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Exam Prep > Cardiology > Flashcards

Cardiology Flashcards

1
Q

The circumflex artery is a branch of the:

A

Left coronary artery

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2
Q

The tricuspid valve is:

A

located between the right atrium and right ventricle

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3
Q

The thick, muscular middle layer of the heart wall necessary for contraction is the?

A

myocardium

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4
Q

The cavity between the parietal and visceral pericardium contains pericardial fluid, approx?

A

30-50ml

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5
Q

Myocytes are jointed together into a continuous mass of ned-to-end gap junctions called

A

intercalated discs

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6
Q

T/F: the myocardial walls of each ventricle are much thicker than the atria

A

True

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7
Q

T/F: the coronary arteries originate from the aorta and the suppliers of arterial blood to the heart

A

True

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8
Q

Cardiac output

A

the amount of blood pumped by the left ventricle in 1 min

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9
Q

Stroke volume is dependent on preload, after load, and _________

A

myocardial contractility

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10
Q

A classic sign of decreased cardiac output is:

A
  • change in mental status
  • dyspnea
  • hypotension
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11
Q

Parasympathetic control of the heart is provided by the:

A

vagus nerve

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12
Q

The ventricles are innervated mainly by the:

A

somatic nerve fibers

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13
Q

The primary chief mediator of the sympathetic division of the autonomic nervous system is

A

norepinephrine

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14
Q

Chronotropy refers to

A

heart rate

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15
Q

Acetylcholine affects the heart by:

A

decreasing the heart rate

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16
Q

T/F: contractile cells generate an initial spark that sends current through your pacemaker cells

A

False

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17
Q

T/F: the nervous system can increase and decrease heart rate contractility and generate electrical impulses

A

False

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18
Q

Resting membrane potential in contractile cells is always recorded from the inside of the cell as:

A

-70mV to -90mV

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19
Q

In a normal heart, the primary pacemaker is the

A

SA node

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20
Q

The inherent beats/min of the AV node is:

A

40-60

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21
Q

T/F: The SA node is located in the left atrium, posterior to the tricuspid valve

A

False

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22
Q

The AV node is also known as the

A

gatekeeper

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23
Q

Depolarization takes place when

A

sodium ions rush into the cell

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24
Q

The AV junction is formed by the AV node and the:

A

Bundle of His

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25
Q

Atrial kick is MOST accurately defined as

A

15-30% of ventricular filling caused by atrial contraction

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26
Q

The mechanism of ectopic impulses are:

A

enhanced automaticity AND re-entry

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27
Q

Re-entry occurs when an impulse is:

A

delayed or blocked

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28
Q

T/F: a specific polarity is designated to each electrode regardless of selection

A

False

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29
Q

T/F: precordial chest leads view electrical activity in the heart on a transverse/horizontal plane

A

True

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30
Q

T/F: lead aVF is a “distant recording electrode” and does NOT view any wall of the heart

A

True

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31
Q

Each small square represents __ mV

A

0.1

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32
Q

the vertical axis of the graph paper corresponds with

A

voltage

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33
Q

A biphasic waveform represents an electrical impulse that moves

A

perpendicular to the positive electrode

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34
Q

An ECG machine is properly calibrated when an electrical signs is produced measuring __ mV

A

1

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35
Q

ECG paper normally records at a constant speed of

A

25mm/sec

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36
Q

The most common cause of acute coronary syndromes is what

A

rupture of atherosclerotic plaque

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37
Q

T/F: s&s of angina may be atypical in diabetics, the elderly and women

A

True

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38
Q

S&S of stable angina may occur after

A
  • exertion
  • emotional distress
  • eating
  • environmental stressors (ex. heat)
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39
Q

T/F: pts will ALWAYS experience chest pain during myocardial infarctions

A

False

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40
Q

What are common signs of an MI?

