Cardiovascular Flashcards
is anything other than a NSR
Dysrhythmia
Dysrhythmia
Electrical causes include
(5)
Occur when the SA node fires slower than 60 or more than 100
The SA node fails
Conduction is blocked
Aberrant conduction pathways are activated
Ectopic foci initiate impulses
Every cardiac cell has the ability to generate a beat
Dysrhythmia Pathological causes include
6
Metabolic Electrolyte imbalances Chronic illnesses Medications Congenital disorders Abuse of stimulants
Dysrhythmia Pathological causes Metabolic include
derangements such as hypoxia, acidosis, alkalosis
Dysrhythmia Pathological caues Electrolyte imbalances, include
(4)
hypokalemia, hyperkalemia, hypocalcemia, hypomagnesemia
Dysrhythmia Pathological causes chronic illness, include
3
coronary artery disease, COPD, CHF
Dysrhythmia Pathological causes Medications, include
cardiac glycosides and bronchodilators
Dysrhythmia Pathological causes include abuse
4
caffeine, nicotine, cocaine, and amphetamines
Normal P - R interval is
0.12 to 0.20 seconds
Normal QRS duration is
0.06 to 0.12 seconds
what is a Mural clot?
the development of a thrombus on or against an interior wall of the heart
what are some causes of Atrial Fibrillation and Flutter (14) 5 that begin with C 3 that begin with H 3 that begin with P
- Atrial enlargement
- cardiac valve disease
- cardiomyopathy
- chronic lung disease
- CHF
- CAD
- HTN
- hyperthyroid
- hypoxia
- pericarditis
- myocarditis
- PNA
- pulmonary
- embolus
what are three ways to treat atrial fibrillation and flutter?
anticoagulation
cardioversion
calcium channel blockers
Cardioversion; A fib treated with cardioversion, the patient should be treated with an anticoagulant first, because cardioversion can cause the thrombi to mobilize
Patients with A fib can be treated with calcium channel blockers in order to control rapid ventricular rate, as well as beta blockers
what defines a Wandering pacemaker?
Defined as at least three different P wave configurations to be present to constitute wandering atrial pacemaker
What is Wolf Parkinson White?
Is a preexcitation syndrome that can occur intermittently, which permits impulse conduction from the atria to the ventricles while bypassing the AV node.
what are the symptoms of Wolf Parkinson White?
Usually asymptomatic, often found incidentally on an EKG that is unrelated to the CC.
Symptoms may include heart palpitations and a rapid heart rate.
How is Wolf Parkinson White identified on an EKG?
WPW is identified by a widened QRS and a slurred upstroke or delta wave
Junctional Dysrhythmias
Occur when…
Occur when; the SA node fails to generate an impulse, an SA generated impulse is blocked from leaving the node or not conducted into the ventricles, or the rate of the SA node is slower than that of the AV junction
____ ____ ____ (hint: PJC) is less common than a PAC or a PVC and is rarely problematic. They can occur in healthy hearts and rarely require intervention.
Premature Junctional Complex
When the SA node fails and the AV node assumes pacemaker of the heart. A ____ ____ ____ occurs when three or more consecutive beats occur.
junctional escape rhythm
junctional escape rhythm is usually between __ - __ BPM
Usually between 40 - 60 BPM
Describe P waves in a Premature Junctional Complex
P wave can occur before, during, or after the QRS complex. The P is commonly inverted.
describe P waves in a Junctional escape rhythm
P waves can occur anywhere, or be absent
Because a junctional rhythm originates above the ventricles, the QRS is typically ____, and it’s rhythm is ____
narrow
regular
Junctional Escape Rhythm Management if ____ with ____, ____, or ____ ____.
symptomatic
O2, atropine, or transcutaneous pacing.
an accelerated junctional tachycardia occurs when an ectopic focus in the AV node begins firing faster than the SA node and takes over as the pacemaker is called what?
