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CCRN Study Time! > The Heart Does One Thing…. > Flashcards

The Heart Does One Thing…. Flashcards

1
Q

A STEMI in the inferior wall of the heart would show ST elevation in which ECG leads?

A

Leads II, III, and aVF

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2
Q

ST elevation in leads V1-V4 indicates an infarction in which wall(s)?

A

The anterior/septal walls

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3
Q

Name that heart block!

A

1st degree AV block
“If the R is far from the P, it means you have a 1st degree”

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4
Q

Which coronary artery feeds the inferior wall of the heart?

A

RCA

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5
Q

Where can you auscultate the aortic valve?

A

2nd ICS, right sternal border

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6
Q

Where can you auscultate the pulmonic valve?

A

2nd ICS, left sternal border

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7
Q

Which valve can you auscultate between the 4th and 5th ICS, @ the LEFT sternal border?

A

The tRIcuspid valve (between the R atrium and R ventricle)

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8
Q

Which valve can you auscultate @ the 5th ICS, @ the left mid-clavicular line?

A

The mitraL (mighty, mighty LEFT! Between left atrium and left ventricle)

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9
Q

What does the S1 heart sound represent?

A

*Systole
*closure of the mitral and tricuspid valves
*auscultate @ mitral area (5th ICS)

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10
Q

What does the S2 heart sound represent?

A

*Diastole
*Closure of aortic and pulmonic valves
*Auscultate over aortic area (2nd ICS, right sternal border)

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11
Q

Name 3 reasons an S3 heart sound might be present? Where can you auscultate it?

A

*Listen for S3 over apex
1. Increased preload (ex. fluid overload)
2. Normal in kids and pregnancy
3. VSD, mitral/tricuspid regurgitation

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12
Q

An S4 (pre-systolic) heart sound is caused by the vibration of the atria ejecting blood into ________________ ventricles. **Bonus: name 3 causes.

A

Non-compliant (a.k.a. “Impaired relaxation”)

**Bonus: ischemia, CAD, pulmonary/aortic stenosis, left ventricular hypertrophy

“A S4 heart sound can be an important sign of diastolic heart failure or active ischemia and is rarely a normal finding. Diastolic heart failure frequently results from severe left ventricular hypertrophy, or LVH, resulting in impaired relaxation (compliance) of the LV. In this setting, a S4 is often heard. Also, if an individual is actively having myocardial ischemia, adequate adenosine diphosphate cannot be synthesized to allow for the release of myosin from actin; therefore, the myocardium is not able to relax, and a S4 will be present.

It is important to note that if a patient is in atrial fibrillation, the atria are not contracting, and it is impossible to have a S4 heart sound.”

https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/s4-heart-sound

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13
Q

In ACS there is an imbalance of ________ supply and demand.

A

Oxygen

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14
Q

Semilunar valves (aortic and pulmonic) are open during _____________.

A

Systole (blood out to body and lungs)

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15
Q

AV valves (mitraL and tRicuspid) are open during ____________.

A

Diastole (filling)

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16
Q

The posterior wall of the heart is perfused by the _______ in 90% of the population, but by the ________ in 10% of people.

A

RCA; circumflex

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17
Q

The LATERAL wall of the heart (containing the left atrium and the back of the left ventricle) is perfused by the ________.

A

Circumflex artery

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18
Q

The ____________ wall of the heart contains the R atrium, the SA node, the AV node, the R ventricle, and the back of the septum.

A

Inferior (fed by RCA)

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19
Q

The _______ perfuses the septal and anterior walls (which include the front and bottom of L ventricle, and the front of the septum).

A

LAD

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20
Q

The “widowmaker” refers to a blockage in which coronary artery?

A

The LEFT MAIN (upstream of both the circumflex and LAD = bad news, shock, HD instability)

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21
Q

Coronary arteries are perfused during which phase of the cardiac cycle?

A

During DIASTOLE (backflow); coronary sinuses are @ the base of the aorta

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22
Q

How do measure preload?
Right side: ________
Left side: _________

A

Right side: CVP (but not super useful alone — doesn’t tell you if they’ll be fluid responsive)
Left side: PAOP (wedge)

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23
Q

____________ is the resistance ventricles have to overcome as they’re moving blood

A

Afterload

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24
Q

Increased afterload on the R side of the heart is ____________

A

Pulmonary vascular resistance

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25
Q

Increased afterload on the left side of the heart is called __________.

A

Systemic vascular resistance (SVR)

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26
Q

Systole usually accounts for ___ of the cardiac cycle, while diastole accounts for ____.

A

1/3, 2/3 (shortened c/ tachycardia!)

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27
Q

When can you auscultate a split S1 or S2, and what do they represent?

A

Best heard during INSPIRATION.
Split S1: mitral closes before tricuspid (R BBB, PVCs, V-pacing)
Split S2: aortic closes before pulmonic (overfilled R ventricle, ASD)

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28
Q

____________ is the forward flow of blood through NARROW, OPEN valves.

A

StenOsis (not open all the way)

29
Q

____________ is the backward flow of blood through incompetently closed valves.

A

Insufficiency (not closed all the way)

30
Q

_____________ murmurs are heard between S1 and S2; mitral and tricuspid valves are closed (insufficiency), and aortic and pulmonic valves are OPEN (stenosis).

