CVS

Question 1

Types of Heart Blocks

Answer 1

First Degree
Second Degree (Type 1 Mobitz)
Second Degree (Type 2)
Third Degree

Question 2

First Degree Heart Block

Answer 2

• all atrial impulses are conducted through AV node into the ventricles but at a rate slower than normal.
• Rate of P waves to QRS is 1:1
• PR intervals are extended longer than 0.20 seconds
• Atrial and ventricular rate/rhythm depend on underlying rhythm
• P wave and QRS should be normal

Question 3

Second Degree, Type 1 (Mobitz) Heart Block

Answer 3

• When all but one of the atrial impulses are conducted through the AV node into ventricles.
• Each atrial impulse takes longer (extended PR interval) to be conducted than the previous one until one impulse is fully blocked.
• Ratio of P waves to QRS is > than 1:1
• QRS shape and duration is usually normal

Question 4

Second Degree, Type 2 Heart Block

Answer 4

• When only some of the atrial impulses are conducted through the AV node into ventricles.
• PR interval is consistent when they are followed by QRS complexes, normal length
• QRS shape and duration is usually abnormal
• Usually atrial rhythm is regular but RR may be irregular
• Ratio of P waves to QRS is > than 1:1

Question 5

Third Degree

Answer 5

• No atrial impulse is conducted through the AV node into ventricles.
• Two impulses stimulate the heart. One stimulates the ventricles (junctional or ventricular escape rhythm), represented by QRS complex. Another stimulates the atria (sinus rhythm or atrial fibrillation), represented by P wave.
• P waves can be seen but electrical activity is not conducted down into the ventricles to cause QRS complex, called AV dissociation.
• PP and RR intervals are regular but not related to each other.
• QRS shape and duration depend on whether a junctional or ventricular escape rhythm is present
• PR interval is irregular
• Ratio of P waves to QRS complexes is > than 1:1

Question 6

Treatment of Heart Block

Answer 6

• Based on cause of block and patient stability
• Goal: increase heart rate to maintain normal cardiac output
• Symptomatic if patient has: SOB, chest pain, dizziness, or low BP
• IV bolus of atropine is initial treatment
• If patient does not respond to atropine or has an acute MI TCP should be started
• Permanent pacemaker may be necessary for a chronic block

Question 7

Normal ECG waveform
P wave
PR interval
QRS

Answer 7

P wave < 0.10
PR = 0.12 - 0.20
QRS = < 0.12
ST depression or elevation > 0.5mm is a concern

Question 8

Total Cholesterol

Answer 8

This is the sum of HDL, LDL and VLDL

Desirable levels are >200mg/dL (<5.2mmol/L)

Question 9

HDL (high-density lipoprotein)

Answer 9

“Good cholesterol”
Binds with fat from the body in the bloodstream and carries it to the liver
May confer anti inflammatory and antioxidant benefits on the arterial wall (Barter, 2004)
HDL levels are generally higher in women
Exercise and smoking cessation can help raise HDL levels (Scruth & Haynes, 2011)
Desirable level >40mg/dL (<1.00mmol/L)

Question 10

LDL (low-density lipoprotein)

Answer 10

“Bad cholesterol”
Carries fat from the liver to other parts of the body
High levels are associated with increased risk of coronary artery disease, peripheral artery disease and stroke.
Desirable level <2.00mmol/L)

Question 11

VLDL: (very low-density lipoprotein)

Answer 11

Primary carrier of triglycerides in the blood
Distributes the triglycerides produced by the liver, then is reduced to LDL
Not usually mentioned during routine cholesterol screening, as there is no direct way to measure it. Its value is estimated as a percentage of the triglyceride level.
Desirable level <1.67mmol/L)

Question 12

Triglycerides

Answer 12

Carried by VLDL
High triglyceride level along with a high LDL cholesterol increases risk for CAD more than having a high LDL cholesterol level alone.
Desirable level <1.7mmol/L)

Question 13

Antihypertensive medications

Answer 13

diuretics, 
beta-blockers
ACE inhibitors, 
angiotensin II receptor blockers
Calcium antagonists

Question 14

SAMPLE history

Answer 14

Signs and Symptoms
Allergies
Medications
Past medical history, injuries, illnesses
Last meal/intake
Events leading up to the injury and/or illness

Question 15

CARDIAC history

Answer 15

Chest pain
Ankle swilling
Reduced exercise tolerance
Dysnpoea, orthopnea
Irregular heart beat and palpitations
Altered colour of lips or cyanosis
Conciousness reduced or LOC

Question 16

PQRST

Answer 16

Preceding events
Quality
Radiating
Severity
Time

Question 17

Cardiac enzymes

Answer 17

Creatine kinase (CK),
Creatine kinase–myocardial band isofraction (CK-MB), Troponin I
Troponinin II

Question 18

S/S of MI

Answer 18

Sudden chest pain or discomfort, palpitations
Heart sound may include S3 , S4
Tachycardia, bradycardia, or dysrhythmias
Shortness of breath, dyspnea, tachypnea,
Nausea and vomiting; Indigestion
Anxiety, restlessness, light-headedness
Cool, pale, and moist skin
Patient history of presenting symptoms and previous illnesses, and family history of heart

Question 19

Pharmacology for MI

Answer 19

fibirinolytic therapy: alteplase, reteplase, or tenecteplase, as fibrinolytic therapy,
infusion of heparin or enoxaparin, as antithrombotic therapy to prevent rethrombosis,
clopidogrel to inhibit platelet aggregation
beta-blocker to prevent ventricular arrhythmias and ischemia;
nitroglycerin for angina;
atorvastatin to reduce cholesterol levels;
alprazolam for anxiety; and
morphine sulfate for pain