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N 4300 > Cardiac Review; CV alterations; Hemodynamics; EKG > Flashcards

Cardiac Review; CV alterations; Hemodynamics; EKG Flashcards

1
Q

Definition of systole

A

Contraction phase of the heart

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2
Q

Definition of diastole

A

filling phase of the heart

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3
Q

What is the right side AV valve pump and when is it open?

A

Tricuspid; during atrial systole & ventricle diastole

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4
Q

What is the left side AV valve pump and when is it open?

A

Mitral; during atrial systole & ventricle diastole

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5
Q

What is the right side SL valve pump and when is it open?

A

Pulmonic; ventricle systole & atrial diastole

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6
Q

What is the left side SL valve pump and when is it open?

A

Aortic; ventricle systole & atrial diastole

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7
Q

What does S1 occur with (lubb)?

A

Ventricular systole (AV valves close)

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8
Q

What does S2 occur with (dubb)?

A

Ventricular diastole (SL valves close)

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9
Q

S3 heart sound is a sign of?

A

heart failure; increase venous return (fever, volume overload)

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10
Q

S4 heart sound is a sign of?

A

forceful atrial contraction; occurs after MI

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11
Q

Normal values for K, Na, Mg, Ca?

A

3.5-5.5; 135-145, 1.5-2.5; 9-11

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12
Q

Normal Serum lipids: Cholesterol, triglycerides, LDL, HDL?

A

Less than 200; 40-190; if no CAD or less than 2 risk factors less than 160 & if CAD less than 100; HDL greater than 35

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13
Q

How to calculate MAP?

A

systolic BP+ 2 X diastole BP/ 3 (good estimate of overall tissue perfusion)

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14
Q

Definition of CO? normal?

A

volume of blood ejected by each ventricle in 1 min (CO=SV x HR) normal : 4-6 L/min

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15
Q

Definition of SV?

A

volume of blood ejected by each ventricle per contraction; normal: 60-100 ml

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16
Q

Definition of Ejection fraction?

A

fraction of blood ejected with each beat; normal 60-70%

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17
Q

What perfect of circulating blood volume is in veins?

A

70%

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18
Q

When does injury occur to coronary arteries if there is atherosclerosis?

A

reduced 50-70%

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19
Q

What does PQRST stand for?

A

Provoke, Quality, Radiation, Severity, Timing

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20
Q

What side of heart is low pressure? High?

A

right side (venous return); left side (power house pumps to rest of body)

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21
Q

What is the most common cause of clots?

A

Atrial fibrillation

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22
Q

What three things are essential for perfusion, cardiac status, & hemodynamics?

A

pressure, flow, resistance

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23
Q

In a cardiac catheter it is important to assess what?

A

for hemorrhage, monitor vitals, distal pulses, hold metformin could cause lactic acidosis

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24
Q

What are the two types of angina?

A

stable: occurs w exertion relieved by rest; unstable: partial blockage by thrombus; pain severe not relieve by rest, increased risk for MI

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25
Q

How should you take Nitrates?

A

take 1 tab every 5 min repeat 5 min if still in pain call 911; get new after 6 months; hold if systolic less than 100

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26
Q

Difference between Angina and MI?

A

Angina: pain less than15 min w. exertion or stress, doesn’t vary with position, relieved by rest or NTG; MI: pain greater than 15 min, resp. distress more severe, pain not relieved by rest or NTG, skin cold, clammy, N&V, pulse rapid. Irreg

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27
Q

What is non STEMI MI?

A

non Q wave MI; partial occlusion of CA, ST depression, Elevated Cardiac enzymes

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28
Q

What is STEMI MI?

A

Q wave MI; total occlusion of CA, ST elevation, Elevated Cardiac enzymes

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29
Q

What does MONA stand for?

A

Morphine, Oxygen (2L), NTG, Aspirin (2-4 baby chewable)

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30
Q

What five things does Morphine do?

A

decreases Chest pain, smooth muscle relaxant, decreases anxiety, decreases preload and afterload.

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31
Q

What artery primarily feeds the hearts anterior wall?

A

Left anterior descending artery

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32
Q

What must a patient be for thrombolytic Mgt of AMI?

A

symptomatic 20 min unrelieved by nitro and with ST segment elevation

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33
Q

What type of patients can’t get thrombolytics?

A

stroke, uncontrolled htn, recent surgery/trauma, internal bleeding, aortic dissection, recent preg.

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34
Q

What do nitrates do?

A

decreases preload & afterload, vasodilates coronary arteries.

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35
Q

What do Beta Blockers (Inderal) do?

A

decreases HR & contractility.

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36
Q

What do Ace Inhibitors (Vasotec, Captoprol) do?

A

decrease SVR

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37
Q

What do Phosphodiesterase inhibitors (Amrinone/Inocor) do?