A

Systolic

31
Q

___________ murmurs are heard after S2; tricuspid and mitral valves are OPEN, and aortic and pulmonic valves are CLOSED.

A

Diastolic

32
Q

Murmur =
Regurgitation =

A

Stenosis (forward flow through open valves that aren’t totally open)
Insufficiency (backflow through closed valves that aren’t totally closed)

33
Q

Would mitral insufficiency cause a systolic or diastolic murmur?

A

Systolic (occurs when valves are closed = regurgitation!)

34
Q

Why are patients with mitral regurgitation and mitral stenosis prone to developing Afib?

A

Due to left atrial enlargement

35
Q

Pink cheeks, pulmonary edema, and pulmonary HTN with a diastolic murmur are all symptoms of:

A

Mitral stenosis

36
Q

Medical management of mitral stenosis focuses on reduction of _________ and ________.

A

Preload and afterload

37
Q

MI, ruptured chordae tendineae, severe left sided heart failure (dilated), rheumatic fever, endocarditis, and L ventricular cardiomyopathy are all potential causes of what type of valvular dysfunction?

A

Mitral insufficiency (regurgitation)

38
Q

Aortic insufficiency occurs when the valve doesn’t close all the way, which results in a backflow of blood and a reduced _________ pressure.

A

Diastolic (ventricle already partially filled with back flowing blood!)

39
Q

What can happen to the muscle in the left ventricle if a pt has aortic stenosis?

A

Hypertrophy!

40
Q

What is the gold standard test for diagnosis of aortic stenosis?

A

***ECHO!

41
Q

TAVR (transcatheter aortic valve replacement) pts should be carefully monitored for signs of bleeding/hematoma, bradycardia and heart blocks, as well as ___________.

A

Signs of stroke (plaque rupture)

42
Q

A “sail-shaped” ST segment can indicate _______.

A

Coronary vasospasm (Prinzmetal’s angina)
(Treat with NTG, CCBs)

43
Q

The body views plaque rupture as an _______ and responds accordingly, leading to __________ aggregation which can lead to the formation of occlusive thrombi.

A

Injury; platelet

44
Q

What do pathologic Q-waves represent?

A

An old MI (usually days after, persist for life sometime)

45
Q

Troponin levels rise in about 3-4 hours, peak at about _____to_____ hours, and return to normal levels in about 1-2 weeks.

A

14-20

46
Q

What is the goal “door to balloon” time for PCI in the case of a STEMI?

A

90 minutes or less

47
Q

The standard “MONA” bundle of treatment is now considered somewhat antiquated; what does “MONA” stand for, and which two elements are now given only if necessary (instead of as part of standard treatment).

A

“MONA” = Morphine, Oxygen, Nitro, Aspirin

Morphine and Oxygen are now only given as needed

48
Q

This medication is used indefinitely post-MI in order to disable platelet aggregation

A

Aspirin

49
Q

What are two contraindications for administering nitroglycerin to STEMI patients?

A

DO NOT give to STEMI pts with right ventricular infarction or pts who take phosphodiesterase inhibitors (i.e. Viagra)

50
Q

Hyperoxemia can contribute to _________ _________ after an MI.

A

Oxidative injury

51
Q

Tachycardia, hypotension, back and/or groin pain, and flank ecchymosis are all potential s&sx of what complication following a femoral approach heart cath?

A

Retroperitoneal bleed
(Note: tachycardia may be masked by beta blockers)

52
Q

Patients with _______ ventricular failure become preload dependent, and may need IV fluids in order to maximize preload.

A

Right

53
Q

A posterior wall MI would show reciprocal changes in which leads?

A

Leads V1 and V2

54
Q

A patient has chest pain that improves when sitting up & leaning forward, with ST elevation in leads I&II. What do you suspect is the issue?

A

Pericarditis

55
Q

Alpha adrenergic receptors are located in ______ _________.

A

Blood vessels

56
Q

Beta1 receptors are located ____________.

A

On the heart

57
Q

Beta2 receptors are located ____________.

A

In the bronchial and vascular smooth muscle

58
Q

Dobutamine is a positive inotrope that primarily effects _______ receptors.

A

Beta1 (on the heart)

59
Q

This vasopressor is the first-line choice in sepsis, and affects alpha and some beta1 adrenergic receptors.

A

Norepinephrine

60
Q

Phenylephrine only acts on ________ receptor.

A

Alpha (in blood vessels)

61
Q

Longer cardiac bypass time can lead to increased risk of stroke, neurological injury, and ___________.

A

Bleeding

62
Q

The pericardial space normal contains about ______ to ______ mL of fluid.

A

20 to 50

63
Q

“Beck’s Triad” includes:
1. Elevated CVP with JVD
2. Hypotension
3. Muffled heart sounds
….. and indicates what?

A

Cardiac tamponade

64
Q

A greater than 10 mmHg drop in BP during inspiration is called _____ ______.

A

Pulsus paradoxus (indicates cardiac tamponade)

65
Q

Amiodarone is safer to use for Afib patients with a _________ ejection fraction (over beta blocker or CCBs)

A

Decreased (because not a negative inotrope like BBs and CCBs)

66
Q

For a pt in hypertensive crisis, goal is to reduce BP by _____% over 1-2 hours

A

25%

67
Q

A patient describes a “ripping” chest pain radiating to the back. What do you suspect?

A

Aneurysm (types: TAA, AAA, aortic)

68
Q

___________ is a direct arterial vasodilator.

A

Nicardipine

69
Q

BP difference of greater than 25 mm Hg between arms is a sign of what?

A

Aortic dissection

CCRN Study Time! (5 decks)

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