Accelerated Junctional Tachycardia
By definition, an accelerated junctional tachycardia is __ to __ BPM
7
130
This dysrhythmia occurs in patients with heart disease, digoxin toxicity, MI, or myocarditis
Can develope ischemia as a result
Treatment involves managing the underlying cause
Accelerated Junctional Tachycardia
These Occur when the myocardium is irritable and an ectopic focus in the ventricles causes depolarization
Premature Ventricular Contractions or PVC’s
What are some causes of PVC’s?
Most often?
Can also result fom…(5)
Most often arise in patients with cardiac disease or myocardial ischemia or when infarction occurs.
Can also result from ; conditions that cause hypoxia, hypovolemia, electrolyte imbalances such as hypokalemia or hypomagnesemia, or abuse of stimulants such as nicotine or caffeine
Describe Unifocal PVC’s
can occur in healthy individuals and patients are usually unaware
Describe Multifocal PVC’s
PVCs look different and arise from various foci points and present various configurations. Patients with multifocal premature ventricular complexes should be closely monitored because these complexes indicate a more serious condition
What is Bigeminy?
is a pattern in which every other beat is a PVC
Waht is Trigeminy?
a repeating pattern in which every third beat is a premature ventricular contraction. Each PVC arises from the same ectopic focus
What is a Couplet?
is a pair of PVCs, and are usually from the same ectopic foci. These are considered potentially dangerous PVC complexes because they can become arrhythmogenic for ventricular tachycardia.
Define Ventricular Tachycardia
Is a series of three or more beats of PVCs.
Rarely happens in people who don’t have heart disease.
This type of Ventricular Tachycardia usually lasts less than 30 seconds and does not require treatment unless the patient is symptomatic.
Nonsustained
Sustained V tach is potentially fatal because of the
increased demand for O2 and the reduction in cardiac output, causing transition into ventricular fibrillation
Test new card
This is a new card
This is another new card
New card 2
V tach can be ____or ____
Poly morphic or monomorphic
Polymorphic v tach is called what
Torsades de pointes
Torsades de pointes Can result from
(2) 3, 2
Can result from
- medications that prolong the QT interval, such as amiodarone, Ibutilide, Procainamide,
- toxic levels of drugs such as tricyclic antidepressants and congenital long QT syndrome
Unstable patient with monomorphic ventricular tachycardia, expect what?
immediate synchronized cardioversion
For unstable patient with polymorphic or torsades, what is the priority
immediate defibrillation is the priority
Ventricular Fibrillation what is the Most common cause
Coronary artery disease CAD
AV blocks can be the result of these three meds
tricyclic antidepressants, clonidine, digoxin
Lyme disease ; late stage can present as
third degree block
2nd degree
Type 1
Management; administer ____ of the patient has symptomatic bradycardia, which should not delay the implementation of ____ ____ for patients with poor perfusion.
atropine
external pacing
2nd degree
Type 2
Most commonly the result from what?
considered life threatening because it can progress into ____ ____
Probably won’t respond to ____, expect ____ ____ or continuous infusion of ____ or ____ until when?
acute MI
third degree
atropine, expect transcutaneous pacing or continuous infusion of dopamine or epinephrine until transvenous pacing is initiated.
A bundle branch block in one bundle causes the ventricle on that side to ____ ____ than the ventricle in the intact side, resulting in an abnormal QRS that is what?
depolarize later
wide and bizarre
____ bundle branch block, which is the most common intraventricular conduction abnormality, can occur in healthy individuals.
____ bundle branch block, however usually indicates heart disease
Right
Left
This is a unique and recently described clinical and electrocardiographic disease that can result from a defect in the cardiac sodium channel.
Brugada syndrome
The specific characteristics of Brugada syndrome are
complete or incomplete right BBB with ST segment elevation in the right precordial leads V1 through V3.
Although patients with Brugada syndrome are usually young and asymptomatic, they are at risk for ____ ____ ____ which can be prevented how?
pharmacological treatment for this syndrome is what?
