CH. 17 CARDIOVASCULAR EMERGENCIES Flashcards
a sac or bulge in the wall of the abdominal portion of the aorta, resulting in weakening of that wall; it is considered life threatening if it ruptures
abdominal aorta aneurysm
a term used to describe the shape of the QRS complex in aberrantly conducted beats
aberration
the early phase of cardiac repolarization wherein the heart muscle cannot be stimulated to depolarize
absolute refractory period
a chemical mediator used in both the sympathetic and parasympathetic nervous systems
acetylcholine (ACh)
term used to describe any group of clinical symptoms consistent with acute myocardial ischemia
acute coronary syndrome (ACS)
a condition present when a period of cardiac ischemia caused by sudden narrowing or complete occlusion of a coronary artery leads to death (necrosis) of myocardial tissue
acute myocardial infarction (AMI)
the hormone produced by the adrenal gland with alpha and beta sympathomimetic properties
adrenaline
the resistance against which the ventricle contracts
afterload
pertaining to the period of dying
agonal
a cardiac dysrhythmia seen just before the heart stops altogether; essentially asystole with occasional QRS complexes that are not associated with cardiac output
agonal rhythm
a sac or bulge resulting from the weakening of the wall of a blood vessel or ventricle
aneurysm
the sudden pain from myocardial ischemia, caused by diminished circulation to the cardiac muscle; the pain is usually substernal and often radiates to the arms, jaw, or abdomen, and usually lasts 3 to 5 minutes and disappears with the rest
angina pectoris
the largest artery in the body, originating from the left ventricle
aorta
the valve between the left ventricle and the aorta; also called the aortic valve
aortic semilunar valve
the lack of a cardiac rhythm; asystole
arrhythmia
the muscular, thick walled blood vessels that carry blood away from the heart
arteries
a small blood vessel that carries oxygenated blood branching into smaller vessels called capillaries
arteriole
a pathologic condition in which the arterial walls become thickened and inelastic
arteriosclerosis
an artificial product; used to refer to noise or interference in an ECG tracing
artifact
the absence of ventricular contractions; a straight line ECG
asystole
an accumulation of fat inside blood vessels resulting in narrowing of the lumen diameter
atherosclerosis
the volume of blood pumped into the ventricles by the atria
atrial kick
a specialized structure located in the AV junction that slows conduction through the AV junction
atrioventricular node
the mitral and tricuspid valves
atrioventricular valves
a parasympathetic blocker that opposes the action of ACh on the heart causing an increase in heart rate
atropine
on an ECG, leads that only contain one true pole; the other is a combination of information from other leads; includes leads aVR, aVL, and aVF
augmented unipolar leads
a smart defibrillator that can analyze the patient’s ECG rhythm and determine whether a defibrillating shock is needed
AED
spontaneous initiation of depolarizing electric impulses by pacemaker sites within the electric conduction system of the heart
automaticity
a subdivision of the nervous system that controls primarily involuntary body functions like the sympathetic and parasympathetic nervous system
autonomic nervous system
the portion of the electric conduction system of the heart located in the upper part pf the inter ventricular septum that conducts the excitation impulse from the atria to the Bundle of His
AV junction
a component of the ECG that looks at the direction of travel for the electricity going through the heart as it depolarizes
axis deviation
the combination of narrowed pulse pressure, muffled heart tones, and jugular vein distension associated with cardiac tamponade
Beck’s triad
early repolarization that is thought to be a normal variant; characterized by ST segment elevation (or J-point elevation), a J or fishhook appearance at the J point, and concave ST-segment morphology
benign early repolarization
blockage of any combination of two of the fascicles or conduction pathways: a right bundle branch block (RBBB) and anterior hemiblock, a RBBB and posterior hemiblock, or an anterior hemiblock and posterior hemiblock
bifascicular block
a dysrhythmia in which every other heartbeat is a premature contraction; can be atrial or ventricular
bigeminy
on an ECG, leads that contain a positive and a negative pole; includes I,II,III
bipolar leads
the pressure exerted by the pulsatile flow of blood against the arterial walls
blood pressure
narrowing of the bronchial tubules
bronchoconstriction
widening of the bronchial tubes
bronchodilation
a genetic disorder involving sodium channels in the heart; characterized by incomplete RBBB and ST segment elevation that aggressively returns to baseline
Brugada syndrome
abnormal whooshing sounds indicating turbulent blood flow within a blood vessel
bruits
