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Cardiopulmonary > Midterm > Flashcards

Midterm Flashcards

1
Q

Pericardium

A

-fibrous sac around heart
-Serous layers: Parietal (outer), visceral (on heart and contains fluid within space)
-Innervated by Phrenic Nerve (sensory)

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2
Q

Diastole

A

-Relaxation
-Filling

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3
Q

Systole

A

-contraction
-ejection

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4
Q

Afterload

A

pressure needed to expel blood from the heart
-synonymous with BP

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5
Q

Myocardium

A

Cardiac muscle fiber
-actin-myosin complex
-Automaticity: contract w/o external stimuli
-Rhythmicity: contract with rhythm
-Conductivity: nerve impulses from one cell to the other due to intercalated discs
-Intercalated disc junctions: Desmosomes (adhesion) and Connexins (conductivity)

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6
Q

Endocardium

A

-Smooth muscle, innermost layer

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7
Q

Pulmonary Artery

A

-only artery to carry deoxygenated blood

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8
Q

Pulmonary vein

A

-only vein to cary oxygenated blood

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9
Q

Right Coronary Artery

A

-Supplies right ventricle, AV node and SA node
-Right posterior descending
-Right marginal

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10
Q

Left Coronary Artery (supplies)

A

-supplies left ventricle, L atrium, septum, SA node

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11
Q

SA Node

A

-sets heart at pace of >100 without other input
-Susceptible to disease due to pericarditis, occulsion

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12
Q

Sympathetic NS

A

-increase
-norepinephrine

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13
Q

Inotropic

A

-strength of contraction

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14
Q

Chronotropic

A

-speed of contraction

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15
Q

Parasympathetic NS

A

-decrease
-vagus nerve
-acetylcholine
-60-90 bpm

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16
Q

AV Node

A

-receive from SA
-to Bundle of His to bundle branches to perkinjie fibers
-40-60 bpm without exernal stimuli
-0.04s to contract Vs
Susceptible to disease due to RCA occlusion

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17
Q

P Wave

A

atrial depolarization

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18
Q

PR interval

A

-travel of impulse to Vs

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19
Q

QRS Complex

A

ventricular depolarization

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20
Q

T Wave

A

ventricular repolarization

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21
Q

QT Internal

A

Ventricular systole

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22
Q

Low K

A

Harder to depolarize, slower heart rate

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23
Q

High K

A

Easier to depolarize as myocardium is excitable, higher heart rate

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24
Q

Cardiac Output

A

-CO= HR x SV
-5-6L at rest, can increased 4-7x with exercise
-Effects systolic BP

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25
Q

Blood Pressure

A

BP=HR x SV x Total peripheral Resistance
TPR affects diastolic BP

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26
Q

Mean Arterial Blood Pressure

A

-average pressure in the systemic system, perfusion of organs and peripheral tissues
MAP= DBP + 1/3 (SBP-DBP)
-Normal: 70- 93 mmHg
-cautions <60mmHg

Determined By:
-BV, CO, Peripheral resistance, distribution of blood in veins

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27
Q

Pulse Pressure

A

SBP-DBP, difference
-how hard heart is working
>60 working too hard; HTN
<40 failing heart; cardiomyopathy;shock

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28
Q

Effect of Posture on BP

A

Standing: lower BP, blood pools in legs
Laying: blood evenly in veins, higher BP

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29
Q

BP Normal

A

<120/<80

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30
Q

BP Elevated

A

120-129/<80

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31
Q

High BP Stage 1

A

130-139/80-89

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32
Q

High BP Stage 2

A

> 140/>90

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33
Q

Hypertensive Crisis

A

> 180/>120

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34
Q

HR

A

-Beats per minute

->120bpm @ rest, not enough time to refill, decreases CO
-<45bpm @ rest not enough CO, low bp

Affected by: Baroreceptors, ANS, endocrine, integrity of the system, temperature, emotions

