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CSCT Review > CSCT Exam Review > Flashcards

CSCT Exam Review Flashcards

1
Q

what conditions can alter ST segment causing false-positive ST changes

A

body position
hyperventilation
digoxin, quinidine
LVH
pre-exitation
smoking
conduction system abnormalities

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2
Q

what is NOT a frequent or severe side effect of Beta adrenergic blocking agents

A

thyroid dysfunction

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3
Q

what would be used to treat a pt with nocturnal angina

A

beta blockers and nitrate therapy

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4
Q

identify the modified chest lead that is most useful in detection of ST segment change due to ischemia

A

modified lead 5

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5
Q

most common cyanotic congenital heart defect IN infancy

A

transposition of the great vessels

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6
Q

3 cardiac defects that obstruct LV and RV outflow

A

aortic stenosis
pulmonary stenosis
coarctation of the aorta

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7
Q

which of the following is not a Class I antiarrhythmic:
quinidine, diltiazem, procainamide, mexeletine, propanolol….

A

diltiazem

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8
Q

which classification of antiarrhythmics has the primary effect of slowing the AV conduction

A

Class IV calcium channel blockers

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9
Q

most common side effect of amiodarone

A

pulmonary toxicity

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10
Q

T/F - by the time a child is 3-8 y/o, the precordial leads will assume the adult QRS pattern

A

True

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11
Q

T/F - episodes of sinus tachy/brady lasting longer than 15s is abnormal

A

True

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12
Q

it can be said that most children who develop SVT have…

A

no associated cardiac disease

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13
Q

the most common form of congenital heart disease

A

VSD

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14
Q

the most common cyanotic congenital heart disease BEYOND infancy

A

tetralogy of fallot

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15
Q

the danger of PVC’s in the presence of ischemia heart disease or cardiomyopathy is that they maybe the forerunner to…

A

sudden death, onset of VT/VFIB

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16
Q

the danger of R on T is the potential of the development of

A

VT or VFIB

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17
Q

what 3 drugs are associated with the development of torsades

A

quinidine, disopyramide, and trycilic antidepressants

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18
Q

2 most common rhythm disturbances than can cause onset VFIB are

A

PVC and VT

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19
Q

T/F - when the ventricles are fibrillating the heart muscle is able to eject only a small volume of blood

A

False, no circulation or even a small amount of blood

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20
Q

aberrant ventricular conduction may either be RBB or LBB, although most of the time its _______

A

RBBB

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21
Q

AFIB and PAC’s frequently are conducted w/ aberrancy bc aberrant ventricular conduction occurs due to a _____ cycle length

A

shortening

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22
Q

T/F - QRS duration of a normal newborn is less than in adults

A

True

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23
Q

T/F - T waves in V1 are upright throughout childhood as well as adulthood

A

False, T waves are usually inverted in childhood in V1

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24
Q

T/F - amplitude of the R wave in V1 is usually greater than the S wave in V1 in an infant of less than one month

A

True, they are more dominant in the RV

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25
Q

mechanism in sinus arrest is depression of impulse _____ and mechanism of sinus block is depression of impulse ______

A

formation, conduction

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26
Q

if the pause in the rhythm is a multiple of the P-P interval, the diagnosis is

A

sinus block

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27
Q

the passive rhythm that develops in complete AV block may originate from an _____ focus or a ______ focus

A

idiojunctional, idioventricular

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28
Q

WPW syndrome can occur if the anomalous accessory pathway called the _______ exists.

A

bundle of kent

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29
Q

the rapid rate caused by WPW can cause the risk of development of

A

VFIB

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30
Q

will vagal maneuvers be effective in WPW

A

No

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31
Q

will WPW respond to cardioversion

A

Yes

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32
Q

what drug therapies may be used in WPW (8)

A

quinidine
procainamide
disopyramide
aprinidine
amiodarone
encainide
propaferone
sotalol

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33
Q

AV re-entry tachycardia caused by WPW may be treated with (6)

A

digitalis
propanolol
diltiazem
amiodarone
verapamil
encainide

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34
Q

structures of the conduction system innervated by the PNS

A

SA node, AV node, atria

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35
Q

3 methods by which ions may move across a cell membrane

A

diffusion
osmosis
active transport pumps

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36
Q

what part of the action potential curve represents cell activation or depolarization