A

increase contractility & decrease afterload

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38
Q

What does Dopamine do?

A

stimulates adrenergic receptors; tx of low CO

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39
Q

What does Dobutamine do?

A

Sympathomimetic. Direct action inotropic agent that enhances myocardial contractility, SV, CO, renal blood flow, UO

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40
Q

Hemodynamics studies relationships among?

A

HR, blood flow, O2 delivery, tissue perfusion.

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41
Q

Pressure =?

A

flow x resistance

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42
Q

What is the force exerted on the liquid?

A

pressure

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43
Q

What is the amount of fluid moved overtime?

A

flow

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44
Q

What is the measure of the ease with which the fluid flows through the lumen of a vessel?

A

resistance

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45
Q

What is the pressure of the right atrium and ventricle?

A

2-6 mm hg; 15-25 mm hg

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46
Q

What is the pressure of the left atrium and ventricle?

A

8-12 mm hg; 110-130 mm hg systolic/ 8-12 mm hg diastole

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47
Q

What are some factors that affect blood flow?

A

blood vessel changes, turbulence flow, HR, contractility, renin/angiotension/aldosterone cascade.

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48
Q

What are some factors that affect resistance?

A

diameter & length of vessel, elasticity of artery, blood viscosity (thickness).

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49
Q

What are some noninvasive ways to assess hemodynamics?

A

noninvasive BP, assess JVP (measures preload), assess serum lactate levels

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50
Q

BP Size?

A

width 40% of arm circumference; length bladder cuff covers 80-100% of arm circumference.

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51
Q

JVP elevated could mean?

A

Fluid overload, HF, R ventricular dysf

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52
Q

What are normal lactate levels? High levels w. hypo perfusion can cause?

A

0.5-1.6 meq L.; circulatory shock, resuscitation, metabolic acidosis, end organ damage/poor perfusion.

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53
Q

What is determined by the stretch of the ventricles at the end of diastole?

A

preload

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54
Q

What patients benefit from invasive hemodynamic monitoring?

A

ineffective tissue perfusion, sepsis, decreased CO, impaired gas exchange, fluid excess/dehydration.

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55
Q

What are examples of invasive modalities?

A

AP monitoring, RAP/CVP monitoring, PA pressure monitoring

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56
Q

How much pressure needed to push fluid into artery?

A

300 mm hg

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57
Q

Sites for arterial pressure?

A

radial, brachial, femoral arteries

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58
Q

What does RAP/CVP catheters measure?

A

measures R heart filling pressures, fluid status, guides fluid resuscitation

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59
Q

Where do you zero the transducer?

A

phlebostatic axis: 4th intercostal space LMCL

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60
Q

When do you measure RAP?

A

end of expiration

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61
Q

What assessments during and after RAP insertion?

A

pulses, no numbness, neurovascular checks, Breath sounds, HS, Chest x-ray

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62
Q

What do PA caths measure?

A

RA, RV, PA pressures.

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63
Q

What position does patient need to be in to insert PA catheter?

A

Trendelenburg, towel roll between shoulder blades.

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64
Q

Why do you inflate catheter balloon?

A

to float catheter in PA

65
Q

What function does PA catheter reflect?

A

Left ventricular function

66
Q

What is the normal PA pressure?

A

25 mm hg systolic/ 10 mm hg diastole; mean 15 mm hg

67
Q

What are the five components of Invasive Hemodynamic monitoring?

A

invasive catheter, noncompliant pressure tubing, flush system, transducer, bedside monitor

68
Q

What component of invasive hemodynamics allows for efficient & accurate transfer if intravascular pressure changes to the transducer & monitoring system?

A

noncompliant pressure tubing & flush system

69
Q

What component of invasive hemodynamics translates intravascular pressure changes into waveforms and numeric data?

A

transducer

70
Q

Phlebostatic axis tells us what?

A

the exact pressure in heart and artery

71
Q

How do we know the A-line pressure wave is working correctly?

A

dicrotic notch will be seen. (aortic valve is closing)

72
Q

In hemodynamics if preload is elevated what will you see? decreased?

A

E: increased JVP, peripheral edema, taught skin turgor, crackles
D: decreased skin turgor w. tenting, dry mucus membranes, hypotension, decreased UO

73
Q

In hemodynamics if afterload is elevated what will you see? decreased?

A

E: cool, peripheral, weak peripheral pulses, changes in LOC
D: warm extremities, bounding pulses, changing in LOC

74
Q

What does SvO2 show?

A

overall O2 use by tissues and organs

75
Q

What is normal values for SvO2? ScvO2? high means? low means?

A

60-75%; 65-85%; tissues cannot use O2; O2 demand > delivery

76
Q

What are the four factors that affect SvO2?

A

hemoglobin, CO, arterial oxygen saturation, oxygen consumption(VO2)

77
Q

What are some signs of increased metabolic demand for O2?

