FINALS Flashcards
What represents ventricular repolarization in an ECG?
T-wave
Where is the V1 electrode placed in a standard ECG?
Fourth intercostal space just to the right of the sternum
Which lead does not record the electrical activity of the heart in the lateral area?
Lead III
What percentage of cross-sectional diameter reduction can cause angina?
70%
What condition has no regularity shape of the QRS complex because all electrical
activity is disorganized and there are no P waves or PR intervals present?
Ventricular Fibrillation
Where is the V4 electrode placed in a standard ECG?
Fifth intercostal space in the mid-clavicular line
Which finding is associated with a PR interval > 0.22 seconds?
First-degree AV block
What represents atrial depolarization in an ECG?
P-wave
Where is the RA electrode placed in a standard ECG?
On the right arm, avoiding thick muscle
Which condition has a ventricular rate usually between 150 and 250 beats per
minute, with variable ventricular complex?
Irregular Wide Complex Tachycardia
What is the most common cause of injury to the intimal walls of the artery?
Hypertension
What is the most common cause of injury to the intimal walls of the artery?
Hypertension
What condition has a ventricular rate less than 60bpm, but usually more than
40bpm, with a consistent PR interval between 0.12 and 0.20 seconds in duration?
SInus Bradycardia
Which enzyme peaks at 24-36 hours following a major myocardial injury?
Creatine kinase-myocradial band
Which lead uses the positive electrode on the left leg and a combination of the
right arm and left arm electrodes as the negative pole?
Lead II
Is high blood pressure, with a systolic blood pressure of 130
mmHg or higher, and/or a diastolic blood pressure of 80 mmHg or higher?
Hypertension
is the pressure in the arteries when the heart contracts
Systolic Blood Pressure
is the pressure in the arteries when the heart is relaxed between beats
Diastolic Blood Pressure
is swelling in the legs, ankles, and feet due to the accumulation of
fluid in the tissues
Peripheral Edema
is the accumulation of fluid in the lungs, which can cause difficulty breathing,coughing and other respiratorty symptoms.
Pulmonary Edema
is a complication of untreated streptococcal pharyngitis (strep
throat) that can cause damage to the heart valves and lead to rheumatic heart disease.
Rheumatic Heart Fever
is a congenital heart defect that consists of four abnormalities: a
ventricular septal defect (a hole between the right and left ventricles), pulmonary
stenosis (narrowing of the pulmonary valve and artery), right ventricular hypertrophy
(enlargement of the right ventricle), and an overriding aorta (the aorta is shifted to the
right and receives blood from both the right and left ventricles).
Tertalogy of Fallot
can lead to cardiac muscle disease through a process called hypertensive
heart disease. When blood pressure is consistently elevated, it causes the heart to work
harder to pump blood against the increased resistance in the blood vessels. Over time,
this increased workload can cause the heart muscle to thicken and become stiff, a
condition called left ventricular hypertrophy (LVH). LVH can lead to a variety of
complications, including diastolic dysfunction, systolic dysfunction, and other
conditions that can lead to heart failure, arrhythmias, and other complications.
Hypertension
What are the two hallmark symptoms of right-sided heart failure?
Peripheral Edema, Jugular Venous Distension
A score of _ on the modified Berg Scale indicates that the person is able
to perform activities with moderate difficulty, but can continue with activity
7
is a bulge or weakening in the wall of an artery, which can develop in
various locations throughout the body.
Aneurysm
it can cause internal
bleeding and life-threatening complications
Aneurysm Ruptures
is the most common form
of heart disease. It is the result of atheromatous changes in the
vessels supplying the heart.
Coronary Artery Disease
is used to describe a range of clinical disorders from
asymptomatic atherosclerosis and stable angina to acute coronary
syndrome
Coronary Artery DIsease
A stenosis of >50% of diameter
or >75% cross-section diameter
reduction can lead to?
Angina
Thrombus formation after
plaque disruption can lead
to
Acute Coronary syndrome
Symptoms of CAD are not
experienced until the lumen is
at least how many percent occluded.
70%
Most myocardial infarctions occurred in the______ and _______?
