Cardiology

Question 1

Tamponade key points

Answer 1

• 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

Question 2

Looks different every time

Answer 2

Polymorphic

Question 3

Blood cells dying

Answer 3

Lyse (“lice”)

Question 4

SCAPE patients
what SCAPE means

Answer 4

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

Question 5

Fluid builds up in the abdomen.
Can also lead to fluid buildup in the chest.

Answer 5

Ascites (a SAI diz)

Question 6

When the body grows new blood vessels to overcome injury

Answer 6

Angiogenesis

Question 7

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

Answer 7

• Costochondritis (kasto kan DRY des)
  Aka , Chest wall pain syndrome or costosternal syndrome

Question 8

• 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

Answer 8

• Pleurisy (PLA ra si)- aka pleuritis,

Question 9

Acute pressure and volume overload of the right ventricle because of pulmonary hypertension. Indicate PE, acute bronchospasms, pneumothorax, and other acute lung disorders.

Answer 9

Cor pulmonale

Question 10

The PR segment details

Answer 10

• 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

Question 11

QRS complex details

Answer 11

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)

Question 12

When QRS and T are not pointing the same direction

Answer 12

qrst discordance (means disease). Opposite is concordance

Question 13

RCA [Right Coronary Artery] provide blood to…

Answer 13

1. SA node
   
   2. AV node
   3. RV
   4. Inferior wall LV

Question 14

LMCA (main) provide blood to…
[Left Main Coronary Artery (LMCA aka LMA)]

Answer 14

1. LAD (aka Widow Maker) anterior wall LV
   
   2. LCx superior lateral LV

Question 15

Posterior descending artery (PDA) provide blood to…

Answer 15

Back of the LV. This artery branches off from either the RCA or the LMCA

Question 16

Systolic/Diastolic meaning

Answer 16

Ventricles contract / Ventricles fill in their resting position

Question 17

Rates of the heart’s pace makers

Answer 17

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

Question 18

Treatment for ischemia in lab

Answer 18

Percutaneous Coronary Intervention (PCI), aka angioplasty with stents (catheter lab)

Question 19

Inferior MI considerations

Answer 19

1. obtain a right-sided EKG (V4R) to evaluate RV involvement.
2. If ST elevation in V4R strong indication of a STEMI
3. Do not give nitroglycerin due to risk for hypotension.
4. inferior wall MI means also anterior MI; not the other way around

Question 20

Frequency (electrical) of modes in ECG

Answer 20

• 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

Question 21

Normal heart rates infant to adult

Answer 21

• Adult - 80bpm
• Ped - 100 pbm
• Inf - 120 bpm

Question 22

Defibrillation rhythms and voltage

Answer 22

Start with 200j, 300, 360
VF
VT no pulse
PMVT (even if there is a pulse)

Question 23

Shockable SCV rhythms and voltage

Answer 23

100j
SVT
VT w Pulse
2:1 AF (flutter)
1:1 AF
Afib/RVR (200j)

Question 24

Pacing TCP rhythms

Answer 24

1. Sinus Brady
2. Junctional
3. Idioventricular
4. 2nd Degree type 2
5. 3rd Degree

Question 25

Unshockable rhythms

Answer 25

PEA, asystole

Question 26

Heart location and inclusion

Answer 26

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

Question 27

Cardiac output

Answer 27

Volume of blood each ventricle ejects every minute
At rest, adult make is 5.25, female 4.9

Question 28

Autonomic regulation of the heart

Answer 28

Medulla oblongata regulates the heart rhythm and passes signals to the heart through the vagus nerve (CN X)

Question 29

The heart wall layers

Answer 29

1. Outermost epicardium (visceral pericardium);
2. Middle and thickest myocardium; performs the bulk of the heart’s work. Thickest in the left ventricle
3. Innermost - endocardium,

Question 30

Left side blood flow

Answer 30

1. 4 veins (2 from each lung) return ox blood to LA
2. From LA through BICUSPID MITRAL (two triangular cusps) to LV
3. In LV chordae tendineae and papillary muscles hold cusps
4. Aortic valve, tricuspid (three semilunar) no chordae tendineae needed

Question 31

Getting hit in middle of chest when heart is volnurable

Answer 31

Commotio Cordis (ko MOdio KOR dis)