A

fever, hyperthermia, Pain, stress, seizure, shivering

78
Q

Definition of depolarization?

A

(precedes systole) electrical firing of impulse: atria= p wave; ventricles: QRS

79
Q

Definition of repolarization?

A

Electrical charging(precedes diastole); atria= within QRS; ventricles= t wave

80
Q

What is the resting potential of myocardial cells?

A

-90 mv

81
Q

What happens in phase 0-1 of action potential?

A

Na rushes in. fast ventricular depolarization takes place

82
Q

What happens in phase 2 of action potential?

A

Ca moves thru the slow Ca channel(+20 mv)

83
Q

What happens in phase 3 of action potential?

A

rapid repolarization, K leaves the cell.

84
Q

What happens in phase 4 of action potential?

A

returns to normal resting state.

85
Q

What is the lead II placement?

A

right arm(below clavicle)- neg lead(white); left lower abdomen or left leg- pos. lead(red); left arm- ground lead can be on lower right chest or upper left chest area(black, green, brown)

86
Q

What is the value of little EKG box? big box?

A

.04; .20

87
Q

How many seconds on a EKG strip is used to determine HR?

A

6 secs

88
Q

What is P wave generated by?

A

SA node (pacemaker of the heart): sinus rhythm

89
Q

Where is PR interval located? normal range value?

A

beginning of p wave to beginning of QRS: (.12-.20)

90
Q

Where is QRS complex located? normal range value?

A

beginning of Q to S: (.06-.12)

91
Q

What does a wide QRS and no p wave indicate?

A

ventricular rhythm

92
Q

QT can be used to determine ?

A

certain effect of certain drugs on the myocardium(Quinidine)

93
Q

True or false ST segment should be isoelectric?

A

TRUE

94
Q

ST segment depression could indicate? elevation?

A

myocardial ischemia; myocardial injury or infaract

95
Q

Any changes with your patient or complaints or pain or discomfort requires a ____ ______ EKG to fully assess the myocardial status?

A

12 lead

96
Q

What is atrial kick?

A

an additional 30% of blood volume into ventricles

97
Q

Baroreceptors detect changes in? chemoreceptors?

A

BP;

ph, O2, & CO2 levels

98
Q

True or False myocardial cells primary function is electrical?

A

false: mechanical

99
Q

What is the primary property of myocardial cells?

A

contractility

100
Q

True or False Pacemaker cells primary function is electrical

A

TRUE

101
Q

What is the primary property of pacemaker cells?

A

automaticity/conductivity

102
Q

True or false action potentials primary function is chemical

A

TRUE

103
Q

What are some signs of a decreased CO?

A

diaphoretic, SOB, altered LOC, weakness, fatigue, dizzy, low BP, ischemia, low Pox.

104
Q

What does it mean by generating electrical impulses without being stimulated?

A

automaticity

105
Q

What is the ability of the cardiac muscle cell to respond to an outside stimulus?

A

excitability/irritability

106
Q

What is the ability to receive an electrical impulse and conduct to an adjoining cardiac cell?

A

conductivity

107
Q

What is the ability of myocardial cell to shorten in response to an impulse?

A

contractility

108
Q

What does polarized mean?

A

when the inside of cell is more neg than outside

109
Q

True or false a cell can conduct another impulse before repolarization occurs.

A

FALSE: cannot

110
Q

True or False a refractory period is a valuable protective mechanism for the heart and is essential for cells to recover.

A

TRUE

111
Q

What is absolute refractory period?

A

cells cannot no matter what be stimulated to conduct an electrical impulse

112
Q

True or False in a relative refractory period cells can be stimulated if stimulus is strong enough.

A

TRUE

113
Q

How many bpm is SA node? AV and bundle of his? purkinje’s network?

A

60-100; 40-60; 20-40

114
Q

True or false the slower the heart rate the lower in the heart the impulse started.

A

TRUE

115
Q

What do most cardiac EKG strips run out of machine at?

A

25 mm/sec

116
Q

P wave represents?

A

atrial depolarization

117
Q

PR interval is the time for ?

A

atrial depolarization to enter the bundle of his

118
Q

QRS represents?

A

ventricular depolarization

119
Q

T wave represents?

A

ventricular repolarization

120
Q

How to count heart rate on EKG?

A

count the R’s in a 6 sec strip and multiply by 10

121
Q

True or False If not normal QRS doesn’t really count as heart rate, but count anyways.

A

TRUE

122
Q

What can drop SvO2 levels?

A

suctioning, turning patient, weighing, shivering, seizure, pain, increased PEEP, increased intrathorasic levels

123
Q

True or False having head of bed not elevated and flexed hip can cause increase in intrathorasic pressure.

A

TRUE

124
Q

What are the three sites of impulse formation?

