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CMC > Pacemakers > Flashcards

Pacemakers Flashcards

1
Q

The first initial of a pacemaker’s pacing mode is chamber __________, and the second initial is the chamber ____________

A

Paced; sensed

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2
Q

Coronary arteries are perfused during __________

A

Diastole

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3
Q

Because coronary arteries are perfused during diastole, ____________ is a challenge in _______ __________ because it decreases diastolic ___________ time

A

Tachycardia; heart failure; filling

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4
Q

The RCA is significant for perfusing the __________ wall, as well as the right ______ and ventricle, the _____/_____ node, and the _____________ wall (90% of ppl) and (front/back) of septum

A

Inferior; atrium; SA/AV; posterior; back

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5
Q

The LMA bifurcates into what two branches?

A

Left Anterior Descending and Left Circumflex

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6
Q

The LAD perfused the _________ and anterior wall

A

Septal

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7
Q

The LAD perfuses the __________ and ____________ wall, the (front/back) of septum, most of the _______ and left bundles, the distal bundle of _______, __________ ____________ muscle of the mitral valve

A

Anterior; septal; front; right; His; anterior papillary

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8
Q

The LCX perfuses the __________ wall, the _______ ________, and the (front/back) of the left ______________

A

Lateral; left atrium; back; ventricle

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9
Q

What coronary artery supplies the septal wall?

A

LAD

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10
Q

What coronary artery supplies the inferior wall and back of the septum?

A

RCA

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11
Q

What coronary artery perfuses the left atrium?

A

LCX

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12
Q

What coronary artery perfuses the lateral wall of the heart?

A

LCX

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13
Q

Loss of atrial kick/contraction when pt rhythm converts to Afib is not tolerated very well in those with _______ ______ states/heart ___________

A

Low EF; failure

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14
Q

What pt condition does not tolerate tachycardia well due to the decrease in diastolic filling time?

A

Heart failure

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15
Q

S3 is a ____________ gallop, auscultated with ___________ is elevated

A

Ventricular; preload

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16
Q

S4 is an ________ gallop, created by the force of atrial contraction into ________________ ventricles

A

Atrial; noncompliant

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17
Q

Causes of S4 sound May include MI/__________, CAD, ________, __________ (or pulmonic) stenosis, and _______ ventricular ________________

A

Ischemia; HTN; aortic; left; hypertrophy

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18
Q

The AV on the left side of heart is the…….

A

Mitral valve

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19
Q

The semilunar valve on the left side of heart is the……

A

Aortic valve

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20
Q

Cardiac resuscitation includes early _______ with ____________ interruptions

A

CPR; minimal

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21
Q

Good quality CPR compressions: 100-______/minute, with ____-_____ inch depth

A

120; 2-2.5

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22
Q

Cardiac resuscitation includes early CPR as well as early ______________

A

Defibrillation

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23
Q

Avoid excessive ventilaton in cardiac resuscitation - give _____ breaths/min, or _____:2

A

10; 30

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24
Q

Vfib arrest: immediately ____________ (repeat every ____ minutes), CPR for two minutes - minimize _________, ___________ check and shock is warranted, ______________ 1 mg IV, _________________ 300 mg with repeat bolus of 150 if still in _________/__________

A

Defibrillate; 2; pauses; rhythm; epinephrine; amiodarone; VFIB/VTACH

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25
Q

True or False: In a Vfib arrest, the most recent rhythm was organized rhythm with no pulse (PEA). The next step is to administer Amiodarone

A

False - pt is not still in Vfib or in Vtach

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26
Q

Torsades de Pointes - caused by _______________, prolonged ______, and multiple _______________

A

Hypomagnesemia; QT; medications

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27
Q

In Vfib arrest, epinephrine ____ mg is given every _____-______ minutes

A

1; 3-5

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28
Q

Treatment of Torsades: IV/IO _____________ sulfate 1-___ grams

A

Magnesium; 2

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29
Q

In cardiac arrest situation immediate (CPR/defibrillation) occurs, followed by ventilation that is delayed until after a cycle of _____ ____________

A

CPR; 30 compressions

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30
Q

During CPR, compressions should maintained WITHOUT ________ for ________________

A

Pauses; ventilation

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31
Q

In resuscitation, opening the airway (with _____-_______ chin lift maneuver) and initiating ventilation occurs after the initial ______ ____________

A

Head-tilt; 30 compressions

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32
Q

In cardiac resuscitation, 30:2 ventilaton is used for someone not breathing - however, for someone who is adequately breathing, position them on the _______ side in the ______________ position

A

Left; recovery

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33
Q

It is KEY to initiate rapid defibrillation - defibrillation should be performed _____________ for Vfib or ____________ ________, as soon as a ________________ is available

A

IMMEDIATELY; pulseless Vtach; defibrillator

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34
Q

Timing of rapid defibrillation initiation - ideally within ____ ___________

A

3 minutes

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35
Q

Capnography during resuscitation - if ETCO2 is consistently <_____ mmHg despite adequate compressions, discuss _____________ of __________________ efforts - UNLESS the cardiac arrest is due to a suspected _____________ ______________