To prevent sudden cardiac death, patients may receive an implantable cardiac defibrillator (ICD)
sudden cardiac death.
No pharmacological treatment currently exists for this syndrome.
To prevent sudden cardiac death, patients may receive an implantable cardiac defibrillator (ICD)
____ ____ ____ is a group of cardiac conduction disturbances characterized by syncope and sudden death.
Long QT syndrome (LQTS)
A QT interval that exceeds __ seconds is abnormal, generally speaking because it can vary with HR
0.44
The QT interval is considered prolonged when it is longer than __ of the R to R interval.
50%
What are 2 methods of treating long QT syndrome?
Expect antiarrhythmic drugs, usually beta blockers
Electrolyte replenish
Sudden cardiac arrest, what are the 4 causal rhythms?
The four rhythms; VT, pVT, PEA, and asystole
Sudden cardiac arrest
Metabolic causes include
(4)
Metabolic causes include
hyperkalemia (most common, especially in patients with renal failure), hypokalemia, hypermagnesemia, and hypercalcemia
Sudden cardiac arrest Drug induced causes are
5
; overdoses of digitalis preparations, beta blockers, and tricyclic antidepressants. And also illicit drugs such as cocaine, heroin
Sudden cardiac arrest Pulmonary causes
any disease that causes hypoxia
Sudden cardiac arrest Circulatory causes (5)
Circulatory causes such as tension pneumothorax, pulmonary embolus, pericardial tamponade, sepsis, and hemorrhage
Sudden cardiac arrest Neurogenic causes; Increased intracranial pressure
Increased intracranial pressure
Cardiac arrest initial management
What are the two drugs used?
Epinephrine
Vasopressins
Cardiac arrest initial management
What is the first line drug?
What is the dose?
What does it do?
Epinephrine; first line drug
Repeat every 3 to 5 minutes with a bolus of 20 ml of saline
Stimulate alpha and beta-adrenergic effects
Stimulate the heart in asystole and idioventricular rhythms
Cardiac arrest initial management
What is the second line drug?
Vasopressin
No advantage over epinephrine
ET tube drugs
What is the acronym?
LEAN-V
ET tube drugs
What are they and what do they all have in common?
(5+ in common)
LEAN-V; Lidocaine, epinephrine, atropine, naloxone, vasopressin
All lipid soluble drugs
ET tube drugs, what is the typical dosage and what are they usually given with?
Expect the dose to be 2 to 2.5 times the recommended IV dose followed by 5 to 10 ml of saline
Sodium Bicarb; is reserved for treating cardiac arrest in a patient with a specific disorder, such as what?
(3)
Sodium Bicarb; is reserved for treating cardiac arrest in a patient with a specific disorder, such as hyperkalemia, acidosis, or tricyclic antidepressant overdose
Cardiac arrest initial management; calcium chloride; recommended for
(3)
hyperkalemia, hypocalcemia, and calcium channel blocker toxicity
Magnesium sulfate; useful for treatment of TDP, and what else?
dysrhythmias caused by toxicity
Management after cardiac arrest
Bradycardia; for bradycardia associated with poor perfusion, expect to administer ____ and consider transcutaneous pacing or a continuous infusion of ____ or ____
Atropine
Dopamine
Epinephrine
What is another name for dopamine?
(intropin)
Management after cardiac arrest
If a patient has a wide-complex monomorphic ventricular tachycardia, prepare to administer ____, ____, or ____.
If a patient with a wide complex monomorphic ventricular tachycardia is unstable, prepare for a ____ ____
Amiodarone
Procainamide
Sotalol
Synchronized cardioversion
What is another name for amiodarone?
Cordarone
What is another name for procainamide?
Pronestyl
What is another name for sotalol?
Betapace
If a patient with a wide complex monomorphic ventricular tachycardia is unstable, prepare for a ____ ____
synchronized cardioversion
How is Hypothermia after Cardiac Arrest implemented, for how long?