A

phase 0

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37
Q

which cell possess spontaneous diastolic depolarization

A

SA node, AV junction & purkinje’s

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38
Q

which cell has the LEAST negative RMP

A

SA node

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39
Q

which cardiac cell has the most perpendicular phase 0 slope

A

ventricular myocardium

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40
Q

which cardiac cell typically has the steepest rise in phase 4

A

SA node

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41
Q

which cardiac cell typically has the longest refractory period

A

purkinje cell

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42
Q

atrial depolarization is

A

posteriorly, downwards and to the left

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43
Q

depolarization in the ventricular septum is

A

from left to right, anteriorly to inferiorly

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44
Q

late depolarization of the ventricles

A

to the left, posteriorly and superiorly

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45
Q

normal septal depolarization is from

A

left to right

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46
Q

what conditions cause enhanced automaticity

A

hypokalemia
hypocalcemia
dig toxicity
fever
hypoxia
trauma
MI

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47
Q

atrial flutter is believed to be most commonly due to

A

intra-atrial re-entry

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48
Q

2 passive escape rhythms

A

junctional and idioventricular

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49
Q

Name 3 areas of the conduction system where a block can occur

A

SA node, AV node, bundle branches

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50
Q

has a phasic variation of rate due to changes in vagal tone typically affected by respiratory cycle

A

sinus arrhythmia

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51
Q

what is the most controllable function of the ECG

A

output

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52
Q

3 main differences between single and multichannel ECG

A
  1. all precoridal leads must be connected at the same time
  2. when tracing is complete it doesnt need to be mounted
  3. cost and time effective
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53
Q

define voltage

A

amount of pressure in an electrical loop which is measured in volts (V)

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54
Q

what can increase when the ECG is subject to corrosive and humid environments

A

leakage current

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55
Q

what is the function of the fat prong or neutral pin

A

provides a direct path back to the power source

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56
Q

define bipolar leads

A

a recording of electrical differences between 2 points of reference

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57
Q

what is einthovens law

A

sum of amplitude of the recorded complexes in Lead I and Lead III is = to amplitude recorded in Lead II

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58
Q

where is zero potential located

A

center of the heart

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59
Q

recording the third dimension of the heart is the function of the

A

chest leads

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60
Q

the small bump felt where the manubrium meets the sternal body is known as the

A

sternal angle

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61
Q

what are the qualities of a technically and clinically acceptable ECG

A

standardization - 1mV 10mm High
Clarity - visible deflection
Baseline - constant
Leads - approx. 3-6 complexes
Tracing - centered, coded and labelled

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62
Q

Causes of single artifact

A

loose electrode connection
lead switch over
operation induces static electricity
metallic particles in skin or in electrode cream
surgical implanted metal plate or screw

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63
Q

causes of wandering baseline

A

muscle tension
pt. not comfortable
pt. physical or mental condition
tech incomplete patient prep/attitude

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64
Q

Causes of somatic tremor

A

lack of relaxation
poor electrode contact
loose electrode connection
breathing
conversation
cable swinging/dangling

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65
Q

An invasive procedure using a unipolar lead to identify atrial activity or P waves

A

esophageal lead

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66
Q

emergency procedure to terminate VFIB or VT

A

defibrillation

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67
Q

used to diagnose and correct SVT caused by re-entry

A

vagal maneauvers or carotid massage

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68
Q

Some conditions where it may be impossible to acquire the exact anatomical position of the precordial leads

A

chest or thoracic surgery
chest trauma
presence of skin growth
monitoring equipment

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69
Q

when should a rhythm strip be obtained for evaluation of arrhythmias

A

HR below 40BPM
multifocal or frequent ectopy
any pt. who is not in sinus rhythm

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70
Q

when should double standard be used

A

voltage is too low

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71
Q

conditions associated w/ tamponade

A

trauma
infection
post CPR
neoplastic dx
myocardial rupture
post cardiac surgery

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72
Q

why is a 15-lead ECG done

A

posterior & RVMI

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73
Q

define electrocardiography

A

process of recording the variations of electrical potential produced by the heart

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74
Q

who published the first well known textbook of electrocardiography

A

thomas lewis

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75
Q

who invented the first sensitive and reliable instrument for measuring and recording cardiac potential

A

William Einthoven

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76
Q

What decade was the first portable ECG available?

