Cardiac Form/s,#s, & Def/s Flashcards
Poiseuille’s law:
Example:
= vessel w/ relative radius of 1 would transport 1mL per min at BP difference of 100mmHg. Keep pressure constant
= Less blood = vaso-press
Starling’s Law of heart:
= states that the more the myocardium is stretched, up to a certain amount, the more forceful the subsequent contraction will be
% of drug concentration=
Grams in 100mLs
(60%) Fluid compartments % of water:
45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%
(ECG Paper) (Horizontal Boxes) small box duration:
5 small boxes makes:
Each large box duration:
(Vertical Boxes) Each small box volt & measurement:
5 small boxes makes:
Each large box voltage:
2 large boxes equivalent:
= 0.04 sec
= 1 large box
= 0.20 sec
= 0.1 mV & 1 mm
= 1 large box
= 0.5 mV
= 1 mV & 10mm
(ECG Vertical Boxes) Each small box is & what:
5 small boxes equal:
Each large box is:
2 large boxes equal
= Each small box 1 mm & 0.1mV
= 1 large box
= 0.5 mV & 5mm
= 1mV & 10mm
Einthoven’s triangle(Bipolar/limb leads) leads 2 views:
Lead 2 Negative:
Lead 2 Positive:
= Inferior wall diagonally towards left foot
= Right Arm
= Left Leg
Einthoven’s triangle(Bipolar/limb leads) leads 1 views:
Lead 1 Negative:
Lead 1 Positive:
= Left Lateral wall
= Right Arm
= Left Arm
Einthoven’s triangle(Bipolar/limb leads) leads 3 views:
Lead 3 Negative:
Lead 3 Positive:
= inferior (down & rightward) 50% MI has R ventricle Infarction
= Left Arm
= Left Leg
Limb leads) placement:
positive to negative makes wave:
positive to negative makes wave:
= mid forearm on M. & inside of calf (if amputee/ go less distally)
= positive wave
= negative wave
P wave) Limb leads amplitude:
Precordial “chest” leads amplitude:
= <2.5mm in limb leads Avl (2.5mV)
= <1.5mm in precordial (1.5mV)
1st line IV med in cardiac arrest
Epi
1st line IV med in cardiac arrest
Epi
1st line med in cardiac arrest
oxygen
1st line med in cardiac arrest
oxygen
A normal P wave in Precordial leads should be:
A normal P wave Limb leads should be:
= nice & round w/ amplitude <1.5mm
= nice & round w/ amplitude <2.5mm
A normal PRI should be between
A normal QRS duration should be between:
= 0.12-0.20 seconds
= 0.04-0.12 seconds.
VSD=
Right side balloon out & hypertrophic
Abdominal situs Inversus=
Spleen & Liver flipped but H normal
Absolute refractory period:
Relative refractory period:
= Apex of T wave Q-T wave apex of wave: ventricle not ready to work
= T wave top to end of T wave: (commodo cordis) cells not repolarized (torsades de pointes more dead from repolarization not in sync)
Afterload:
= resistance against which the heart must pump against afterload become increased w/ increased ventricular workload
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Normal T Wave in any limb lead should have a max amplitude of:
Normal T Wave in any chest lead should have a max amplitude of:
= 5 mm
= 10 mm
ANP Atrial natriuretic peptide:
made, stored, & released by atrial M> cells in response to atrial distension & Sympathetic stim & counters RAAS system, Decreases afterload pressure
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
RP of a cardiac autorhythmic cell is:
AP of a cardiac autorhythmic cell is:
Influx of what causes depolarization of autorhythmic cells:
Efflux of what ion causes repolarization:
= -60mVs
= -40mVs
= Calcium
= Potassium
ASD:
