Cardiology Flashcards
Risk factors for cardiovascular disease
HTN Elevated cholesterol level Smoking Diabetes Obesity Sedentary lifestyle High stress lifestyle/personality Hormonal replacement & oral contraceptive Family hx Age
H’s for reversible and treatable causes of cardiac arrest
Hypothermia (1 shock and transport) Hypoxia Hypovolemia Hydrogen ions (acidosis) Hyperkalemia/Hypokalemia Hypoglycaemia
T’s for reversible and treatable causes of cardiac arrest
Toxins Thrombosis (MI) Thrombosis (PE) Tension pneumothorax Tamponade Trauma
3 lead placement, and type of lead
Right arm
Left arm
Left leg
Bipolar lead
Unipolar leads
aVR
aVL
aVF
Single electrode to a target area of the heart.
Precordial lead placement
V1) 4th intercostal right of sternum V2) 4th intercostal left of sternum V3) directly between 2 and 4 V4) 5th intercostal, mid clavicular line V5) level with V4, L anterior axillary line V6) level with V5, mid axillary line
Atherosclerosis
Plaque buildup in the arteries caused by age, genetics, diet, smoking, ethnicity, gender, and other pathologies.
Risk of thrombus, emboli, and decreased arterial elasticity.
Angina pectoris
Ischemia of the myocardium. 4 types:
Unstable: unresponsive to meds and rest. Random onset.
Stable: responds to meds and rest. Onset with exertion.
Prinzmetals: temporary spasm of coronary artery.
Decubitis: laying supine. Increased O2 consumption
Myocardial infarction
Decreased O2 to myocardium leading to necrosis of tissue.
Subendocardial: partial thickness
Transdural: full thickness
Unstable angina MI: MI caused by unstable angina.
PCP treatments for chest pain
Limit movement ASA during primary survey Titrate O2 to 95 (nonSOB/no shock SS) High-flow O2 for shock/SOB NTG (don’t delay transport for NTG) Entonox for pain IV above the wrist, and 18g, left arm
Heart failure
Failure of the heart to pump blood properly to meet the demands of the body.
R HF: blood backup to vena cava ie. Pedal pitting edema
L HF: blood backup to pulmonary circulation
Systolic HF: contraction failure
Diastolic HF: filling (preload) issue
High-output: symptoms with increased demand
Low-output: chronic decrease in CO from decreased contractility
PCP treatment for heart failure
CPAP, PEEP, high flow O2 if SOB, 100ml bolus fluid for cardiogenic shock (no fluid if patient has crackles in lungs)
Pericardial tamponade
Effusion from an increase of fluid in the pericardial sac. Pulsus paradoxus plus Beck’s triad: JVD Muffled heart sounds Hypotension
Pericarditis
Inflammation of the pericardium (usually due to infection or trauma) which can result in pericardial tamponade.
SS: sharp CP, ST elevation, fever, pain can radiate towards the back.
Myocarditis
Inflammation of the myocardium usually due to a viral infection. Decreased cardiac output, fever (if viral cause), and chest pain.
Endocarditis
Inflammation of the endocardium usually due to bacteria or blood infections leading to damaged heart valves. SS signs of sepsis, chest pain (especially on inhalation, valvular problems, potentially leads to HF
Arterial occlusion
Sudden blockage of an artery due to trauma, emboli, or thrombus.
Thoracic aortic aneurysm.
Weak/bulging point in the aorta in the thoracic region which is usually caused by HTN. Presents with chest pain.
Aortic dissection
Blood enters space between tunica intima and tunica media due to an acute tear causing hypotension. Usually occurs in the aortic arch.
Sharp, acute C/P, hypotension.
Check bilat radial pulse and bilat BP.
Peripheral vascular disease
Encompasses any peripheral vascular pathology that interferes with blood flow. Atherosclerosis Varicose veins Raynauds DVT
Cardiac action potentials phases
P0) rapid depolarizing. Hits threshold potential (-70mv)Fast gated Na opens.
P1) early rapid repolarization. Fast Na closes, K leaves
P2) plateau. Voltage gated Ca opens
P3) repolarization. K leaves cell quickly, Ca channels close
P4) resting membrane potential (-90mV)
Normal P wave
Upright deflection
0.10 second
No more than 2.5mm high.
PR interval ECG
Up to 0.2 seconds (0.1 sec P wave plus 0.1 sec PR segment)
QRS complex ECG
0.08 to 0.12 seconds long.
ECG box measurements
- 04 (40ms) second per each 1mm box
- 2 (200 ms)second per each 5mm x 5mm cube
- 1mV amplitude per 1mm box
- 5mV amplitude per 5x5 cube
ECG rhythms
Sinus: SA node is primary pacemaker
Junctional: AV node is primary pacemaker. Results in inverted P wave.
Ventricular (escape): purkinje fibres are primary pacemaker. Results in no P wave.
When to perform a 12 lead ECG
Patient with suspected ACS
Patient post ROSC
Suspected dysrhythmia
Possible use with syncope, acute pulmonary edema, and other symptoms
Pacemaker rates
SA node: 60 to 100 bpm
AV node: 40 to 60 bpm
Purkinje fibres: 20 to 40 bpm
Coronary arteries
Left coronary artery
Circumflex coronary artery (branches off LCA)
Left anterior descending artery
Right coronary artery
Cardiac output
Stroke volume x heart rate = CO
Normal CO is usually 5-6L/min in an adult
Stroke volume
The amount of blood pumped out by either ventricle in a single contraction. Usually 60-100ml/beat at rest.
How to test for jugular venous pressure
Position the patient semi Fowler’s (45 degrees) and note the jugular venous distension.
Normal JVP is 2-4cm above the sternal notch.
3x4 12 lead ECG table
LCA/Lateral wall LV leads: 1,aVL, V5, V6
RCA/inferior wall LV leads: 2, 3, aVF
LCA/septum LV leads: V1, V2
LCA/anterior wall LV leads: V3, V4
Method for counting HR on an ECG
6 second method: count QRS within 6 second strip and multiply by 10
Sequence method: Count amount of 5mm boxes between R waves using the following sequence. 300, 150, 100, 75, 60, 50.
Example: 3 5mm boxes between R-R interval would equal 100bpm.
