Cardiovascular Function and Basic ECGs

Question 1

What is the definition of perfusion?

Answer 1

The flow of blood through arteries and capillaries delivering nutrients and oxygen to cells.

Question 2

How is a sarcomere described?

Answer 2

it is the functioning unit of the cardiac muscle.

Question 3

What are the three factors that effect stroke volume?

Answer 3

Preload, after load, contractility

Question 4

What is the definition of preload?

Answer 4

The degree of stretch o the cardiac muscle fibers at the end of diastole. (Think volume)

Question 5

What is the definition of after load?

Answer 5

The resistance to ejection of blood from the ventricle; affected by systemic vascular resistance and pulmonary vascular resistance. (Think pressure)

Question 6

What is the definition of contractility?

Answer 6

Cardiac muscles forces Ex) inotropic capability

Question 7

What increases the preload?

Answer 7

Hypervolemia and regurgitation of cardiac valves.

Question 8

What increases the after load?

Answer 8

Hypertension and vasoconstriction

Question 9

If the after load is increased what also gets increased?

Answer 9

the workload

Question 10

How is hydrostatic pressure described

Answer 10

The driving force of the heart tends to push fluid out of the capillaries

Question 11

How is oncotic pressure described?

Answer 11

The pressure exerted by plasma proteins tends to pull fluid into capillaries.

Question 12

How is filtration pressure described?

Answer 12

The net force on fluid

Question 13

How is filtration pressure determined?

Answer 13

By the balance between Hydrostatic Pressure (HP) and Oncotic Pressure (OP)

Question 14

How is automaticity described?

Answer 14

The ability of cardiac cells to initiate an electrical impulse

Question 15

How is excitability described?

Answer 15

The ability to respond to an electrical impulse and generate an action potential

Question 16

How is conductivity described?

Answer 16

Ability to transmit an electrical impulse from one cell to another

Question 17

How is contractility described?

Answer 17

Ability of the cardiac muscle to shorten in response to an electrical impulse

Question 18

Why does perfusion only discuss the blood flow running through arteries, arterioles, and capillaries?

Answer 18

Because there is little oxygen in venous return

Question 19

What does epicardium refer to?

Answer 19

Outer layer of heart including the hearts nerves and blood vessels

Question 20

What does the myocardium refer to?

Answer 20

The middle layer or muscle of the heart

Question 21

What does endocardium refer to?

Answer 21

The inner layer of the heart including the heart valves.

Question 22

When do the arteries that supply the heart with oxygen fill up with blood?

Answer 22

During diastole

Question 23

What node does the SA node communicate to when stimulating a heart beat?

Answer 23

The AV node

Question 24

When the AV node gets the impulse for the heart to beat where does it send that information to?

Answer 24

The Bundle of His

Question 25

When the Bundle of His gets the impulse for the heart to beat where does it send the information to?

Answer 25

The Purkinje fibers

Question 26

When happens inside the calcium channels during depolarization?

Answer 26

Sodium and calcium enter the cell and potassium leaves

Question 27

What happens inside the calcium channels during repolarization?

Answer 27

Sodium and calcium leaves the cell and potassium enters.

Question 28

What percentage of the total blood volume in the heart gets ejected during each beat?

Answer 28

55-65%

Question 29

What is the equation to find cardiac output or CO?

Answer 29

Heart Rate (HR) x Stroke Volume (SV)

Question 30

How much blood is released from the left ventricle per minute? (in L)

Answer 30

4-6 L

Question 31

How much blood is ejected from the heart during each stoke? (in mL)

Answer 31

60-130 mL

Question 32

What is the equation to find the Ejection Fraction? (EF)

Answer 32

Stroke volume (SV)/ End Diastolic Volume (EDV)

Question 33

What needs to remain the same regardless of how much end diastolic volume here is?

Answer 33

The residual left in the heart per stroke needs to remain the same regardless of the amount of volume was placed in the heart.

Question 34

How is depolarization described?

Answer 34

Electrical activation of a cell causes the influx of sodium into the cell while potassium exits the cell

Question 35

How is repolarization described?

Answer 35

Return of the cell to the resting state caused by re-entry of potassium into the cell while sodium exits.

Question 36

How is the effective refractory period described?

Answer 36

Phase in which cells are incapable of depolarizing

Question 37

How is the relative refractory period described?

