EMT254 Flashcards
1
Q
What is the MOST important drug that any pt with chest pain should receive?
A
Oxygen
2
Q
The definition of myocardial ischemia is…?
A
Deprivation of oxygen and other nutrients to the heart muscle with the tendency to produce repolarization abnormalities
3
Q
Pain associated with angina pectoris is temporary—yes/no?
A
Yes
4
Q
The primary goal of management of the pt with symptomatic chest pain is to ___?
A
Interrupt the infarction process
5
Q
ST segment elevation is a primary indicator of ___?
A
Myocardial injury
6
Q
The coronary arteries receive oxygenated blood from the ___?
A
Aorta
7
Q
The most common cause of AMI’s is ___?
A
Thrombus formation
8
Q
The SA node is located in the ___
A
Right atrium
9
Q
When interpreting dysrhythmias, you should remember that the most important key is the ___
A
Patient’s clinical appearance
10
Q
You respond to a 86 y/o female having substernal crushing chest pain. She is anxious, diaphoretic, pale, most likely having an MI and needing definitive care. What does this mean?
A
Thrombolytic treatment in the hospital
11
Q
What are the 5 steps in an initial reading of an ECG?
A
QRS complex P-wave Rate Rhythm PR interval
12
Q
EKG changes of significance with myocardial ischemia include ST segment depression, T wave inversion, or ___?
A
Peaked T wave
13
Q
The V2 electrode is placed where?
A
4th intercostal space, left of the sternum
14
Q
A normal QRS measures how many seconds on the ECG?
A
0.08 - 0.12 (depending on source, could also be 0.08 - 0.10)
15
Q
Augmented leads are defined as ___?
A
1 positive electrode and 2 or 3 negative electrodes
16
Q
Name the two lead placements as related to lead II
A
(+) left leg
(-) right arm
17
Q
Name the lead placements as related to aVF
A
(+) left leg
-) central terminal (right arm and left arm
18
Q
A small box on the EKG paper equals how many seconds of time?
A
0.04 seconds
19
Q
The normal PR interval is ___?
A
0.12 - 0.20 seconds
20
Q
How many seconds is a large box on ECG paper?
A
0.20 seconds
21
Q
What does ST segment elevation indicate on an ECG?
A
Injury
22
Q
What is the significance of a pathological Q wave?
A
Infarct (either old or new)
23
Q
Define Starling’s law
A
When the volume of blood in the ventricles is increased, stretching the ventricular myocardial fibers, it results in a more forceful contraction
24
Q
Where is the positive electrode in lead III?
A
Left leg
25
What is the intrinsic rate of the ventricles?
20-40 bpm
26
What is the measurement of one small square on ECG paper?
1 mm
27
What are the two measurements on ECG paper?
Amplitude (vertical axis)
| Time (horizontal axis)
28
What occurs during depolarization?
Sodium ions rush in, causing contraction
29
The movement of potassium through the cell membrane is what type of process?
Active transport
30
Is a foreign body obstruction a respiration or a ventilation problem?
Ventilation
31
Unstable atrial fibrillation should be electrically treated how?
Sync cardiovert @ 120J
32
What does the term "blue bloater" refer to?
A pt with chronic bronchitis
33
What size ET tube would you choose for a surgical cric?
6.0-7.0
34
Right or left coronary arteries larger?
Left
35
What is coronary circulation?
The process of oxygenated blood being distributed throughout the heart muscle
36
What are the two branches of the left coronary artery?
Left anterior descending
| Left circumflex
37
What are the two branches of the right coronary artery?
Right marginal
| Right posterior descending
38
Which artery is the major branch of the left coronary artery?
Left anterior descending
39
The posterior descending branch of the right coronary artery also supplies blood to what part of the heart?
The posterior and inferior part of the heart's left ventricle
40
The short trunk that serves to receive deoxygenated blood from the veins of the myocardium is called the ___.