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35
Q

SV

A

-amount of blood pumped out each beat
-Afterload-Preload, heart contractility
-increases 40-60% during exercise

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36
Q

Cardiac Preload (& determinants)

A

-End diastolic volume: amount of left ventricular blood volume prior to contraction

Dependent on:
-venous return, BV, LA contraction, Starling law

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37
Q

Cardiac Afterload

A

-Amount of resistance encountered by left ventricle

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38
Q

Myocardial Contractility

A

-neural and hormonal influences

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39
Q

Ejection Fraction

A

Ejection Fraction= SV/EDV
-55-70%
-Low EF indicates systolic heart failure: <40
-EF can be preserved with overall decrease in BV, weak heart increases backflow that increases SV

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40
Q

Hypoxia

A

O2 concentration of tissues

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41
Q

Hypoxemia

A

O2 concentration of blood

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42
Q

ESV

A

End Systolic volume: volume of blood in a ventricle at the end of a contraction

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43
Q

Right Shift in O2 Concentration

A

-reduced affinity for for O2, higher po2 will result in lower hemoglobin concentrations

-high temp, high acidity

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44
Q

Left Shift in O2 concentration

A

-increased affinity for O2, lower po2 will result in higher hemoglobin concentrations

-low temp, basic environment

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45
Q

Fick equation

A

-VO2= HR x SV x (a-vO2 diff)

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46
Q

a-vO2 Diff

A

-difference in O2 between arteriole and venule

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47
Q

CO Distribution

A

Muscles: 10-15% (80-85% with exercise)
Trunk: 20-30%
Brain and heart: 5%

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48
Q

Oxygen Extraction

A

-tissues utilize the same relative amount of o2 in relation to blood o2

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49
Q

Pulmonary O2 Exchange Factors

A

-Area of capillary membrane
-Diffusion capacity of alveoli
-Pulmonary Capillary volume
-Ventilation to perfusion ratio

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50
Q

Area of Capillary Membrane

A

invaginations increase the surface area

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51
Q

Diffusion capacity of alveoli

A

-changes in surface area
-changes in membrane
-gas uptake issues

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52
Q

Pulmonary capillary volume

A

-increases with exercise

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53
Q

Ventilation to Perfusion Ratio (V/Q)

A

-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8

Reduced: decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2

Increased: increased ventilation to perfusion, vasodilation to increase BV, dead space

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54
Q

Arteriole Vasoconstriction Mechanism of Action

A

-alpha receptors
Shunt blood to muscles, from skin and mesenteric

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55
Q

Arteriole Vasodilation Mechanism of Action

A

-induced by increased vessel stretch
-induced by low O2 or high H+, CO2, metabolites

Beta Receptors
-increased blood flow to Skeletal muscle
-increase ventilation and alveolar perfusion

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56
Q

Cardiac Muscle Dysfunction

A

-most common cause of Congestive Heart Failure

Symptoms:
-dyspnea
-fluid buildup
-fatigue at rest

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57
Q

Most common cause of pulmonary congestion

A

-heart failure
-mostly right side affected

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58
Q

Causes of Cardiac Muscle Disease: Hypertension

A

Increased BP
-increased workload w/o increased blood supply
-decreased BV
-hypertrophy of myocardium that cannot relax well
-BV damage

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59
Q

Causes of Cardiac Muscle Disease: Coronary Artery Disease

A

-2nd most common cause of CMD
-supply and demand issue

-lipid deposits: atherosclerosis
-scar formation: decreases contractility

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60
Q

Causes of Cardiac Muscle Disease: Myocardial Infarction

A

-irreversible myocardial necrosis
-most commonly affects left ventricle

PT
-Increased Troponin, CK-MB that needs to come down
-ST elevation on ECG “Stimmy”

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61
Q

Causes of Cardiac Muscle Disease: Cardiac Arrhythmias

A

-abnormal rate of contractions
-can cause sudden cardiac arrest from SA node
-can lead to decreased CO