Right coronary artery and Left anterior descending artery
the new terminology for ischemic heart disease or CAD.
Acute coronary syndrome
It involves a spectrum of entities ranging from the least involved condition
on the spectrum (unstable angina) to the worst involved condition (sudden
cardiac death).
Acute Coronary Syndrome
cardiac-related chest pain, is due to ischemia.
Angina
is a temporary condition due to the imbalance between the
myocardial oxygen supply and demand.
Ischemia
It is chest pain that increases in severity, frequency, and duration and
is refractory to treatment.
Unstable angina
when angina occurs during exercise or activity. Chest pain is
experienced at a certain intensity of exercise when the myocardial
oxygen demand exceeds the blood supply to the myocardium and is
alleviated by decreasing the MVO2.
stable angina
caused by a vasospasm of coronary arteries in the absence of
occlusive disease.
Variant or Prinzmetal angina
preferred long-term pharmacological choice for variant angina
Calcium Channel Blockers
results from interruption of myocardial blood flow and resultant
ischaemia and is a leading cause of death worldwide
Myocardial infraction
can occur in those with poor visceral sensation
(diabetics, post-cardiothoracic surgery) and may manifest with other
symptoms of myocardial compromise, e.g. breathlessness
Silent ischaemia
is a complex clinical syndrome that results from
either functional or structural impairment of ventricles resulting in
symptomatic left ventricle (LV) dysfunction.
Congestive Heart Failure
It can result from disorders of the pericardium, myocardium,
endocardium, heart valves, great vessels, or some metabolic
abnormalities
Congestive Heart Failure
is the first presentation of heart failure or a sudden onset of
heart failure
Acute CHF
is when heart failure is recurrent or episodic
Transient CHF
is heart failure that is persistent, worsening, or
decompensate (to lose ability to function).
Chronic CHF
This is the most common form of heart failure, gradually pushing up
the pressure in the left atrium and pulmonary vascular system. The
resulting pulmonary hypertension may force fluid into the alveoli
creating pulmonary edema.
Left Ventricular Failure
This generally occurs secondary to cardiopulmonary disorders such as
pulmonary hypertension, right ventricle infarction, congenital heart
disease, pulmonary embolism or COPD.
Right Ventricular Failure
occurs from direct insult to the RV caused by conditions that increase
PA pressure.
Right-sided heart failure
Symptoms can be reflective of both left and right-sided heart failure, including shortness of breath and swelling due to a build-up of fluid
Biventricular heart failure
Increased peripheral arterial pressure contributes to increased afterload and pathological hypertrophy of the left ventricle.
Hypertension
Acute injury to myocardial tissue damages ventricular contractility causing systolic
dysfunction. Scar formation seen in infracted tissue alters relaxation and may lead to diastolic dysfunction.
Coronary Artery Disease
Normal electrical conduction through the heart allows for normal mechanical contraction of the ventricles. Altered electrical conduction alters the mechanical activity of the ventricles
exacerbating heart failure.
Cardiac Dysrhythmias
Cardiac valve pathology (stenosis or regurgitation) causes structural changes to the chamber behind the valve resulting in
cardiac muscle dysfunction and failure.
Valve Abnormalities
Damage to the myocardial cells from various pathological processes alters the systolic and/or diastolic function of the ventricles
Cardiomyopathies
Inflammation of the pericardium
Pericarditis
An abnormal dilatation in
the arterial wall, vein or the
heart
Aneurysm
three common sites of aneurysm
Thoracic, Peripheral and Abdominal
a bluish color of the skin, nail beds, and possibly lips and tongue, may be present when arterial oxygen saturation is 85% or less.
Cyanosis
the absence of a pink, rosy color, may indicate a decrease in CO.
Pallor
(excess sweating, cool clammy skin) should also be noted because it may indicate excessive effort or inadequate cardiovascular response
Diaphoresis
these drugs help relax and widen the blood vessels, reducing blood pressure.
ACE Inhibitors
Lisinopril, Enalapril, Captopril, Ramipril are all examples of what type of cardiovascular drug
ACE inhibitors
what do ACE inhibitor drugs end in?