A
  • confusion
  • denial
  • ashen skin
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41
Q

T/F: distinguishing between unstable angina and AMI can be accomplished during initial presentation

A

False

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42
Q

With regards to 15 lead placement, V4R is placed:

A

5th intercostal space at right midclavicular line

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43
Q

The 1st change in the evolving pattern of STEMI is

A

development of the T wave

44
Q

A Q wave is pathological when it is:

A

more than 1/3rd the height of the R wave in the lead

45
Q

Reciprocal changes in inferior leads are

A

Leads I and AVL

46
Q

15 lead ECG placement consists of which new leads:

A

V4R, V8 and V9

47
Q

Acute coronary syndromes refer to all of the following

A
  • ST segment elevation MI
  • Non ST segment elevation
  • unstable angina
48
Q

The left coronary artery divides into which two branches:

A
  • circumflex
  • LAD artery
49
Q

Mean vector lies between

A

0 and +90

50
Q

Two lead method of axis deviation involves which leads:

A

I and aVF

51
Q

Criteria for identification of a right or left BBB includes a QRS equal or greater than 0.12s and

A

A QRS produced by supraventricular activity

52
Q

T/F: V2 is the single best lead to use when differentiating between right and left BBB

A

False

53
Q

T/F: with regards to a RBBB, the last 0.04secs of the QRS is deflected upright

A

True

54
Q

Increase in thickness of a chamber due to pressure overload:

A

hypertrophy

55
Q

Right atrial enlargement produces

A

abnormally tall and peaked initial part of P wave

56
Q

T/F: left ventricular hypertrophy is a STEMI imitator

A

True

57
Q

T/F: with regards to pericarditis, symptoms are made better by lying flat and worse by sitting up

A

False

58
Q

T/F: in pericarditis, concave ST elevation is noted in almost every lead (except aVR and V1)

A

True

59
Q

Hyperkalemia is abnormally high level of what serum in the blood

A

Potassium

60
Q

T/F: tall and tented T waves are present in mild cases of hyperkalemia

A

True

61
Q

T/F: hyperkalemia is a STEMI imitator

A

True

62
Q

VF and aystole occur in hyperkalemia patients with a blood serum of:

A

10-12 mEq/L

63
Q

A 15 lead ECG should be performed on

A
  • any inferior MI
  • tall R waves and ST depression in V1-V3
64
Q

Tunica intima is what layer of the coronary artery

A

innermost

65
Q

Monomorphic ventricular tachycardia is best described as:

A

3 or more unifocal PVCs in a row at a rate >100

66
Q

ST segment is best described as:

A
  • early repolarization of the ventricles
67
Q

PR interval is considered prolonged if it is more than how many seconds in duration

A

0.20s

68
Q

Multifocal atrial tachycardia is best described as

A

irregularly irregular

69
Q

Common characteristics of SVT include

A
  • p waves are non-discernable
  • regular
  • > 100 bpm
70
Q

Atrial flutter is most commonly caused by

A

a rapid re-entry circuit

71
Q

Location of MI - V1 and V2 elevated

A
  • affected myocardial area: septal
  • occluded artery: proximal LAD
72
Q

Location of MI - V3 and V4 elevated

A
  • affected myocardial area: anterior
  • occluded artery: LAD
73
Q

Location of MI - V5 and V6 elevated

A

affected myocardial area: lateral (apical)
occluded artery: distal LAD, circumflex or right coronary artery

74
Q

Location of MI - I and aVL elevated

A

affected myocardial area: lateral
occluded artery: circumflex artery

75
Q

Location of MI - II, aVF, and III elevated

A

affected myocardial area: inferior
occluded artery: 90% RCA, 10% LCx

76
Q

Location of MI - V7, V8 and V9 elevated

A

affected myocardial area: posterolateral (posterior)
occluded artery - RCA or LCx

77
Q

When does the left coronary artery become occluded:

A

lateral, septal and anterior MI

78
Q

STEMI ECG Changes - 1st change

A

Development of T wave (hyperacute phase)
- increases in height, more symmetrical and pointed
- may occur within first few mins of infarction

79
Q

STEMI ECG Changes - 2nd change

A

ST elevation (early acute phase)
- primary indication of myocardial injury in progress
- may occur within the first few hours of infarction

80
Q

STEMI ECG Changes - 3rd change

A

T wave inversion (later acute phase)
- T wave inversion suggests presence of ischemia

81
Q

STEMI ECG Changes - 4th change

A

Development of Q wave (fully evolved phase)
- 1st evidence that tissue death has occurred

82
Q

STEMI ECG Changes - final change

A

The Q wave remains (healed phase)
- in time, the T wave regains its normal contour and ST segment returns to isoelectric line BUT Q waves remain as evidence an infarct occurred

83
Q

What is automaticity?