A

1950

77
Q

Name 3 basic functions of the ECG

A

input
output
signal averaging

78
Q

Electrical signal collected by the ECG is amplified by ____ before it is transmitted to the galvanometer

A

20 000 000 000

79
Q

Resting potential of a pacemaker cell

A

-60mV

80
Q

resting potential of a cardiac cell

A

-90mV

81
Q

Ashmans beat

A

a premature beat with a RBBB morphology

82
Q

what BBB has the longest refractory

A

RBBB

83
Q

Irregular rhythms

A

Sinus arrhythmia
WAP
MAT
AFIB
VFIB

84
Q

Baye’s Theorem

A

describes the probability of an event, based on conditions that may be related to the event

85
Q

2 main effects to sodium-channel blocker poisoning are:

A

seizures
ventricular dysrhythmias

86
Q

What coronary artery supplies the Sinus node

A

RCA

87
Q

what coronary artery supplies the AV node

A

90% RCA and 10% LCA

88
Q

what coronary artery supplies the atria

A

RCA and LCA

89
Q

what coronary artery supplies the right ventricle

A

RCA

90
Q

what coronary artery supplies the left ventricle

A

LCX and LAD

91
Q

Layers of the heart

A

epicardium
myocardium
endocardium

92
Q

Most common cause of CAD

A

athlerosclerosis

93
Q

S1 resembles

A

tricuspid and mitral valves closing

94
Q

S2 resembles

A

semilunar valves closing

95
Q

Galvanometer

A

amplifies current

96
Q

5 nonpathological conditions for ECG changes

A

less than 30 years
advanced age
large body
athletes
thin women

97
Q

Bachmans bundle is the _______ conduction system

A

inter-atrial

98
Q

State the conduction system in order

A

SA node
internodal pathways
AV node
Bundle of His
Left bundle
right bundle
Purkinje fibres

99
Q

Major ECG sign of an anterior wall infarction is

A

loss of normal R wave progression in the chest leads

100
Q

SVT and PAT are the same. Treat with _______

A

Adenosine

101
Q

What is the more common fasicular block?

A

LAFB

102
Q

Fasicular blocks caused the ventricles to be…

A

innervated asynchronously and aberrantly

103
Q

Intrinsicoid Deflection

A

amount of time it takes the electrical impulse to travel from purkinje -> endocardium -> epicardium under an electrode

104
Q

RCA is dominant in ____ and Cirumflex is dominant in ___

A

90% and 10%

105
Q

Hyperkalemia

A

suppression of SA node
reduces conduction of AV node/HIS system
Causes bradycardia, conduction blocks, cardiac arrest

106
Q

Treat Prinzmetals angina w/

A

treat with nitrates and calcium channel blockers

107
Q

Swelling or edema throughout the body

A

Anasarca

108
Q

bifasicular block

A

RBBB combined with LAFB or LPFB

109
Q

trifasicular block vs incomplete trifasicular block

A

Bifascular block + 1st or 2nd degree AV block

incomplete: Bifascicular block + 3rd degree AV block

110
Q

Takotsubo syndrome

A

can be triggered by an intense emotional or physical stress. It causes sudden chest pain or shortness of breath. The symptoms of TCM can look like a heart attack.

111
Q

Dilated cardiomyopathy

A

ECG changes include atrial and ventricular hypertrophy
Most common

112
Q

Hypertrophic cardiomyopathy

A

usually genetic disease, can lead to sudden death bc of VT and VF, needs ICD

113
Q

Restrictive cardiomyopathy

A

stiff and fibrotic ventricles, reduced compliance, usually needs transplant
ECG changes include low voltage QRS, Q waves, BBB, AVB
LEAST common

