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CARDIOLOGY FISDAP > FISDAP Review > Flashcards

FISDAP Review Flashcards

All cardiology topics covered in the FISDAP exam

1
Q

Intrinsic rate of the AV node

A

40-60 BPM

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2
Q

Intrinsic rate of the SA node

A

80-100 BPM

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3
Q

Intrinsic rate of the ventricles (Purkinje fibers)

A

20-40 BPM

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4
Q

START to finish Bradycardia Algorithm

A

Bradycardia: Heart rate typically less than 50 BPM if bradyarrhythmia, (identify and treat underlying cause) ABC, cardiac monitor, IV access. 12 lead if available. Don’t delay therapy for a 12 lead. Is Bradycardia causing Hypotension? AMS? Signs of shock? Ischemic chest discomfort? Acute heart failure? NO=Stable=monitor and consider giving atropine/Dopamine infusion or Epinephrine infusion. YES=Unstable=Pace the patient. If unable to capture and medication interventions haven’t been made, consider using this. Dopamine drip will be the most effective.

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5
Q

Three characteristic findings in WPW syndrome on an EKG?

A

Short PR interval, QRS widening, and delta wave

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6
Q

These leads show which portion of the heart? Leads 2, 3, and aVF

A

Inferior Wall

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7
Q

These leads show which portion of the heart? v1 and v2?

A

Septal wall

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8
Q

These leads show which portion of the heart? v3 and v4?

A

Anterior Wall

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9
Q

These leads show which portion of the heart? 1, avL, v5, and v6

A

Lateral Wall

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10
Q

In what leads do you see negative deflection? In a normal EKG.

A

AvR and V1

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11
Q

What do hyperacute T waves represent?

A

Occur seconds after the occlusion arises. These persist only for a few minutes.

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12
Q

What location of infarct is most common? What leads will you see elevation in? What leads will you see depression in? Which coronary artery is involved?

A

The most common infarct in the inferior wall, you will see ST elevation in leads 2, 3, and AVF. You will see reciprical depression in lead 1 and AVL. The right coronary artery is affected.

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13
Q

What location is the most lethal for an infarction? What leads will you see it in? What depression will you see? And which coronary artery is involved?

A

Anterior Wall infarctions are the most lethal. You will see elevation in V3 and V4. You won’t see any reciprocal changes. The Left anterior descending artery.

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14
Q

You see elevation in 2, 3, and aVf. What type of STEMI is this? Where will you see reciprocal changes? What artery is involved?

A

Inferior Wall. Reciprocal changes in 1 and avL. The right coronary artery is affected.

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15
Q

You see ST elevation in V1 and V2. Where is your infarction? Which coronary artery is affected?

A

Septal MI. Left anterior descending artery

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16
Q

You see ST elevation in V3 and V4. Where is your infarction? What coronary artery is it affecting?

A

Anterior STEMI. Most lethal. Left anterior descending artery. No reciprocal changes.

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17
Q

You see ST elevation in 1, avL, V5 and V6. Where is your infarction? Which artery is being affected? Where do you see reciprocal changes?

A

Lateral MI. Circumflex artery is being affected. Reciprocal changes in 2, 3, and avF.

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18
Q

If you have an inferior MI, what should you consider?

A

Doing a right sided EKG

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19
Q

What classifies ST elevation? (boxes)

A

More than 2 small boxes up

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20
Q

What are the three diagnostic rules for Atrial Fibrillation on an EKG?

A

NARROW
IRREGULAR
NO P-WAVES

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21
Q

What is A-fib with RVR?

A

A-Fib with RAPID ventricular response. Faster than 100 BPM

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22
Q

What kind of P-waves do you have with A-fib?

A

YOU DONT. No P waves

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23
Q

What is your rhythm for A-fib? What is your rate? What is your treatment?

A

IRREGULAR, 60-100 BPM, and treatment depends on stability. Unstable follow your cardiac arrest algorithm. Stable-treat underlying cause.

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24
Q

What characteristics will you see with Atrial Flutter?

A

“Sawtooth waves”

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25
Q

What is your rhythm with A-flutter? What does your QRS look like?

A

Regular and QRS is narrow and positive.

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26
Q

What is a PAC?

A

Premature Atrial Contraction

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27
Q

How do your P-waves look with a PAC?

A

Present, but the one itself will look different than all the other P-waves.

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28
Q

PR interval with a PAC.

A

PR Interval can be normal or slightly short. It’ll stand out from all the others as if it doesn’t belong.

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29
Q

What does the QRS in a PAC look like? What rhythm do you see?

A

Narrow and upright. Irregular.

