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CFRN Studying > Cardiac Physiology > Flashcards

Cardiac Physiology Flashcards

1
Q

Layers of the Heart

A

Pericardium

Epicardium
Myocardium (thickest)
endocardium

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2
Q

S1 Heart Sound

A

Initial closing of mitral and tricuspid valves

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3
Q

S2 Heart Sound

A

Closure of Aortic and Pulmonic Valves

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4
Q

S3 Heart Sound

A

Produced during passive filling of left ventricle when blood strikes a compliant left ventricle. Physiologic? Athletes and Individuals <40

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5
Q

S4 Heart Sound

A

Occurs during active filling LV when atrial contraction forces blood into a noncompliant left ventricle.

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6
Q

Location of Heart Sounds

A

Aortic - Second intercostal space, right sternal border
Pulmonic - Second intercostal space, left sternal border
Tricuspid - Fifth intercostal space, left sternal border
Mitral - fifth intercostal space, mid clavicular.

S3 and S4 is heart on mitral border.

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7
Q

Cardiac Conduction

A

SA - 60-100
AV - 40-60

Right Bundle Branch

Left Bundle Branch:

  1. Left anterior fascicle
  2. Left posterior fascicle

Purkinje Fibers - 15-40

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8
Q

Systolic Murmurs

A

Mitral Regurgitation (Common new finding after inferior MI) / Aortic Stenosis

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9
Q

Diastolic Murmurs

A

Pulmonary Regurgitation / Mitral Stenosis

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10
Q

Isolated Posterior Wall MI

A

Depressions in V2-V4 only. Normal posterior MI will shows depressions in V2-V4 with associated inferior lead ST changes.

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11
Q

Which leads to which artery/EKG tracing?

A

II, III, aVF = Inferior leads / RCA
V1-V4 - Anterior wall, LAD (V1, V2 - can be considered septal)
V5, V6, I, aVL, - Lateral leads, Left circumflex branch

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12
Q

Systemic Approach to EKG

A
  1. Check V1 for BBB
  2. Start a 1 and look through leads. II and aVL are twins. Reciprocal.
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13
Q

Left Ventricular Hypertrophy Signs EKG

A

Kissing QRS

R wave in V1 and V6 added up:
>35mm diagnostic for LVH

R-wave in aVL higher than 11mm

aVF higher than 20mm

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14
Q

Early Repolarization Signs on EKG

A

“fish hook” - Early (benign) repolarization. Younger adults/African Americans

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15
Q

Osborn Waves signs on EKG

A

J wave (Osborn wave) . Seen in hypercalcemia. Many times secondary to hyperparathyroidism.

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16
Q

Pericarditis signs on EKG

A

ST elevations throughout the entire 12-Lead (Dressler Syndrome)

PR interval is downsloping

Sharp Chest Pain, Radiates to the base of neck, unable to lay supine

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17
Q

Aberrant Conduction (LBBB)

A

V1 >.120 or 120ms. Need to look at scarbossa to definitively diagnose OMI.

Downward deflection = Left
Upward deflection: Right

18
Q

Raised ICP signs on EKG

A

High sympathetic tone:

Increased ICP leads to deep inverted T waves. Higher than 10 mm.

19
Q

Device-Paced Rhythm signs on EKG

A

Pacer Spikes
Global Wide QRS complexes

20
Q

False OMI EKG acronym

A

LEOPARD

Left Ventricular Hypertrophy
Early Repolarization
Osborn Waves
Pericarditis
Abberant Conduction (BBB)
Raised ICP
Device Paced Rhythm

21
Q

Wellen’s Syndrome

A

Normal to slight elevation in cardiac markers
Biphasic T-waves in V2-V3

> 75% patients will proceed to anterior OMI in a few weeks.

Type 1: Deep biphasic inverted T waves
Type 2: Deep inverted symmetric T waves

22
Q

aVR Diagnostic

A

If aVR and V1 have st elevation with associated depressions in V3-V6. It is diagnostic for left main insufficiency.

23
Q

Left Bundle Branch Block

A

Sgarbossa Criteria

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

3 points for likely OMI

24
Q

De Winters T-Wave

A

Tall prominent T-waves
Upsloping ST-segment depression >1mm
ST-segment elevation in aVR

Potential Left Main Insufficiency.

25
Q

Acronym for unique EKG findings

A

WALDO

Wellen’s Syndrome
aVR Diagnostic
Left Bundle Branch Block
De Winters Syndrome
Out of hospital ROSC

26
Q

SHIP

A

Subtle Inferior/Lateral
Hyper-acute T-Waves
Isolated Posterior OMI

27
Q

Beta-Blockers

A

Antagonists of the beta receptors in the heart and lungs.

Decreased inotropic, chronotropic, dromotropic effects on the heart.

May cause bronchospasm

28
Q

Esmolol

A

Beta-Blocker - Blood pressure and heart rate.

Antagonizes Beta-1 adrenergic receptors of heart and lungs

Contra:
Bronchospasms/Asthma
Bradycardia, AV blocks, cardiogenic shock, CHF

29
Q

Labetalol

A

Antihypertensive.

Selective Alpha 1 and non-selective beta antagonist.

30
Q

Calcium Channel Blockers

A

Blocking Ca++ into vascular smooth muscle
- Vascular smooth muscle relaxation, especially at coronary arteries.
Slowing impulses through SA and AV nodes.
Vasodilation

31
Q

Dopamine

A

2-5 mcg/kg Primarily beta stimulation
Increased Q, contractility, and renal perfusion.

5-10 - Alpha/beta
Loss of renal action

32
Q

Norepinephrine

A

Stimulates alpha receptors.

33
Q

Inodilators

A

Dobutamine, milrinone

Beta 1 and beta 2 effects

Decrease peripheral vascular resistance

Milrinone increases intracellular calcium leading to improved myocardial contractility and stroke volume.

34
Q

Methylene Blue

A

Nitric Oxide Inhibitor

Combats the vasodilation from nitric oxide released secondary to pro-inflammatory mediator release.

35
Q

Vasodilators

A

Hydralazine

Dilates arterial system
Decreases afterload
PIH/HTN

Nitroglycerin
Dilates primarily venous system - decreases preload Dilates arterial in higher doses.

36
Q

Nitroprusside

A

Relaxes vascular smooth muscle
Dilates arterial and venous system. Decreased afterload and preload.

Precautions: Pregnancy. Watch for cyanide toxicity.

37
Q

Heparin

A

Accelerates formation of antithrombin III, thrombin complex, inactivates thrombin and prevents conversion of fibrinogen to fibrin.

38
Q

TPA

A

Alteplase, Activase, t-PA

ischemic stroke
STEMI
PE

39
Q

Axis Deviation

A

Normal Axis - 0-90
Left Axis Physiological - 0-30
Left Axis Pathological 31 to -90
Right axis - +90 - +180

Left - points away
Right - points together
Normal - up together

LVH, LBBB, Inferior MI, Paced Rhythm, Left anterior fascicular block

40
Q

Right Axis

A

Chronic - RVH, COPD, Lateral Wall MI

Acute - Misplaced Leads
PE
Sodium Channel blocker (Lidocaine, Procainamide Amiodarone Quinidine), TCA, cocaine

CFRN Studying (23 decks)

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