Answer 37

Phase in which cells require a stronger-than-normal stimulus to depolarize

Question 38

What are the two most common reported clinical symptoms in terms of issues of the heart?

Answer 38

Chest pain and dyspnea

Question 39

What does JVD stand for?

Answer 39

Jugular Vein Distention

Question 40

How can you tell if a patient has JVD?

Answer 40

They have a very large and rebounding jugular vein. You can see it pulsating.

Question 41

What causes JVD?

Answer 41

hypervolemia

Question 42

Where on the body can you hear the aortic valve?

Answer 42

On the right side, 2nd intercostal space, against the sternal boarder.

Question 43

Where on the body can you hear the pulmonic valve?

Answer 43

On the left side, 2nd intercostal space, against the sternal boarder.

Question 44

Where on the body can you hear Erb's point?

Answer 44

On the left side, 3rd intercostal space, against the sternal boarder.

Question 45

Where on the body can you hear the tricuspid valve?

Answer 45

On the right side, 4th intercostal space, against the sternal boarder.

Question 46

Where on the body can you hear the mitral valve?

Answer 46

On the left side, 5th intercostal space, midclavicular line.

Question 47

How is the S1 sound described?

Answer 47

The closing of the AV valves (tricuspid and mitral) "lub"

Question 48

When do you hear the S1 sound?

Answer 48

At the beginning of ventricular systole.

Question 49

Where is the S1 sound best heard?

Answer 49

At the apex aka the mitral valve

Question 50

How is the S2 sound described?

Answer 50

The closing of the semi-lunar valves (aortic and pulmonic) "dub"

Question 51

When do you hear the S2 sound?

Answer 51

The end of systole and the beginning of ventricular diastole

Question 52

Where is the S2 sound best heard?

Answer 52

At the aortic or pulmonic area.

Question 53

How are murmurs described?

Answer 53

A turbulent flow caused by the stenosis or regurgitation of a valve.

Question 54

What do you need to document when describing a murmur?

Answer 54

Timing Location Loudness Pitch Quality

Question 55

What type of creatine kinase is specific to the heart?

Answer 55

Creatine MB (CK-MB)

Question 56

How is Holter Monitoring described?

Answer 56

A 5-lead EKG over 24 hours.

Question 57

Why would a patient need to be on Holter Monitoring?

Answer 57

Because they are experiencing angina and the doctor is trying to pinpoint why.

Question 58

What does a patient who is on Holter Monitoring need to tell the doctor?

Answer 58

When they experienced the angina pain and what activity they were doing.

Question 59

Where do you assess the pulses on a patient who underwent a heart catheterization?

Answer 59

The pulse that is distal to the incision site.

Question 60

How long should your patient lay flat after a heart catheterization?

Answer 60

2-6 hours

Question 61

When the heart rate decreases what happens to the hearts work load?

Answer 61

It increases

Question 62

How is dysrhythmias described?

Answer 62

Disorders of the formation or condition (of both) of the electrical impulses in the heart

Question 63

What can cause disturbances of the heart?

Answer 63

Rate, rhythm or both

Question 64

How are dysrhythmias diagnosed?

Answer 64

By analysis of ECG waveform

Question 65

What do dysrhythmias have the potential to do?

Answer 65

Alter blood flow and cause hemodynamic changes

Question 66

When the SA node is in charge: how many beats per minute does the heart conduct?

Answer 66

60-100 bpm

Question 67

When the AV node is in charge: how many beats per minute does the heart conduct?

Answer 67

40-60 bpm

Question 68

When the bundle branch and/or purkinje fibers are in charge: how many beats per minute does the heart conduct?

Answer 68

20-40 bpm

Question 69

On a 5 lead EKG where do you place the white colored lead?

Answer 69

Upper right part on the chest. \*Remember: white = right!

Question 70

On a 5 lead EKG where do you place the green colored lead?

Answer 70

Lower right part on the chest. \*Remember: Snow over trees or clouds on grass

Question 71

On a 5 lead EKG where do you place the black colored lead?

Answer 71

Upper left part on the chest

Question 72

On a 5 lead EKG where do you place the red colored lead?

Answer 72

Lower left part on the chest \*Remember: Smoke over fire!

Question 73

On a 5 lead EKG where do you place the brown colored lead?

Answer 73

On the center of the chest- centered between the four other leads.

Question 74

What part of the heart is responsible for the P-wave?

Answer 74

The electric communication between the SA and AV nodes causing the atrial contraction

Question 75

What part of the heart is responsible for the QRS complex?