-pril
they reduce the effects of adrenaline and related hormones, which typically increase heart rate and constrict blood vessels. They slow down the heart rate and lower blood pressure.
Beta Blockers
Metoprolol, Propranolol, Atenolol, Carvedilol are all examples of what type of cardiovascular drugs?
Beta blockers
What do Beta blockers end in?
-olol
prevent calcium from entering the cells of the heart and blood vessels. This action relaxes and widens the blood vessels, allowing for better blood flow and reducing the workload on the heart. They also help lower blood pressure.
Calcium Channel Blockers
Amlodipine, Nifedipine, Verapamil, Diltiazem are all examples of what type of cardiovascular drug?
Calcium Channel Blockers
what are the two endings of Calcium channel blockers?
-pine and -zem
act on specific kidney receptors to balance potassium and sodium levels in the body.
Diuretics
Hydrochlorothiazide, Furosemide, Spironolactone, Chlorthalidone are all examples of what cardiovascular durg ?
Diuretics
What are the two endings of Diuretics?
-ide and -ctone
Hearts Location *3 pinpoints
Centrally, Substernally and tilted to the Left
one third of the heart is located on the
right side
two-thirds of the heart is located on the
left side of the midline
the base of the heart is located
below the third rib as it approaches the sternum
the base of the heart is directed superiorly to the ____ of _____ and _______
right of midline and posterior
the pointed apex of the heart projects to the ______ of the ______ and _________
to the left of the midline and anterior
the outer layer of the wall of
the heart and is formed by the visceral
layer of the serous pericardium.
Epicardium
the muscular middle
layer of the wall of the heart and has
excitable tissue and the conducting
system. It is composed of three
discernable layers of muscle that are
seen predominantly in the left ventricle
and inter-ventricular septum alone.
Myocardium
The three layers of the myocardium
-Subepicardial layer
-Middle concentric layer
-Subendocardial layer
the innermost
layer of the heart is formed of the
endothelium and subendothelial
connective tissue
Endocardium
Receives oxygenated blood from the lungs via the left and right pulmonary veins.
Left atrium
what veins enter the heart as two pairs of veins inserting posteriorly and
laterally into the left atrium.
pulmonary
the smallest pulmonary veins are called
thebesian
what veins drain
deoxygenated blood from the atrial myocardium directly into the left atrium.
thebesian
is found midline, posterior to the right atrium and superior to the
left ventricle.
left atrium
the walls of the atrial appendage are
pectinate
the walls of the left atrium are
smooth
the left atrium discharges into the left ventricle through the ______ valve
mitral valve
Region of the right atrium: smooth-walled
posterior
other name for posterior part of the right atrium
sinus venarum
Region of the right atrium:which is lined by horizontal, parallel ridges of muscle bundles
that resemble the teeth of a comb
Anterior part
other name for the anterior part of the right atrium
pectinate muscle
receives both the superior and inferior venae cavae and the
coronary sinus. It also contains the fossa ovalis, the sinoatrial node and the
atrioventricular node. *septum
Atrial septum
location of the atrial septum
Right atrium
where in the right atrium is the tricuspid valve attached to *septum
membranous septum
It pumps blood throughout the body via the aorta.
Left ventricle
The ______________ septum appears from within the left ventricle to bulge into
the right ventricle; this creates a barrel-shaped left ventricle.
interventricular septum
It pumps blood to the lungs through the pulmonary trunk and arteries.
Right Ventricle
Part of the right ventricle: extends from tricuspid annulus to the insertions of the papillary
muscles.
The inlet
this septum separates the left and right ventricular outflow tracts and is located just inferior
to both semilunar valves
infundibular septum
consists of three semilunar cusps with free edges
projecting upward into the lumen of the pulmonary trunk thus
prevents the backflow of blood as it is pumped from the right
ventricle to the pulmonary artery.
pulmonary valve
prevents the backflow of blood as it is pumped from the right atrium
to the right ventricle.
tricuspid valve
thus prevents the backflow of blood as it is pumped from the left
ventricle to the aorta.
aortic valve
It prevents the backflow of blood as it is pumped from the left atrium
to the left ventricle and are continuous with each other at the
commissures.
