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Flight Paramedic Certification > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Pericardium

A

Sack around heart

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2
Q

Epicardium

A

Thin, outmost layer of heart

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3
Q

Myocardium

A

Thick, muscular layer of heart

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4
Q

Endocardium

A

Thin, inside layer of heart

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5
Q

AV valves are located between __ and ___.

A

Atria and Ventricles

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6
Q

AV valves ___ with low ventricular pressure and ___ with high ventricular pressure.

A

Open, Close

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7
Q

What are the four AV valves in order?

A

Tricuspid, Pulmonic, Mitral, Aortic

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8
Q

Coronary circulation divides from the Aorta into the ___ and the ___.

A

Left Coronary Artery and Right Coronary Artery

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9
Q

The Left Coronary Artery bifurcates into the __ and __.

A

Left Circumflex and Left Anterior Descending

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10
Q

The Right Coronary Artery bifurcates into the __ and __.

A

Right Coronary Artery and Posterior Descending Artery

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11
Q

What does the Left Circumflex supply?

A

Left Lateral wall

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12
Q

What does the Left Anterior Descending supply?

A

Left Anterior wall

Left Anterior 2/3rds Septum

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13
Q

What does the Right Coronary Artery and Posterior Descending Artery supply?

A 
SA node
AV node
Right Ventricle
Left Inferior
Left Posterior
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14
Q

What is the major intra-atrial pathway?

A

Bachmann’s Bundle

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15
Q

Electrical conduction in the heart

A

SA node -> AV node -> Bundle of His -> RBB / LBB (LBB -> Anterior / Posterior Fascicle) -> Perkinje fibers

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16
Q

Transmural Infarct

A

Includes full thickness of myocardium, endocardium, and epicardium.

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17
Q

Non-transmural (subendocardial) Infarct

A

Damage limited to subendocardial region

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18
Q

Define Unstable Angina

A

Positive cardiac markers and negative 12 lead changes

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19
Q

Define NSTEMI

A

Positive cardiac markers and ST depression or T wave changes

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20
Q

Define STEMI

A

Positive cardiac markers and ST elevation on 12 lead

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21
Q

Septal wall infarcts

A

LAD occlusion

Associated with Anterior MI, RBBB, LAFHB

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22
Q

Anterior wall infarcts

A

LAD occlusion
Associated with Septal MI
Anticipate Mitral valve regurgitation due to papillary muscle involvement (flash pulmonary edema)

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23
Q

Lateral wall infarcts

A

Left Circumflex

Can be associated with Anterior or Anterioseptal wall MI

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24
Q

Inferior wall infarcts

A

RCA occlusion
Associated with Posterior wall / Right ventricle
Look for AV node involvement with high occlusion (Frequent rhythm changes)

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25
Q

Posterior wall infarcts

A

RCA occlusion
Associated with Inferior wall / Right ventricle
Look for AV node involvement with high occlusion

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26
Q

Pathological Q waves

A

1/3rd of total height of R wave or 1 small box (0.04s)

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27
Q

1mm on EKG

A

0.04 seconds, 1 small box

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28
Q

5mm on EKG

A

0.2 seconds, 1 big box

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29
Q

Posterior EKG placement

A

V4 -> V7 (posterior axillary line, left of shoulder blade)
V5 -> V8 (mid-scapular line)
V6 -> V9 (left spinal border)

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30
Q

Pericarditis S/S

A

Atypical, sharp pain that changes with position change. Reproduceable with pressure, wants to lean forward, deep breathing causes pain.

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31
Q

Pericarditis 12 lead

A

Abnormalities in multiple, seemingly unrelated leads. Look for J point notching

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32
Q

Stable Angina

A

Onset with physical exertion or emotional stress. Pain lasts 1-5 minutes and is relieved by rest. Predictable.

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33
Q

Unstable Angina

A

Stable angina that has changed in frequency, quality, duration, or intensity. Pain lasts longer than 10 minutes despite rest and NTG.

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34
Q

Variant (Prinzmetals) Angina

A

Spontaneous episodes of C/P frequently noted at rest or on early rising (associated with circadian rhythm). Relieved with NTG.

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35
Q

Silent Angina

A

Objective evidence of ischemia in asymptomatic patients (Positive 12 lead or elevated enzymes).

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36
Q

Mixed Angina

A

Combination of Stable and Variant Angina.

