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Term 2 > Chapter 17- Cardiovascular Emergencies > Flashcards

Chapter 17- Cardiovascular Emergencies Flashcards

1
Q

How does oxygenated blood reach the heart?

A

Coronary arteries

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2
Q

Where is the point of maximal impulse located?

A

Left anterior chest, fifth intercostal space

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3
Q

What is the most inner layer of the heart?

A

Endocardium

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4
Q

What is the structure that protects the heart and provides lubrication for the heart between itself and surrounding structures?

A

Pericardium

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5
Q

What does the left main coronary artery subdivide into?

A

Left anterior descending artery and circumflex coronary artery

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6
Q

What valves make up the atrioventricular valves?

A

Tricuspid valve separates the right atrium from the right ventricle and the mitral valve separates the left atrium from the left ventricle. Both valves prevent backflow during ventricular contraction

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7
Q

What is the function of the chordae tendinae?

A

Prevent valve leaflets from inverting (prolapsing) during ventricular contraction

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8
Q

What valve prevents backflow from the artery into the right ventricle and separates the right ventricle from the pulmonary artery?

A

Pulmonic valve

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9
Q

What does the aortic semilunar valve do?

A

Prevents blood that has already entered the aorta from flowing back into the left ventricle

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10
Q

What is atrial kick?

A

The contribution to ventricular filling made by the contraction of the atrium

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11
Q

What is preload?

A

Initial stretching of the myocytes prior to the contraction of the left side of the heart

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12
Q

What is Afterload?

A

The pressure which the heart must pump against

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13
Q

What is systemic circulation?

A

All blood vessels between left ventricle and right atrium

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14
Q

What is pulmonary circulation?

A

Consists of all blood vessels between the right ventricle and left atrium

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15
Q

What is the exception to arteries?

A

The usually carry oxygenated blood but the pulmonary arteries are the exception. They carry oxygen depleted blood from the right ventricle to the lungs

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16
Q

What is the exception for veins?

A

Veins normally carry deoxygenated blood to the heart. The only exception are pulmonary veins, which carry oxygenated blood to the left side of the heart

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17
Q

What is cardiac output and what is normal for an adult?

A

The amount of blood pumped out by either ventricle, normal is 5-6 L/min

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18
Q

What is ejection fraction and what range is normal for adults?

A

The percentage of blood that leaves the heart each time it contracts. Left ventricular ejection fraction has a normal range of 55-70%

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19
Q

What kind of medication would have an effect on frank starling?

A

Inotropic

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20
Q

What is excitability?

A

Cardiac cells responding to an electrical impulse

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21
Q

What is conductivity?

A

Cardiac cells can pass an electrical impulse from one cell to another

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22
Q

What is automaticity?

A

Heart muscle can generate its own electrical impulses without stimulation from nerves

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23
Q

What causes a delta wave?

A

Bundle of Kent and bundle of his de polarizing at the same damn time

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24
Q

What is a key characteristic of an idioventricular rhythm?

A

20-40 bpm

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25
Q

What is a valsalva maneuver?

A

Pressure on the carotid sinus, straining against a closed glottis

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26
Q

What effect do beta-1 have on the heart?

A

Increases rate, force, and automaticity

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27
Q

What do andrenergic sympathetic nerves connect to?

A

Ventricles, vessels

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28
Q

What do cholinergic sympathetic nerves connect to?

A

Sweat glands, vessels

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29
Q

What do dopaminergic sympathetic nerves connect to?

A

Renal glands, vessels

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30
Q

What does atropine do?

A

Parasympathetic blocker, opposing the vagus nerve. Used to speed the heart when excessive vagal firing has caused bradycardia

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31
Q

What does norepinephrine (levophed) do?

A

Sympathetic agent causing vasoconstriction. Used to increase blood pressure when hypotension is caused by vasodilation such as in neurogenic shock. Almost pure alpha.

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32
Q

What would a Dopeamine dose of 1-2 mcg/kg/min be used for?

A

Increased renal perfusion by targeting dopaminergic receptor sites

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33
Q

What would a dose of 2-10 mcg/kg/min of dopamine be used for?

A

Increased rate and force (chrontrope,inotrope) of heart by targeting beta 1 receptor sites

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34
Q

What would a dose of 10-20 mcg/kg/min of dopamine be used for?

A

Vasoconstriction by targeting alpha receptor sites

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35
Q

If you have a drop in cardiac output, what needs to happen in order to maintain adequate blood pressure?

A

Vasoconstriction

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36
Q

If a patient is found unresponsive in cardiac arrest scenario, what is your order of operations?

A

CAB, circulation, airway, breathing

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37
Q

What could a difference between central and peripheral pulses indicate?

A

Internal bleed

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38
Q

What are palpitations?

A

Sensation of an abnormally fast or irregular heartbeat, except after extreme exertion. May report feeling like their heart skipped a beat

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39
Q

What are beta blockers used for?