-Sick Sinus node syndrome
-Suprasventricular tachycardia
-V fib

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62
Q

Lab Values: Sodium

A

Increased
-dehydration

Decreased
-overhydration

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63
Q

Lab Values: Potassium

A

Increased
-Renal retention, decreased insulin

Decreased
-Excess renal secretion, aldosterone, burns

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64
Q

Lab Values: Calcium

A

Increased:
-hyperparathyroidism, hyperthyroidism

Decreased: hypoparathyroidism, renal failure

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65
Q

Causes of Cardiac Muscle Disease: Renal Insufficiency

A

-contributes to CMD due to increased fluid triggered by low BP or low BV
-RAAS
-maintains Na and K balance

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66
Q

Causes of Cardiac Muscle Disease: Cardiomyopathy

A

-disease of heart muscle leading to heart failure
-impaired contractility
-HTN, MI, metabolic disorders, heart valve issues

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67
Q

Causes of Cardiac Muscle Disease: Dilated Cardiomyopathy

A

Heart failure with reduced ejection fraction (<40)

-systolic dysfunction: less effective pump, decrease CO, fluid back up
-increased LV EDV
-lead to electrical issues

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68
Q

Causes of Cardiac Muscle Disease: Hypertrophic Cardiomyopathy

A

-enlarged heart that cannot relax
-Heart failure with preserved EF
-diastolic dysfunction: less compliant
-increases left EDP
-rapid ventricular emptying
-muscle cells disorganized

-common cause for sudden cardiac arrest in young athletes

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69
Q

Causes of Cardiac Muscle Disease: Restrictive Cardiomyopathy

A

-cannot relax
-EF preserved
-diastolic dysfunction; decreased filling
-scar tissue in myocardium (sarcoidosis/radiation) OR defect in myocardial relaxation
-hypertrophy

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70
Q

Heart Valve Abnormalities Consequences

A

-contracts more forcefully
-induces myocardial hypertrophy
-deceases ventricular distensibility
-decreases CO and BP

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71
Q

Pericardial Effusion

A

-buildup of fluid compress the heart

Cardiac Tamponade
-pressure on heart leads to decreased heart function
-worse when lying down
-relieved when standing

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72
Q

Pulmonary Embolism

A

-lung infarction due to decreased BV
-increased pulmonary hypertension
-increases load to right side of heart
-presence of ascities, bilateral LE edema and jugular vein distension
-increases V/Q ratio

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73
Q

Pulmonary Hypertension

A

-risk for cardiac disease
->20mmHg
-increased R ventricle work (Swangan’s Catheter)

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74
Q

Heart Disease Vitals

A

-pO2: hypoxia (92-96%)
-RR: tachypnea
-HR: tachycardia
-BP: orthostatic hypotension

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75
Q

Congestive Heart Failure

A

-decreased CO
-LV failure
-increased BNP (stretch protein in heart)
-attempts compensatory strategies (sympathetic, RAAS, heart receptors, EPO)

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76
Q

Skeletal Muscle Function and CHF

A

-decreased type 1 fibers
-less contraction strength

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77
Q

Pancreas and CHF

A

-impairs blood flow
-impairs insulin release

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78
Q

Hematologic function and CHF

A

-polycythemia (thick blood)
-thrombocytopenia (low platelets)

Anemia
-can cause CHF
-can harm or help
-shifts curve to right; more o2 needed

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79
Q

Neurohumoral Function and CHF

A

-SNS overstimulation and downreg of B1 receptors

B1: myocardial inotrophy and chronotrophy
B2: arteriole vasodilation and bronchodilation
a1: vasoconstriction
a2: arterial vasodilation (constriction of coronary)

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80
Q

Renal Function and CHF

A

-RAAS
-a receptor activity
-decreased renal activity

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81
Q

Rate Pressure Product

A

-SBP*HR
-exercise threshold
-myocardial o2 demand
->10,000 @ rest, increase risk of angina