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37
Q

Management of Acute MI: Preload reduction

A

Nitrates (improves coronary blood flow, decreases preload and left ventricle end diastolic pressure)
Morphine (decreases sympathetic tone, heart rate and O2 demand)

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38
Q

Normal CorPP

A

> 50

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39
Q

Coronary Perfusion Pressure formula

A

CorPP = DBP - PCWP

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40
Q

Management of Acute MI: HR and O2 demand reduction

A

Beta blockers (decrease HR and increase diastolic filling time- use ONLY in post acute phase)

Calcium channel blockers (produce dilation of coronary arteries and collateral vessels along with decreased in contractility and conduction)

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41
Q

Management of Acute MI: Clot prevention and lysis

A

ASA/Glycoprotein IIb/IIIa inhibitors
Heparin/Lovenox
Fibrinolytics

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42
Q

True or False: Evidence suggests equivalent mortality of thrombolytics @ 30 minutes and angioplasty @ 90 minutes with angioplasty being safer.

A

True

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43
Q

Thrombolytics Indication

A

New onset STEMI

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44
Q

Thrombolytics Complications

A

Bleeding everywhere and anywhere.

Reperfusion dysthymias common.

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45
Q

Thrombolytics Absolute Contraindications

A 
Active internal bleeding
Suspected aortic dissection
Known intracranial neoplasm
Previous hemorrhagic stroke at any time
Any stroke in past year
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46
Q

Pacing complications: oversensing

A

“Detecting” T waves or artifact as R waves. Shuts off demand pacer.

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47
Q

Pacing complications: Failure to sense

A

Does not recognize R waves and randomly fires pacer. (most dangerous due to refractory period)

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48
Q

Pacing complications: Asynchronized pacing

A

Pacing spikes and R waves not aligning. Can cause R on T

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49
Q

Define Dilated Cardiomyopathy

A

Systolic heart failure caused by stretched heart and muscles thinned. Usually due to volume overload.

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50
Q

Treatment of Dilated Cardiomyopathy

A

Cardiac glycosides (Digitalis)
Diuretics (Lasix)
Inotropes (Dopamine/Dobutamine)

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51
Q

How does Digitalis work?

A

Poisons regular sodium pumps, Secondary pumps then push out sodium and pulls in calcium to the cell. Increased calcium = increased contractility.

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52
Q

Define Hypertrophic Cardiomyopathy

A

Diastolic failure caused by heart muscle becoming thick and large, decreased space for blood causing decreased preload and cardiac output.

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53
Q

Treatment of Hypertrophic Cardiomyopathy

A

Increase Preload, Increase ventricular filling with beta blockers or calcium channel blockers.

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54
Q

Define Restrictive Cardiomyopathy

A

Systolic failure caused by stiff and fibrous heart due to scar tissue.

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55
Q

Treatment of Restrictive Cardiomyopathy

A

Diuretics, anticoagulants, digitalis

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56
Q

Primary vs Secondary Cardiomyopathy

A 
Primary = Cardiomyopathy causing other problems
Secondary = Other issues caused Cardiomyopathy
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57
Q

Define Stenotic Valve

A

Valve doesn’t want to open

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58
Q

Define Regurgitant valve

A

Valve doesn’t want to close

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59
Q

Most common cause of valve disease

A

Rheumatic fever / disease

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60
Q

Two most common valves to have problems

A

Mitral and Aortic

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61
Q

“Systolic murmur 2nd intercostal space right of sternum”

A

Aortic Stenosis

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62
Q

“Lub murmur dub”

A

Systolic murmur

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63
Q

“Lub dub murmur”

A

Diastolic murmur

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64
Q

Tricuspid valve location

A

Between Right Atrium and Right Ventricle. Listen at 4th ICS, left mid-clavicular

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65
Q

Pulmonary valve location

A

Between Right Ventricle and Pulmonary Artery. Listen at 2nd ICS, Left side of sternum

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66
Q

Mitral valve location

A

Between Left Atrium and Left Ventricle. Listen at 5th ICS Left side

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67
Q

Aortic valve location

A

Between Left Ventricle and Aorta. Listen at 2nd ICS Right side.

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68
Q

Valves that Open on Systole and Close on Diastole

A

Pulmonic and Aortic

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69
Q

Valves that Open on Diastole and Close on Systole

A

Tricuspid and Mitral

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70
Q

Chest X-ray shows “Widened Mediastinum with diffuse infiltrates”

A

Leaking Aorta!