A

Relief for angina, lower blood pressure, prevent recurrence of MI. All end in -lol

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40
Q

What is digitalis used for?

A

CHF, rapid atrial arrhythmias. Acts by increasing the strength of cardiac contractions, improving CO

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41
Q

What 3 major classes of drugs are used to treat pain from angina?

A

Nitrates, beta blockers, calcium channel blockers. All of them diminish myocardial oxygen demand

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42
Q

How long does it take nitro to work?

A

3-5 min

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43
Q

What is another good use for nitro?

A

Causes significant vasodilation. Can be useful for treatment to pulmonary edema secondary to left side heart failure.

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44
Q

What is a common side effect of nitro?

A

Throbbing headache

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45
Q

When a patient tells you they take nitro, what are two important questions to ask?

A

Did they take it today, how much? & did it relieve the pain? (Could be expired)

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46
Q

What medication could you use for a dysrhythmia caused by the toxic effects of digitalis?

A

Dilantin - also used for seizures

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47
Q

What is orthostatic hypotension?

A

An experience a patient has when moving from a recumbent to a sitting or standing position where they feel giddy. Occurs because of their antihypertensive medication and you should check their blood pressure before you have them move so you don’t get a false reading

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48
Q

What are pradaxa and plavix used for?

A

Pradaxa is an anticoagulant medication and plavix is a anti platelet medication. Both are used in managing myocardial infarction

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49
Q

What is S1?

A

Beginning of ventricular contraction when the mitral and tricuspid valves close

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50
Q

What conditions can diminish s1?

A

Obesity, emphysema, cardiac Tamponade

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51
Q

What is s2?

A

Occurs near the end of ventricular contraction when the pulmonary and aortic valves close

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52
Q

What is s3?

A

Heard in children and young adults, in older adults it signifies heart failure

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53
Q

What does an opening snap indicate?

A

A noncompliant valve

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54
Q

What is ejection click?

A

High pitched sound occurring after s1. May indicate dilated pulmonary artery or septal defect

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55
Q

What is a pericardial friction rub?

A

To and fro sound that can be heard in systole and diastole. Heard in patients with pericarditis

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56
Q

What is a murmur?

A

Ambiguous sound associated with turbulent flow through the heart valves

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57
Q

What is pericardial knock?

A

High pitched sound during diastole that indicates a thickened pericardium that is limiting how far the ventricle can expand during diastole phase

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58
Q

What can an irregular pulse indicate?

A

A disturbance in cardiac rhythm

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59
Q

What does a weak thready pulse indicate?

A

Reduction in cardiac output

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60
Q

What is pulse deficit?

A

When the palpated radial pulse is less than the apical pulse rate; reported numerically as the difference between the two

61
Q

What is pulsus alternans?

A

Pulse alternates between strong and weak beats and typically represents left ventricular systolic damage

62
Q

How do you look at the right side of the heart?

A

Move V4 to the right

63
Q

How do you look at the posterior of the heart?

A

Move v4,v5,v6 to the back

64
Q

What is the j point?

A

Where the ST segment begins, ends at beginning of t wave

65
Q

In sinus dysrhythmia, what is the reflex that increases the heart rate because of increased filling pressures during inspiration?

A

Bainbridge reflex

66
Q

What is sinus arrest?

A

Occurs when the SA node fails to initiate an impulse, eliminating the p wave, QRS, and or t wave for one cardiac cycle

67
Q

What can cause sinus arrest?

A

Ischemia of the SA node, increased vagal tone, carotid sinus massage, and use of drugs such as digitalis

68
Q

What is sick sinus syndrome?

A

Encompasses a variety of rhythms that involve a poorly functioning SA node and is common in elderly patients, normally goes back and forth between bradycardia and tachycardia. Some patients experience syncopal or near syncopal episodes, dizziness, and palpitations. Other patients are asymptomatic.

69
Q

How do you distinguish an idioventricular rhythm?

A

Under 20-40 beats, no p waves

70
Q

How do you differentiate between an agonal rhythm and an idioventricular rhythm?

A

An idioventricular rhythm may have a palpable pulse, an agonal will not

71
Q

What is Wolff-Parkinson-white syndrome?

A

A preexcitation disorder that is characterized by short PR interval, widened QRS, and presence of a delta wave

72
Q

What is the process of dissolving blood clots called?

A

Fibrinolysis

73
Q

What is pericarditis and how will it present with a patient?

A

Inflammation of the pericardial sac as a result of an infection (bacterial, viral, or fungal) or trauma. Patients will present with positional chest pain that is often alleviated by sitting forward, SOB, and recent HX of infection or fever. Characterized by slight ST elevation and a down sloping PR segment. Can lead to pericardial effusion which can develop into pericardial Tamponade. Tx is pericardialcentesis. Will hear a to and fro sound in systole and diastole which is defined as a pericardial friction rub.