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82
Q

Stethoscope Diaphragm

A

-high frequency sounds

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83
Q

Stethoscope Bell

A

-low frequency sounds

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84
Q

S1

A

-first heart sound (higher frequency)
-closure of M1 and T1
-best heard in Mitral Area

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85
Q

S2

A

-second heart sound (lower frequency)
-closure of semilunar valves valves
-best heard in Aortic Area

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86
Q

Aortic Area

A

-right sternal border
-2nd intercostal space
-S2 best heard

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87
Q

Pulmonic Area

A

-left sternal border
-2nd intercostal space

88
Q

Tricuspid Area

A

-left sternal border
-4th intercostal space

89
Q

Mitral Area

A

-left side under nipple
-apex of heart
-5th intercostal space
-S1, S3, S4 best heard

90
Q

Apical Pulse

A

Listen to apex of heart for 1 min

91
Q

S3

A

-dilated/large ventricle causes rapid flling causes loud sound
-systolic issue
-could be abnormal (heart failure, dilated cardiomyopathy, late diastole) or normal (pregnancy/children, athletes)
-extra heart sound after S2
-“kenTUCKy”
-listen with bell @ apex

92
Q

S4

A

-rigid ventricle decreases filling, atria contract late to push past force
-diastole issue
-always abnormal (HTN, MI, atrial kick of blood into stiff ventricle diastolic bad)
-right before S1
-gallop

93
Q

Respiratory Cycle

A

Inspiration: 1/3, faster and louder

Expiration: 2/3, slower and softer

94
Q

Vesicular Breath Sounds

A

-most of lung area
-inspiratory longer than expiatory
-soft

95
Q

Brocho-Vesicular Breath Sounds

A

-near midline around upper spine and sternum
-inspiratory equal expiatory

96
Q

Bronchial Breath Sounds

A

-above manubrium
-loud
-inspiratory shorter than expiatory

97
Q

RV Failure S/S

A

-venous insufficiency, edema, weightt gain, liver issues

98
Q

LV Failure S/S

A

-pulmonary issues, effusion, S3, crackles, decreased O2, paleness, increased HR, increased Breathing

99
Q

Ischemic heart Disease (Medications)

A

-restablish balance of o2 supply and demand
-decreasing HR or BP to reduce O2 demand
-increase artery size, remove thrombus,

100
Q

Heart Failure (Medications)

A

-maintain CO, adress underlying issue, regulate fluids, decrease preload and afterload, increase conttractility, reduce workload, decrease SNS

101
Q

Arrhythmias (Medications)

A

-inhibit abnormal impulses by affectting membrane permeabiliy to specific ions (Cl, K, Ca, Na)
-SA & AV node
-prelong refractory period

102
Q

Hypertension (Medications)

A

-reduce fluid, limit SNS, decrease RAAS

103
Q

Beta Blockers

A

-olol
-reduced beta receptor binding
-selective of nonselective

B1: increases HR and contractility
B2: bronchoconstriction and vasodilation

CI
-HTN, ischemic HD, heart failure, arrhythmias

SE
-sedation, may mask hypoglycemia, reduced thermoregulatry response, spasms, orthostatic hypotension

Max HR: 164 - (.7 x age)

104
Q

Orthostatic Hypotension

A

decreased of BP 20 and HR increase of 30 when standing from sitting

105
Q

Calcium Channel Blockers

A

-pine
-decrease HR & BP, conrtactility, O2 demand
-cause vasodilaiton of coronary artieries

CI
-reduce re-infarctions (dead tissue releases Ca), ischemic HD, heart failure, arrhythmias

SE
-negative inotropic effects, blunted HR responses to exercise

106
Q

Nitrates

A

-nitr
-slows HR, reduce preload and afterload, decrease contrtactility, lower BP, vasodilation