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71
Q

Debakey classification of aortic aneurysm Type 1

A

Begins at aortic valve, ascends through ascending aorta, through arch and into descending aorta.

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72
Q

Worst aortic aneurysm prognosis

A

Type 1

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73
Q

Debakey classification of aortic aneurysm Type 2

A

Begins at aortic valve and goes into ascending aorta

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74
Q

Debakey classification of aortic aneurysm Type 3

A

Only in descending aorta

75
Q

Best aortic aneurysm prognosis

A

Type 3

76
Q

Treatment of Aortic Aneurysm

A 
Lower BP (Nipride)
Lower HR (Metoprolol/Esmolol)
Pain control (Fentanyl)
77
Q

Treatment of Hypertensive Crisis

A 
Try to get to their normal BP over 30-60 minutes.
Nipride
Hydralazine
Labetalol
Ace inhibitors
Diuretics
78
Q

Types of invasive hemodynamic monitoring

A

Arterial
Central venous
Pulmonary Artery

79
Q

Always monitor ___ port for most accurate hemodynamic monitoring.

A

Distal

80
Q

Fluid filled monitoring systems are pressurized to __

A

300 mmHg

81
Q

Transducer placement

A

Even with the Phlebostatic Axis (4th ICS mid-axillary)

82
Q

True or false: Arterial lines should not be used for fluid resuscitation or medication infusion.

A

Monitor and draw only!

Do not fluid resuscitate or infuse medications

83
Q

Arterial line uses

A

Provides continuous BP

Easy access for labs and blood gas

84
Q

Where are Arterial lines usually placed?

A

Radial or Femoral arteries

85
Q

Trace a drop of blood through the heart

A

Vena cava -> RA -> Tricuspid -> RV -> Pulmonic -> Pulmonary Artery -> Lungs -> LA -> Mitral -> LV -> Aortic -> Aorta

86
Q

Renin-Angiotensin-Aldosterone system

A

Renal system mechanism to improve hemodynamics by vasoconstricting and retaining water.

87
Q

Lab value measuring Congestive Heart Failure

A

BNP

88
Q

Chest X-ray: “Curly A/B lines, lung vasculature is super dense, enlarged heart”

A

Congestive Heart Failure

89
Q

Treatment of Congestive Heart Failure

A 
Correct systolic failure, Increase LV clearing
Decrease preload (NTG, Morphine, Lasix)
Decrease afterload (Nitroprusside)
Decrease rate (Carvedilol)
Increase contractility (Dobutamine)
Inhibit RAA system (Ace inhibitors)
90
Q

Define Cardiogenic Shock

A

“Pump” failure causing hypotension

91
Q

Treatment of Cardiogenic Shock

A

IABP
LVAD
Dopamine/Dobutamine
Nitroprusside

92
Q

Where is Central Venous Pressure measured?

A

In the Vena Cava at entrance to Right Atrium (Preload)

93
Q

Normal CVP?

A

2-6 mmHg

94
Q

What does CVP measure?

A

Hydration status, RV function, preload

95
Q

Causes of low CVP

A

Hypovolemia

Vasodilation

96
Q

Causes of high CVP

A 
Hypervolemia
RV failure / infarct
Cardiac tamponade
Positive pressure ventilation
P.E.
Pulmonic stenosis
Tricuspid Stenosis
97
Q

CVP waveform

A

“Gentle rolling waveform”

98
Q

Normal Right Ventricle Pressures

A

Systolic - 15-25 mmHg

Diastolic - 0-5 mmHg

99
Q

RV waveform

A

Sharp upstroke and downstroke

notching on ascending side = Right Atrial kick

100
Q

Normal Pulmonary Artery Pressures

A

Systolic - 15-25 mmHg

Diastolic - 8-15 mmHg

101
Q

What does Pulmonary Artery Pressure measure?

A

Right heart output
Left heart output
Pulmonary compliance

102
Q

Causes of low PAP

A

Dehydration
RV failure / infarct
Pulmonic stenosis

103
Q

Causes of high PAP

A 
Fluid overload
Mitral stenosis
Aortic stenosis
High PVR / SVR
Left ventricle failure
104
Q

Pulmonary Artery Waveform

A

Sharp upstroke and downstroke with obvious dicrotic notch on descending terminal

105
Q

Normal Pulmonary Capillary Wedge Pressure

A

4-12 mmHg

106
Q

How is PCWP measured?