a disturbance in electric conduction through the right or left bundle branch from the bundle of His
bundle branch block
the portion of the electric conduction system in the interventricular septum that conducts the depolarizing impulse from the AV junction to the right and left bundle branches
bundle of His
extremely narrow blood vessels composed of a single layer of cells through which oxygen and nutrients pass to the tissues; these form a network between arterioles and venules
capillaries
the period from one cardiac contraction to the next; each cardiac cycle consists of ventricular contraction (systole) and relaxation (diastole)
cardiac cycle
amount of blood pumped by the heart per minute, calculated by multiplying the stroke volume with the heart rate
cardiac output
restriction of cardiac contraction, failing cardiac output, and shock, caused by the accumulation of fluid or blood in the pericardium
cardiac tamponade
the sudden and often unexpected cessation of adequate cardiac output
cardiopulmonary arrest
fibrous strands shaped like umbrella stays that attach the free edges of the leaflets, or cusps, of the atrioventricular valves to the papillary muscles
chordae tendinae
the effect on the rate of contraction of the heart
chronotropic effect
one of the two branches of the left main coronary artery
circumflex coronary artery
a severe pain in the calf muscle that is caused by narrowing of the arteries in the calf muscle and leads to a painful limp
claudication
the mesh of arteries and capillaries that supplies blood to a segment of tissue whose original arterial supply has been obstructed
collateral circulation
a pattern in which the QRS complexes are all in the same direction in the precordial leads
concordant precordial pattern
the property that enables cardiac cells to pass an electrical impulse from one cell to another
conductivity
a condition that occurs when the heart is unable to pump powerfully enough or fast enough to empty its chambers; as a result, blood backs up into the systemic circuit, the pulmonary circuit or both
congestive heart failure
leads that view geographically similar areas of the myocardium; useful for localizing areas of ischemia
contiguous leads
the ability to shrink, shorten, or contract
contractility
the blood vessels of the heart that supply blood to its walls
coronary arteries
a pathologic process caused by atherosclerosis that leads to progressive narrowing and eventual obstruction of the coronary arteries
coronary artery disease (CAD)
a large vessel in the posterior part of the coronary sulcus into which the coronary veins empty
coronary sinus
the groove along the exterior surface of the heart that separates the atria from the ventricles
coronary sulcus
two premature ventricular contractions occurring sequentially
couplet
a classification system for aortic dissections that include three categories
DeBakey classification
the use of an unsynchronized direct current (DC) electric shock to terminate ventricular fibrillation
defibrillation
the slurring of the upstroke of the first part of the ORS complex that occurs in the Wolff Parkinson-White sydrome
delta wave
the process of discharging resting cardiac muscle fibers by an electric impulse that causes them to contract
depolarization
the period of ventricular relaxation during which the ventricles passively fill with blood
diastole
the drugs used in the treatment of congestive heart failure and certain atrial dysrhythmias
digitalis preparations
in reference to blood vessels, an aneurysm, or bulge formed by the separation of the layers of an arterial wall
dissection
the effect on the velocity of conduction
dromotropic effect
disturbances in the cardiac rhythm
dysrhythmias
a high pitched heart sound that occurs just after the S1 sound
ejection click
the percentage of blood that leaves the heart each time it contracts
ejection fraction (EF)
in the heart, the specialized cardiac tissue that initiates and conducts electric impulses including the SA node, internodal conduction pathways, AV junction, AV node, bundle of His and the Purkinje network
electrical conduction system
inflammation of the endocardium
endocarditis
the thin membrane lining inside the heart
endocardium
the thin membrane lining outside the heart
epicardium
the property that allows cells to respond to an electrical impulse
excitability
disease or ischemia of either of the anterior and posterior fascicles of the electrical conduction system of the heart; also called hemiblock
fascicular block
the process of dissolving blood clots
fibrinolysis
the therapy that uses medications that act to dissolve blood clots
fibrinolytic therapy
a partial disruption of the conduction of the depolarizing impulse from the atria to the ventricles causing prolongation of the PR interval
first degree heart block
a characteristic of cardiac muscle that enables it, when stretched, to contract with greater force; the more cardiac muscle stretches, the greater the force of its contraction, the more completely it empties and the greater the volume