CI
-HTN, ischemic HD, heart failure, angina

SE
-hypotension, dizziness, reflex tachycardia, skin flushing

107
Q

Angina (Medications)

A

-chest pain due to ischemia
-lack of O2 stimulates pain receptors

-treated by nitrates, BB, CC blockers
S/s
-tightness and chest pain
-simular to MI
-ECG ST downward shift

108
Q

Stable Angina

A

-pain free at rest
-relieved by nitrates
-predictable

109
Q

Unstable Angina

A

-unpredictable
-at rest
->15mins
-progression of disease

110
Q

Prinzmetal’s Variant Angina

A

-only at rest; morning
-ST elevation
-cardiac vasospasm (CC blockers)

111
Q

Thrombolyic Agents

A

-break clots up quickly
-goal to keep ischemic time <120min

SE
-arrhythmias due to rapid reperfusion (high K, reflex tachycardia), bleeding, hemorrhage CVA

112
Q

Anti-Platelet Agents

A

-prevent platelet aggregation and thrombus formation
-decrease platele adverance to site of injury

113
Q

Anticoagulants

A

-prevention of blood clots, inhibit thrombin

Common: heparin, pradaxa, xarelto, eliquis

114
Q

Diuretics

A

-ide
-decrease blood volume by peeing
-improve cardiac contractility
-reduce cardiac demand
-act of kidneys (loop of henle most potent)

CI
-HTN, heart failure

SE
-hypotension, arrhyhmias (K+)

115
Q

Carbonic Anyhyrase Inhibitor Diuretics

A

-mild diuretics
-proximal tubules of kidney

116
Q

K+ Sparring Diuretics

A

-mild
-collecting tubules and ducts

117
Q

Thiazides Diuretics

A

-moderate
-can cause low K+ and glucose intolerance

118
Q

Sodium-Glucose Transporter Inhibitors

A

-ozin
-lower blood sugar, reduce CV deaths and kidney disease, reduce BP, weight loss

SE
-hypoglycemia, Hypotension, UTIs, diabetic ketoacidosis

119
Q

ACE Inhibitor

A

-pril
-prevents conversion of ang 1 to 2

SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia

120
Q

Angiotension II

A

-vasoconstriction
-water and Na retention
-aldosterone and ADH stimulation

121
Q

Angiotensin Receptor Blockers (ARBs)

A

-sartan
-limits effects of ang 2

SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia

122
Q

Neprolysin Inhibitor

A

-reduces abnorrmal remodeling
-diuresis
-vasodilation

123
Q

Aldosterone Antagonists

A

-suppresses aldosterone
-decreased fluid retention (diuretic)

ex: spironolactone

SE
-hyperkalemia, Orthostatic hypotension

124
Q

Positive Inotropes

A

-increase contractions and HR
-opposite of BB

CI
-heart failure

125
Q

Cardiac Glycosides

A

-positive inotropes
-increase Ca+
-decrease HR
-increase delay from SA to AV
-increase PR interval
-anti arrhythmics

ex: digoxin

CI
-dilated cardiomyopathy
-a fib
NOT FOR 2nd or 3rd Heart Blocks

SE
-lots of symptoms of digitalis toxicity

126
Q

Sympathomimetics

A

-positive inotropes
-mimic SNS, treat shock, heart failure
-short term use only to prevent downrreg

CI
-parenteral use for hheart failure

127
Q

Phosphodiesterase Inhibitors

A

-positive inotropes

CI
-severe CHF, strengthen contractions

128
Q

Vasodilators

A

-decrease bv, vascular resistance
-Arterial: reduce afterload
-Venous: reduce preload

CI
-HTN, HF, ischemic heart disease

SE
-compensatory SNS actitvation

129
Q

Alpha Adrenergic Antagonists

A

-vasodilator
-manage HTN

SE
-reflex tachycardia
-increase in BV

130
Q

Morphine

A

-vasodilator
-decrease preload via venodilation
-reduce anxiety and effort during heart failure