Left to right shunt→ overloads right side decreases BP
Atrial Kick
the contraction “kick” @ end of systole to give more blood to ventricles accounts for 20-30%
Shock & perfusion definitions:
= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body’s lack of perfusion
CPP Cerebral Perfusion:
= (MAP-ICP) + 10
MAP:
= (PP/3) + DBP
Pulse pressure:
= SBP-DBP
Pulse pressure:
MAP:
CPP Cerebral Perfusion:
= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10
BNP Brain Natriuretic peptide:
secreted by ventricles in response to stress to excessive stretching of myocytes & Counter RAAS
BP form/s:
BP is related to:
= (SV x HR) x SVR or CO x SVR
= CO & peripheral resistance
Cardiac depolarization:
RP of Ac:
RP of Cc:
Phases 0-4 of Cc:
= reversal charges of cell membrane inside becomes + & outside -,
= -60 slow Na & fast Ca -40
= -90 Na & -85 gap Junctions fast Na influxes
= 0 depolar, 1 early repolar, 2 plateau + for +, 3 K pumps, 4 refractory
Cardiac output formula:
= SV x HR
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= CO x SVR
Blood Pressure formula:
= (SV x HR) x SVR / CO x SVR
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
Shock) Cardiogenic:
Types & defined:
= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT
Cardioversion (synchronized) for:
= Tachyarrhythmias w/ pulse unstable} AFib, AF, ASVT, PSVT, SVT, VT w/ pulse
Cardioversion for:
higher start:
lower start:
= VT, SVT, ASVT, PSVT, too fast HR “convert down”
= ST>100J, 200J, 300J, 360J
= ASVT, PSVT, SVT> 50-100J (AF w/ RVR 120-200J)
Cardiovert is for:
“conVERT to normal” too fast
Celsius# to degrees Fahrenheit form
Fahrenheit# to Celsius form
C# to F=(C# -32) / 1.8
F# to C= (1.8 x F) + 32
Chrontropy:
Inotropy:
Dromotropy:
= HR, + tropic +HR vice versa
= Contraction force
= Speed of impulse transmission, usually goes w/ Inotropy
Inotropy:
= Contraction force
Chrontropy:
= HR, + tropic +HR vice versa
Dromotropy:
= Speed of impulse transmission, usually goes w/ Inotropy
(Electrolytes affects) Cl
Na
K
Ca
Mg
= Cl picks up Co2 (shift) to keep neutrality
= depolarizing myocardium
= depolarization & majority myocardial contractile
= influences repolarizations
= regulates contractility & rhythm
Communication or the connecting of two or more vessels is known as:
= Anastomosis
Contractility:
= ability of CM. cells to contract, or shorten (Actin Myosin)
Defib for:
amounts:
= pulseless arrhythmias VFib, Pulseless VT
= 120-200 joules for biphasic defibrillators & 300-360 joules for monophasic
Dynamic CO:
=1 up other down, L diastole P = L afterload, PVR pulmonary & oil
(ECG Horizontal Boxes) small box is how long
5 small boxes:
Each large box is how long
= 0.04 sec
= 1 large box
= 0.20 sec
Ejection Fraction (EF):
<45% usually indicates:
<30%:
= Ratio of blood pumped from the ventricle to the amount remaining @ the end of diastole/ %of blood pumped out from ventricle (60-70%)
=<45% usually indicates in or going to CHF
=<30% in CHF & chronic cardiac crip on oxy
Ejection Fraction (EF):
<45% usually indicates:
<30%:
= Ratio of blood pumped from the ventricle to the amount remaining @ the end of diastole/ %of blood pumped out from ventricle (60-70%)
=<45% usually indicates in or going to CHF
=<30% in CHF & chronic cardiac crip on oxy
Equation for cardiac output:
Heart & SV volumes:
Equation for BP:
How can you make a + & - effect on it?