Mitral valve
other name for mitral valve
bicuspid valve
The left atrium via the anterior interventricular branch is supplied by the
Left Coronary Artery
The right coronary artery supplies the right atrium via which branch
atrial branch
Venous drainage of the heart:
is a wide venous channel that runs from left to right in the posterior part of the coronary
groove. It receives the great cardiac
vein at its left end and the middle
cardiac vein and small cardiac veins at
its right end.
Coronary sinus
Venous drainage of the heart:
is the main tributary of the coronary
sinus and it drains the areas of the heart supplied by the LCA.
great cardiac vein
Venous drainage of the heart:
begin over the anterior surface of the
right ventricle, cross over the coronary groove, and usually end directly in the right atrium; sometimes they enter the small cardiac
vein.
anterior cardiac veins
Nerve Supply:
decreases heart rate, reduces force of contraction and constricts the coronary
arteries.
Parasympathetic preganglionic fibers
Nerve supply:
increases heart rate and increases the
force of contraction.
Sympathetic fibers
Nerve Supply:
from the heart, a part of the cardiac plexus pass
through the cardiac plexus and return to the central nervous system in the cardiac nerves from the sympathetic trunk and in the vagal cardiac branches.
Visceral afferents fibers
Conduction System of the Heart:
an excitation signal (an action potential) is created by the
Sinoatrial (SA) Node
Conduction System of the Heart:
delays action potential signal
Atrioventricular (AV) node
Conduction System of the Heart:
spreads the wave impulses along the ventricles,causing them to contract.
*2 items
Bundle of HIS and Purkinje fibers
Conduction System of the Heart:
is a collection of specialised cells (pacemaker
cells), and is located in the upper wall of the right atrium, at the junction where the superior vena cava enters.
Sinoatrial (SA) node
Conduction System of the Heart:
conducts the impulse to the Purkinje fibres of
the right ventricle
Right bundle branch
Conduction System of the Heart:
conducts the impulse to the Purkinje fibres of
the left ventricle.
Left bundle branch
Conduction System of the Heart:
are a network of specialised cells. They are abundant with glycogen and have extensive gap junctions.
Purkinje Fibers
Heart Sounds:
“lub”,closure of AV valves
s1
Heart sounds:
“dub”,closure of SL valves
s2
Heart sounds:
“dub”,closure of SL valves
s2
Heart sounds:
occurs soon after s2
s3
Heart sounds:
occurs just before s1
s4
– Refers to the amount of time required for refill after compression of a nailbed, and indicates perfusion status.
Capillary Refills
Auscultation:
2(R) ICS
Aortic
Auscultation:
2(L) ICS
Pulmonic
Auscultation:
5(L) ICS
Mitral
Auscultation:
4(L) ICS
Tricuspid
Palpation:
3(L) ICS
Aortic
Palpation:
3(L) CC
Pulmonic
Palpation:
4(L) CC
Mitral
Palpation:
4(R) ICS
Tricuspid
Palpation:
4(R) ICS
Tricuspid
Electrode Name:
On the right arm, avoiding thick muscle.
RA
Electrode Name:
In the same location where RA was placed, but on the left arm.
LA
Electrode Name:
In the fourth intercostal space (between ribs 4 and 5) just to the right
of the sternum (breastbone)
V1
Electrode Name:
In the fourth intercostal space (between ribs 4 and 5) just to the left of
the sternum.
V2
Electrode Name:
Between leads V2 and V4.
V3
Electrode name:
In the fifth intercostal space (between ribs 5 and 6) in the mid-
clavicular line.
V4
Electrode Name:
Horizontally even with V4, in the left anterior axillary line.
V5
Electrode Name:
Horizontally even with V4 and V5 in the mid-axillary line.
V6
Limb Leads:
is the voltage between the (positive) left arm (LA) electrode and right arm (RA)
Lead I
Limb Leads:
is the voltage between the (positive) left leg (LL) electrode and the right arm (RA)
Lead II
Limb Leads:
is the voltage between the (positive) left leg (LL) electrode and the left arm (LA)
Lead III
They are derived from the same three electrodes as leads I, II, and III,
but they use Goldberger’s central terminal as their negative pole.