A

10; cessation; resuscitation; pulmonary embolism

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36
Q

For manual defibrillation in Vfib/pulseless VTach, the first step is to _________ __________

A

Check pulse

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37
Q

In defibrillation, turn on defibrillator and make sure that _______________ is OFF

A

Synchronization/synchronizer

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38
Q

When shocking Vfib/pulseless VTach, you want the defibrillator to be in (synchronized/non synchronized) mode

A

Non synchronized

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39
Q

True or False: During defibrillation, temporary pacemaker can be left on and pt can be defibrillated normally

A

False - turn pulse generator of pacemaker off

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40
Q

In automated defibrillation (AED), instead of setting J yourself, turn on machine and press ‘_________’ and machine will determine ___________ and if __________ is indicated

A

Analyze; rhythm; shock

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41
Q

True or False: With AED, rhythm will be analyzed, and if indicated, shock will be automatically delivered

A

False - you have to press shock button to deliver shock

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42
Q

Energy level for defibrillaton: (biphasic) _______-200J (monophasic) ________J

A

150; 360

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43
Q

After delivery of shock in defibrillation, the next step is to (perform rhythm check to assess for restoration of organized rhythm/immediately resume CPR beginning with chest compressions)

A

immediately resume CPR beginning with chest compressions

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44
Q

After defibrillation, it rhythm/pulse restored, next step is to administer _________________ ___________

A

Antidysrhythmic

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45
Q

After defibrillation - if rhythm/pulse is not restored, next step is to _____________ with appropriate ______________

A

Continue; algorithm

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46
Q

True or False: After shock is delivered during defibrillation, if rhythm/pulse is restored, the next step is administration of vasopressors and inotropes

A

False - next step is administration of antidysrhythymic therapy

47
Q

TTM goal temperature is 32-____ degrees C for _____ hours post cardiac arrest

A

36; 24

48
Q

Side effects of TTM cooling include (hypokalemia/hyperkalemia)

A

Hypokalemia, when it COOLING (not rewarming)

49
Q

Shivering during cooling for TTM should be (monitored/aggressively treated)

A

Aggressively treated

50
Q

Bradycardia as a side effect of cooling only needs to be treated if patient is _____________

A

Hypotensive

51
Q

Side effect of cooling in TTM/hypothermia is (vasoconstriction/vasodilation) induced _____________

A

Vasoconstriction; hypertension

52
Q

Electrolyte imbalances in hypothermia/TTM - hypokalemia, _______________, and __________________, due to cold induced __________

A

Hypophosphatemia; hypomagnesemia; diuresis

53
Q

Atrial fibrillation is known as the “_________” rhythm because of incidence of (hemorrhagic/embolic) stroke

A

Neuro; embolic

54
Q

Atrial fibrillation risk factors include _____________ disease or dysfunction/________ enlargement, ________ failure, MI, _________________, ___________ heart disease, lung disease, obesity, and __________ (cardiac surgery)

A

Valvular; atrial; heart; atherosclerosis; rheumatic; CABG

55
Q

What surgery is a risk factor for Afib

A

CABG

56
Q

Above ______ bpm in Afib is considered RVR - thus, there is a loss of atrial _______ and decrease in _________ ___________

A

100; kick; cardiac output

57
Q

In chronic Afib, thrombi most commonly form in the left ________ and left ________ _____________

A

Atrium; atrial appendage

58
Q

In chronic Afib - cannot convert patient without performing ______ beforehand, to confirm there is no ___________ present

A

TEE; thrombus

59
Q

True or False: Anticoagulation is not always necessary for Afib

A

False- anticoagulation is necessary

60
Q

Afib is managed with emergent synchronized ____________ of the Afib is (new/chronic) and (stable/unstable)

A

cardioversion; new; unstable

61
Q

Emergent cardio version for Afib is only done for Afib that is ______ and hemodynamically _____________

A

New; unstable

62
Q

For a patient with new Afib that is UNSTABLE - ____________ _____________ _______________ is indicated

A

Emergent synchronized cardioversion

63
Q

With _____________ use in Afib, it is key to know the patient EF

A

Antidysrhythmic

64
Q

It is important to know a pt with Afib’s ___________ fraction, before using _______________

A

Ejection; Antidysrhythmics

65
Q

In Afib - ___________ is a safer Antidysrhythmic to use with reduced EF

A

Amiodarone

66
Q

For Afib, which Antidysrhythmic is safer to use for reduced EF/heart function?

A

Amiodarone

67
Q

Other medications for management of Afib other than Amiodarone include _______ or calcium channel blockers, ____________, and ________________ (if sustained Afib)

A

Beta; digoxin; anticoagulation

68
Q

Calcium channel blocker for patients with Afib - must be used cautiously in ___________ ______

A

Reduced EC

69
Q

If Afib is SUSTAINED, what medication is indicated for necessary medication management?

