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JW: Principles II > Cardiac Monitoring (Cornelius) Exam 1 COPY > Flashcards

Cardiac Monitoring (Cornelius) Exam 1 COPY Flashcards

1
Q
A
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2
Q

What is indicated by the pink highlighted portion of the EKG below?

A

Right Atrial Enlargement

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3
Q

What is indicated by the blue highlighted portion of the EKG below?

A

Left Atrial Enlargement

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4
Q

P-waves for lead II and Lead VI are shown below. What would be indicated by this EKG waveform?

A

Bi-atrial enlargement

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5
Q

What EKG sign would be indicative of myocardial ischemia? (ischemia, not infarction)

A

Inverted symmetrical T-waves

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6
Q

What EKG sign would be indicative of non-salvageable tissue damage post acute myocardial infarction?

A

Pathological Q-waves: 1mm wide or ⅓ the height of R-wave.

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7
Q

What type of pacemaker is most sensitive to electromagnetic interference?

A

Unipolar

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8
Q

Do Bipolar or Unipolar pacemakers utilize less energy?

A

Bipolar uses less energy (more efficient)

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9
Q

What’s the most common pacemaker?

A

Single lead → single chamber

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10
Q

What type of electrocautery is more safe for patients with permanent pacemakers?

A

Bipolar Cautery

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11
Q

In what situations would Bi-ventricular pacemakers be utilized?

A

Anywhere were resynchronization therapy is indicated.

  • HF
  • BBB
  • Hx of cardiac arrest
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12
Q

Label the a, c, & v waveforms on the Wiggers diagram below.

A
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13
Q

What causes an (a) waveform on a Wiggers diagram?

A

↑ CVP due to atrial contraction sending blood into ventricles and backwards.

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14
Q

What causes the (c) waveform on a Wiggers diagram?

A
  • Backward “bowing” of the valves (from ventricular contraction) slightly displacing blood backwards.
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15
Q

What causes a (v) waveform on a Wiggers diagram?

A
  • Volume accumulating in the atria until opening of the tricuspid/mitral valves.
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16
Q

What is the A-wave?

A

Atrial contraction

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17
Q

What is the C-wave?

A

Backwards “bowing” of valves in response to high ventricular pressures

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18
Q

What is the V-wave?

A

Rapid filling of the atria

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19
Q

What is the H-wave or H-plateau?

A

Diastolic plateau (not a lot of blood movement until atria contract to produce the a-wave)

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20
Q

What is the X-descent or x-wave?

A

Steep drop in pressure as atria relax and start filling.

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21
Q

What is the Y-descent or y-wave?

A

Atria filling the ventricles in early diastole

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22
Q

An h-plateau occers immediately before the ________ wave.

A

a-wave

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23
Q

The x descent happens after the ________ wave

A

c-wave

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24
Q

The y descent happens after the ______ wave.

A

v-wave

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25
Q

During atrial fibrillation, loss of the ___ wave and enlargement of the ___ wave occurs to the CVP waveform.

A

loss of A-wave, enlargement of C-wave

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26
Q

What characteristics are seen on a CVP waveform in a patient with significant tricuspid regurgitation?

A
  • Tall Systolic C-V wave
  • Loss of X-descent

Very similar to RV waveform

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27
Q

What characteristics are seen on a CVP waveform in a patient with significant tricuspid stenosis?

A
  • Tall A-wave
  • Attenuated Y-descent
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28
Q

What is 2 on the photo?

A

30 cm proximal
Monitors CVP

Slide 40

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29
Q

What 3A and 3B on the photo?

A

3A = 40 cm mark
thin lines = 10 cm

3B = 50 cm mark
thick line = 50 cm

30
Q

What is 4 on the photo?

A

4th Lumen
Houses temperature thermistor

Lies just proximal to balloon

31
Q

What is 5 on the photo?

32
Q

What is 6 on the photo?

A

Lock for Balloon

3rd lumen leads to a balloon near the tip

33
Q

What is 7 on the photo?

A

Balloon Syringe

Most of these are gonna be 1/2 to 1 1/2 C’s of air that go into that balloon

34
Q

The PA catheter typically used in clinical practice is how many centimeters long?
A) 80 cm
B) 100 cm
C) 110 cm
D) 130 cm

A

C) 110 cm
marked at 10 cm intervals

Cornelius: You may also see there’s some variation as far as the size of the catheters for length, so some of them are longer than 110 centimeters, some are shorter, especially if you have one that’s more of like a pacing catheter or something like that.

Slide 43

35
Q

What PA catheter complication is associated with very high mortality?