114
Q

3 Stages of athlerosclerosis

A

development of fatty streak
plaque progression
plaque distribution

115
Q

After an MI, go home w/

A

Beta blockers
ACE inhibitors
ASA (antiplatelet)
Statins

116
Q

Heparin

A

inhibits thrombin, antidote is protamine sulphate

117
Q

Warfarin

A

antidote is vitamin K

118
Q

Persantine

A

anti-anginal agent and anti-platelet agent, antidote is aminophylline

119
Q

INR

A

International Normalized Ratio
the time it takes normal blood to clot and coumadin blood to clot. Coumadin should have an INR btw/ 2-3

120
Q

Alteplase

A

most effective if administered ASP following indications of a clot

121
Q

Steptokinase

A

similar to alteplase but does not have any affinity for clots

122
Q

If a lead conductor was partially fractured…

A

Impedance/resistance would inc.
Current would dec.
Battery energy would be conserved.

123
Q

Complete fracture

A

infinite impedance and no current flow

124
Q

Fractured conductor while insulation remains in tact

A

Resistance/impedance will inc.

125
Q

Normal lead impedance values

A

300-1000 ohms.

126
Q

Unipolar

A

lead tip to can

127
Q

Bipolar

A

lead tip to ring on lead

128
Q

Programming a lower sensitivity value in mV causes the pacemaker to do what?

A

become more sensitive to signals

129
Q

Pacemaker implantation

A

generally implanted subcutaneously under the pectoral muscle in the infraclavicular region

Uses subclavian, internal/external jugular, and cephalic veins

130
Q

Magnet response

A

Prevents sensing, resulting in asynchronous pacemaker operation
Allows assessment of pacemaker function during inhibition

131
Q

Causes of Loss of Capture (7)

A

Lead dislodgement
Lead insulation break
lead wire fracture
battery depletion
electrical circuit failure
Pacing/sensing programmed too high/low
Pacemaker/lead connector issues

132
Q

S3

A

Associated with CHF

133
Q

S4

A

Associated with hypertrophy

134
Q

What occurs during pulseless electrical activity

A

it is not palpable

135
Q

What drugs does someone NOT need after leaving the hospital with a stent

A

anticoagulant, ace inhibitors, beta blockers and CCB

136
Q

What phase does the ST segment represent

A

phase 2

137
Q

Which stage would torsades be triggered at

A

Phase 3 (R on T)

138
Q

Osborn J waves

A

Hypothermia

139
Q

What rhythms do we NOT cardiovert?

A

VF

140
Q

What MI is most commonly associated with death

A

Anterior

141
Q

What 3 things close after birth?

A

Ductus arteriosus, ductus venosus, foramen ovale

142
Q

What would happen in arm lead reversal?

A

P, QRS would be upright in AVR
Negative QRS in Lead I

143
Q

What artery supplies the LATERAL leads

A

Circumflex

144
Q

What artery supplies the INFERIOR leads

A

Right coronary artery

145
Q

What artery supplies the ANTERO-SEPTAL leads

A

Left anterior descending

146
Q

Long QT

A

hypocalcemia
hypokalemia
hypomagnesia
class ia and III antiarrhythmics
tricyclic antidepressents
CNS trauma
ischemia, myocarditis

147
Q

What 2 congenital defects cause long QT

A

Romano-ward
Jervell-Lange-Nielsen

148
Q

Hyperacute

A

ST elevation only

149
Q

Acute

A

Significant Q wave and ST elevation

150
Q

Old

A

Significant Q waves

151
Q

Wenckebach & grouping

A

2nd Degree AV block type I

152
Q

Requirements for re-entry

A

2 different pathways for conduction
conduction is slowed in one of the pathways and failure of conduction
conduction is slower than normal in the unblocked pathway

153
Q

Examples of re-entry arrhythmias

A

AVRT
AVNRT
SVT
AFlutter
AFIB
VT
VF

154
Q

What supplies the inferior wall of the left ventricle

A

RCA

155
Q

What supplies the septal wall

A

LCA

156
Q

What supplies the anterior wall of the LV

A

LCA - LAD

157
Q

What supplies the lateral wall of the LV

A

LCA - Circumflex

158
Q

Indications for ICD

A

VT/VF survivors w/ irreversible etiology
Sustained VT w/ structural heart disease
Syncope with VT/VF
LV ejection fraction of <35%
Post MI LV EF of <30%
Post MI LV EF of <40% with VT/VF