131
Q

Anti-Hypertensive

A

-regulate BP, decrease HR and CO
-BB, Ca blockers, ACE inhib, vasodilators, diuretics

132
Q

Anti-Arrhythmics

A

Membrane stabilizers
-v tach and a fib
-reduces Na+ in cell

SE
-arrhythmias, bradycardia, photosensitivity, hepatotoxicity, hypothyroidism

133
Q

Risk factors of Critical Illness Weakness

A

-bed rest
-immobility
-ventilatory suport
-sepsis
-organ failure

134
Q

Bedrest

A

-harmful
-no motion against gravity
-skeletal muscle declines 1-1.5% per day

135
Q

Immobility

A

-immobility due to meds
-skeletal muscle declines 5-6% per day

136
Q

3 Causes of Motor Weakness in ICU

A

-pre-existting neuromuscular disorder
-new neuromuscular disorder
-CIP or CIM

137
Q

Critical Illness Polyneuropathy

A

-sensory and motor nerves involved
-main contributor to persistent disability
-sepsis and organ failure
-chronic denervation

138
Q

Critical Illness Myopathy

A

-diffuse flaccid weakness in all limbs
-can have complete recovery
-chronic denervation
-can be caused by steroid use

139
Q

Causes of CIP and CIM

A

-critical illness and cytokine production lead to cascade of issues

140
Q

Phase I of ICU Mobility and Walking

A

-restricted to bed
-unable to bear weight

141
Q

Phase II of ICU Mobility and Walking

A

-able to stand
-cannot ambulate

142
Q

Phase III of ICU Mobility and Walking

A

-able to ambulate
-improve endurance

143
Q

Phase IV of ICU Mobility and Walking

A

-can walk at a high level
-ready to discharge

144
Q

How much O2 in atmosphere?

A

21% O2

145
Q

Nasal Cannula

A

-24-44% o2
-1-6L

146
Q

Reservoir Cannula

A

-conserve o2, stored in reservoir
-100% o2 in each breath
-retains exhhaled air

147
Q

High Flow Cannula

A

-1-15L w/ humidification
-24-75% o2
-not harsh on nose

148
Q

Simple O2 Mask

A

-6-10L
-30-70%
-6L minimum to brevent rebreathing

149
Q

Face Tent

A

-for mouth breathers or facial trauma
-8-15L
-21-40%

150
Q

Aerosol Mask

A

-liquid medicatitons into mist
-must be able to see mist
-8-15L
-21-60%

151
Q

Venturi Mask

A

-rroom air mixed with specific concentration
-color coded

152
Q

Nonrebreathing Mask

A

-highest 02
-75-100%
-8-15L
-bag must be 1/3-1/2 full
-might be close to intubation

153
Q

Tracheostomy Mask

A

-straight into tracheostomy tube
-35-60%
-10-15L

154
Q

High Flow humidification Systems

A

-up to 60L
-up to 100% o2
-humidified and warmed air

155
Q

Mechanical Ventilation

A

-meet physiological needs of pulmonary system

  1. Rrespiratory failure
  2. Protection of airway and lung
  3. Relief of upper airway obstruction
  4. Improvement of ulmonary toilet (unable to clear airways)
156
Q

Paradoxical Breathing

A

-diaphragm fatigued from working hard
-must be inubated

157
Q

Ventilator Settings to Know

A

-mode of ventilation
-FiO2: o2 concentration being administered (>60 concern)
-PEEP

158
Q

Ventilator Patient Data to Know

A

-Minute ventilation
-respiratory rate

159
Q

PEEP

A

-Positive End Expiratory Pressure
-resisdual pressure in alveoli after exhalation
-pressure required to inflate alveoli and prevent collapse

Low PEEP 3-5: normal
Moderate PEEP 5-15: treat refractory hypoxemia
High PEEP >15: severe lung injury
-put pressure on IVC and decreased CO