Coronary sinus
41
ST depression is indicative of ___.
Ischemia
42
Where is the carina located?
Under the angle of Louis
43
What is the innermost layer of the heart called?
Endocardium
44
Where is the SA node located?
In the right atrium
45
What is the normal pH of blood?
7.35 - 7.45
46
What is the quality of angina?
Constriction, narrowing
47
What is the most common cause of myocardial infarction?
Thrombus
48
What is the most appropriate intervention that assists as a dysrhythmic?
Oxygen
49
What leads picture the inferior part of the heart?
II, III, and aVF
50
What leads picture the lateral part of the heart?
I, aVL, V5, and V6
51
What leads picture the septal part of the heart?
V1 and V2
52
What leads picture the anterior part of the heart?
V3 and V4
53
What is the name of the valve between the right atrium and right ventricle?
Tricuspid valve
54
What is the first treatment of an MI?
Oxygen
55
Definition of reciprocal changes?
ECG changes that occur in reciprocal leads
Appear on an ECG as opposite changes in leads that visualize opposite sides of the heart (e.g. elevation in one set of leads vs depression in an opposite set of leads)
56
The anterior part of the heart is mostly supplied by what coronary artery?
Left anterior descending
57
The left anterior descending is also known as what due to its high incidence of mortality of occluded?
Widowmaker
58
Inferior wall infarctions are commonly associated with what artery?
Right coronary artery
59
The six branches off the left anterior descending are known as what?
Septal perforating arteries
60
Septal MIs will primarily involve what artery?
Left anterior descending
61
When using the R-R method, how do you calculate a rate based on the number of seconds?
Count the number of seconds between R-R, and divide into 60
62
When using the R-R method, how do you calculate a rate based on large boxes?
Count the number of large boxes between R-R, and divide into 300
63
When using the R-R method, how do you calculate a rate based on small boxes?
Count the number of small boxes between R-R, and divide into 1500
64
What is the term for 3x PVCs in a row?
Salvo
| Or a run of v-tach
65
What does CHAPS stand for?
```
Chest pain
Hypotension
Altered mental status
Pulmonary edema
Syncope/shock
```
66
What is the setting for cardioversion of SVT?
50J
67
What is the normal axis of the heart?
+90 degree to 0 degrees
68
The fibrous sac covering the heart, which is in contact with the pleura, is called the ___.
Pericardium
69
The heart chamber with the thickest myocardium is the ___.
Left ventricle
70
The pulmonic and aortic valves are open during ___.
Systole
71
The large blood vessel that returns unoxygenated blood from the head and neck to the right atrium is called the?
Superior vena cava
72
The innermost layer of the arterial wall is the ___.
Tunica intima
73
The most numerous blood vessels in the body are the ___.
Capillaries
74
Blood flow between the heart and the lungs comprises the ___.
Pulmonary circulation
75
___ are fine chords of dense connective tissue that attach to papillary muscles in the wall of the ventricles.
Chordae tendineae
76
The right and left coronary arteries branch off the ___.
Trunk of the aorta
77
The central section of the thorax is called the ___.
Mediastinum
78
The smooth outer surface of the heart is known as the ___.
Epicardium
79
An inflammation of the serous pericardium is called ___.
Pericarditis
80
T/F - The left side of the heart is referred to as a low-pressure pump.
False
81
Cardiac output is a product of which elements?
Heart rate x Stroke volume
82
The chief chemical neurotransmitter for the parasympathetic nervous system is ___.
Acetylcholine
83
The heart has ___ chambers.
Four
84
The chief chemical neurotransmitter for the sympathetic nervous system is ___.
Norepinephrine
85
Unoxygenated blood flows from the inferior/superior vena cavae into the ___.
Right atrium
86
One cardiac cycle occurs every ___ seconds.
0.8
87
What kind of receptors do the body's blood vessels have? The only exception?
