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NUR352 2018 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is the systematic approach for recognising rhythms on an ECG

A

QRS regular or irregular?
P Waves present?
QRS normal or prolonged?
Is there a QRS for every P Wave?

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2
Q

What is the normal P - R Interval?

A

< 5 small squares OR

< 0.2 seconds

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3
Q

What is the normal QRS Complex width?

A

2.5 small squares OR 0.1 seconds

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4
Q

How long does a small square on an ECG represent?

A

0.04 seconds

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5
Q

How long does one Large square represent on an ECG?

A

0.2 seconds

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6
Q

How long does 5 Large squares / 25mm represent on an ECG?

A

1 second

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7
Q

How do you calculate a REGULAR HR on an ECG?

A

Count the number of large squares between 2 R Waves and divide by 300

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8
Q

How do you calculate an IRREGULAR HR on an ECG?

A

Count 30 large squares (6 seconds), count the number of R Waves in that space and times by 10

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9
Q

Describe the lead placement on a 12-Lead ECG

A

Limb Leads
• Left arm and leg
• Right arm and leg

Chest leads
• V1 - 4th ICS right sternal border
• V2 - 4th ICS Left sternal border
• V3 - between V2 and V4
• V4 - 5th ICS mid-Clavicular line
• V5 - 5th ICS Anterior Axilla
• V6 - 5th ICS Mid Axilla
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10
Q

What are the shockable rhythms?

A

VT and VF

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11
Q

Which part of the heart do leads 1, aVL, V5 and V6 look at?

A

Lateral aspect

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12
Q

Which ECG leads measure the lateral aspect of the heart?

A

1, aVL, V5 and V6

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13
Q

Which aspect of the heart do ECG leads 2, 3 and aVF look at?

A

Inferior

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14
Q

Which ECG leads measure the Inferior aspect of the heart?

A

2, 3 and aVF

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15
Q

Which ECG leads measure the Septal aspect of the heart?

A

Leads V1 and V2

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16
Q

What aspect of the heart do leads V1 and V2 measure?

A

Septal

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17
Q

What aspect of the heart do leads V1, V2, V4 and V3 measure?

A

Anterior

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18
Q

Which ECG leads measure the Anterior aspect of the heart?

A

Leads V1, V2, V3 and V4

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19
Q

What is Acute Coronary Syndrome (ACS)?

A

An umbrella term that encompasses any condition brought on by a sudden reduction or blockage of blood flow to the heart

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20
Q

What are some ischaemic causes of chest pain?

A

ACS
Stable Angina
Severe aortic stenosis
Tachy arrhythmias

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21
Q

What are some Non-Ischaemic cardiovascular causes of chest pain?

A

Aortic dissection
PE
Pericarditis
Myocarditis

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22
Q

What are some Non-Ischaemic non-cardiovascular causes of chest pain?

A

Musculoskeletal
GI
Pulmonary
Other (sickle cell crisis, herpes zoster)

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23
Q

What are the Initial Assessment requirements for those presenting with Acute chest pain or ACS symptoms?

A
  • 12 - Lead ECG recorded and assessed < 10 mins of presentstion
  • receive care based on the ACS assessment protocol
  • have bloods taken to measure cardiac specific troponin and CK-MB enzyme
  • maintain Sa02 <93% in non-COPD patients and apply supplemental oxygen if below
  • maintain Sa02 88-92% in COPD patients
  • administer Aspirin 300mg PO unless contraindicated
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24
Q

Trace the cardiac conduction system

A

SA/pacemaker node -> AV Node -> Bundle of His -> Purkinje fibres

25
Q

Which aspect of the heart does the Right Bundle Branch supply

A

Right Ventricular Apex

26
Q

Which aspect of the heart does the Left Bundle Branch supply

A

Left anterior and left posterior aspect

27
Q

Which aspect of the heart do the Purkinje fibres supply

A

Ventricular apices to Outer Myocardium

28
Q

What differentiates cardiac cells from other muscle cells of the body?

A

The are “autorhythmic” meaning they are capable of soontaneous depolarisation

29
Q

What does the P wave on an ECG represent?

A

RA/LA depolarisation

30
Q

What does the QRS represent

A

Ventricular depolarisation

Atrial repolarisation occurs concurrently

31
Q

What does the ST Segment represent?

A

Ventricular depolarisation

Ventricles contract

32
Q

What does the T wave represent

A

Ventricular repolarisation

33
Q

What is cardiac output?

A

The amount of blood that is pumped out of the heart into circulation over one minute
• litres/minute (approx 5L/min)

34
Q

What is end-diastolic volume

A

Maximum amount of blood that fills the ventricle during relaxation

35
Q

What is end- systolic volume

A

Maximum amount of blood that remains in the ventricle at the end of contraction

36
Q

What is the Ejection Fraction

A

The percentage of blood filled into the ventricle and then ejected with ventricular contraction
(End diastolic volume - end systolic volume)

37
Q

What factors determine Cardiac Output

A

Preload
Afterload
Myocardial contractility
Heart rate

38
Q

What is the ‘Frank-Starling Law’?