A

Inflating balloon until waveform changes. Never more than 1.5 ml of air.

107
Q

Causes of low PCWP

A

Dehydration

Vasodilation

108
Q

Causes of High PCWP

A 
LV failure
Pericarditis
Mitral valve stenosis
Aortic valve stenosis
Fluid overload
109
Q

What does PCWP measure?

A

Pre-load to left ventricle

110
Q

PCWP waveform

A

“Low amplitude rolling waveform”

Resembles CVP with slightly higher values

111
Q

PA Catheter Troubleshooting: Inadvertent wedge

A

Caused by migration or balloon inflation.
Fully deflate balloon
Withdraw catheter until PA waveform

112
Q

PA Catheter Troubleshooting: Inadvertent RV waveform

A

PA tip is whipping around in ventricle
Verify balloon deflated
Withdraw until CVP waveform

113
Q

Normal cardiac output

A

4-8 L/min

114
Q

Cardiac Output formula

A

CO = HR x SV

115
Q

Normal Cardiac Index

A

2.5-4.2 L/min

116
Q

Cardiac Index formula

A

CI = CO / BSA

117
Q

Normal Stroke Volume

A

60-135 ml

118
Q

Increased preload = __ stroke volume

A

Increased

119
Q

Increased afterload = __ stroke volume

A

Decreased

120
Q

Increased contractility = __ stroke volume

A

Increased

121
Q

Stroke volume = __ End diastolic volume

A

2/3rd

122
Q

Normal Ejection Fraction

A

67%

123
Q

EF >__ is “OK”

A

55%

124
Q

Management to Decrease Preload (CVP / PCWP)

A

Vasodilators
Morphine
Diuretics
Ace inhibitors

125
Q

Management to Increase Preload (CVP / PCWP)

A

Fluids

Vasoconstrictors

126
Q

What is Afterload?

A

Resistance heart must pump against to eject blood from ventricles

127
Q

What is normal Pulmonary Vascular Resistance?

A

50-250 dynes

128
Q

What does PVR measure?

A

Afterload of Right heart

129
Q

What causes decreased PVR?

A

Dehydration

RV failure

130
Q

What causes increased PVR?

A

Pulmonary HTN

Hypoxia

131
Q

What is normal Systemic Vascular Resistance?

A

800-1200 dynes

132
Q

What does SVR measure?

A

Afterload of Left heart

133
Q

What causes decreased SVR?

A

Dehydration
Neurogenic / Septic / Anaphylactic shock
Vasodilators

134
Q

What causes increased SVR?

A

Aortic Stenosis
HTN
Vasoconstrictors
Hypovolemic shock

135
Q

Management to decrease afterload (SVR)?

A

Vasodilators
Nitroprusside
Dobutamine
Nifedipine

136
Q

What is a metabolite concern with Nitroprusside?

A

Thiocyanate -> cyanide

137
Q

Management to increase afterload (SVR)?

A 
Vasopressors
Dopamine
Neosynephrine
Nor-Epi
Epi
138
Q

Management to increase contractility

A

Sympathetic Nervous System stimulation
B1 agonist (Dobutamine, Epi)
Increase calcium
Cardiac glycosides (Digitalis)

139
Q

Causes of decreased contractility

A

Electrolyte imbalance
Hypoxia
Acidosis

140
Q

1 cause of dampening waveform

A

Air in line

141
Q

When do you re-zero invasive lines?

A

Take off, cruise altitude, landing

142
Q

Invasive line monitoring priorities

A

PA catheters (due to wedge)
Arterial lines
CVP

143
Q

IABP should be used in patient’s with AMI complicated by _________.

A

Cardiogenic shock

144
Q

IABP Indications

A

Support of AMI in cardiogenic shock
Circulatory support in post-CABG patients
Support in high risk Cath’s
In severe ischemia as a bridge to revascularization

145
Q

IABP placement

A

Enters Femoral artery into Aorta. Tip is distal of Left subclavian, 2-4 ICS

146
Q

When does deflation occur on an IABP?

A

Beginning of systole, causing 0 or negative afterload

147
Q

When does inflation occur on an IABP?

A

Diastole to push blood into coronary arteries

148
Q

What zone should the IABP cath tip be in?

