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Fall24 PoA II > Cardiac Monitoring (Exam I) > Flashcards

Cardiac Monitoring (Exam I) Flashcards

1
Q

How would a bundle branch block be distinguished right from left?

A

In V1 lead, find j-point and go backwards to QRS segment. If wave goes up = RBBB, if wave goes down = LBBB

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2
Q

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

A

Right Atrial Enlargement

long left, high right

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3
Q

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

A

Left Atrial Enlargement

long left, high right

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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?

A

Inverted symmetrical T-waves

ischTemia

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6
Q

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

A

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

infarQt

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7
Q

What type of pacemaker is most sensitive to electromagnetic interference?

A

Unipolar

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8
Q

What part of a pacemaker device provides current and an energy source? What is exposed metal end in contact with the endocardium? What is the insulated wire inbetween these two parts?

A
  • Generator
  • Electrode
  • Lead
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9
Q

Do Bipolar or Unipolar pacemakers utilize less energy?

A

Bipolar uses less energy (more efficient)

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10
Q

What’s the most common pacemaker?

A

Single lead → single chamber

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11
Q

How is the function of a pacemaker explained in its name? (order)

A

Acronym Letters:

  • 1st - Chambers paced
  • 2nd - Chambers sensed
  • 3rd - Response to sensing
  • 4th - Rate modulation
  • 5th - Multisite pacing
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12
Q

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

A

Bipolar Cautery

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13
Q

In what situations would Bi-ventricular pacemakers be utilized?

A

When resynchronization therapy is indicated.

  • HF
  • BBB
  • Hx of cardiac arrest
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14
Q

What is an ICD device?

A

Implantable Cardioverter-Defibrillator

  • capable of terminating VF or Vtach
  • measures R-R interval
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15
Q

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

A
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16
Q

What is a normal CVP value?

A

1-7 mmHg

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17
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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18
Q

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

A
  • Backward “bulging” of the tricuspid valve (from ventricular contraction) slightly displacing blood backwards.
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19
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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20
Q

What is the a-wave?

A

Atrial contraction

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21
Q

What is the C-wave?

A

Backwards “bulging” of tricuspid valve in response to high ventricular pressures

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22
Q

What is the V-wave?

A

Rapid filling of the atria

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23
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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24
Q

What is the X-descent or x-wave?

A

Steep drop in pressure as atria relax and start filling.

25
Q

What is the Y-descent or y-wave?

A

Tricuspid valve opens and atria fills the ventricles in early diastole

26
Q

An h-plateau occers immediately before the ________ wave.

27
Q

The x descent happens after the ________ wave

28
Q

The y descent happens after the ______ wave.

29
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
(lost atrial kick, atria remains more full)

30
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
(blood leaks back into R atrium from RV contraction)

31
Q

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

A
  • Tall A-wave
  • Attenuated Y-descent

(increased backward pressure generated with atrial kick)

32
Q

Describe each portion of a Swan-Ganz Catheter.

33
Q

What is the preferred site for PA catheter placement?

34
Q

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

A

Right Atrium
(essentially CVP)

35
Q

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

36
Q

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

A

Pulmonary Artery

37
Q

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

38
Q

What is the total length of the PA catheter?

39
Q

What PA catheter complication is associated with very high mortality? What are the presenting s/s?

A

Pulmonary artery rupture

  • Hemoptysis (Bright red and copious)
  • Hypotension
40
Q

How are PA ruptures treated?

A
  • ↑ Oxygenation
  • Double lumen ETT
  • PEEP (to tamponade bleeding)
  • Reverse anticoagulation
  • Tamponade bleed w/ catheter
  • Definitive surgical repair

Thoughts and prayers

41
Q

What would a PCWP waveform look like in a patient with mitral regurgitation?

A
  • Tall V-wave
  • C & V wave fused
  • No X-descent
42
Q

What would a PAWP waveform look like in a patient with mitral stenosis?

A
  • Slurred, early Y-descent
43
Q

How will the PA catheter waveform present with an acute LV MI?

A
  • Tall A-waves
  • Increased LVEDV & LVEDP
  • PAWP increases
44
Q

What is the typical range for SVR?

A

800 - 1600 dynes/sec/cm⁵

45
Q

What is the typical range for PVR?

A

40 - 180 dynes/sec/cm⁵

46
Q

What is the typical range for stroke volume?

A

60 - 90 mL

47
Q

What is the typical range for cardiac output?

A

4 - 6.5 L/min

48
Q

What is the typical range for mixed venous O₂ saturation?

49
Q

What would the following cardiac output thermodilution curve indicate?

A

Low CO (Longer time to return to baseline temp)

50
Q

What would a high cardiac output thermodilution curve look like?

A

Return to baseline temp quickly

51
Q

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

52
Q

How many “views” are in a full echocardiogram?

53
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
54
Q

What is assessed with a parasternal long-axis view?

A
  • Overall Function
  • Left Heart and aortic root
55
Q

What is assessed with a parasternal short-axis view?

A
  • LV function & volume status
56
Q

What is assessed with an apical four chamber view?

A
  • RV vs LV size
  • Tricuspid & Mitral function
  • Descending Aorta
57
Q

What is assessed with a subcostal four chamber view?

A
  • Pericardial Effusion
  • Four chambers
58
Q

What is assessed with a Subcostal IVC view?

A

IVC

  • Diameter
  • Collapsibility (especially in determining volume status)
59
Q

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

A
  • Esophageal Varices
  • Lap Banding

Fall24 PoA II (34 decks)

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