Usually performed quickly, maintained for about 12 to 24 hours, and then followed by gradual rewarming
Hypothermia after Cardiac Arrest
Maintain body temperature between __ and __F or __ to __C
89.6 and 96.8 or 32 to 36C
Hypothermia after Cardiac Arrest Apply cooled IV fluids, cooling blankets, and ice packs to what areas of the body?
(4)
groin, axilla, head and neck
Hypothermia after Cardiac Arrest Manage shivering by administering IV ____-____ __ mg to avoid increasing the metabolic rate, which can worsen the cellular injury
Demerol-meperidine 12.5
What is Acute Coronary Syndrome?
What does it include?
(3)
Refers to the continuum of coronary artery disease and the related signs and symptoms which include
Unstable angina
ST elevation stemi
NSTEMI
Right coronary artery may cause a ____, ____ or ____ wall infarction, and also may lead to what condition in an inferior wall MI?
RV, posterior or inferior wall infarction, and also may lead to Mobitz type 1 (Wenckebach) in an inferior wall MI
Wenckebach refers to what condition?
Mobitz type 1
Left Descending Coronary artery blockage may cause
3
An infarction of the inferior wall
May affect the papillary muscle, which attaches to the mitral valve
May lead to second-degree heart block, Mobitz type 2, or a 3rd degree block in an anterior MI
If the phrenic nerve becomes stimulated, expect ____ in MI
Hiccups
Patients older than 85 experience ____ as the classic symptom of an MI
SOB
Describe MI pain in a transplant patient
Heart transplant patients do not experience pain since the pain receptors are denervated during the transplant procedure
Patients with ____ are more prone to neuropathy and may not experience pain from an MI.
Diabetes
Describe stable angina Pain-areas of the boby, subjective terms Duration What makes it worse Two meds to treat it with.
Stable; occurs predictably, usually substernal, may radiate to the jaw and neck, and down the arms and back, described as aching, squeezing, choking, burning that lasts 1 to 5 minutes. The pain worsens with activity, eating, and reclining. It is relieved best with nitroglycerine and isosorbide
What EKG findings can be expected with stable angina?
An EKG will show a transient EKG depression that disappears with pain relief
Name 3 details that identify chest pain as Unstable angina
pain occurs at rest
is new in onset
or is a worsening of stable angina in terms of frequency or duration of attacks.
What are two terms used to describe or somonomously with Unstable angina?
It is often called preinfarction angina or crescendo angina and is usually caused by a plaque rupture
Another name for varient angina is what?
Prinzmetal angina
Prinzmetal Angina; varient angina, usually occurs when?
usually occurs between sleeping hours
Patients with this type of angina tend to be younger
Prinzmetal or varient angina
With this type of angina, EKG usually will show ST-segment elevation during the pain episode
Prinzmetal or varient angina
Only __ to __ percent of acute chest pain patients have acute coronary syndrome
15
25
A decreased __ heart sound can result from reduced myocardial activity
S1
An increased __ heart sound can be caused by increased pulmonary artery pressure
S2
An __ heart sound (gallop) can result from ventricular dilation and increased ventricular fluid pressure
S3
An S3 heart sound can also be called a what?
Gallop
A transient friction rub can result from what?
inflammatory response to myocardial necrosis
JVD can develop when this happens
vascular congestion increases pressures, causing backflow into the jugular veins
STEMI - the elevation of ST segment as shown in leads V__ through V__
1
5
A new MI has probably occurred if the ST segment is elevated by __ mm or more in at least __ contiguous leads or if an abnormal __ wave appears in two or more leads. The ST segment can remain elevated for __ hours after the event.
1
2
Q
24
Pathological __ waves, which measure more than __ seconds in width and at least __ percent or more of the overall QRS height, occur within __ hours and indicate irreversible myocardial cell death.
Q
0.04
25
24
which may cause tall, peaked T waves.
hyperkalemia
Patients with an NSTEMI elevation MI show no signs of injury in the EKG tracing, so how is the Dx made?