Alpha-adrenergic receptors
| Exception: capillaries
88
What kind of receptors do the heart and lungs have?
Beta-adrenergic receptors
89
The end-diastolic pressure reflective of volume in the ventricles during diastole is called ___.
Preload
90
The nerve endings of the sympathetic nervous system are called ___.
Adrenergic
91
Stroke volume is estimated as ___ cubic centimeters per beat.
70
92
The primary functions of the myocardial working cells include: (2)
Contraction
| Relaxation
93
The ability of cardiac pacemaker cells to spontaneously generate their own electrical impulses without external (or nervous) stimulation is known as ___.
Automaticity
94
Which of the characteristics of myocardial cells is specific to the pacemaker cell sites of the electrical conduction system?
Conductility
95
The ability of cardiac cells to respond to an electrical stimulus is known as ___.
Excitability
96
Excitability is also referred to as ___.
Irritability
97
The ability of cardiac cells to receive an electrical stimulus and to then transmit the stimulus to other cardiac cells is known as ___.
Conductivity
98
T/F - Conductivity is a characteristic shared by all cardiac cells.
True
99
Cardiac muscle cell groups that function collectively as a unit are known as ___.
Syncytia
100
T/F - Repolarization is a slower process than depolarization.
True
101
The period during which repolarization is almost complete and the cardiac cell can be stimulated to contract prematurely if the stimulus is stronger than normal is known as ___.
Relative refractory period
102
The relative refractory period is also known as the ___ period.
Vulnerable
103
A decrease in sodium blood levels is called ___.
Hyponatremia
104
An increase in calcium blood level is called ___.
Hypercalcemia
105
The resting state of a cardiac cell, wherein the inside of the cell is electrically negative relative to the outside of the cell, is called ___.
Polarized state
106
The point at which a stimulus will produce a cell response is called the ___.
Threshold
107
The AV node is located in the ___.
Atrioventricular septum
108
The intrinsic firing rate of the AV junction is ___.
40-60 bpm
109
The intrinsic firing rate of the SA node in the adult is ___.
60-100 bpm
110
The ECG is used to ___.
Evaluate electrical activity in the heart
111
The primary pacemaker of the heart is the ___.
SA node
112
The bundle of His is also traditionally referred to as the ___.
Common bundle
113
T/F - The fibers of the Purkinje network can only be identified with the aid of a microscope.
True
114
A group of interatrial fibers contained in the left atrium is referred to as ___.
Bachmann's bundle
115
The interventricular septum is the wall between the ___.
Right and left ventricle
116
T/F - Purkinje's network fibers are smaller in diameter than ordinary cardiac muscle fibers.
False
117
The SA node receives its blood supply primarily from the ___.
SA artery
118
Ventricular diastole refers to ventricular ___.
Relaxation
119
The single-lead ECG primarily is used to ___.
Evaluate electrical activity in the heart
120
The PR interval should normally be ___ seconds or smaller.
0.20
121
The QRS interval should normally be ___ seconds or smaller.
0.12
122
The point at which the QRS complex meets the ST segment is known as the ___.
J point
123
How many cardiac monitor pads are utilized when obtaining a 12-lead ECG?
10
124
The change of the QRS complex from a negative deflection to a positive deflection in the V leads is called ___.
R wave progression
125
In the aVR lead, the T waveforms are ___ deflected.
Negatively
126
In the aVL lead, the T waveforms are ___ deflected.
Biphasic
127
In the aVF lead, the T waveforms are ___ deflected.
Positively
128
The augmented leads may be referred to as ___.
Unipolar
129
The intrinsic firing rate of the AV node is ___.
40-60 bpm
130
The 12-lead ECG cannot be used to evaluate ___.
Valvular dysfunction
131
The T wave on the ECG strip represents ___.
Rest period
132
The development of pathologic Q waves indicates ___.
Irreversible tissue damage
133
The right and left coronary arteries branch off of the ___.