74
Q

What will j waves or Osborne waves on an ECG indicate?

A

Severe hypothermia

75
Q

What do tall and sharply peaked T waves indicate?

A

Hyperkalemia

76
Q

What does an ECG with a flat or absent t wave and a u wave indicate?

A

Hypokalemia

77
Q

What is brugada syndrome?

A

Genetic disorder involving sodium channels of the heart common among Asian males in their 40’s or 50’s. Presents with sudden onset of syncope or cardiac arrest. Characterized by incomplete RBBB.

78
Q

What is the contraindication for a carotid sinus massage?

A

Presence of Bruits in the carotid arteries

79
Q

What is prehospital treatment for a thromboembolism?

A

Supportive care

80
Q

What occurs in angina pectoris?

A

Occurs when the supply of oxygen to the myocardium is insufficient to meet the demand. As a result, the cardiac muscle becomes ischemic and switches to anaerobic metabolism

81
Q

What is prinzmetal angina?

A

A coronary artery spasm that is common in women in their 50’s

82
Q

How will a patient present in left sided heart failure?

A

Shortness of breath when lying down, cheyne stokes respirations, patient will be extremely restless and agitated, high BP, crackles, wheezes, pink frothy sputum. CPAP will be an effective tool

83
Q

What are two good medications for left sided heart failure?

A

Lasix, nitro

84
Q

How will right sided heart failure present?

A

Usually occurs because of left sided heart failure or as a result of PE or COPD. Patient will have JVD, peripheral edema. Make sure you assess jugular veins in the semi fowler position. Treatment is to make the patient comfortable.

85
Q

How can the development of a cardiac Tamponade (gradual vs. trauma) affect what the patients chief complaint will be?

A

If onset is gradual like in pericarditis the patient may report of dyspnea and weakness. If the cause is traumatic the chief complaint will be chest pain

86
Q

For cardiac Tamponade, what is becks triad?

A
  1. ) narrowing pulse pressure
  2. ) muffled heart tones
  3. ) JVD
87
Q

What is the way you differentiate between cardiac Tamponade and a tension pneumothorax?

A

In cardiac Tamponade, breath sounds will all be equal and the trachea will be midline because the lungs are not affected

88
Q

When will cardiogenic shock occur?

A

When 40% or more of the left ventricle has been infarcted.

89
Q

What are the symptoms of cardiogenic shock?

A

Difficulty breathing, extreme fatigue, general malaise

90
Q

What will a patient complain of if the underlying issue is a dissecting aneurysm?

A

The worst pain I have ever experienced, a ripping or tearing sensation, like a knife. Pain will come on suddenly and is located anterior chest or in the back between the shoulder blades.

91
Q

How can you differentiate between the presentation of an AMI to that of a dissecting aneurysm?

A

AMI will be accompanied by nausea or weakness and tends to be a more gradual “crushing” pain related to pressure. Dissecting aneurysms will be more of a “stabbing” pain and will be sudden. Also the back is involved with aneurysms whereas it is not with AMI’s

92
Q

What should you suspect in a patient who is male, 50-60’s with a sudden onset of abdominal or back pain?

A

Abdominal aortic aneurysm

93
Q

How will a patient with a AAA present and complain of?

A

Believe they may have pulled a muscle in their back. Pain will radiate to their thigh or groin, will have an urge to defecate, pulsatile mass palpable in the abdomen.

94
Q

What treatment should you consider for AAA?

A

Apply but do not inflate MAST, lactated ringers

95
Q

What are common symptoms of a hypertensive emergency?

A

Throbbing headache, dizziness, epistaxis, tinnitus, blurred vision

96
Q

How is a hypertensive crisis defined?

A

A sudden rise of BP greater than 200/130

97
Q

When MAP exceeds 150 in a hypertensive crisis, what occurs?

A

Pressure breaches blood-brain barrier and fluid leaks out, increasing intracranial pressure

98
Q

What is the goal of treatment in a hypertensive emergency?

A

Lower BP in a gradual and controlled manner during a 30 to 60 minute period so cerebral flow is restored to normal

99
Q

How is endocarditis caused and who usually gets it?

A

Exclusively caused by staph or strep infection. Most likely to get it are patients who abuse intravenous drugs and patients who have prosthetic heart valves

100
Q

What is rheumatic fever?

A

Inflammatory disease caused by streptococcal bacteria strains. Can cause stenosis of the mitral or aortic valve leading to heart complications.

101
Q

What is scarlet fever?

A

Disease caused by the same bacteria for strep throat. Characterized by fever, rash, and “strawberry” tongue. Usually prevalent in patients younger than 1 year old.

102
Q

What two conditions could electrical alternans be caused by?