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30
Q

IDENTIFY THE RHYTHM

A

A-Fib

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31
Q

IDENTIFY THE RHYTHM

A

A-Flutter

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32
Q

What is a PJC?

A

Premature Junctional Contraction

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33
Q

What does the P-wave and QRS look like in a PJC?

A

P-wave’s are typically absent or inverted. QRS is positive and narrow.

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34
Q

What is a PVC? What is it mainly caused by?

A

Premature ventricular contraction caused by Hypoxia

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35
Q

P wave identifiers for a PVC, QRS. What are some different ways to identify a PVC?

A

P wave is typically absent, QRS is wide and ugly. Can be a multifocal or unifocal PVC. Can be a couplet (2 back to back), Bigeminy, Trigeminy, runs of PVC

36
Q

What is a MAT?

A

Multifocal Atrial Tachycardia (WAP that is fast)

37
Q

What is the typical rate you’ll see with a MAT? Rhythm? What kind of P-waves will you see?

A

Exceeding 100 BPM. You see an irregular rhythm and you’re going to see different P-waves because you have multiple focai firing causing difference in P waves.

38
Q

What is WAP?

A

Wandering Atrial Pacemaker

39
Q

What type of rhythm do you see? What rate? What kind of P-waves? QRS? What is an important identified for this?

A

You see an irregular rhythm. At a rate of 60-100 BPM. P-waves have an abnormal morphology (3 or more different looking P-waves) because they’re all originating from different Atrial sources. QRS is upright and narrow.

40
Q

What RATE do you see with a MAT? With a WAP?

A

MAT exceeds 100 BPM. WAP is between 60-100 BPM

41
Q

IDENTIFY THIS RHYTHM

A

Sinus rhythm with a PAC

42
Q

IDENTIFY THIS RHYTHM

A

Sinus Rhythm with a PJC

43
Q

What ION is responsible for depolarization of the myocardium?

A

Sodium

44
Q

When are coronary arteries perfused?

A

Ventricular diastole

45
Q

A 75 year old male complains of weakness and fatigue. He has dependent edema and jugular vein distension. Last year, he had three cardiac stents placed. What should you suspect?

A

Right Ventricular heart failure

46
Q

What does a P-wave represent and what is the normal duration for it?

A

P-waves represent Atrial depolarization (contraction) and should be 0.10 seconds or less

47
Q

What does the PR interval represent and what is it’s duration?

A

PR interval represents the time required for the electrical impulse to be conducted through the AV node. This is where you have your Atrial kick. PR interval duration should be 0.12-0.20 seconds. Anything exceeding 0.20 seconds is a 1st degree block

48
Q

What does the QRS represent and what is it’s duration?

A

QRS represents ventricular depolarization and it’s duration is 0.08-0.12. More than 3 small squares is a widened QRS which could be a LBBB

49
Q

ST segment. What is represents?

A

ST segment represents the early phase of repolarization in the left and right ventricles. This is where you’re going to look for any ST depression or elevation. Elevation is classified as more than 2 small squares high.

50
Q

T waves. What they represent and their duration?

A

T-waves represent ventricular repolarization. Normally the duration is 4 small boxes. Keep in mind that heightened T-waves represent hyperkalemia.

51
Q

Chronotropic

A

Heart Rate

52
Q

Amiodarone (Class, MOA, Indic., Contra., side effects, dosages)

A

Antidysrhythmic, MOA-Blocks sodium, potassium, and calcium channels, prolongs action potential and repolarization, decreases AV and SA node function. Indications: V-tach with a pulse, cardiac arrest (pulseless v-tach/v-fib), stable, regular narrow complex tachycardia following failure to convert from vagal maneuvers or adenosine.
Contraindications: Cardiogenic shock, 2nd or 3rd degree AV block, sick sinus syndrome.
Side Effects: ARDS, pulmonary edema, dyspnea, heart failure, bradycardia, hypotension, prolonged QT interval, burning at IV site.
Dosage:
Adult v-fib or pulseless v-tach: 300mg IVP followed by 150mg IVP after 3-5 minutes. Wide complex tachycardia: 150mg in 100ml over 10 minutes
Pediatric v-fib or pulseless v-tach: 5mg/kg IVP, repeat once in 3-5 minutes
Duration: 30min-2hrs, peak-3-7hrs

53
Q

Identifiers of a 1st degree block

A

Prolonged PR-interval of more than 0.20 seconds. Consistent all the way through.

54
Q

Identifiers of a 2nd degree type 1 block. Or a Mobitz 1.

A

“Longer, longer, longer, drop. Now we have wenckebach” PR interval keeps getting longer and longer until there is a p-wave not followed by a QRS.

55
Q

Identifiers of a 2nd degree type 2 block. Or a Mobitz 2.