= CO= SV x HR
= usually squeezes 70mLs & heart holds 100-110mL
= BP=(SV X HR) X SVR
= Meds: diuretics, vaso-constructors
ETCO2 levels <10 mmHg indicates
NO ROSC
SVR vs. PVR:
= Body’s circulation resistance & Lung’s circulation resistance
SVR (Systemic Vascular Resistance):
= resistance blood faces in systemic circulation (arteries size)
PVR (Pulmonary Vascular Resistance):
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
Vascular Resistance:
= Resistance to overcome to push blood through circulatory system
Frank Starling law/mechanism:
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
Frank Starling law/mechanism:
Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body’s circulation resistance & Lung’s circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
Heart’s ENdocrine organ horomones:
stores & secretes 2 hormones, when released failings heart} BNP & ANP
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
In any limb lead, a normal P wave shape & maximum amplitude is:
In any chest lead, a normal P wave has maximum amplitude of:
= nice & round w/ maximum amplitude of: 0.25 mV
= maximum amplitude of: 0.15 mV
(only in heart) Intercalated discs:
Discs speed Vs standard cell membrane:
Syncytium:
= Special tissue bands inserted between myocardial cells that increase the rate(400x) in which AP is spread from cell-cell thus Syncytium
= 400x faster than standard cell membrane drom/Inotropy
= Group of cardiac cells physiologically function as a unit, “working together in sync” “top in syncytium to bottom”
Isolated Dextrocardia=
(Hearts on right side) Heart is flipped “Right is Left”, so have to mirror leads, AEDs,
“Lol”
Beta-Blockers
MONA):
M:
O:
N:
A:
= Morphine, Oxygen 94-98%, Nitro, Aspirin
= Morphine: never
= Oxy: maybe
= Nitro maybe: 2nd w/ MI if not contra (decrease afterload)
= Aspirin: maybe (most important) should always 1st line
Morphine & fent drop BP by:
= body releasing Histamines
Normal blood pH range=
7.35 - 7.45 mmHg
A normal QRS has a duration between:
A normal PRI has a duration between:
= 0.04-0.12 secs / 1-3SB
= 0.12 - 0.20 secs/ 3-5SB
Normal ECG paper speed is
On ECG paper, 1 Small horizontal box represents:
On ECG paper, 1 Large horizontal box represents
= 25mm/sec
= 0.04 secs
= 0.20 secs
On ECG paper, one small vertical box represents:
On ECG paper, one large vertical box represents:
= 0.1mV/ 1mm
= 0.5mV/ 5mm
Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:
= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones
Oxy freeradicals affect what most:
Definition:
= Neurons & cardio myocytes the most killing them
= apopcytosis cell suicide
Pacing is for:
“picking up the pace” too slow
Phases 0, 1, 2, 3, 4 of CC: Phase0:
Phase1:
Phase2:
Phase3:
Phase4:
= depolarization Cell gap Junction rapid Na influx by an impulse gen/ed elsewhere in heart. Na then stops entering cell once inside +
= K slowly leaves cell slowly returning cell to normal negative charge
= “plateau” M contraction: Ca+ interrupts w/ influxing into cell. (M.s ussing Ca for contraction). This plateau phase slows repolarization
= Repolarization: cessation Ca influx & rapid K efflux
= Refractory & moving ions back to original seats for RP
Preload:
= pressure (volume) w/in the ventricles at the end of diastole & Also commonly called the end diastolic volume (frank starlings law)
Preload:
Afterload:
Mean Arterial Pressure (MAP):
= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)
PRI measured by:
PRI “PR/PRI” interval rep/s:
A normal PRI interval range:
prolonged PRI indicates:
= distance from beginning of P wave to beginning of QRS complex.
= time impulse takes from atria-ventricles “Gatekeeper Gandolf”
= 0.12-0.20 sec / 3-5 SB
= a delay in the AV node & possible HB
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
Pulsus paradoxus
BP drop more than 10→ can indicate severe obstructive lung disease.