Answer 75

The electrical signal going through from the AV node through the Bundle of His and Purkinje Fibers. Causing contraction of the ventricles.

Question 76

What is occurring in the heart during the T-wave?

Answer 76

Ventricle repolarization

Question 77

What are the 5 portions of a heart beat when represented on an EKG?

Answer 77

P-wave P-R interval QRS complex S-T segment T-wave

Question 78

What are the 5 questions you need to answer in reference to the p-wave?

Answer 78

1. Is it present? 2. Are they occurring regularly? 3. Is there a p-wave for every QRS complex? 4. Are they smooth, rounded and upright or are they inverted? 5. Do all the p-waves look similar?

Question 79

How many seconds are in a PR interval?

Answer 79

0.12-0.2 seconds

Question 80

How many seconds are in a QRS complex?

Answer 80

less than 0.12 seconds

Question 81

What is the time significance between each QRS complex on EKG strip?

Answer 81

It is how you can tell if the patient has a normal heart rate

Question 82

What are the components of a normal sinus rhythm?

Answer 82

-The measure of time between each R and R is constant. -Uniform P waves -60-100 BPM -One P-wave for each QRS -P-R Interval: 0.12-0.20 seconds and is constant -QRS: less than 0.12 seconds

Question 83

What is the criteria for sinus bradycardia?

Answer 83

Meets all criteria for normal sinus rhythm EXCEPT: less than 60 BPM

Question 84

If the sinus bradycardia is asymptomatic what treatment should be done?

Answer 84

None

Question 85

If the sinus bradycardia is symptomatic what treatment should be done?

Answer 85

Treat the underlying cause

Question 86

What may a patient need if they have sinus bradycardia?

Answer 86

A pacemaker

Question 87

What medications do you need to check for if a patient has bradycardia?

Answer 87

Digoxin Beta blockers Calcium channel blockers

Question 88

What are the criteria for sinus tachycardia?

Answer 88

Meets all criteria for normal sinus rhythm: EXCEPT: Greater than 100 BPM \*Usually between 100 - 160

Question 89

If a patient has sinus tachycardia what may it be secondary to?

Answer 89

Exercise Heightened emotions Caffeine Nicotine ETOH Cocaine Amphetamines

Question 90

If a patient has sinus tachycardia what may this signal?

Answer 90

Massive heart damage Impending heart failure Shock

Question 91

What underlying causes may there be if a patient has sinus tachycardia?

Answer 91

Blood or fluid loss MI Pulmonary Edema

Question 92

What medication do you need to check for in a patient with sinus tachycardia?

Answer 92

Beta blockers Calcium channel blockers

Question 93

What criteria does an EKG reading need to have in order for it to be labeled as a dysrhythmia?

Answer 93

-R to R varies: may change with respirations -Uniform P wave for each Q wave -Normal heart rates: 60-100 bpm -PR interval constant: 0.12-0.20 seconds -QRS complex: less than .12

Question 94

Based on this EKG strip: What would the patients diagnosis be?

Answer 94

Sinus Tachycardia

Question 95

Based on this EKG: What would this patient be diagnosed with?

Answer 95

Dysrhythmia

Question 96

Based on this EKG strip: What would this patient be diagnosed with?

Answer 96

Sinus Bradycardia

Question 97

Based on this EKG strip: What would this patient be diagnosed wtih?

Answer 97

Normal Sinus Rhythm

Question 98

Based on this EKG strip: What would this patient be diagnosed with?

Answer 98

Premature Atrial Contraction (PAC)

Question 99

How many seconds do you need to look at an EKG strip to diagnose a patient with an abnormality?

Answer 99

6 seconds

Question 100

In a Premature Atrial Contraction (PAC) what happens to the P-wave?

Answer 100

It is not rounded- it is spiky

Question 101

What happens to the P and T waves during Premature Atrial Contraction (PAC)?

Answer 101

They almost connect. The p-wave starts directly after the t-wave

Question 102

What is the heart not doing properly during Premature Atrial Contaction?

Answer 102

Repolarizing

Question 103

What is happening to the PR interval and QRS complex during a Premature Atrial Contraction (PAC)?

Answer 103

Nothing- both of them are within normal limits

Question 104

Why can pulmonary edema occur in a patient who has sinus tachycardia?

Answer 104

The heart is not pumping enough blood out of the heart so it is backing up in the lungs