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FlightBridgeEd > Cardiac Physiology > Flashcards

Cardiac Physiology Flashcards

1
Q

Heart valves

A

Tricuspid(R) and Mitral(L) = blood into the Ventricals
Pulmonic(R) and Aortic(L) = blood out of the ventricles

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2
Q

Why Pulmonic valve is important

A

Maintains diastolic pressure in pulmonary artery
MAP is made up of 2/3 diastolic pressure

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3
Q

Cardiac Output

A

> 4-8L/min
HR quickest way to increase CO(Q)
Stroke volume (SV) = preload, after load, contractility. Amount of blood ejected during systolic pressure
Tachycardia increases O2 use and decreases O2 supply. Tachycardia = 220-age
Are they hot, hypoxic, or hypovolemic?

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4
Q

Dicrotic notch

A

End of the T wave

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5
Q

Heart sounds

A

S1-closing of Mitral and tricuspid
S2-closing of the aortic and pulmonic
S3-ventricular filling sounds like “Ken-TUCKy”. Normal
S4-LV filling when non-compliant. Pathological sound. “Ten-nessee”

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6
Q

RCA

A

Feeds SA/AV node, RA, RV, and Inferior/Posterior wall

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7
Q

LAD

A

V1-V4

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8
Q

Pre-cordial leads

A

V-leads

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9
Q

How and when to perform a right side 12-lead

A

All patients with an Inferior STEMI should get a right sided 12-lead. Just move V4 to the right side of the chest. That’s all you need to do

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10
Q

Left circomflex artery

A

Leads 1-aVL(high lat)
V5-V6(low lat)

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11
Q

Hyper acute T wave

A

Early change suggestive if STEMI
Tall and peaked symmetrical
*Only seen in the affected area

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12
Q

Pathologic Q waves

A

> 25% of R wave height
2mm in depth
At least 40(0.04)ms wide
Associated with necrotic cells
Usually seen days or weeks after

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13
Q

aVL and Inferiors

A

If you see as little as 0.5mm of depression in aVL, it’s 97% predictive in identifying inferior MI.

If ACS patient has aVL depression, Inferior MI is likely coming soon

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14
Q

Where is WALDO and his SHIP

A

W-Wellen’s syndrome
A-aVR STE
L-LBBB
D-DeWinters T wave
O-out of hospital ROSC

S-subtle Inferior-High Lat wall
H-Hyper acute T wave
I-Isolated
P-Posterior

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15
Q

EKG with pericarditis

A

Global STE without reciprocal changes

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16
Q

Imitators of STEMI

A

LVH
Paced/Ventricular beats
Pericarditis
Early depolarization

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17
Q

LVH

A

> S wave depth in V1 + tallest R wave in V5-V6 = >35mm
aVL R wave >11mm
aVF R wave >20mm

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18
Q

Benign Early Repolarization(BER)

A

Normal
STE
Tall T waves
Often seen in Inferior/Lat leads
Males 20-40 yo and African American
ST segment “fish hook” sign

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19
Q

Patho Left axis deviation

A

LVH
Left Anterior hemi block
LBBB
Inferior MI
Paced

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20
Q

Causes of Right axis deviation

A

RVH/COPD
PE
TCA OD
Lat wall MI
Left posterior hemiblock

21
Q

SCB with bifasicular block?

