Cardiology Flashcards
Tamponade key points
- The symptoms jvd, pulse pressure, hypotension
- As it progresses - a narrowing pulse pressure (higher diastolic, lower systolic)
- Never add more pressure to the patient with CPAP or bagging
Looks different every time
Polymorphic
Blood cells dying
Lyse (“lice”)
SCAPE patients
what SCAPE means
Sympathetic Crashing Acute Pulmonary Edema
Rapid onset of pulmonary edema (flash)
Very high BP and air hunger
Strong gurgling sounds
They get the nitro drip
Must be stabilized before we move them
Fluid builds up in the abdomen.
Can also lead to fluid buildup in the chest.
Ascites (a SAI diz)
When the body grows new blood vessels to overcome injury
Angiogenesis
Benign inflammation of the cartilage that connects the ribs to the breastbone. It can cause sharp pain in the chest wall, especially when moving or breathing deeply.
* Can lead to MCI
- Costochondritis (kasto kan DRY des)
Aka , Chest wall pain syndrome or costosternal syndrome
- Inflammation of the pleura, the two thin layers of tissue that separate the lungs from the chest wall.
- Sharp chest pain while breath, cough, sneeze, or move.
- May also be felt in the shoulder.
Can lead to MCI
- Pleurisy (PLA ra si)- aka pleuritis,
Acute pressure and volume overload of the right ventricle because of pulmonary hypertension. Indicate PE, acute bronchospasms, pneumothorax, and other acute lung disorders.
Cor pulmonale
The PR segment details
- Delay in conduction by the AV node to allow the ventricles to fill
- No more than 200 ms (5 boxes)
- Longer than 200 ms there is a delay which represent a problem
QRS complex details
Qrs duration is no longer than 120 milliseconds (ms) - above it is wide and below is narrow
* Q depol of intraventricular septum. Negative deflection
* R wave LV depolarizing, positive, must follow Q
* S wave from the R to negative territory
Two of the same letter, the second is called “prime” (RR’ = R and R prime)
When QRS and T are not pointing the same direction
qrst discordance (means disease). Opposite is concordance
RCA [Right Coronary Artery] provide blood to…
- SA node
- AV node
- RV
- Inferior wall LV
LMCA (main) provide blood to…
[Left Main Coronary Artery (LMCA aka LMA)]
- LAD (aka Widow Maker) anterior wall LV
- LCx superior lateral LV
Posterior descending artery (PDA) provide blood to…
Back of the LV. This artery branches off from either the RCA or the LMCA
Systolic/Diastolic meaning
Ventricles contract / Ventricles fill in their resting position
Rates of the heart’s pace makers
SA node, main pacemaker, 60-100.
Ectopic Atrial myocytes can fire at 300
AV junction (secondary) 40-60.
Right and Left bundle branches, top of the ventricle 20-40; lower 10
Treatment for ischemia in lab
Percutaneous Coronary Intervention (PCI), aka angioplasty with stents (catheter lab)
Inferior MI considerations
- obtain a right-sided EKG (V4R) to evaluate RV involvement.
- If ST elevation in V4R strong indication of a STEMI
- Do not give nitroglycerin due to risk for hypotension.
- inferior wall MI means also anterior MI; not the other way around
Frequency (electrical) of modes in ECG
- 3 lead the monitor is in “Monitor Mode” which is between 1-30 Hz
- 12 lead is “Diagnostic Mode” which is 0.05-40 Hz for adults, or 0.05-150 Hz for ages 15 or lower.
○ How to confirm a pacemaker = since artificial pacemakers fire at around 120 Hz, change the monitor to be age 15 (150 Hz) so it will show well in the strip
Normal heart rates infant to adult
- Adult - 80bpm
- Ped - 100 pbm
- Inf - 120 bpm
Defibrillation rhythms and voltage
Start with 200j, 300, 360
VF
VT no pulse
PMVT (even if there is a pulse)
Shockable SCV rhythms and voltage
100j
SVT
VT w Pulse
2:1 AF (flutter)
1:1 AF
Afib/RVR (200j)
Pacing TCP rhythms
- Sinus Brady
- Junctional
- Idioventricular
- 2nd Degree type 2
- 3rd Degree
Unshockable rhythms
PEA, asystole
Heart location and inclusion
300g, 12x9x6cm
Located in the middle of the mediastinum; between second and fifth rib; between the sternum and the thoracic vertebrae
Enclosed in the pericardium
Cardiac output
Volume of blood each ventricle ejects every minute
At rest, adult make is 5.25, female 4.9
Autonomic regulation of the heart
Medulla oblongata regulates the heart rhythm and passes signals to the heart through the vagus nerve (CN X)
The heart wall layers
- Outermost epicardium (visceral pericardium);
- Middle and thickest myocardium; performs the bulk of the heart’s work. Thickest in the left ventricle
- Innermost - endocardium,
Left side blood flow
- 4 veins (2 from each lung) return ox blood to LA
- From LA through BICUSPID MITRAL (two triangular cusps) to LV
- In LV chordae tendineae and papillary muscles hold cusps
- Aortic valve, tricuspid (three semilunar) no chordae tendineae needed
Getting hit in middle of chest when heart is volnurable
Commotio Cordis (ko MOdio KOR dis)