A) Endocarditis
B) Catheter knots
C) Pulmonary artery rupture
D) Dysrhythmias

A

C) Pulmonary artery rupture

  • Hemoptysis (Bright red and copious)
  • Hypotension

Slide 44

36
Q

Which interventions are recommended in the treatment of a pulmonary artery (PA) rupture? (Select all that apply)

A) ↑ Oxygenation
B) Volume
C) Reverse anticoagulation
D)Tamponade bleed with catheter (PEEP)
E) Float balloon into rupture vs withdrawing catheter
F) Definitive surgical repair

A

A) ↑ Oxygenation
(Endobronchial intubation; single or double lumen tube)

C) Reverse anticoagulation
(Unless on bypass; Bronchoscopy to control bleeding)

D)Tamponade bleed with catheter (PEEP)

E) Float balloon into rupture vs withdrawing catheter

F) Definitive surgical repair
(Oversew pulmonary artery, resection)

Slide 45

37
Q

Which of the following characteristics might be observed on a CVP waveform in a patient with mitral regurgitation?

A) Tall V-wave
B) Prominent A-wave
C) C & V wave fused
D) No X-descent

A

A) Tall V-wave
C) C & V wave fused
D) No X-descent

No specificity/sensitivity to severity of MR d/t: LA compliance, LA volume

Slide 48

38
Q

Which of the following features might be observed on a CVP waveform in a patient with mitral stenosis?

A) Tall V-wave
B) Prominent A-wave
C) Slurred, early Y-descent
D) Absent C-wave

A

C) Slurred, early Y-descent

A wave may be absent d/t frequent assoc. with A-fib

Slide 49

39
Q

Which of the following characteristics are typically observed in the PA catheter waveform of a patient with an acute LV myocardial infarction?

A) Tall A-waves
B) Decreased LVEDP
C) Increased LVEDV
D) Flattened V-waves
E) Increased LVEDP

A

A) Tall A-waves
C) Increased LVEDV
E) Increased LVEDP

*PAWP increases

Slide 50

40
Q

At what depth (in cm) should the PAC tip be located when it reaches the right atrium?
A) 10-15 cm
B) 20-25 cm
C) 30-35 cm
D) 40-45 cm

A

B) 20-25 cm

Slide 43

41
Q

What is the typical depth range (in cm) for the PAC to reach the right ventricle?
A) 10-15 cm
B) 20-25 cm
C) 30-35 cm
D) 40-45 cm

A

C) 30-35 cm

Slide 43

42
Q

At what depth (in cm) should the PAC tip be located when it reaches the pulmonary artery?
A) 20-25 cm
B) 30-35 cm
C) 40-45 cm
D) 50-55 cm

A

C) 40-45 cm

Slide 43

43
Q

The wedge position of the PAC is typically found at what depth (in cm)?
A) 20-25 cm
B) 30-35 cm
C) 40-45 cm
D) 45-55 cm

A

D) 45-55 cm

Slide 43

44
Q

Which of the following is/are NOT potential complication(s) associated with a pulmonary artery catheter (PAC)?

A) Dysrhythmias, PVCs/V-tach
B) Transient RBBB or complete heart block
C) Catheter knots
D) Pulmonary edema
E) Pulmonary infarction
F) Pulmonary artery rupture
G) Endocarditis
H) Valve injury

A

D) Pulmonary edema

Slide 44

45
Q

What would a high cardiac output thermodilution curve look like?

46
Q

If SVV is > _____% then patient is likely to respond well to fluids for hypotension.

47
Q

Which of the following pressures are monitored by a Pulmonary Artery Catheter (PAC)?

A) Pulmonary Artery Pressure (PAP)
B) Central Venous Pressure (CVP)
C) Pulmonary Artery Wedge Pressure (PAWP)
D) Right Atrial Pressure (RAP)

A

A) Pulmonary Artery Pressure (PAP)

C) Pulmonary Artery Wedge Pressure (PAWP)
* Indirect measurement of left atrial pressure
* PAD pressure often used as alternative

Slide 46

48
Q

For accurate measurement, the tip of the Pulmonary Artery Catheter (PAC) should be in which zone of the lung?

A) Zone 1
B) Zone 2
C) Zone 3
D) Any zone is acceptable

A

C) Zone 3

Schmidty!

Slide 46

49
Q

Which conditions can cause a Pulmonary Artery Catheter (PAC) to provide a poor estimate of Left Ventricular End-Diastolic Pressure (LVEDP)? (Select all that apply)

A) Compliance
B) Aortic regurgitation
C) PEEP
D) Ventricular Septal Defect (VSD)
E) Mitral stenosis/regurgitation
F) Systemic hypertension

A

A) Compliance
B) Aortic regurgitation
C) PEEP
D) Ventricular Septal Defect (VSD)
E) Mitral stenosis/regurgitation

Cornelius: It doesn’t provide a good estimate of Compliance. If you have somebody with Aortic regurgigation, it’s gonna artificially increase your numbers. PEEP may affect things because you’re increasing pressure on the heart. If you’ve got a VSD in place, you may have altered flow so it may not provide you with a good estimate, or if you have somebody with a any sort of Mitral problem, you may not get good numbers.