159
Q

What is CHADS

A

a scoring system used by healthcare professionals to calculate a patient’s risk of having a stroke secondary to atrial fibrillation.
Congestive heart failure
Hypertension
Age
Diabetes
Stroke

160
Q

Antidromic Tachycardia

A

Conduction goes down the accessory pathway and back up through the AV-node, causes retrograde conduction - wide QRS

161
Q

Orthodromic Tachycardia

A

Conduction goes through the AV node and then back up through the accessory pathway (normal conduction), causes antegrade conduction - narrow QRS

162
Q

Elevated cardiac enzymes

A

CPK, SGOT

163
Q

What is in blood

A

platelets, serum, plasma (enzymes in plasma)

164
Q

Subarachnoid Hemorrhage

A

will have deeply inverted T waves

165
Q

Atrial flutter

A

one ectopic site in the atrium is firing, usually right atrium in an area called Crista Terminalis
runs counter clockwise

166
Q

Stokes Adams Attack

A

Periods of syncope due to CHB (loss of consciousness)

167
Q

Pacemaker Class 1 Indications

A

3RD DEGREE & ADVANCED SECOND DEGREE AVB:
➢ Symptomatic bradycardia due to AV Block
➢ Documented periods of asystole >3 seconds in duration
➢ Escape rate of <40 bpm while awake; symptom free patients
➢ Post AV junction ablation
➢ Post-OP AVB not expected to resolve
➢ 2nd degree AVB regardless of type or site with associated symptomatic bradycardia

168
Q

Electrical Alternans

A

Pericarditis
Pericardial effusion
pulmonary embolism
cardiac tamponade

169
Q

Dobutamine

A

used to treat shock

170
Q

Aortic Regurgitation

A

Can also be called Water Hammer Pulse because the diastolic BP will decrease in the aorta and pulse pressure will widen

171
Q

4 Components of TOF

A

VSD
Pulmonary stenosis
Overriding Aorta
RVH

172
Q

Coronary Perfusion

A

epicardium to endocardium, ischemia will impair BF to subendocardial layer first

173
Q

3 Major determinants of O2 Demand

A

Ventricular wall stress
HR
Contractility

174
Q

Trendelenburg

A

the body is lain supine, or flat on the back on a 15–30 degree incline with the feet elevated above the head.

175
Q

what test is least commonly ordered for CAD in CHF patients

A

regular gxt (stress test)

176
Q

Cheyne-strokes

A

abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in temporary stop in reaching called apnea. the pattern repeats with each cycle usually taking 30 sec - 2 minutes
Cheyne-strokes is linked to HF + strokes

177
Q

Sgarbossa Criteria

A

Concordant ST elevation > 1mm in leads with a positive QRS complex
Concordant ST depression > 1 mm in V1-V3
Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex

178
Q

What mode should be used for a pt. with AFIB

A

VVI or VVIR

179
Q

Pulseless Electrical Activity
7 H’s
7 T’s

A

Hyperkalemia
Hypoxia
Hypothermia
Hydrogen Ion access
Hypovolemia
Hypoglycemia

Tamponade
Tension Pseumothorax
Thrombosis (Pulmonary embolus)
Thrombosis (MI)
Toxins
Trauma

180
Q

ICDS:
What stores energy?

A

capacitor

181
Q

Arrhtyhmias caused by re-entry (4)

A

SVT, VT, Afib, AFlutter

182
Q

Impulse formation disorders (3)

A

sinus arrest
sinus brady
brady/tachy

183
Q

Impulse conduction disorders (2)

A

exit block, AV block

184
Q

Causes of LVH

A

hypertension
aortic valve stenosis
hypertrophic cardiomyopathy
athletic training

185
Q

RAE causes

A

COPD
pulmonary embolism
pulmonary hypertension
mitral, tricuspid, pulmonary valve disease

186
Q

LAE causes

A

LV failure
restricted cardiomyopathy
HTN
aortic/mitral valve disease

187
Q

What is seen with LAE

A

LBBB
LVH
LAFB

188
Q

What MI is most associate w/ death

A

Anterior (LAD)

CSCT Review (4 decks)

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