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Clinical Methods > Clinical Methods TEST ONE > Flashcards

Clinical Methods TEST ONE Flashcards

1
Q

Polarity

A

is maintaned by membrane pumps necessary to keep the inside of the cells electronegatave

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2
Q

which pump maintains membrane electrical polarity

A

sodium/potassium

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3
Q

Ratio of Na to K

A

3 Na outside for every 2 K inside

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4
Q

What is needed to keep cell polarized

A

ATP

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5
Q

pacemaker cells

A

electrical power source of the heart

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6
Q

electrical conducting

A

the hard wiring of the heart

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7
Q

myocardial cells

A

the contractile machinery of the heart

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8
Q

what determines rate of depolarization

A

innate electrical characteristcs of the cell and the external neurohormonal input

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9
Q

action potential

A

a record of one elecrical cycle of depolarization & repolarization from a single cell

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10
Q

sinus node

A

dominant pacemaker of the heart, located in the RA, rate 60-100 BP, altered by Autonomic NS

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11
Q

Automaticity

A

all hearts cells posses ability to behave as a pacemaker.

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12
Q

intrinsic pacing SA node

A

60-100

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13
Q

intrinsic pacing atrial foci

A

60-75

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14
Q

junctional foci AV

A

40-60

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15
Q

Ventricular foci (his bundle, etc.)

A

30-40

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16
Q

horizontal small square distance in time

A

.04 sec

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17
Q

horizontal large square distance in time

A

.2 secc

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18
Q

vertical small square voltage

A

.1mV

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19
Q

vertical large square voltage

A

.5mV

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20
Q

P Wave

A

depolarization

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21
Q

3 parts of ventricular conduction

A

1-bundle of Hi, 2-Bundle Branches, 3-Terminal Purkinje fibers

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22
Q

Q wave

A

1st downard deflection

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23
Q

R wave

A

1st upward deflection

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24
Q

R prime

A

a second upward upward deflection

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25
Q

S wave

A

1st downard deflection following an R wave

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26
Q

QS wave

A

entire configuration consits solely of one downward deflection

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27
Q

Repolarization

A

restoration of electronegative state

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28
Q

T wave

A

represents the wave ventricular repolarization

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29
Q

PR Interval

A

from p wave to the start of QRS

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30
Q

ST Segment

A

from the end of the QRS complex to the beginning of the T wave

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31
Q

QT interval

A

includes the QRS complex, ST segment, and the T wave

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32
Q

positive deflection

A

a wave of depolarization towards a positive electrode

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33
Q

negative deflection

A

a wave of depolarization away from a positive electrode

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34
Q

biphasic wave

A

a depolarizing wave moving perpendicular to a postive electrode

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35
Q

lead I

A

right arm (-) left arm (+)

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36
Q

lead II

A

right arm (-) legs (+)

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37
Q

Lead III

A

right arm (-) legs (+)

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38
Q

AVL

A

left arm (+) other limbs (-)

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39
Q

AVR

A

right arm (+) other limbs (-)

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40
Q

AVF

A

legs (+) arms (-)

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41
Q

Anterior view of the heart

A

V2, V3, V4

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42
Q

Left Lateral view of the heart

A

I, aVL, V5, V6

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43
Q

Inferior view of the heart

A

II, III, aVF

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44
Q

right ventricular

A

aVR, V1

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45
Q

arrhythmia

A

disturbance of rate, regularity, site or origin, or conduction.

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46
Q

NSR

A

60-100 bpm

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47
Q

clinical manifestations

A

palpitations, syncope, angina, CHF, death

48
Q

awarenes of own heartbeat

A

syncope

49
Q

angina

A

rapid arrhythmia pain, ^ O2 demands

50
Q

HIS DEBS

A

hypoxia, ischemia, symp stim, drugs, electrolytes, bradycardia, stretch

51
Q

most info from which lead

A

Lead II

52
Q

first action when you see an arrythmia?

A

print a strip

53
Q

Holter monitor

A

ambulatory, portable EKG, 1-2 days, 1 limb lead, 1 precordial

54
Q

Event monitor

A

rhythm disturbances, infrequent, patient records

55
Q

KNOW! Rhythm analysis (5 steps)

A

rate, regularity, P waves, PR interval, QRS duration

56
Q

inefficient depolarization of ventricles

A

ectopy

57
Q

how do you calculate rate?

A

divide 300 by the # large boxes seperating two R waves

58
Q

5 large sqares

A

1 sec

59
Q

If R-R distances have a pattern the rhythm is?

A

regular

60
Q

What if there is no P wave?

A

originate below the atria

61
Q

Inverted P waves?

A

current flowing backwards

62
Q

Normal PR interval?

A

atrial depol to beginning of vent. depola. 0.12-0.20 sec

63
Q

Prolonged PR interval>

A

AV block

64
Q

QRS duration?

A

0.04-0.12s 1-3 small boxes

65
Q

electrical activity normal but too fast, slow, or irregular

A

arrythmia of sinus origin

66
Q

origin of electrical activity elsewhere

A

ectopic rhythm

67
Q

electrical activity trapped in electrical racetrack

A

reentrant arrythmias

68
Q

usual pathway with blocks or delays

A

conduction blocks

69
Q

accessory conduction pathway (short cut)

A

pre-excitation syndromes

70
Q

When can you see sinus tachycardia?