Proximal portion of the aorta
134
Collateral circulation allows for ___.
Alternate path of blood flow in the event of occlusion
135
Myocardial infarction is due to ___.
Myocardial cell death
136
T/F - In acute MIs, chest pain is long in duration and not relieved by nitroglycerin.
True
137
T/F - Patients experiencing an AMI will always complain of chest pain.
False
138
Timely assessment and management including immediate O2 administration must be rapidly completed within a ___ minute time interval.
10
139
The function of the chordae tendineae and papillary muscles is to ___.
Prevent backflow of blood into the atrium
140
The right atrium receives deoxygenated blood from the myocardium via the ___.
Great cardiac vein
141
The coronary sinus returns deoxygenated blood from the ___.
Myocardium
142
Most cardiac dysrhythmias are caused by ischemia secondary to hypoxia; therefore, the most appropriate drug to give a patient with any dysrhythmia is ___.
Oxygen
143
Defined as death of the myocardial tissue, a myocardial infarction commonly results from ___.
Myocardial necrosis
144
One ECG change you would not expect to see as a result of myocardial ischemia/injury/necrosis is ___.
PR interval prolongation
145
The development of pathologic Q waves often begins within the first 2 hours after the MI and, in most cases, is complete within ___ hours.
24
146
T/F - ST segment depression may be evident on a 12-lead ECG strip following both angina and strenuous exercise.
True
147
With myocarcial injury, the most significant and frequently identifiable change is ___.
ST segment elevation
148
A Q wave is considered abnormal when? (width and height)
If it is greater or equal to 0.04 seconds (one small box) in width
And has a depth of greater than 1/3 of the height of the succeeding R wave
149
Inferior wall infarctions are associated with which artery:
Right coronary artery
150
A pt with JVD and hypotension may be indicative of what type of infarct?
Right ventricular infarction
151
The anterior surface of the heart is supplied oxygen and blood from the:
Left anterior descending
152
The lateral wall of the left ventricle is supplied oxygen and blood from the:
Left marginal branch
153
The posterior wall of the heart is supplied oxygen and blood from the:
Right posterior descending
154
The coronary artery that is the largest of the coronary arteries and is termed the "Widowmaker" is the ___.
Left anterior descending
155
What do "crackles" heard during assessment of the lungs signify?
Congestive heart failure
156
Which of the types of blocks are more common with anterior MIs?
Mobitz type II
Third degree AV block
Bundle branch blocks
157
Which of the types of blocks are more common with lateral MIs?
Mobitz type II
Third degree AV block
Bundle branch blocks
158
Which leads are facing leads for the septal wall of the myocardium?
V1, V2
159
Which leads are facing leads for the lateral wall of the myocardium?
I, aVL, V5, V6
160
Which leads are facing leads for the anterior wall of the myocardium?
V3, V4
161
Two primary structures that are responsible for delivering oxygen-rich blood to the myocardium are the ___.
Coronary arteries
162
There are ___ main coronary arteries.
Two
163
Myocardial infarctions may be classified as either transmural or ___.
Subendocardial
164
Subendocardial infarctions are commonly referred to as ___.
Nontransmural
165
T/F - ECG findings of infarction may occur in a single lead or in a combination of leads.
True
166
If the pt is hypotensive and is exhibiting ECG changes consistent with an inferior MI, you should consider ___.
Right ventricular MI
167
Reciprocal leads for the inferior MI are leads:
I and aVL
168
When obtaining a right-sided ECG, the leads that should be moved are:
V3, V4, and V5
169
A non-Q wave MI is consistent with:
Nontransmural
170
T/F - Generally, anterior MIs tend to involve a larger muscle mass than do inferior MIs.
True
171
The ___ branch of the left coronary artery supplies blood to the lateral wall of the left ventricle.
Marginal
172
The ___ branch of the left coronary artery extends around to the posterior side of the heart and its branches supply blood to much of the posterior wall of the heart.