A

“If some P’s don’t get through, now we have mobitz 2” Your P-waves are consistent but you have a dropped beat. P-wave that is not followed by a QRS.

56
Q

Identifiers of a third degree block. Complete heart block.

A

Your P-P intervals and R-R intervals are consistent. P’s are not married to QRS.

57
Q

Why do we sync before cardioverting?

A

To avoid shocking the patient during the absolute refractory period. “R on T”.

58
Q

Inotropic

A

Force of contractions

59
Q

Dromotropic

A

Rate of electrical conduction

60
Q

Signs and symptoms of Left Ventricular heart failure

A

-Severe respiratory distress, orthopnea, foamy/blood-tinged sputum, cyanosis, bilateral crackles, JVD, anxiety, and sometimes chest pain

61
Q

Signs and symptoms of Right ventricular heart failure

A

Tachycardia, engorged liver or spleen, peripheral edema, pitting edema, fluid accumulation in abdomen and pericardium

62
Q

Signs and symptoms for AAA

A

Unexplained hypotension, unexplained syncope, sudden onset of abdominal or back pain describes as “tearing/ripping”, flank pain, urge to defecate, pulsatile mass

63
Q

Signs and symptoms of DVT

A

Deep vein thrombosis. S&S include pain, edema, warmth, blue discoloration, and tenderness

64
Q

Signs and symptoms of a pulmonary embolism

A

Dyspnea, cough, pain, anxiety, syncope, hypotension, diaphoresis, tachypnea, sinus tachycardia, fever, distended neck veins, crackles

65
Q

Signs and symptoms of a Stroke/TIA

A

Can be numbness, confusion, seizures, slurred speech, headache, dizziness, double vision. TIA symptoms usually resolve within a short period of time.

66
Q

Signs and symptoms of cardiac tamponade

A

Chest pain that worsens with inspiration, palpitations, JVD, faint or muffled heart sounds, shortness of breath, low voltage QRS and T waves, pulsus paradoxus, and tachycardia

67
Q

What is beck’s triade?

A

JVD, hypotension, and distant (muffled) heart sounds

68
Q

What is cushing’s reflex?

A

Widened pulse pressure, bradycardia, and irregular respirations

69
Q

Signs and symptoms of pericarditis?

A

Pedal edema, anxiety, difficulty breathing when lying down, chest pain relieved by sitting up and learning forward, dry cough, fatigue, fever, 12 lead changes such as st elevation, PR-segment depression, and notched J point

70
Q

What is cor pulmonale?

A

Right sided heart failure usually caused by chronic lung disease

71
Q

What does the Beta 1 receptor do?

A

Increases the contractility of the heart and the heart rate therefore increasing stroke volume and cardiac output

72
Q

What is starling’s law?

A

Increasing the stroke volume in the left ventricle will increase the cardiac output from the right ventricles in response

73
Q

What are murmurs?

A

Result of turbulence of the flow of blood within the heart chambers

74
Q

Describe your ROSC algorithm

A
  1. Optimize ventilation and oxygenation (spo2 over 94% and consider advanced airway with capno). 2. Treat hypotension IV/IO bolus, vasopressor infusion(epinephrine 0.1-0.5mcg/kg per minute), 12-lead. Can the patient follow commands? NO-induce hypothermia. YES-Cath lab
75
Q

Peaked T-waves indicate?

A

Hyperkalemia, Administer calcium. or new onset of myocardial ischemia

76
Q

Inverted T-waves indicate?

A

cardiac ischemia

77
Q

Inverted P-waves indicate what?

A

Conduction firing in the wrong direction (most likely towards to AV node instead of towards the ventricles)

78
Q

What does p-pulmonale represent?

A

Right Atrial enlargement. (COPD pts) Classical sign on an EKG are peaked p-waves (2.5 mm high)

79
Q

What does P-mitrale represent?

A

Left Atrial Enlargement. (hypertension pts) At least 0.12 seconds longs and you see a notch in the middle in the EKG. Looks like a camel hump

80
Q

What is the normal PR interval duration?

A

0.12-0.20. 3-5 boxes.

81
Q

What is a short PR-interval?

A

Less than 0.11 seconds. Causes can be Junctional p-waves or WPW syndrome

82
Q

PR interval depression indicates…

A

Possible pericarditis, tachycardia, notched j-points

83
Q

Left ventricular hypertrophy

A

very tall QRS. Usually seen in multiple leads. Height of two leads should exceed 35 mm

84
Q

How do you identify Right ventricular hypertrophy?

A

You have an R wave thats taller than your S wave in either leads V1 or V2.

85
Q
A

CARDIOLOGY FISDAP (1 decks)

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