A

Anticoagulation

70
Q

Amiodarone AE - monitor ______ _____________, as well as for hypotension or _______________

A

QT interval; bradycardia

71
Q

Metoprolol in Afib should be used with caution in patient with concurrent __________ (risk of bronchocontriction)

A

Athsma

72
Q

Esmolol is used to treat _______, HTN, and achieve _______ control in _______ and ___________

A

SVT; rate; Afib; Aflutter

73
Q

Other than rate control in Afib and Aflutter, esmolol is used to treat what other tachyarrhthymia?

A

SVT

74
Q

AEs of metoprolol include Bradycardua/hypotension, ________ failure, and ____________

A

Heart; hypoglycemia

75
Q

True or False: Digoxin can be used for atrial fibrillation management

A

True

76
Q

Adverse effect of esmolol includes heart ________ or heart _________

A

Block; failure

77
Q

True or False: Esmolol can cause a heart block as a side effect

A

True

78
Q

If pt on Esmolol develops AEs, ______ the ______________

A

Stop; infusion

79
Q

AE of diltiazem is _____ or _____ degree AV block, bradycardia/hypotension, asystole, and heart __________

A

2nd or 3rd; failure

80
Q

What two medications for Afib management have a risk for heart block?

A

Esmolol and Diltiazem

81
Q

What Afib management medication has an AE of possible 2nd or 3rd degree heart block

A

Diltiazem

82
Q

Digoxin in Afib is used to control ____________ rate in Afib/Aflutter

A

Ventricular

83
Q

Digoxin May be best suited for use in patients with _____ AND concurrent _______

A

HF; Afib

84
Q

Pt with HF and Afib - recommended medication would be…..

A

Digoxin

85
Q

Digoxin increases myocardial ______________, and also ________ conduction of the impulse through (SA/AV) bode

A

Contractility; slows; AV

86
Q

_____________ (electrolyte imbalance) increases risk of Digoxin toxicity

A

Hypokalemua

87
Q

For patient on Amiodarone, what EKG finding should be monitored?

A

QTc - QTc interval may be prolonged

88
Q

What Afib management medication has to be used carefully for pts with reduced EF?

A

CCBs/Diltiazem

89
Q

Therapeutic range of digoxin - 0.5-____

A

2.0

90
Q

Signs of digoxin toxicity include bradycardia, prolonged _____ interval, prolonged ______ interval, ST ________________, ________ changes, n/v and dizziness

A

PR; QT; depression; vision

91
Q

MAZE procedure is a (short/long) term treatment of Afib - surgical incisions are made in _______ and ________ ___________ to create ________ tissue that cannot conduct erratic impulses

A

Long; left; right atrium; scar

92
Q

Aflutter differs from Afib in that it has _____________ rates that can be faster than Afib, and more difficult to _____________

A

Ventricular; control

93
Q

Symptoms of Aflutter: _________, palpitations, fatigue, ___________ introlerance, __________, and chest _________

A

Syncope; exercise; SOB

94
Q

True or False: Symptom of Aflutter is SYNCOPE

A

True

95
Q

Short term treatment for Aflutter - _______________ // Long term treatment for Aflutter - ____________ ____________

A

Cardioversion; catheter ablation

96
Q

If it has been greater than _____ hours since onset of Afib (or unknown onset), pt must be anticoagilated

A

48

97
Q

(TTE/TEE) is preferred method for evaluating Atrial Flutter

A

TTE

98
Q

(TEE/TTE) is the best viewing for assessing ores ends of ____________ in ________ atrium from Afib/Aflutter

A

Thrombus; left

99
Q

SVT - (stable) Vagal maneuvers, ___________, IV __________ or _______ blocker

A

Adenosine; Diltiazem; gets

100
Q

Unstable SVT - ______________ ___________

A

Synchronized cardioversion

101
Q

Adenosine depresses ______ node _____________ and SA node activity

A

AV; conduction

102
Q

First line non pharmacological treatment for stable SVT is…..

A

Vagal maneuvers

103
Q

If stable, second line medication treatment of SVT (after use of adenosine) is admin of IV ____________ or ________ _____________

A

Diltiazem; beta blocker

104
Q

When patient is having adenosine administered, use the IV ____________ to the _________

A

Closest; heart

105
Q

Adenosine should NOT be used in pt with heart _________ or _________/bronchospasm

A

Block; Athsma

106
Q

WPW has (short/long) PR interval and ________ wave (____________ upstroke in the QRS)

A

Short; delta; slurred

107
Q

Wide complex tachycardia (QRS >._____ seconds) consult an _____________

A

12; expert

108
Q

Wide Complex Tachycardia - leads ____-______ are best for differentiating if _________ vs ventricular in origin

A

V1; V6; SVT;

109
Q

Wide Complex Tachycardia, can do ______________, adenosine, or (for monomorphic wide complex tachycardia) ______________

A

Amiodorone; Lidocaine

110
Q

What two drugs starting with A can be used for wide complex tachycardia?

A

Amiodarone; adenosine

111
Q

For antidysrhythymic medications - monitor leads V1 and/or _____

A

V6

112
Q

For Antidysrhythmic medications, monitor leads _____ and _______ and monitor the ________ interval

A

V1; V6; QTc

113
Q

Electrolytes to monitor in Wide Complex Tachycardua: K+, _____, _____

A

Mg; Ca

CMC (2 decks)

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