Circumflex
173
Because of its size and the large amount of myocardium that it supplies, massive infarction may result if the ___ becomes totally occluded.
Left anterior descending
174
Leads V3 and V4 visualize the ___ wall of the heart's left ventricle.
Anterior
175
In addition to the occurrence of ST elevation, ___ and the evolution of significant Q waves in leads V3 and V4 may indicate anterior myocardial infarction.
T wave inversion
176
Due to the large degree of myocardial muscle involvement, ___ MIs have a greater predisposition for the development of complications such as lethal ventricular dysrhythmias and cardiogenic shock.
Anterior
177
T/F - Anterior infarctions tend to result in hyperactivity of the sympathetic nervous system.
True
178
Anterior MIs are associated with the development of ___.
Third-degree heart blocks
179
T/F - Loss of R wave progression rarely occurs with anterior MIs.
False
180
The reciprocal lead changes in the anterior MI, though uncommon, are:
II, III, and aVF
181
Generally, an MI that involves the interventricular septum will also involve the ___ of the heart.
Left ventricle
182
The left anterior descending artery has six branches called:
Septal perforating arteries
183
Other branches of the left anterior descending are called ___ arteries and supply blood to the anterolateral wall of the left ventricle.
Diagonal
184
The left and right halves of the heart are divided by a wall called the ___.
Septum
185
The ___ septum is located between and divides the two atria.
Interatrial
186
The ___ septum is located between and divides the two ventricles.
Interventricular
187
T/F - Pathologic Q waves are not an early indicator or ECG finding, but occur as later evidence of myocardial tissue damage.
True
188
To diagnose an acute septal MI, evidence of ___ must be present in leads V1 and V2.
ST segment elevation
189
T/F - Electrical conduction system dysrhythmias are a common occurrence in patients with septal MIs.
True
190
ST elevation in leads V1, V2, V3, and V4 are indicative of ___ MI.
Anteroseptal
191
T/F - The anatomy of some individuals varies slightly, especially with respect to the distribution areas of the coronary arteries.
True
192
T/F - ST elevation that resembles the appearance of a tombstone signifies that the occurring ischemia and injury is massive in nature and is a very serious and acute finding.
True
193
T/F - Myocardial infarctions of the lateral wall of the heart most commonly occur as a result of an extension of anterior and/or inferior wall MIs.
True
194
Pathologic Q waves indicate:
Necrosis
195
The concept of poor R wave progression refers to the absence of R waves in lead:
V2
196
An example of a high-degree block is:
Third-degree block
197
Placement of posterior lead V7 is where?
5th intercostal space, posterior axilla
198
Placement of posterior lead V8 is where?
5th intercostal space, midscapula
199
Placement of posterior lead V9 is where?
5th intercostal space, 2 cm left of the spine
200
When conducting the mirror test, the mirror should be placed ___ the V leads of the 12-lead ECG
Above
201
Which disease processes can be expected in left axis deviation?
Wolff-Parkinson-White syndrome
| think not related to lungs
202
Which disease process can be expected in right axis deviation?
COPD
| think related to lungs
203
Right bundle branch terminates where?
Papillary muscles
204
Time measurement for incomplete BBBs? Complete BBBs?
```
Incomplete = 0.10-0.11 seconds
Complete = 0.12 seconds or greater
```
205
The maximum benefit of fibrinolytic therapy is best achieved when the agent is administered within ___ hours after onset.
6 hours
206
The major complication associated with fibrinolytic therapy is:
Hemorrhage
207
One common complication associated with transcutaneous pacing?
Pain
208
Synchonized cardioversion is designed to deliver the shock when?
10 ms after the peak of the R wave
209
Three routes of administration for lidocaine?
IV, IO, ET
210
Verapamil is an:
Antidysrhythmic
211
The administration of an IV solution by regulating its flow rate based upon observation or desired or undesired effects is called:
Titration