frank starling mechanism
the number of heart contractions per minute
heart rate (HR)
an excessive amount of potassium in the blood
hyperkalemia
high blood pressure usually a diastolic pressure of greater than 90 mm Hg
hypertension
an acute elevation of blood pressure with evidence of end organ damage
hypertensive emergency
a condition that may complicate any form of hypertension and which is usually signaled by a sudden marked rise in blood pressure to levels greater than 200/130 mm Hg; known as acute hypertensive crisis
hypertensive encephalopathy
a condition in which the heart muscle is unusually thick which means that the heart has to pump harder to get blood to leave
hypertrophic cardiomyopathy
a low level of calcium in the blood
hypocalcemia
a low concentration of potassium in the blood
hypokalemia
related to only the ventricles and produced by the ventricles
idioventricular
death or necrosis of a localized area of tissue caused by the cutting off of its blood supply
infarction
death of myocardial tissue involving the lower portion of the heart
inferior wall MI
the effect on the contractility of muscle tissue especially cardiac muscle
inotropic effect
the three pathways of the electrical conduction system found in the atria that transmit the impulse form the SA node to the AV node
internodal pathways
a thick wall that separates the right and left ventricles
interventricular septum
tissue anoxia form diminished blood flow to tissue, usually caused by narrowing or occlusion of an artery
ischemia
when referring to a wave, the wave is neither positive or negative
isoelectric
the baseline of the ECG
isoelectric line
a dysrhythmia arising from ectopic foci in the area of the AV junction; often shows an absence of the P wav, P-wave inversion, a short PR interval, or a P wave appearing after the QRS complex
junctional rhythm
the electrical cable attaching the electrode to the ECG monitor; the voltage difference between two points. Lead I is the voltage difference between the left and right arm electrodes
leads
dilation of the left atrium that results either form systemic hypertension, mitral, or aortic valve stenosis or an athletic heart
left atrial enlargement
the upper left chamber of the heart; receives blood from the pulmonary veins
left atrium
a condition in which the left ventricle cannot effectively pump; this leads to a backup of blood behind the left ventricle and eventually serum is forced out of the pulmonary capillaries and into the alveoli
left sided heart failure
the thick walled, muscular lower left chamber of the heart
left ventricle
a cardiac condition in which the left ventricle becomes enlarged most commonly due to hypertension
left ventricular hypertrophy LVH)
the ECG leads attached to the limbs and that form the hex axial system, along the frontal plane
limb leads
a condition characterized by a QT interval exceeding approximately 450 ms
long QT syndrome
a disorder that causes pre excitation of ventricular tissue and which is characterized on the ECG by a short PR interval and a normal QRS duration
Lown-Ganong-Levine syndrome
the inside of an artery or other hollow structure
lumen
a mode available on automated external defibrillators allowing the paramedic to interpret the cardiac rhythm and determine if defibrillation is needed rather than the monitor making the determination
manual defibrillation
the valve located between the left atrium and the left ventricle of the heart
mitral valve
having one common shape
monomorphic
arising from or pertaining to many foci or locations
multifocal
an ambiguous heart sound that is associated with turbulent blood flow through the heart valves
murmur
inflammation of the myocardium
myocarditis
the cardiac muscle
myocardium
the death of tissue usually caused by cessation of its blood supply
necrosis
a NT and drug sometimes used in the treatment of shock; producing vasoconstriction through its alpha stimulation properties
norepinephrine
the normal rhythm of the heart wherein the excitation impulse arises in the SA node, travels through the internodal pathways to the AV junction, down the bundle of His, through the bundle branches and into the Purkinje network without interference
normal sinus rhythm
a heart sound indicative of a noncompliant valve
opening snap
severe dyspnea experienced when lying down and relieved by sitting up
orthopnea
a fall in blood pressure when changing to an erect position
orthostatic hypotension
the first wave of the ECG complex representing depolarization of the ventricles
P wave
the specialized tissue within the heart that initiates excitation impulses; an electronic device used to stimulate cardiac contraction when the electronic conduction system of the heart is malfunctioning especially in the complete heart block; consists of a battery powered pulse generator and a wire that transmits the electric impulse to the ventricles
