L6-7 Cardi

Question 1

1. Cardiac conduction
2. Cardiac output & various cardiac volumes
3. ECG interpretation
4. Acute Coronary Syndrome diagnosis and Management

Question 2

Cardiac conduction

Answer 2

Contain
1. SA nodes
2. AV nodes
3. Bundle of his
4. Left / right bundle branch
5. Purkinje fibres

Question 3

SA nodes

Answer 3

SA nodes located at right atrium

Pace 60-100bpm

Initiate action potential

Depolarising

Generate cardiac rhythm

Stimulate atrial contraction

Question 4

AV node

Answer 4

Receive electric signal from SA node

Only pathway between atrial & venrtricle

AV delay: on hold ventricle contraction before atrium completely contracted

Question 5

Bundle of his

Answer 5

Carry signal into intraventricle (septum , apex, ventricles)

Speed up conduction of ventricle depolarisation
-) contraction

Question 6

Cardiac output = stroke volume * bpm

Question 7

PQRST

Answer 7

P wave / PR interval: SA node depolarisation
QRS complex: ventricle depolarisation
T wave: ventricle repolarisation

Question 8

ECG

Answer 8

V1: fourth intercostal space at right sternal edge
V2: fourth intercostal space at left sternal edge
V4: fifth intercostal space on midclavicular line
V3: middle of V2 & V4
V5: fifth intercostal space of left anterior axillary line
V6: fifth intercostal space at left mid-axillary line

Question 9

Dysrhythmia

Answer 9

1. Sinus dysrhythmia
   -) sinus dysrhythmia
   -) premature atrialiiid contraction ( beta blocker)
   -) Sinus bradycardia (atropine)
   -) Sinus tachycardia (adenosine)
2. Atrial dysrhythmia
   -) atrial flutter ( adenosine)
   -) atrial fibrillation (oral betablocker)
   -) Atrioventricular nodal reentry
   tachycardia
   -) superventricular tachycardia (adenosine)
3. Ventricular dysrhythmia
   -) ventricular tachycardia (deliver electric current sync to patient electrical event)
   -) ventricular fibrillation (CPR)

4, conduction abnormalty
-) 1 / 2 / 3rd degree heart block
(1: constantly delay (Calcium channel blocker)
2: more & more delay (atropine)
3: independant

Pacemaker✅✅

Question 10

Acute coronary syndrome diagnosis

Answer 10

Diagnostic test

1. Blood test
   -) CK-MB enzyme increase when MI)
   -) myoglobin level increase after 1-3 hrs peak 12
   -) troponin I / T ✅✅for cardiac muscle
   -) chest x ray

Diagnosis
1. Chest pain
2. Pain surrounding neck , jaw, arm
3. Shortness of breathe
4. Nausea

Question 11

Acute coronary syndrome management

Answer 11

1. Beta blocker
2. Calcium channel blocker
3. Anti-platelet

Question 12

PCI

Answer 12

Percuttaneous coronary intervention

PTCA ( ballon)
Coronary stenting ( frame)
Arthrectomy (drill)
IVUS

Preparation
1. Consent
2. Skin preparation
3. Fasting
4. Medication

Question 13

CABG, fibrinolytic therapy 溶栓

Answer 13

Coronary artery bypass graft

Question 14

Antithrombotic drug

Answer 14

Anticoagulant
Anti-platelet
Thrombolytic