AVF?
Inferior wall
If cardiogenic shock stems from the right side of the heart, what medications do you want to avoid and why?
Medications which reduce preload such as diuretics, morphine, and nitroglycerin since they will cause further hypotension
How is a non-ST elevation myocardial infarction diagnosed?
Elevation or serum cardiac enzymes
Transportation with an intraaortic balloon pump (IABP) requires monitoring for which complications?
Limb ischemia, infection, thrombus formation, arterial damage, and malpositioning of the balloon
Why is it imperative to correct rapid ventricular rate in patients with anomalies of the mitral valve?
Susceptibility to congestive heart failure
What is the standard anti-platelet medication used in acute coronary syndrome?
Aspirin
What is the proper needle placement for pericardiocentesis?
Insert the needle at the left costal arch and advance towards the tip of the left shoulder or directly cephalad
How does nitroglycerin achieve decreasing myocardial oxygen demand?
By reducing preload and afterload
What does an imbalance between myocardial oxygen supply and demand cause?
Myocardial ischemia and eventually infarction if not corrected
Patients with congestive heart failure will exhibit what changes in central venous pressure (CVP) and systemic vascular resistance (SVR)?
Increased
When traditional therapies of oxygen, nitrates, lasix and morphine prove unsuccessful in treating congestive heart failure, what non-invasive technique may be added to the treatment regimen?
CPAP (continuous positive airway pressure) or BiPAP
What additional findings do women present with to make their presentation of acute coronary syndrome differ from that of men?
Indigestion, dizziness, nausea, vomiting, discomfort between shoulder blades, sense of impending doom, unexplained fatigue
How do beta blockers decrease myocardial oxygen demand?
By decreasing heart rate and contractility
During what portion of the cardiac cycle does the intraaortic balloon pump (IABP) inflate?
Diastole
Where does the tip of a transvenous temporary pacer terminate?
Right ventricle
How does intravenous nitroglycerin work to improve ischemic chest pain?
Directly vasodilates the systemic and coronary blood vessels to improve blood flow
A patient who displays diminished femoral pulses with hypotension should pose a high index of suspicion for what?
Abdominal aortic aneurysm
Tall or peaked T waves on an electrocardiogram are indicative of what electrolyte imbalance?
Hyperkalemia (elevated potassium)
What is the major difference between aortic dissection and aortic aneurysm?
Aortic dissection causes bleeding where a false lumen is created between the layers of the vessel whereas an aneurysm tears through all three layers of the lumen and bleeds into the thoracic or abdominal cavity
A septal wall acute myocardial infarction (AMI) will show ST elevation in which leads?
V1 and V2
What can be administered to a patient suffering from a right ventricular myocardial infarction to increase central venous pressure?
Intravenous fluid Boris