pacemaker
a sensation felt under the left breast of the heart skipping a beat usually caused by a premature ventricular contraction
palpitations
protrusions of the myocardium into the ventricular cavities to which the chordae tendinae are attached
papillary muscles
a subdivision of the autonomic nervous system that is involved in control of the involuntary vegetative functions mediated largely by the vagus nerve through the chemical acetylcholine
parasympathetic nervous system
severe shortness of breath occurring at night after several hours of recumbency during which fluid pools in the lungs; the person is forced to sit up to breathe; caused by left heart failure or decompensation of COPD
paroxysmal nocturnal dyspnea (PND)
a to and fro sound that is an abnormal heart sound and which can be heard in systole and diastole; heard in patients who have pericarditis
pericardial friction rub
a high pitched heart sound heard during diastole
pericardial knock
inflammation of the pericardium
pericarditis
the double layered sac containing the heart and the origins of the superior vena cava, inferior vena cava, pulmonary artery and aorta
pericardium
a therapy in which balloons, stents, or other devices are passed through a catheter via a peripheral artery to recanalize and keep a blocked coronary artery open
percutaneous coronary intervention (PCI)
inflammation of the wall of a vein sometimes caused by an IV line manifested by tenderness redness slight edema along part of the length of the vein
phlebitis
in cardiology the white or yellow lesion found in atherosclerosis that is made up of lipids cell debris and smooth muscle cells; in older people it may also include calcium
plaque
a naturally occurring clot dissolving enzyme usually present in the body in its inactive form plasminogen
plasmin
the palpable beat of the apex of the heart against the chest wall during ventricular contraction; normally palpated in the fifth left intercostal space in the midclavicular line
point of maximal impulse (PMI)
the period between the beginning of the P wave (atrial depolarization) and the onset of the QRS complex (ventricular depolarization) signifying the time required for atrial depolarization and passage of the excitation impulse through the AV junction
PR interval
another term used to describe the chest leads in an ECG
precordial leads
early depolarization of ventricular tissue due to the presence of an accessory pathway between the atria and ventricles
pre excitation
the pressure under which the ventricle fills
preload
a type of chest pain that occurs when a person is at rest, when oxygen needs are minimal
Prinzmetal angina
one or two arteries that carry deoxygenated blood from the right ventricle to the lungs
pulmonary artery
the flow of blood from the right ventricle through the pulmonary arteries and all their branches and capillaries in the lungs and back to the left atrium through the venules and pulmonary veins; also called the lesser circulation
pulmonary circulation
congestion of the pulmonary air spaces with exudate and foam, often secondary to left heart failure
pulmonary edema
obstruction of a pulmonary artery or arteries by solid liquid or gas material swept through the right side of the heart to the lungs
pulmonary embolism
the valve between the right ventricle and pulmonary artery also called the pulmonic valve
pulmonary semilunar valve
the vessels that carry oxygenated blood from the lungs to the left atrium
pulmonary veins
a situation in which the palpated radial pulse rate is less than the apical pulse rate; reported numerically as the difference between the two
pulse deficit
an organized cardiac rhythm other than V tach on an ECG monitor that is not accompanied by any detectable pulse
pulseless electrical activity (PEA)
a pulse that alternates between strong and weak beats characteristic of left ventricular systolic damage
pulsus alternans
a weakening or loss of a palpable pulse during inhalation, characteristic of cardiac tamponade and severe asthma
pulsus paradoxus
a system of fibers in the ventricles that conducts the excitation impulse from the bundle branches to the myocardium
purkinje fibers
deflections of the ECG produced by ventricular depolarization
QRS complex
the opening up of new channels through a blocked artery
recanalization
specialized cells that respond to stimuli such as pressure, light or chemicals
receptors
a short period immediately after depolarization in which the myocytes are not yet repolarized and are unable to fire or conduct an impulse
refractory period
the resumption of blood flow through an artery
reperfusion
situated or occurring behind the sternum
retrosternal
an inflammatory disease caused by streptococcal bacteria strains that can cause a stenosis of the mitral valve or aortic valve
rheumatic fever
dilation of the right atrium that results when returning venous pressure is elevated or pulmonary pressure are high
