Cardiology

Question 1

how to use aVR to distinguish between SVT with aberrancy and VTach

Answer 1

SVT will have a primary qS in aVR and a primary R wave in V6

VTach will be opposite.

Question 2

should you treat a bifiscicular block with a sodium channel blocker

Answer 2

no
-it will cause a blockage of the 3rd fascicle causing a complete heart block.
-no amiodarone, lidocaine, or procainamide

Question 3

what is Sgarbossa criteria

Answer 3

looking for MI criteria in a LBBB
-concordant STE >= 1mm is 5 points
-STD >=1mm in V1-V3 is 3 points
-Discordant STE >=5mm is 2 points

need a total of 3 points to meet MI criteria

Question 4

how to determine left anterior fascicular block

Answer 4

Left axis deviation
qR complex in lead I,aVL
RS complex in lead aVF, III

Question 5

how to determine left posterior fascicular block

Answer 5

Right axis deviation
-RS complex in lead I
-qR complex in lead II, III

Question 6

if you are not able to determine if there is a fascicular block in wide complex tachycardia how should you treat it.

Answer 6

you should synchronize cardiovert them

Question 7

what is a trifascicular block.

Answer 7

a bifascicular block plus a 1st degree heart block.
will typically be a complete heart block

Question 8

how to determine a bifascicular block

Answer 8

RBBB plus a left anterior fascicular block or left posterior fascicular block

Question 9

how many fascicles are on the heart

Answer 9

3
-left anterior fascicle
-left posterior fascicle
-Right fascicle

Question 10

what is a common visual of benign early repolarization

Answer 10

ST segment “fish hook” appearance

Question 11

what leads is benign early repolarization seen.

Answer 11

seen primarily in R wave leads
II, III, aVF, V4, V5, V6

Question 12

how do you determine LVH

Answer 12

-S wave height in V1
plus
R wave height in V5 or V6
if greater than 35 mm it is LVH
- aVL has an R wave >11mm
-aVF has an R wave >20mm

-only need 1 of the 3 criteria

Question 13

What are the imitators of OMI/ACS

Answer 13

-LVH
-BBB (sgarbossa criteria)
-ventricular beats
-pericarditis
-early repolarization

Question 14

how can aVR be used as a diagnostic tool when there is anterior depression

Answer 14

-STE indicates left main disease
-use to diagnose SVT w/ aberrant conduction vs VTach
-aVR is elevated along with V1 and aVR is greater than V1 with global depression is considered left main insufficiency. 3 vessel occlusion of 97% or greater

Question 15

how can aVR be used for a diagnostic tool when there is anterior ST elevation

Answer 15

elevation is aVR and V1 is highly suggestive and diagnostic for proximal LAD obstruction

Question 16

can you use aVR as a diagnostic tool on 12 EKG

Answer 16

yes

Question 17

what lead is aVL a twin with. the reciprocal change will mirror it.

Answer 17

lead III

Question 18

what artery feeds the anterior wall of the heart

Answer 18

left main
left ascending

Question 19

what artery feeds the lateral wall of the heart

Answer 19

-High lateral- left circumflex
-low lateral- left circumflex, left marginal, left diagonal.

Question 20

what artery feeds the inferior wall of the heart

Answer 20

-90% of the population is the RCA
-10% is the LAD

Question 21

when are the coronary arteries perfused

Answer 21

during the diastolic phase.

Question 22

stroke volume is made up of what 3 things

Answer 22

-preload
-afterload
-contractility

Question 23

what is the normal ejection fraction

Answer 23

50-70%

Question 24

why is diastolic filling so important

Answer 24

it is 2/3 of your MAP

Question 25

how much blood is ejected during the systolic phase

Answer 25

60-135 cc

Question 26

what is the quickest way to increase cardiac output

Answer 26

increase the heart rate

Question 27

what is normal cardiac output

Answer 27

4-8 L/min

Question 28

What does rule out the 3 H’s mean

Answer 28

-rule out hypoxia
-rule out hypovolemia
-rule out hyperthermia (fever)

Question 29

What is the S1 heart sound

Answer 29

closure of the tricuspid and mitral valves

Question 30

What is the S2 heart sound

Answer 30

closure of the pulmonic and aortic valves

Question 31

what is the S3 heart sound

Answer 31

-produced during passive filling of the LV.
-when blood hits a compliant LV

Question 32

What is the S4 heart sound

Answer 32

-produced during active LV filling.
-when atrial contraction forces blood into a noncompliant LV

Question 33

where will you hear the S3-S4 sounds

Answer 33

over the mitral valve location

Question 34

can you diagnose off of a 4 lead EKG

Answer 34

no- it is set to monitor quality

Question 35

what is the J point

Answer 35

start of the ST segment