Cardiac Monitoring (Exam I) Flashcards
What is indicated by the pink highlighted portion of the EKG below?
Right Atrial Enlargement
What is indicated by the blue highlighted portion of the EKG below?
Left Atrial Enlargement
P-waves for lead II and Lead VI are shown below. What would be indicated by this EKG waveform?
Bi-atrial enlargement
What EKG sign would be indicative of myocardial ischemia? (ischemia, not infarction)
Inverted symmetrical T-waves
What EKG sign would be indicative of non-salvageable tissue damage post acute myocardial infarction?
Pathological Q-waves: 1mm wide or ⅓ the height of R-wave.
What type of pacemaker is most sensitive to electromagnetic interference?
Unipolar
Do Bipolar or Unipolar pacemakers utilize less energy?
Bipolar uses less energy (more efficient)
What’s the most common pacemaker?
Single lead → single chamber
What type of electrocautery is more safe for patients with permanent pacemakers?
Bipolar Cautery
In what situations would Bi-ventricular pacemakers be utilized?
Anywhere were resynchronization therapy is indicated.
- HF
- BBB
- Hx of cardiac arrest
Label the a, c, & v waveforms on the Wiggers diagram below.
What causes an (a) waveform on a Wiggers diagram?
↑ CVP due to atrial contraction sending blood into ventricles and backwards.
What causes the (c) waveform on a Wiggers diagram?
- Backward “bowing” of the valves (from ventricular contraction) slightly displacing blood backwards.
What causes a (v) waveform on a Wiggers diagram?
- Volume accumulating in the atria until opening of the tricuspid/mitral valves.
What is the A-wave?
Atrial contraction
What is the C-wave?
Backwards “bowing” of valves in response to high ventricular pressures
What is the V-wave?
Rapid filling of the atria
What is the H-wave or H-plateau?
Diastolic plateau (not a lot of blood movement until atria contract to produce the a-wave)
What is the X-descent or x-wave?
Steep drop in pressure as atria relax and start filling.
What is the Y-descent or y-wave?
Atria filling the ventricles in early diastole
An h-plateau occers immediately before the ________ wave.
a-wave
The x descent happens after the ________ wave
c-wave
The y descent happens after the ______ wave.
v-wave
During atrial fibrillation, loss of the ___ wave and enlargement of the ___ wave occurs to the CVP waveform.
loss of A-wave, enlargement of C-wave
What characteristics are seen on a CVP waveform in a patient with significant tricuspid regurgitation?
- Tall Systolic C-V wave
- Loss of X-descent
Very similar to RV waveform
What characteristics are seen on a CVP waveform in a patient with significant tricuspid stenosis?
- Tall A-wave
- Attenuated Y-descent
Describe a Swan-Ganz Catheter in detail.
Flip for picture.
What is the preferred site for PA catheter placement?
Right IJ
Where is the PA catheter at based on the waveform below?
Right Atrium
Where is the PA catheter at based on the waveform below?
RV
Where is the PA catheter at based on the waveform below?
Pulmonary Artery
Where is the PA catheter at based on the waveform below?
Wedged
What is the total length of the PA catheter?
110 cm
What PA catheter complication is associated with very high mortality? What are the presenting s/s?
Pulmonary artery rupture
- Hemoptysis (Bright red and copious)
- Hypotension
How are PA ruptures treated?
- ↑ Oxygenation
- Double lumen ETT
- PEEP (to tamponade bleeding)
- Reverse anticoagulation
- Tamponade bleed w/ catheter
- Definitive surgical repair
Thoughts and prayers
What would a CVP waveform look like in a patient with mitral regurgitation?
- Tall V-wave
- C & V wave fused
- No X-descent
What would a CVP waveform look like in a patient with mitral stenosis?
- Slurred, early Y-descent
How will the PA catheter waveform present with an acute LV MI?
- Tall A-waves
- Increased LVEDV & LVEDP
What is the typical range for SVR?
800 - 1600 dynes/sec/cm5
What is the typical range for PVR?
40 - 180 dynes/sec/cm5
What is the typical range for stroke volume?
60 - 90 mL
What is the typical range for mixed venous O₂ saturation?
70 - 80 %
What would the following cardiac output thermodilution curve indicate?
Low CO (Longer time to return to baseline)
What would a high cardiac output thermodilution curve look like?
If SVV is > _____% then patient is likely to respond well to fluids for hypotension.
10%
How many “views” are in a full echocardiogram?
28 views
What five views can be utilized for a focused TTE?
- Parasternal Long Axis
- Parasternal Short Axis
- Apical Four Chamber
- Subcostal Four Chamber
- Subcostal IVC
What is assessed with a parasternal long-axis view?
- Overall Function
- Left Heart and aortic root
What is assessed with a parasternal short-axis view?
- LV function & volume status
What is assessed with an apical four chamber view?
- RV vs LV size
- Tricuspid & Mitral function
- Descending Aorta
What is assessed with a subcostal four chamber view?
- Pericardial Effusion
- Four chambers
What is assessed with a Subcostal IVC view?
IVC
- Diameter
- Collapsibility (especially in determining volume status)
What are the two main contraindications to intra-operative TEE?
- Esophageal Varices
- Lap Banding