160
Q

Mode of Ventilation

A

-how breath is delivered

  1. Assist-Control
  2. SIMV and Pressure Support
  3. Pressure Support
161
Q

Assist-Control

A

-non weaning: breathing for patient
-rate and tidal volume pre-set
-patient can trigger breaths with pre-set tidal volume

162
Q

SIMV

A

-synchronized intermittent Mandatory Ventilation
-Weaning mode: starting to take them off
-rate and tidal volume pre-set
-patient can trigger breaths with pressure support instead of pre-set tidal volume

163
Q

Pressure Support Ventilation

A

-weaning mode: 0-30cmH20 (10 normal)
-applies to spontaneous breaths
-tidal volume not pre-set
-NOT air, only pressure

164
Q

CPAP

A

-constant positive pressure applied in airways
-noninvasive ventilation

165
Q

BIPAP

A

-Bi-level pulmonary airway pressure
-noninvasive ventilation

166
Q

SaO2

A

-actual o2 content in blood

167
Q

SpO2

A

-estimated o2 content in blood
-<88 is concerning, drop in hemoglobin curve

SE
-syncope, dizziness, paleness, quick breathing (>30bpm at rest)

168
Q

4 Steps to check EKG

A
  1. Speed
  2. QRS Wide or narrow
  3. P wave
  4. Regular or Irregular
169
Q

Rule of 300

A

5 Boxes: 60bpm
4 Boxes: 75bpm
3 Boxes: 100 bpm
2 Boxes: 150bpm
1 Box: 300bpm

170
Q

Length of EKG Components

A

P Wave: 2-3 boxes
PR interval: 3-5 boxes
QRS: 1.5-3 boxes

171
Q

Lead I

A

-limb lead
Right arm to Left arm
-normal wave form

-Circumflex A.
-lat wall of LV

172
Q

Lead II

A

-limb lead
Right arm to lower limb
-normal wave form

-Right Coronary A.
-Inferior portion of heart/apex

173
Q

Lead III

A

-limb lead
-leftt arm to lower limb
-normal wave form (may have inverted P and t wave)

-Right Coronary Artery
-Inferior portion of heart/apex

174
Q

aVF Lead

A

-augmented lead
Middle of body to lower limb

-Right coronary Artery
-Inferior portion of heart/apex
-normal wave form

175
Q

aVL Lead

A

-augmented lead
From middle to Left arm

-Circumflex A.
-lat wall of LV
-normal wave form

176
Q

aVR Lead

A

-augmented lead
From middle of body to right arm

-Top of RV
-inverted wave form

177
Q

V1

A

On Right 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.

-inverted P-wave, deep S
-RV

178
Q

V2

A

On Left 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.

-inverted P-wave, deep s
-RV, septum

179
Q

V3

A

On left between 2 and 4
-Anterior Heart, precordial lead

-Right coronary A.
-RV, septum, ant. heart

180
Q

V4

A

On left 5th intercostal space mid clavicular line
-Anterior Heart, precordial lead

-Larger R, small s
-Right coronary A., ant heart

181
Q

V5

A

On left 5th intercostal space anterior axillary line
-Lateral heart, precordial lead

-Larger R, small s
-Circumflex A., lat wall of heart

182
Q

V6

A

On left 5th intercostal space mid axillary line
-Lateral heart, precordial lead

-Larger R, small s
-Circumflex A., lat wall of heart

183
Q

Premature Ventricular Contraction

A

-random cell in ventricles fire out of sync of the rest, prematurely
-wide QRS

184
Q

Ventricular Bigeminy

A

-PVCs occur every 2 beats

185
Q

Ventricular Trigeminy

A

-PVCs occur every 3 beats

186
Q

Ventricular Couplet

A

-PVCs occur in 2s

187
Q

Ventricular Triplet

A

-PVCs occurr in 3s
-non sustained ventricular tachycardia
-STOP and check vitals

188
Q

Ventricular Tachycardia

A

-fast/large/wide QRS with no p wave, regular
-emergency

189
Q

Supraventricular Tachycardia

A

-fast/narrow QRS
-comes from atria not SA node

190
Q

Junctional Rhythm

A

-slow (40bpm) /no p wave/inverted T wave
-originates away from atria but depolarizes ventricles