A

West Zone 3

149
Q

Contraindications of IABP

A 
Aortic insufficiency (Bad Valve)
Severe Aortic disease (AAA)
Severe peripheral vascular disease (Big cath into small vessels)
150
Q

Complications of IABP

A 
Ischemia of limb distal to insertion site
Aortic dissection
Occlude renal artery if too low
Occlude subclavian if too high
Gas emboli
151
Q

If IABP balloon ruptures, what will you see?

A

Rusty colored flakes

152
Q

IABP Early Inflation

A

Inflation before Aortic valve closure. Pushes blood back into left ventricle. Decreases CO and increases SVR. Harmful.

153
Q

IABP Late Inflation

A

Suboptimal due to minimal displacement of blood back toward the coronary arteries.

154
Q

IABP Early Deflation

A

Afterload reduction is lost, normal afterload pressures

155
Q

IABP Late Deflation

A

Causes a “cork in aorta” due to balloon being inflated during systole. Increased workload of Left ventricle. Very harmful

156
Q

True or False: Timing of IABP can be 1:1

A

False due to inability to evaluate efficiency. use 1:2, 1:3, 1:4. 1:8 as indicated.

157
Q

A sharp V at dicrotic notch upon IABP inflation indicates

A

Good timing of inflation

158
Q

A “Gentle U” after IABP deflation indicates

A

Good timing of deflation

159
Q

A sharp V after IABP deflation indicates

A

Late deflation

160
Q

An elevated dicrotic notch upon IABP inflation indicated

A

Early inflation

161
Q

A delay after dicrotic notch before upstroke indicates

A

Late inflation

162
Q

An elongated, non-gentle U shape upon deflation indicates

A

Early deflation

163
Q

What is the primary trigger of the IABP?

A

ECG

164
Q

What is the secondary trigger of the IABP?

A

Arterial pressure line

165
Q

When should you switch to the secondary trigger of an IABP?

A

Artifact on ECG

Cardiac Arrest

166
Q

In event of power failure, cycle balloon manually every __

A

30 minutes

167
Q

How to assure IABP tip placement

A

Get recent chest X-ray.
Balloon is 2cm distal to aortic arch (Left subclavian)
Commonly 2-3 ICS
Proximal end does not occlude renal arteries

168
Q

Transport considerations of IABP

A

Monitor urinary output
Distal pulses to left hand
Insertion side lower extremity pulses
Rust colored flakes in tubing

169
Q

What does NAVEL stand for?

A 
From peripheral to medial:
Nerve
Artery
Vein
Empty space
Lymphatics
170
Q

Normal Pulse Pressure

A

30-40

171
Q 
Right Failure
CVP
CI
SVR
PCWP
A

CVP: High
CI: Low
SVR: High
PCWP: Low

172
Q 
Hypovolemia shock
CVP
CI
SVR
PCWP
A

CVP: Low
CI: Low
SVR: High
PCWP: Low

173
Q 
Cardiogenic shock
CVP 
CI
SVR
PCWP
A

CVP: High
CI: Low
SVR: High
PCWP: High

174
Q 
Vasogenic shock
CVP
CI
SVR
PCWP
A

CVP: Low
CI: High
SVR: Low
PCWP: Low

175
Q 
Distributive shock
CVP
CI
SVR
PCWP
A

CVP: High
CI : Low
SVR: High
PCWP: High

176
Q 
Sepsis shock
CVP
CI
SVR
PCWP
A

CVP: Low
CI: Low
SVR: Low
PCWP: Low

177
Q

What do Alpha 1 receptors cause when stimulated?

A

Constriction of vessels

178
Q

What do Beta 1 receptors do when stimulated?

A

Increase heart rate and contractions

179
Q

What do Beta 2 receptors do when stimulated?

A

Dilation of bronchioles

Dilation of vessels

180
Q

Heart sounds: S1

A

“Lub” (Bicuspid/Tricuspid valve closure)

181
Q

Heart Sounds: S2

A

“Dub” (Aortic / Pulmonic valve closure)

182
Q

Heart sounds: S3

A

Abnormal “Kentucky”

Excess filling of the ventricles most common in CHF

183
Q

Heart Sounds: S4

A

Abnormal “Tennessee”
Blood being forced into stiff ventricle
Associated with Myocardial Infarction

Flight Paramedic Certification (15 decks)

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