Cardiac Monitoring (Exam I) - GY

Question 1

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

Answer 1

Right Atrial Enlargement

Question 2

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

Answer 2

Left Atrial Enlargement

Question 3

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

Answer 3

Bi-atrial enlargement

Question 4

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

Answer 4

Inverted symmetrical T-waves

Question 5

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

Answer 5

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

Question 6

What type of pacemaker is most sensitive to electromagnetic interference?

Answer 6

Unipolar

Question 7

Do Bipolar or Unipolar pacemakers utilize less energy?

Answer 7

Bipolar uses less energy (more efficient)

Question 8

What’s the most common pacemaker?

Answer 8

Single lead → single chamber

Question 9

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

Answer 9

Bipolar Cautery

Question 10

In what situations would Bi-ventricular pacemakers be utilized?

Answer 10

Anywhere were resynchronization therapy is indicated.

• HF
• BBB
• Hx of cardiac arrest

Question 11

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

Answer 11

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What is the A-wave?

Answer 15

Atrial contraction

Question 16

What is the C-wave?

Answer 16

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

Question 17

What is the V-wave?

Answer 17

Rapid filling of the atria

Question 18

What is the H-wave or H-plateau?

Answer 18

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

Question 19

What is the X-descent or x-wave?

Answer 19

Steep drop in pressure as atria relax and start filling.

Question 20

What is the Y-descent or y-wave?

Answer 20

Atria filling the ventricles in early diastole

Question 21

An h-plateau occers immediately before the ________ wave.

Answer 21

a-wave

Question 22

The x descent happens after the ________ wave

Answer 22

c-wave

Question 23

The y descent happens after the ______ wave.

Answer 23

v-wave

Question 24

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

Answer 24

loss of A-wave, enlargement of C-wave

Question 25

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

Answer 25

- Tall Systolic C-V wave - Loss of X-descent *Very similar to RV waveform*

Question 26

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

Answer 26

- Tall A-wave - Attenuated Y-descent

Question 27

Describe a Swan-Ganz Catheter in detail. *Flip for picture*.

Answer 27

Question 28

What is the preferred site for PA catheter placement?

Answer 28

Right IJ

Question 29

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

Answer 29

Right Atrium

Question 30

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

Answer 30

RV

Question 31

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

Answer 31

Pulmonary Artery

Question 32

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

Answer 32

Wedged

Question 33

What is the total length of the PA catheter?

Answer 33

110 cm

Question 34

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

Answer 34

Pulmonary artery rupture - Hemoptysis (Bright red and copious) - Hypotension

Question 35

How are PA ruptures treated? 6

Answer 35

- ↑ Oxygenation - Double lumen ETT - PEEP (to tamponade bleeding) - Reverse anticoagulation - Tamponade bleed w/ catheter - Definitive surgical repair *Thoughts and prayers*

Question 36

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

Answer 36

- **Tall V-wave** - C & V wave fused - No X-descent

Question 37

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

Answer 37

- Slurred, early Y-descent

Question 38

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

Answer 38

- Tall A-waves - Increased LVEDV & LVEDP

Question 39

What is the typical range for SVR?

Answer 39

800 - 1600 dynes/sec/cm5

Question 40

What is the typical range for PVR?

Answer 40

40 - 180 dynes/sec/cm5

Question 41

What is the typical range for stroke volume?

Answer 41

60 - 90 mL

Question 42

What is the typical range for mixed venous O₂ saturation?

Answer 42

70 - 80 %

Question 43

What would the following cardiac output thermodilution curve indicate?

Answer 43

Low CO (Longer time to return to baseline)

Question 44

What would a high cardiac output thermodilution curve look like?

Answer 44

Question 45

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

Answer 45

10%

Question 46

How many "views" are in a full echocardiogram?

Answer 46

28 views

Question 47

What five views can be utilized for a focused TTE?

Answer 47

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

Question 48

What is assessed with a parasternal long-axis view?

Answer 48

- Overall Function - Left Heart and aortic root

Question 49

What is assessed with a parasternal short-axis view?

Answer 49

- LV function & volume status

Question 50

What is assessed with an apical four chamber view?

Answer 50

- RV vs LV size - Tricuspid & Mitral function - Descending Aorta

Question 51

What is assessed with a subcostal four chamber view?

Answer 51

- Pericardial Effusion - Four chambers

Question 52

What is assessed with a Subcostal IVC view?

Answer 52

IVC - Diameter - Collapsibility (especially in determining volume status)

Question 53

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

Answer 53

- Esophageal Varices - Lap Banding