A

Sinus, Atrial, Ventricular

125
Q

What dysrhythmia is HR less than 60, QRS and PR normal limits, reg. rhythm?

A

sinus bradycardia

126
Q

What are some causes of Sinus Bradycardia?

A

digoxin, sleep, hypoxia, MI, heart disease

127
Q

What medication is given only if pt is symptomatic with sinus bradycardia?

A

atropine: 0.5-1mg max of 2. Can stress out heart be cautious

128
Q

What dysrhythmia is HR greater than 100 in adult, QRS and PR in normal range, rhythm reg.

A

sinus tachycardia

129
Q

What are some common causes of sinus tachycardia?

A

fever, HF, anxiety, shock

130
Q

: What dysrhythmia is when a site within the atria fires before the next SA node impulse is due to fire, QRS is normal, PR varies.

A

PAC (Premature atrial contractions): early p wave

131
Q

What happens in a PAC when the SA node tried to reset itself?

A

non compensatory pause

132
Q

What are some causes of PAC’s ?

A

excessive alcohol use, caffeine, anxiety, MI, HF, digoxin toxicity

133
Q

What are some significance of PAC’s?

A

may reflect increasing atrial irritability, not an entire rhythm- it’s a single beat, can lose atrial kick

134
Q

What is the most common dysrhythmia?

A

atrial fibrillation

135
Q

What are some causes of A. fib?

A

injury to atria (open heart surgery), digoxin toxicity, pericarditis, hyperthyroidism

136
Q

What are some dangers of A fib?

A

loss of atrial kick up to 30% decrease in CO, thrombi (clots) along the walls of the atria.

137
Q

What medications for A fib are good for rate control? Rhythm control?

A

beta blockers, Digoxin, Ca+ channel blockers; Cardizem

138
Q

What may be done if pt is A fib with RVR or pt is symptomatic?

A

synchronized cardioversion (shock) on the R

139
Q

What is some management for A fib?

A

anticoagulation- started before attempting to convert or if AF has been present 24-48 hours; hep. Drip initially, lovenox, Coumadin; Amiodarone for persistant A fib

140
Q

What is the 1st line drug for atrial and ventricular dysrhythmias?

A

Amiodarone

141
Q

What dysrhythmia has sawtooth flutter waves with rate of 250-350 bpm, QRS normal, PR can’t measure, no p wave?

A

Atrial flutter

142
Q

True or False some common causes of Atrial flutter may be open heart surgery, MI, heart disease

A

TRUE (also no atrial kick)

143
Q

Where does Supraventricular Tachycardia (SVT) begin?

A

above the bundle of his

144
Q

What are the two types of SVT?

A

atrial tachycardia: atria fires rapidly; Paroxysmal atrial tachycardia: rapid rate that starts and stops quickly (something goes wrong and changes HR)

145
Q

What dysrhythmia has reg rhythm, ventricular rate of 150-250 bpm, QRS normal, p wave may merge with t wave of previous beat?

A

SVT

146
Q

What are some causes of SVT?

A

anxiety, alcohol excess, cigs

147
Q

What medication is given for PAT/SVT?

A

Adenosine (Adenocard)- 6 mg rapid IV push to slow AV conduction

148
Q

What dysrhythmia is no p wave, wide, bizarre QRS complex greater than .12, assume no CO, t wave opposite of QRS, beat occurs early, has a full compensatory pause?

A

Premature Ventricular Contractions (PVC’s)

149
Q

What is a unifocal PVC?

A

came from one irritable ventricular site

150
Q

What is multifocal PVC?

A

Came from multiple irritable ventricular sites

151
Q

What is the R and T phenomenon?

A

elevates ST segment could be MI; can trigger deadly ventricular dysrhythmias

152
Q

What are some causes of PVC’s?

A

acid base imbalance (acidosis 7.24), electrolyte imbalance: low K/Mg

153
Q

What are some signs and symptoms related with PVC’s?

A

palpitations, irreg. pulse, decreased BP, SOB

154
Q

True of False routine medications to treat PVC’s are no longer used.

A

TRUE

155
Q

What dysrhythmia has 3 or more PVC’s in a row, rate greater than 100, QRS wide greater than .12 & bizarre, sometimes marching p waves.

A

Ventricular Tachycardia(VT)

156
Q

What are some causes and possible symptoms of VT?

A

myocardial ischemia, cardiomyopathy, cardiac cath, dig toxicity.
symptoms: hypotension, loss of LOC, chest pain, SOB, cold, clammy skin.

157
Q

True of False in VT you should call 911 its an emergency, why?

A

TRUE: hemodynamically unstable- no pulse, need CPR and defibrillation.

158
Q

What do you treat polymorphic VT or Torsades de pointes with?

A

Mg

159
Q

What does ventricular fibrillation look like?

A

no p waves, no QRS, no pulse..

N 4300 (8 decks)

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