Augmented Limb Leads
is a combination of inputs from two
limb electrodes, with a different combination for each augmented
lead.
Goldberger’s Central Terminal
Augmented Limb Leads:
-has the positive electrode on the right arm.
-The negative pole is a combination of the left arm electrode and the left leg electrode
Lead augmented vector right (aVR)
Augmented Limb Leads:
-has the positive electrode on the left arm.
-The negative pole is a combination of the right arm electrode and the left leg electrode
Lead agumented vector left (aVL)
Augmented Limb Leads:
-has the positive electrode on the left leg.
-The negative pole is a combination of the right arm electrode and the left arm electrode.
Lead Augmented vector foot (aVF)
represents ventricular
depolarization
The QRS complex
represents ventricular repolarization.
The T wave
represents papillary muscle
repolarization
The U wave
ECG – Rhythm:
has the characteristics heart rate of
50–100 beats/minute,P-wave before every QRS complex and positive in lead II and also a
constant PR interval.
Sinus Rhythm
ECG-Rhythm:
Causes are second and third
degree AV block, sinoatrial block and arrest termed sinus node dysfunction (SND)
bradycardia and sick sinus syndrome (SSS) if symptomatic.
Bradycardia
ECG-Rhythm:
Causes are sinus tachycardia, inappropriate sinus tachycardia, sinoatrial re-entry
tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia, and multifocal atrial
tachycardia. Tachyarrhythmia with narrow QRS complexes rarely cause circulatory
compromise.
Tachycardia with narrow QRS complexes
ECG-Rhythm:
The main cause is ventricular tachycardia and it can be life-threatening. QRS complexes
become wide due to abnormal ventricular depolarization but 10% of wide complex
tachycardia starts from the atria.
Tachycardia with wide QRS complexes
Rate: The rate appears rapid, but the disorganized electrical activity prevents
the heart from pumping.
P wave: There are no P waves present.
PR interval: There are no PR intervals present.
QRS complex : The ventricle complex varies
Ventricular Fibrillation
Rate: The atrial rate cannot be determined, Ventricular rate is usually between 150 and 250
beats per minute
P Wave: QRS complexes are not preceded by P waves. There are occasionally P waves in
the strip, but they are not associated with the ventricular rhythm.
PR interval: it is not measured since this is a ventricular rhythm.
QRS complex: it measures more than 0.12 seconds. The QRS will usually be wide and
bizarre. It is usually difficult to see a separation between the QRS complex and the T Wave.
Ventricular Tachycardia
Rate: the atrial rate cannot be determined. Ventricular rate is usually
between 150 and 250 beats per minute.
P Wave: there are no P waves present.
PR interval: there are no PR interval present.
QRS complex: the ventricle complex varies.
Irregular Wide Complex Tachycardia
Rate: there is no rate.
P wave: there is no P waves present
PR interval: PR interval is unable to be measure due to no P waves
being present.
QRS Complex: there are no QRS complexes present.
Pulseless Electrical Activity and Asystole
Rate: the rate is less than 60bpm, but usually more than 40bpm
P wave: there is one P wave in front of every QRS. The P waves
appear uniform
PR interval: measures between 0.12 and 0.20 seconds in duration. PR
interval is consistent.
QRS complex: measures less than 0.12 seconds.
Sinus Bradycardia
Rate the rate is over 100bpm but usually less than 170bpm
P wave: there is one P wave in front of every QRS. The P wave appear
uniform.
PR interval: measures between 0.12-0.20 seconds in duration. PR
interval is consistent.
QRS complex: Measures less than 0.12 seconds.
Sinus Tachycardia
Rate: The atrial rate is normally between 250 to 350. Ventricular rate depends
on conduction through the AV node to the ventricles.
P wave: The P waves will be well defined and have a “sawtooth” pattern to them.