QRS interval measured:
QRS interval represents
QRS interval range:
QRS interval Q,R,&S:
= distance from 1st deflection of complex to last deflection
= time needed for ventricle depolarization (bundle of his > ventricles)
= 0.04-0.12secs / 1-3SB
= 1st -deflection not >1SB, 1st +deflection, -deflection after R
QRS sharp edge “knife” bc:
coming from a side of heart
QT interval:
RR interval:
= any action in ventricles
= measuring HR
Cardiac cell communication w/ ions
Phase 0 of the cardiac contractile cell:
Phase 1 of the cardiac contractile cell:
Phase 2 of the cardiac contractile cell:
Phase 3 of the cardiac contractile cell:
Phase 4 of the cardiac contractile cell:
= gab junction & intercalated disc 400x faster
= P0) Depolarization
= P1) slow K efflux
= P2) Plateau> Slow Ca in & K out “- for +”
= P3) Repolarization> rapid K efflux
= P4) Refractory Na/K pumps & Ca pumps out
Respiration ratio=
1 sec inhalation 2 sec exhalation
Resting potential of the cardiac contractile cell occurs at:
Action potential of the cardiac contractile cell occurs at:
What ion causes the cardiac contractile cell to depolarize?
What ion causes the cardiac contractile cell to repolarize?
= -90mV
= -85mv
= Sodium
= Potassium
Situs Inversus Totali
s= “EVERYTHING WRONG” H right side
ST segment:
QT segment:
U wave:
P-T segment:
RR segment:
= Ventricle contraction
= Any action in ventricles
= “late bloomer”
= 1 cardiac cycle
= provides Rate & Rhythm
Starling’s Law of heart:
= states that the more the myocardium is stretched, up to a certain amount, the more forceful the subsequent contraction will be
Stroke volume:
3 factors that affect stroke volume:
= amount of blood ejected by heart in 1 contraction, varies 60-100mLs w/ average 70mL
= preload, afterload, & contractility
Stroke volume:
3 factors that affect stroke volume:
= amount of blood ejected by heart in 1 contraction, varies 60-100mLs w/ average 70mL
= preload, afterload, & contractility
Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect CO:
Dynamic CO:
= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= “1 up & other down”
Sync Cardioversion:
TCP:
Cardioversion
= “defib in sync”
= “Pick up the pace”
= “Convert/ to slower & normal”
Sync Cardioversion:
TCP:
Cardioversion
= “defib in sync”
= “Pick up the pace”
= “Convert/ to slower & normal”
Systemic vascular resistance:
Nitro dynamics:
= how dilated arteries are
= decreases afterload pressure > decreases workload & O2 demand
T wave represents:
T wave amplitude:
= Repolarization of ventricles
= <5mm in LL <10mm in precordial
Normal QRS duration:
Normal PRI duration:
= 0.04 - 0.12 seconds
= 0.12 - 0.20 secs
Transcutaneous Pacing (TCP) for:
measurement:
= Unstable bradyCs, heart blocks,
= 60-80 milliamps
Triplicate method:
6 sec method:
R to R small box method:
R to R big box method:
= for HR> Big box RR descends 300,150,100,75,50,50,43,38
= Count # of complexes in a 6-sec strip X 10
= Count small boxes between R waves then /1500 EX: 1500 / 22 = 68
= (only regular rhythm) Count big boxes between R waves then divide 300 by this number EX 300 / 4 = 75
U wave:
= “late bloomers” repolarization (hypothermic PTs)
What is considered the normal max amplitude of a P wave in lead II?
What is considered the normal max amplitude of a P wave in lead V1?
= 2.5mm
= 1.5mm
What is considered the normal max amplitude of a T wave in lead I?
What is considered the normal max amplitude of a T wave in lead V1?
= 5mm
= 10mm
1st step an EMS provider will take when deciphering an ECG rhythm?
2nd step an EMS provider will take when deciphering an ECG rhythm?
3rd step an EMS provider will use when deciphering an ECG rhythm?
4th step an EMS provider will take when deciphering an ECG rhythm?
5th step an EMS provider will take when deciphering an ECG rhythm?
= Calculate HR
= Determine if rhythm has normal cadence
= P waves
= Measure PRI
= Evaluate the QRS complexes
Which ECG component represents atrial depolarization?
Which ECG component represents ventricular depolarization?
Which ECG component represents ventricular repolarization?
= P wave
= QRS Complex
= T Wave