A

No!!! No Amio, Lido, or Procainimide to runs of Vtach with a bifasicular block!! You will kill the patient

22
Q

Wellens Syndrome type 1 and 2

A

> Type 1
Biphasic T waves in V2-V3(deep symmetric)
Common in Anterior but could be in any precordial lead
Can be pain free
No STE!
Type 2
Negative(inverted) symmetric T wave
**75% had LAD that will lead to AMI within weeks

23
Q

aVR diagnostic

A

Anterior depression, aVR STE > STE V1 = left main insufficiency and 3 vessel disease process

24
Q

Sgarbossa Criteria(LBBB)

A

Concordant STE >1mm = 5
STD >1mm in V1-V3 = 3
Discordant STE >5mm =2

25
Q

DeWinters T waves

A

Tall T waves
Upsloping STD >1mm
Absence of STE in precordial leads
STE 0.5-1mm in aVR
Normal ST morphology

26
Q

Slow Vtach Tx

A

QRS duration >200ms or 0.20?
It’s hyper K
Killer drugs- CCB Na+ blockers
**Tx with Calcium and Bicarb

27
Q

Brugada syndrome

A

Seen in Asians and young males 20-30 yo
Sodium channel issue
Normal QT
Painless
Ventricular arrhythmias. Biphasic T wave in V1-V2
S/S: dizzy, syncope, SOB, palpitations, young person sudden cardiac arrest

28
Q

FP-C pharm Qs

A

Will be solely based on the following:
>Generic vs Trade name
>use and indication
>mech of action
>contraindication
*doses will be pretty standard, nothing out the normal

29
Q

Agonist vs antagonists

A

> Agonist: activate receptors
Antagonists: block receptors from being activated

30
Q

Beta Blockers(BB)

A

-lol drugs
>Antagonists of the beta receptors in the heart and lungs
>cause decreased Ino/Chromo/Dromo effects on the heart(good); bronchospams in the lungs(bad)

31
Q

Esmolol

A

Action: (BB) Selectively antagonizes Beta-1 adrenergic receptors
> Rapid onset and short acting
>decreases force, rate, and BP
Indications: SVT and uncontrolled HTN
Precautions: Asthma/bronchospasm, hypersensitivity, bradycardia, AV blocks, CHF, and Cardiogenic shock
*seen with aneurysm patients
Dose: 500mcg/kg/min

32
Q

Labetalol

A

Action: (BB) anti-HTN w/ selective Alpha-1 and non-selective beta-antagonist effects.
Indications:patients with HTN issues(head bleed)
Precautions: Bronchial asthma, cardiogenic shock, >1st degree heart block, severe bradycardia
Dose: 10-20mg slow IVP q 10min max of 300mg

33
Q

Calcium channel blockers(CCB)

A

-pine drugs
>acts by blocking Ca++ influx into vascular smooth muscle casuing relaxation especially in the coronary arteries
>negative dromo, slows impulses through SA and AV nodes, and casues vasodilation.

34
Q

Nicardipine(Cardene)

A

Action: (CCB) Relaxes cardiac, smooth, and vascular muscle cells
Indications: HTN
Precautions/contraindications: Pregnancy, CHF, advanced aortic stenosis, and hypersensitivity
Dose: 5mg/hr
*Nicardipine(Cardene) preferred prehospital drug

35
Q

Vasopressors and Inotropes

A

Vasopressor causes vasoconstriction
Inotropes increase force of contraction
Meds: Dopamine, Epi, Norepi, Dobutamine, Phenylephrine(Neosynephrine), Vasopressin, and Methylene Blue

36
Q

Norepinephrine(Levophed)

A

Gold standard vasopressor
Action: stimulates alpha adrenergic receptors resulting in vasocontrictions, increased peripheral vascular resistance, increase in BP.
Indications: Vasogenic shock with tachycardia, sepsis, and neurogenic shock
Dose: 2-12mcg/min and titrate to effect. Peds- 0.1mcg/kg/min titrate to effect.