right atrial enlargement
the upper right chamber of the heart
right chamber
a condition in which the right side has to work increasingly harder to pump blood into engorged pulmonary vessels which leads to an inability to keep up with the increased workload
right sided heart failure
the lower right chamber of the heart and receives blood form the right atrium and pumps blood out through the pulmonic valve into the pulmonary veins
right ventricle
a cardiac condition in which the right ventricle becomes enlarged most commonly due to pulmonary hypertension
right ventricular hypertrophy
the period between the onset of one QRS complex and the onset of the next ORS complex
R-R interval
a disease caused by the bacterium Streptococcus pypgenes and characterized by a sore throat fever rash and strawberry tongue
scarlet fever
the two valves, aortic, and pulmonic that divide the heart from form aorta and pulmonary arteries
semilunar valves
the dominant pacemaker of the heart located at the junction of the superior vena cava and the right atrium
sinoatrial node (SA)
a sinus rhythm with a heart rate of less than 60 beats/min
sinus bradycardia
a slight irregularity of the heart rate caused by changes in parasympathetic tone during breathing
sinus dysrhythmia
sinus tachycardia
a sinus rhythm with a heart rate of greater than 100 beats/min
the interval between the end of the QRS complex and the beginning of the T wave; often elevated or depressed with respect to the isoelectric line when there is significant myocardial ischemia
ST segment
angina pectoris characterized by periodic pain with a predictable pattern
stable angina
a classification system for aortic dissection that includes two categories
stanford classification
the volume of blood pumped forward with each ventricular contraction
stroke volume (SV)
a type of acute myocardial infarction in which the ischemic process affects only the inner layer of muscle
subendocardial myocardial infarction
a subdivision of the autonomic nervous system that governs the body’s fight or flight reactions stimulating cardiac activity
sympathetic nervous system
the use of a synchronized direct current electric shock to convert tachydysrthythmias such as atrial fibrillation to normal sinus rhythm
synchronized cardioversion
fainting
syncope
the flow of blood from the left ventricle through the aorta to all of its branches and capillaries in the tissues, and back to the right atrium through the venules veins and vena cava also called the greater circulation
systemic circulation
the period of time when the atria and ventricles are contracting
systole
the upright, flat or inverted wave following the QRS complex of the ECG; representing ventricular repolarization
T waves
a vibration heart sound that occurs frequently and remains constant
thrill
a blood clot that has formed within a blood vessel and is floating within the bloodstream
thromboembolism
a fixed blood clot
thrombus
the act of depolarizing myocardial tissue with a small electrical charge delivered by a device that sends a small electrical charge through the skin of the chest between one externally placed pacing pad and another
transcutaneous pacing
a type of acute myocardial infarction in which the infarct extends through the entire wall of the ventricle
transmural myocardial infarction
the valve between the right atrium and right ventricle of the heart
tricuspid valve
a blockage or impairment of all three components of the ventricular conduction system with one working occasionally to provide AV conduction
trifascicular block
a premature complex in every third heartbeat
trigemany
the outer layer of tissue of a blood vessel wall composed of elastic and fibrous connective tissue
tunica adventitia
the smooth thin inner lining of a blood vessel
tunica intima
the middle and thickest layer of tissue of a blood vessel wall, composed of elastic tissue and smooth muscle cells that allow the vessel to expand or contract in response to changes in blood pressure and tissue demand
tunica media
a small flat wave sometimes seen after the T wave and before the next P wave
U wave
arming from a single site
unifocal
angina pectoris characterized by a changing unpredictable pattern of pain which may single an impending acute myocardial infarction
unstable angina
one of 12 nerves that comprise the parasympathetic nervous system and responsible for decreasing heart rate
vagus nerve
forced exhalation against a closed glottis; the effect of which is to stimulate the vagus nerve and slow the heart rate
valsalva maneuver
narrowing of the diameter of a blood vessel
vasoconstriction
widening of the diameter of a blood vessel
vasodilation
the blood vessels that carry blood to the heart
veins
the largest vein of the body
vena cava
very small veins
venules
a syndrome characterized by short PR intervals, delta waves, nonspecific ST-T wave changes indicating the presence of an accessary pathway
Wolff-Parkinson-White syndrome