A

exercise, CHF, lung dx, hyperthyroidism

71
Q

Sinus bradycardia?

A

< 60 bpm. athletes, enhances vagal tone, early MI

72
Q

Is a sinus arrythmia normal?

A

yes, slightly irregular but normal. inspiration=^HR, expiration=vHR

73
Q

This occurs when sinus node stops firing

A

sinus arrest

74
Q

myocardial cells take over pacing

A

escape beats

75
Q

what occurs if escape beats do not occur after sinus arrest?

A

asystole

76
Q

Which myocardial cells can behave as pacemakers?

A

virtually all of them

77
Q

Prolonged electrical activity/

A

asystole, no CO or blood flow.

78
Q

Treatment for asystole

A

CPR and epinephrine

79
Q

Can you defibrillate arrythmias?

A

nope

80
Q

what is the rate of nonsinus pacemakers?

A

atrial foci (60-75 bpm), junctional foci (40-60bpm). ventricular foci (30-40 bpm)

81
Q

what are atrial foci?

A

some point IN the atrium that acts as a pacemaker

82
Q

what are ventricular foci?

A

HIS bundle, bundle branches, purkinje system

83
Q

Most common escape mechanism

A

junctional escape. depol near AV node,

84
Q

a P wave is ________ in aVR

A

inverted

85
Q

What is a sustained rhythm of escape beats?

A

ectopic rhythm

86
Q

what can cause ectopic rhythms?

A

enhanced automaticity, digitalis toxicity, reentrant loop

87
Q

Four questions to be answered?

A

normal P wave? QRS wide or narrow? relationship between P wave and QRS? rhythm regular of irregular?

88
Q

single ectopic supraventricular beat that originated in atria?

A

PAC, premature atrial cx

89
Q

single ectopic supraventricular beat that originated near the AV node?

A

junctional premature beats

90
Q

Sudden, narrow QRS tachycardia initiated by a premature supraventricular beat/

A

PSVT. paroxysmal supraventricular tachycardia. 150-250 bpm

91
Q

How do you slow or terminate?

A

carotid massage. 15 seconds.

92
Q

Common triggers of PSVT?

A

alcohol, coffee, stress (so all of us)

93
Q

Mechanism of carotid massage?

A

increases pressure that is sensed by baroreceptors, vagus nerve cause HR to slow

94
Q

Order of steps:

A

listen for carotid bruits, 1 carotid at a time, watch for rhythm changes on strip

95
Q

Regular saw toothed, 250-350 bpm

A

atrial flutter. variety of different ratios of atrial:ventricular rates.

96
Q

Does carotid massage help with atrial flutter/

A

NO! increases block

97
Q

What is treatment?

A

cardioversion/drugs

98
Q

Most common AV block?

A

2:1. for q 2 flutter waves= 1 QRS complex

99
Q

Atrial flutter is common in?

A

HTN, obese, DM, electrolye imbalances, alcohol intox, drug abuse (cocaine/amphetamines), COPD, CAD, CHF….

100
Q

AV node bombard with > 500 impulses/min

A

A-Fib, irregularly irregular. tx: cardioversion and drugs

101
Q

At least 3 different P wave shapes, rate 100-200 bpm

A

multifocal atrial tachycardia MAT. common in severe lung disease.

102
Q

Multifocal atrial tachycardia is AKA

A

wandering atrial pacemaker

103
Q

Results from enhanced automaticity of ectopic atrial focus or reentrant circle w/in atria?

A

paroxysmal atrial tachycardia PAT. most common cause? digitalis toxicity

104
Q

summary: ectopic rhythms

A

PSVT, A-flutter, A-fib. MAT, PAT

105
Q

Carotid massage?

A

PSVT, A-fib

106
Q

Most common ventricular arrythmia?

A

PVC. wide bizarre QRS. no tx. common. REPLACE Mg2+

107
Q

1 normal beat:1 PVC

A

bigeminy

108
Q

2 normal beats:1 PVC

A

trigeminy

109
Q

When are PVC’s a concern?

A

frequent, three consecutive, vary in size, fall on T wave of previous beat (R on T phenomenon)

110
Q

Three of more consecutive PVC’s?

A

V-tach. emergency. preceded cardiac arrest

111
Q

Polymorphic V-tachycardia?

A

Torsades De Pointes. (changes appearance beat to beat). “twisting of the points”. patient with prolonged QT intervals

112
Q

What electrolyte disturbances can cause prolonged QT/

A

decreased Ca, Mg, K

113
Q

Drugs that can cause it?

A

antiarrythmic, tricyclics, phenthiazines, erythromycin

114
Q

Pre-terminal event seen in dying hearts?

A

V-fib. tx: CPR/defibrillation

115
Q

Most frequently encountered arrhythmia with sudden death?

A

V-fib

116
Q

Benign rhythm seen with acute MI?

A

accelerated idioventricular rhythm

117
Q

Treatment of arrythmias?

A

programmed electrical stimulation, defibrillators

Clinical Methods (2 decks)

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