The tracing may show ST-segment depression and T wave inversion.
The Dx is made on the patients SS and cardiac serum biomarkers
When evaluating a possible NSTEMI, If the cardiac biomarkers are not present in two or more blood samples taken at least 6 hours apart, the diagnosis is what?
Unstable angina
With Anterior Wall MI expect changes in these leads, which face the anterior wall of the left ventricle
V3
V4
An anterior wall AMI may cause dysrhythmias, including what?
4
PVCs, atrial flutter, atrial fibrillation, or BBB’s
An ____ Wall AMI developes when the right coronary artery is occluded
An inferior Wall AMI
An inferior Wall AMI developes when the right coronary artery is occluded.Look for ST changes in leads…
Look for ST changes in leads II, III and aVF. Expect reciprical changes in leads V1 through V4 I, and aVL
Bradydysrhythmias and conduction delays, such as first-degree atrioventricular block and second-degree atrioventricular block and second degree Mobitz type I (Wenckebach), are common in this type of MI
Inferior wall MI
Leads I aVL, V5, and V6 view the ____ wall of the left ventricle, so expect changes in those leads.
Leads I aVL, V5, and V6 view the lateral wall of the left ventricle, so expect changes in those leads.
Leads __, __, __, and __ view the lateral wall of the left ventricle, so expect changes in those leads.
I, aVL, V5, and V6
____ wall infarctions often occur as extensions of anterior or inferior wall infarctions.
Lateral
____ Wall infarction usually occur with an inferior or lateral infarction
Posterior
Changes that indicate ____ wall infarctions include ST-segment elevation in the posterior leads (V_ through V_)
Posterior
In all patients with a suspected inferior acute MI, evaluate for a right ventricular infarction by obtaining a what?
right sided electrocardiogram
In adults, ST segment elevation in lead ___ is specific for an acute right ventricular infarction
RV4
The complications of a right ventricular infarction include
6
hypotension, cardiogenic shock, atrioventricular blocks, atrial flutter or fibrillation, and PACs
Pharmacologic Intervention for MI administer oral aspirin unless the patient has a contraindication such as what?
(2)
Expect to give the recommended dose, ranging from 160 - 325 of non enteric coated tabs. If the patient cannot tolerate oral aspirin, a 300 mg rectal suppository may be ordered.
allergy or active gastrointestinal bleeding
160 - 325
300
Nitro for MI, how does it affect preload?
And afterload?
Nitro; the initial drug of choice for treating ischemic chest pain because it dilates the coronary arteries, reduces afterload by dilating the peripheral venous circulation, and reduces preload by decreasing the venous return to the heart.
When administering Nitro, Avoid in ____ patients. The patients BP should be at least __mmHg or no lower than __mmHg below baseline
Hypotensive
90
30
Avoid using nitro in patients with marked ____, ____, or ____.
Avoid using nitro in patients with marked bradycardia, tachycardia, or ventricular infarction.
Do not give nitro to a patient who takes a ____ ____ to treat erectile dysfunction
phosphodiesterase inhibitor
Use nitro cautiously in patients with an ____wall MI. These patients depend on right ventricular filling pressures to maintain cardiac output and blood pressure, and administering nitroglycerine decreases preload.
Inferior
How does morphine treat chest pain?
2
Relieves chest pain and decreases the O2 consumption of the myocardium
If the patient is not ____, prepare to administer morphine
Hypotensive
Because morphine is a venodilator, use it cautiously in patients who may be ____ dependant
Preload
How do ACE inhibitors work?
What does ACE stand for?
ACE inhibitors (angiotensin-converting enzyme); inhibit progressive left ventricular enlargement by reducing ventricular wall stress
Pericarditiscan be treated with this type of drug
Treat with an antiinflammatory drug, such as an NSAID, since it is an inflammatory condition
Blood pressure may vary between the right and left arms with this condition
Thoracic aortic aneurysm