A

Pericardial effusion or cardiac Tamponade

103
Q

What 3 things could cause a wandering atrial pacemaker?

A

COPD, pneumonia, asthma

104
Q

What is sick sinus syndrome?

A

Older heart where exercise causes HR to spike too high and when the heart tries to compensate, it drops it too low

105
Q

What are ostea?

A

Openings to coronary arteries

106
Q

What does a 2-5 dose of Dopeamine cause?

A

Renal response

107
Q

What does a 5-10 dose of Dopeamine cause?

A

Exclusively sympathetic

108
Q

What does a 10-20 dose of Dopeamine cause?

A

Positive inotrope

109
Q

What is a vector?

A

Direction of electrical impulse

110
Q

What is axis?

A

Way to measure the greatest amount of electrical activity

111
Q

What is long QT syndrome?

A

A genetic condition that causes the heart to be bradycardic, pt. Will die at a young age

112
Q

What is the number 1 cause of PVC’s?

A

Hypoxia

113
Q

What are the three irregularly irregular rhythms?

A
  1. ) AFIB
  2. ) multi focal atrial tachycardia
  3. ) wandering atrial pacemaker
114
Q

What causes Sinus arrhythmia?

A

Caused when the diaphragm touches the apex of the heart during inspiration causing the bambridge reflex

115
Q

What can cause PR depression?

A

Pericarditis (tachycardia, ST elevation, pain is positional)

116
Q

What type of block is it if the PRI changes beat to beat?

A

3rd degree

117
Q

If a PVC is not premature than what is it?

A

Escape beat

118
Q

What is the number one cause of left ventricular hypertrophy?

A

Hypertension, failure occurs with more and more pulmonary edema

119
Q

What is the number one cause of right ventricular hypertrophy?

A

Cor pulmonale

120
Q

What are your precordial leads?

A

V1-V6

121
Q

What do biphasic t waves indicate?

A

Wellens syndrome, a pattern of deeply inverted biphasic t waves in v2-3 which indicates stenosis of the left anterior descending artery

122
Q

Where does the heart receive its blood from?

A

Coronary sinus, it drains into the right atrium

123
Q

What are your reciprocal changes?

A

II,III,aVF - 1,aVL

v1,v2 - v7,v8,v9

124
Q

What does ST elevation indicate on an ECG?

A

Indicates where the issue is occurring

125
Q

How do you identify bundle blocks?

A

Look in v1 for the waveform with the greatest vector. If it is on the left or right it is a LBBB or a RBBB.

Wide and up = RBBB
Wide and down = LBBB

126
Q

What do tombstone T’s indicate?

A

Massive left side attack

127
Q

Wide QRS?

A

Think issue with potassium

128
Q

How do you determine axis deviation?

A

Look at 1 and aVF terminal waves, which one has the greatest height or depth? That is your axis deviation

129
Q

Down in 1, down in F =?

A

Extreme right axis deviation

130
Q

Down in 1, up in F =?

A

Right axis deviation

131
Q

Up in 1, down in F =?

A

Left axis deviation

132
Q

Up in 1, up in F =?

A

Normal, no axis deviation

133
Q

What are the main causes of right axis deviation?

A

Right ventricular hypertrophy, dextrocardia, COPD

134
Q

What are the main causes of left axis deviation?

A

Left ventricular hypertrophy, CHF, MI

135
Q

What disorder causes the body to assume the temperature around it?

A

Hypothyroidism

136
Q

What condition will cause there to be a yellow cast around everything in vision?

A

Digitalis toxicity

137
Q

What should you do after ROSC?

A

12 lead, consider hypothermic treatment

138
Q

If you convert a patient in a cardiac dysrhythmia with lidocaine, what else must you do?

A

Use a lidocaine drip because the half life is so short. 2g in 500 mL making 4 mg/mL yielding 1-4 mg/min

139
Q

After the patient comes out of an unstable cardiac dysthymia where there is clinical death, what should you do?

A

Administer 1 liter of fluid, continue CPR for 2 min

140
Q

What is the dose for Dopeamine when mixing it up? For algorithm use.

A

800 mg in 500 mL yielding 1600 mL

141
Q

What does ST elevation in 1 and AVL indicate?

A

High lateral wall MI

142
Q

What are the key characteristics of a PVC?

A

QRS will be wide and bigger than the rest

143
Q

What are the key characteristics of a PAC?

A

Narrow, normal, but early

144
Q

What are the key characteristics of a PJC?

A

QRS will look different from the rest

145
Q

What is the normal range for bicarb levels in the body?

A

23-29

146
Q

If you have a pacemaker failure, what is your next action?

A

TCP

147
Q

What is the dose for an Epi drip?

A

2mg/500 mL

148
Q

What could pulsus alternans indicate?

A

Common in CHF

149
Q

What should you consider if there is decreased pulse on one side?

A

Aneurysm

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