Slide 47

50
Q

What is assessed with a parasternal short-axis view?

A
  • LV function & volume status
51
Q

What is assessed with an apical four chamber view?

A
  • RV vs LV size
  • Tricuspid & Mitral function
  • Descending Aorta
52
Q

What is assessed with a subcostal four chamber view?

A
  • Pericardial Effusion
  • Four chambers
53
Q

Which of the following conditions can mixed venous oximetry help assess? (Select all that apply)

A) Shock
B) Hyperglycemia
C) Cardiac output
D) Liver function

A

A) Shock
C) Cardiac output

Cornelius: this is kind of falling out of favor…it’s not quite as popular as it was. The mixed venous oximetry is kind of an indirect indicator of cardiac output. The problem we run into and the reason we don’t use it is often is because many times all those factors (Hgb, Arterial saturations, O2 consumption) are changing at the same time.

Slide 51-52

54
Q

What is the correct formula for calculating cardiac output?

A) CO = HR / SV
B) CO = SV x HR
C) CO = SV + HR
D) CO = HR - SV

A

B) CO = SV x HR

Total blood flow generated by heart/minute

Slide 53

55
Q

What is the typical range for cardiac output in a healthy adult?

A) 2.5 - 4.0 L/min
B) 4.0 - 6.5 L/min
C) 5.0 - 7.5 L/min
D) 6.5 - 9.0 L/min

A

B) 4.0 - 6.5 L/min

Slide 54

56
Q

What are the two main contraindications to intra-operative TEE?

A
  • Esophageal Varices
  • Lap Banding
57
Q

What is assessed with a Subcostal IVC view?

A

IVC

  • Diameter
  • Collapsibility (especially in determining volume status)
58
Q

What is assessed with a parasternal long-axis view?

A
  • Overall Function
  • Left Heart and aortic root
59
Q

What five views can be utilized for a focused TTE?

A
  1. Parasternal Long Axis
  2. Parasternal Short Axis
  3. Apical Four Chamber
  4. Subcostal Four Chamber
  5. Subcostal IVC
61
Q

How many “views” are in a full echocardiogram?

62
Q

What would the following cardiac output thermodilution curve indicate?

A

Low CO (Longer time to return to baseline)

63
Q

What is the typical range for mixed venous O₂ saturation (SvO₂) in a healthy adult?

A) 50 - 60%
B) 60 - 70%
C) 70 - 80%
D) 80 - 90%

A

C) 70 - 80%

Slide 54

64
Q

What is the typical range for stroke volume in a healthy adult?

A) 40 - 60 mL
B) 50 - 80 mL
C) 60 - 90 mL
D) 70 - 100 mL

A

C) 60 - 90 mL

Slide 54

65
Q

What is the typical range for Pulmonary Vascular Resistance (PVR)?

A) 20 - 100 dynes/sec/cm⁵
B) 40 - 180 dynes/sec/cm⁵
C) 60 - 200 dynes/sec/cm⁵
D) 100 - 300 dynes/sec/cm⁵

A

B) 40 - 180 dynes/sec/cm⁵

Slide 54

66
Q

What is the typical range for Systemic Vascular Resistance (SVR)?

A) 400 - 800 dynes/sec/cm⁵
B) 800 - 1600 dynes/sec/cm⁵
C) 1000 - 2000 dynes/sec/cm⁵
D) 1200 - 1800 dynes/sec/cm⁵

A

B) 800 - 1600 dynes/sec/cm⁵

Slide 54

67
Q

Where is the PA catheter at based on the waveform below?

A

Wedged

Slide 42

68
Q

Where is the PA catheter at based on the waveform below?

A

Pulmonary Artery

Slide 42

69
Q

Where is the PA catheter at based on the waveform below?

A

RV

Slide 42

70
Q

Where is the PA catheter at based on the waveform below?

A

Right Atrium

Slide 42

71
Q

What is the preferred site for PA catheter placement in most patients?
A) Left Subclavian
B) Right Internal Jugular
C) Left Internal Jugular
D) Right Subclavian

A

B) Right Internal Jugular

Slide 42

72
Q

KRISTA’s START

What is 1 on the photo?

A

Distal Port

Most distal - Monitors PAP

Cornelius: very distal port that’s coming out beyond that balloon, and that’s what you’re gonna use to monitor your pulmonary artery pressure.

Slide 40-41

JW: Principles II (28 decks)

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