191
Q

ST Elevation

A

-Acute MI
-Stimi

192
Q

ST Depression

A

-Angina/ischemia/infarction

193
Q

P Wave Inversion

A

-Heart block with junctional rhythm

194
Q

T Wave Inversion

A

-MI or ischemia
-BBB
-hypertrophy
-pulmonary embolism

195
Q

Ventricular Fibrilation

A

-dangerous, call code
-irregular/fast/small

196
Q

Atrial Fibrilation

A

-chaos/irregular
-QRS present, no p wave
-multiple cells firing

-valve issues, ischemia, stroke, arrhythmia

197
Q

Atrial Flutter

A

-saw tooth/bread knife
-1 cell going crazy
-QRS present and irregular

198
Q

Torsades De Pointes

A

-V tach with prolonged QT, irregular
-Looks crazy…how are you alive

199
Q

Right Bundle Branch Block

A

-delayed depolarization of RV
-right lead (V1): “M” in QR, deep S
-Left lead (V6): “W” in S wave

200
Q

R-Wave to find HR

A

-add up r waves in one strip x 6= HR

201
Q

Left Bundle Branch Block

A

-delayed depolarization of LV
-right lead (V1): “W” in R wave
-Left lead (V6): “M” in R wave

-anomally always at tip of QRS

202
Q

1st Degree AV Block

A

-husband is late but comes home, long PR interval
-from SA node
-slow HR

203
Q

2nd Degree AV Block : Type 1

A

-husband is later and later and then doesn’t come home
-longer PR interval then dropped QRS
-AV node

204
Q

2nd Degree AV Block : Type 2

A

-husband randomly doesn’t come home
-normal PR intervals
-randomly dropped QRS
-Bundle of his

-DONT WORK WITHOUT PACEMAKER

205
Q

3rd Degree AV Block

A

-normal p wave unrelated to QRS, no correlation of QRS
-random p waves

-DONT WORK WITHOUT PACEMAKER

206
Q

Percutaneous Revascularization Procedures

A

-revascularize myocardium

  1. Angioplasty
  2. Arthrectomy
  3. Stenting
207
Q

Angioplasty

A

-balloon inflated to push plaque against lumen
-stent then put in
-prone to bleeding
-5-7days no exercise

208
Q

Arthrectomy

A

-larger plaque buildup, cut out the plaque

209
Q

Coronary Artery Bypass Graft

A

-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)

210
Q

Cardiac Complications

A

-infection
-sternal precautions
-scar tissue
-Myocardial Stunning: low cardiac output
-Arryhmias
-Bleeding: migh need blood transfusions
-Neurologic Complications

211
Q

CABG Complications

A

-Renal failure: 5-10%
-Pleural Effusions: 90%
-Pericardial Effusion

212
Q

Sternal Precautions

A

-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control

213
Q

Intraortic Balloon Pump

A

-severe heart failure; shock
-restore CO
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%

214
Q

Valve Replacements

A

-aortic most common (pulmonary valve to replace aortic, aortic cannot be repaired)
-Metal: requires life long blood thinners
-Bovine: reduce stroke risk

215
Q

Arrhythmia Procedures

A

-Ablation: burn off cells causing arrhythmias
-Pacemaker Implant: need to know rate, what makes it come off
-Defibrillator: prevent arrhyhmias

216
Q

Peripheral Vascular Interventions

A

-Endarectomy: plaque removed
-Aneurysm repair

Cardiopulmonary (23 decks)

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