PR interval: Due to the unusual configuration of P waves, the interval is not
measured with atrial flutter
QRS complex: QRS measures less than 0.12 seconds
Atrial Flutter
Normal Range:
Central Venous Pressure (CVP)
0-8mmHg
Right-sided heart catheterization Normal Range:
Right atrial (mean)
0-8mmHg
Right-sided heart catheterization Normal Range:
Pulmonary Artery Systolic
20-25mmHg
Right-sided heart catheterization Normal Range:
Pulmonary Artery Diastolic
6-12mmHg
Right-sided heart catheterization Normal Range:
Pulmonary Artery Mean
9-19mmHg
Right-sided heart catheterization Normal Range:
Pulmonary Capillary Wedge Pressure (PCWP)
6-12mmHg
Left-sided heart catheterization Normal Range:
Left ventricular end-diastolic pressure
5-12mmHg
Left-sided heart catheterization Normal Range:
Left ventricular peak systolic pressure
90-140mmHg
Left-sided heart catheterization Normal Range:
Systemic arterial pressure systolic
110-120mmHg
Left-sided heart catheterization Normal Range:
Systemic arterial pressure diastolic
70-80mmHg
Left-sided heart catheterization Normal Range:
Systemic arterial pressure mean
82-102mmHg
Left-sided heart catheterization Normal Range:
Cardiac Output (CO)
4-5L/min
Left-sided heart catheterization Normal Range:
Cardiac index (CO ^ body index)
2.5-3.5 L/min
Left-sided heart catheterization Normal Range:
Stroke volume
55-100 mL/beat
Left-sided heart catheterization Normal Range:
Systemic vascular resistance
800-1200 dynes/sec/cm-5
Laboratory Tests and Reference Values:
Hgb (male)
13-18
Laboratory Tests and Reference Values:
Hgb (female)
12-16
Laboratory Tests and Reference Values:
HCT (%) male
37-49
Laboratory Tests and Reference Values:
HCT (%) female
36-46
METS:
Lying
1.0
METS:
Sitting
1.2-1.6
METS:
Sitting c writing
1.9-2.2
METS:
standing
1.4-2.0
METS:
(+)wash/shave
2.5-2.6
METS:
(+) dress/undress
2.3-3.3
METS:
walking 1mph
2.3
METS:
Walking 2mph
3.1
METS:
Walking 3mph
4.3
METS:
Run
7.4
METS:
Wheelchair/Drive
2.8
METS:
Stair descend
5.2
METS:
Ascending stairs
9
METS:
2 Step climb
5.7
METS:
Eating
1.5
METS:
Wash face
2.0
METS:
Shower
3.5
METS:
Bedpan
4.0
METS:
Sex c wife
5.0
METS:
Extramarital Sex
8.0
METS:
Light Housework
1.7-3.0
METS:
Heavy Housework
3.0-6.0
METS:
Office work
1.3-2.3
METS:
Backpacking (45lbs)
6-11
METS:
Baseball
4-6
METS:
Basketball
5-12
METS:
Cycling 5mph
2-3
METS:
Cycling 8mph
4-5
First pharmacological intervention for angina
Sublingual Nitroglycerin
CK-MB and LDH peak levels
14-36 hours
Troponin and Myoglobin peak levels
24-36 hours
Normal values for Cardiac Output
5-6 Liters/min
Where is P-wave positive in? *determine the 3 leads
Lead II,III and avF
Persistent mild-severe chest pain that lasts four hours or days; relieved by learning forward
Pericarditis
3 zones of myocardial infarction
Zone 1- Zone of Ischemia
Zone 2- Zone of Injury
Zone 3- Zone Farction
Referred Pain for M.I
(L) jaw, (L) shoulder, (L) Arm and (R) side of chest
What is normal HR range
60-100
Right sided heart failure symptoms are usually…
systemic
Left sided heart failure symptoms are usually…
pulmonary
Difficulty breathing in supine
Orthopnea
DIfficulty breathing in sidelying
Troponea
1 MET is equivalent to how many mL of O2 per kilogram of BW/min
3.5mL of O2/kg of bW/min
What is the other name for irregular wide complex tachycardia
Torsades De Pointes