A

The length-tension relationship that determines Cardiac Output

Excessive stretching wears tension properties, as seen in Heart Failure

39
Q

What are Inotropes

A

Drugs that affect cardiac contractility

+ve inotropes increase
• Adrenaline & Noradrenaline

-ve inotropes decrease
• Dopamine, Acetylcholine-> PSNS & Vagus Nerve

40
Q

How does oxygenation affect heart contractility?

A

Contractility is reduced with SaO2 < 50%

Contractility is increased with SaO2 50-90%

41
Q

What is the ‘Bainbridge Reflex’ ?

A

Where the HR increases with increased venous return or post IVH administration

R/t increased pressure in RA by stretch receptors

42
Q

What is Coronary Heart Disease?

A

Conditions that affect the coronary blood vessels that supply the heart with nutrients and oxygen

43
Q

Explain the pathophysiology of Myocardial Ischaemia

A

Develops if blood flow or oxygen content of blood is insufficient to meet metabolic demands

44
Q

Explain the manifestations of Angina

A

Transient substernal pain that lasts 3-5 minutes. Can be described as heaviness or pressure to severe pain or “clenching”

45
Q

What are the 4 types of Angina

A

Stable Angina
Prinzmetals Angina
Silent Ischaemia
Unstable Angina

46
Q

Explain Stable Angina

A

Gradual luminal narrowing and hardening associated with physical exertion or emotional stress

47
Q

Explain Prinzmetals Angina

A

Occurs mainly at night during sleep and is related to SNS hyperactivity and coronary vasospasm

48
Q

Explain Silent Ischaemia

A

Asymptomatic. Manifests as fatigue, dyspnoea, anxiety and unease. Common in women

49
Q

What is unstable angina

A

Result of myocardial ischaemia
Strong indicator of impending MI
Thrombus ruptures but dissociates within 20 minutes before permanent myocyte damage

50
Q

Acute MI

A

Results from extended blood flow occlusion leading to myocyte death

51
Q

What are the 2 types of MI

A

Subendocardial (NSTEMI)

Transmural (STEMI)

52
Q

Describe a subendocardial MI (NSTEMI)

A

Occurs when significant occlusion in the coronary artery impedes blood flow due to a ruptured plaque and subsequent thrombosis

Infarct occurs distally and ischaemia proximally to the supplying vessels

The Endocardium still receives blood from blood pooling in ventricles

No ST-Elevation

ST-Depression seen

53
Q

Describe a Transmural MI (STEMI)

A

Complete occlusion from thrombosis clot occludes blood flow

Infarction begins distally and moves proximally towards occluded vessel until revascularisation occurs

Transmural involves the whole Myocardium

Risk of damage and rupture of the papillary muscles

Potential complications Mitral Regurgitation or Prolapse

ECG shows ST-Elevation
Evidence of LBBB
• V1 Depressed QRS ‘W’
• V6 Widened QRS ‘M’

54
Q

Explain the drug CATOPRIL

A

ACE - Inhibitor
50 - 100mg PO Daily
Interactions: Loop Diuretics, NSAIDs, Lithium, Potassium Sparing Diuretics

55
Q

Explain the drug DIGOXIN

A 
Cardiac medication which
Increases contractility
Decreases Dysrrhythmias
Decreases HR
Decreases conduction through AV Node

Loading Dose: 250-500mcg/ Max 1.5mg
Onset:
30-120mins PO
5-30mins IV

56
Q

Explain the drug Amiodarone

A

Indications: Atrial and Ventricular Arrhythmias
Acute Tachyarrhythmias
MOA: Blocks Potassium, Sodium and Calcium channels
• Increases refeactory period in all cardiac tissues
Dose: 100mg - 200mg PO Daily

57
Q

Explain the drug ADENOSINE

A 
Indications: Acute SVT, Cardiac Dx Procedures
MOA: Depends on receptor subtype
Inhibits Potassium channel opening
Inhibits pacemaker of SA Node
Decreases contractility
58
Q

Explain the drug GTN

A

Glyceral Trinitrate is used to prevent and treat stable angina as well as treat stable angina and HF associated with acute MI

SL Tabs: 300-600mcg every 3 - 4 mins (max 3 tabs)
SL Spray: 2 x sprays every 5 mins
IV: 5 - 10mcg/min

Contraindicated in cardiomyopathy, aortic or mitral valve stenosis, severe anaemia, raised ICP, glaucoma, hypotension and hypovolaemia

NUR352 2018 (6 decks)

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