A

ability of cardiac pacemaker cells to generate or initiate their own electrical impulse

84
Q

What is excitability?

A

irritability: the ability of cardiac cells to respond to an electrical stimulus

85
Q

What is conductivity?

A

ability of cardiac cells to transmit an electrical stimulus to other cardiac cells

86
Q

What is contractility?

A

ability of cardiac cells to shorten, causing cardiac muscle contraction in response to electrical stimulus

87
Q

What is polarization?

A

phase of readiness
-the muscle is relaxed and the cardiac cells are ready to receive and impulse

88
Q

What is depolarization?

A

phase of contraction
- the cells have transmitted an electrical impulse, usually causing the cardiac muscle to contract

89
Q

What is repolarization

A

recovery phase
- the muscle has contracted and the cells are returning to a ready state

90
Q

Cardiac Action Potential - Phase 0

A

Rapid depolarization phase
- cell membrane has reached “threshold potential”
- sodium channels permit rapid entry of Na into cells making inside more positive than outside of the cell

91
Q

Cardiac Action Potential - Phase 1

A

Early repolarization phase
- flow of sodium into cell stops
- potassium channels open which results in a decrease in the number of positively charged ions in the cell and drop in membrane potential

92
Q

Cardiac Action Potential - Phase 2

A

Plateau phase - prolonged repolarization phase
- calcium channels open
- at the same time, potassium continues to leave the cell

93
Q

Cardiac Action Potential - Phase 3

A

Rapid repolarization phase
- calcium channels close
- while potassium continues to exit the cell

94
Q

Cardiac Action Potential - Phase 4

A

Resting membrane potential
- there is still excess of Na inside and K outside, which causes the sodium-potassium pump to activate
- the Na travels back out and K travels back in
- membrane returns to its resting membrane potential
- phase 0 begins all over again

95
Q

Beginning with the right atrium, describe the normal flow of blood through the heart, lungs and to the systemic circulation

A
  • through the inferior and superior vena cava into the right atrium, through the tricuspid valve into the right ventricle, through the pulmonary valve, through to the right and left pulmonary arteries, to the lungs to become oxygenated
  • down through the right and left pulmonary veins into the left atrium through the bicuspid valve into the left ventricles, where it is pumped through the aortic valve into the aortic arch and to the rest of the body
96
Q

What are the phases of Systole

A

4 phases
- phase 1 - isovolumetric contraction (ventricles squeezing but not pumping)
- phase 2 - ventricular ejection (pumping vigorously)
- phase 3 - protodiastole (pumping less)
- phase 4 - isovolumetric relaxation (relaxing, valves closing to end systole)

97
Q

Discuss the phases of diastole

A

3 phases
- phase 1 - rapid refilling (atria dumping blood into ventricles)
- phase 2 - diastasis (slowing blood flow)
- phase 3 - atrial kick (atria contracting to squeeze remainder of blood into ventricles)

98
Q

“All-or- nothing” principle

A
  • the action potential along the cell membrane acts as a stimulus to the adjacent regions of the cell membrane
  • this causes excitability and once started, it spreads and continues on to the next cell and so forth
99
Q

Define absolute refractory period

A

the cardiac muscle cannot respond to any stimulation

100
Q

Define relative refractory period

A

the cardiac muscle is more difficult than normal to excite, yet it can still be stimulated

101
Q

Intrinsic rate of the SA node:

A

60-100

102
Q

Intrinsic rate of the purkinje fibres:

A

20-40

103
Q

Right coronary arteries:

A

Right coronary artery
- posterior descending artery
- right marginal artery

104
Q

Left coronary arteries:

A

Left coronary artery
- circumflex artery
- left anterior descending artery

105
Q

What is the single best lead to use for differentiating between a right and left BBB?

A

Lead V1

106
Q

1st degree AV block

A

PR interval is prolonged (>0.20secs), prolonged and constant

107
Q

2nd degree Type I AV block

A

PR interval lengthens with each cycle
- gradually longer PR interval until a QRS complex is dropped

Exam Prep (10 decks)

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