37
Q

Dopamine(Intropin)

A

Alpha/Beta (5-10mcg/kg/min)
mixed stimulation
increased CO, contractility, BP, HR
Loss of renal action
*5-10mcg/kg/min is the theraputic range

38
Q

Inodilators(Dobutamine and Milrinone)

A

Sympathomimetic(adrenergic) agents
Action: stimulation of beta-1 receptors, higher ino than chrono, increase contractility, and vasodilation
Indications: actue LV failure, pulmonary vasocontriction, high pulmonary vascular constriction, and low Q states-low perfusion states

39
Q

Dobutamine

A

synthetic catecholamine with beta-1 effects
some beta-2 as well causing vasodilation
use caution with hypotensive patients(borderline)
Dose: 2-20mcg/kg/min
*always fill the tank first. If they are not volume responsive, go with Levo instead

40
Q

Milrinone

A

like Viagra
Action: increases contractitility and stroke volume
Indications: Ischemic and non-ischemic cardiomyopathy, CHF, and Pulmonary HTN
Precautions: Hypersensitivity, hypertrophic cardiomyopathy, WPW or other bypass tracts
Dose: Adult and peds- 0.25mcg/kg/min max of 1mcg/kg/min

41
Q

Vasopressors

A

Phenylephrine(neosynephrine), Vasopressin, Methylene Blue
sympathomimetic (adrenergic) agents
Action: stimulate Alpha-1 & Alpha-2 receptors
>increase vasoconstriction
>low beta properties
Indications: Neurogenic shock, push dose pressors, vasogenic shock states, refractory septic shock

42
Q

Phenylephrine(Neosynephrine)

A

Action: stimulates alpha, causes increased BP without tachycardia, and increases aortic root pressure and coronary artey perfusion pressure
Indications: Vasogenic shock with tachycardia, sepsis, neurogenic shock
Dose: 10-100mcg/min and maintenance 40-60mcg/min

43
Q

Vasopressin

A

**2nd line drug
Action: releases catecholamine receptors
Indications: Vasodilatory shock/septic shock
Dose: Sepsis-0.01-0.04units/min. Upper GI Blled- 0.5units/min
Good for patients with norepi refractory hypotension

44
Q

Methylene Blue

A

Action: Nitric oxide inhibitor. Combats vasodilation from nitric oxide release 2ndary to pro-inflammatory mediator release
Indications: Vasodilatory shock/Septic shock
Dose: 1.5-2mg/kg over 20min-1hr
*decreases the need for other vasopressors or allow for lower vasopressor dosing. NOT SEEN IN PRE-HOSPITAL SETTING

45
Q

Hydralazine

A

Vasodilator/ HTN emergencies
Action: dilates arterial system and decreases afterload
Indications: PIH(pregnancy induced HTN) and HTN
Dose: 5-10mg IV max of 40mg
**WATCH OUT- drops both systolic and diastolic pressure

46
Q

Nitroglycerin

A

Action: Dilates venous system and arterial system at higher doses, decreases preload and afterload, relieves vasospasm, improves blood flow and myocardial O2 consumption
Indications: Angina, MI, acute LV failure, coronary artery spasm
Dose: 5-20mcg/min(or 5-200mcg/min)

47
Q

Nitroprusside

A

Action: relaxes vascular smooth muscle, dilates arterial/venous system, and decreases aferload/preload.
Indications: HTN(hemorrhagic stroke), acute LV failure, cardiogenic shock, acute aortic dissections
Precautions: Pregnancy(cyanide toxicity)
Dose: Adult and ped- 0.5-10mcg/kg/min titrate to effect

48
Q

Heparin

A

Action: decreases the ability for the body to form blood clots
Indications: any condition caused by a clot(DVT, ACS, CVA, PE, MI)
Precautions: recent major surgery, ulcer, GI bleed Hx or renal dysfunction
Dose: 60-80units/kg followed by infusion of 15-18units/kg/hr

49
Q

Alteplase(Activase, t-PA)

A

Action: desolves formed blood clots
Indications: Ischemic stroke, STEMI, PE
Dose: Stroke- 0.9mg/kg over 1hr max 90mg
STEMI <67kg- 15mg over 1-2min max total 100mg
STEMI >67kg- same as above by all 100mg infused over 1.5 hrs
PE- 100mg over 2 hrs

FlightBridgeEd (17 decks)

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