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NUR2226 > WK 3: Cardiac Disorders B > Flashcards

WK 3: Cardiac Disorders B Flashcards

1
Q

What is the purpose of the electrical conduction system?

A

Coordinates the contraction of the heart muscle to effectively pump blood and nutrients around the body

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2
Q

Outline the 5 steps of the electrical conduction pathway

A
  1. SA node sets rhythm (60-100 bpm)
  2. Travels to AV node
  3. Through the bundle of His
  4. Left and right bundle branches
  5. Through the purkinje fibres (Supply 02 to cardium)
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3
Q

What does the P wave represent on an ECG?

A

Atrial depolarisation (Atria contracting(pumping))

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4
Q

What does the QRS complex represent on an ECG?

A

Ventricular depolarisation (Ventricles contracting (pumping))

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5
Q

What does the T wave represent on an ECG?

A

Ventricular repolarisation (Filling))

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6
Q

Where is atrial replorisation occurring within an ECG?

A

Within the QRS complex

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7
Q

Identify the 6 steps to ECG Interpretation

A
  1. Examine the P wave
  2. Measure PR interval
  3. Measure QRS complex
  4. Identify the rhythm
  5. Determine the heart rate
  6. Interpret strip
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8
Q

How do you examine the P wave in ECG interpretation?

A

Present and upright ?

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9
Q

How do you measure the PR interval in ECG interpretation ?

A

Distance between the start of the P wave and the start of the QRS complex. Count the little boxes in this space and multiply by 0.4 seconds. Should be between 0.12 and 0.20

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10
Q

How do you measure the QRS complex in ECG interpretation?

A

Count the little boxes within the QRS in this space. Should be between 0.06 and 0.12

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11
Q

How do you identify the rhythm in ECH interpretation?

A

Measure distance between the R’s in 6 second strip. Mark two on a piece of paper and identify as regular or irregular

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12
Q

How do you determine the HR in ECG interpretation?

A

Get a 6 second strip, find the major three lines, count the QRS complexes. If 6 exactly, HR=60bpm

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13
Q

Identify the place of V1 on the chest in ECG lead placement

A

4th intercostal space right sternal border

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14
Q

Identify the place of V2 on the chest in ECG lead placement

A

4th intercostal space left sternal border

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15
Q

Identify the place of V3 on the chest in ECG lead placement

A

Between V2 and V4

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16
Q

Identify the place of V4 on the chest in ECG lead placement

A

5th intercostal space left mid clavicular line

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17
Q

Identify the place of V5 on the chest in ECG lead placement

A

5th intercostal space left anterior axillary line

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18
Q

Identify the place of V6 on the chest in ECG lead placement

A

5th intercostal space left mid axillary line

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19
Q

Identify the 6 characteristics of sinus rhythm

A 
P wave: Present, upright 
PR interval: 0.12-0.2 ms
QRS complex: Proceeded by normal P wave, <120ms
Rate: 60-100bpm
T wave: Present upright 
Mechanical contraction: Present
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20
Q

What is a N-STEMI?

A

Occurs when ischaemia leads to an infarction due to narrowing leading to decreased oxygen supply and nutrients to the distal area

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21
Q

What is usually the cause of a N-STEMI?

A

Usually accompanied by modifiable risk factors e..g smoking

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22
Q

What is a STEMI?

A

A complete occlusion of coronary arteries (sometimes due to thrombosis) causes infarction. Extends distally and proximally

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23
Q

What is a subendocardial infarction?

A

Occurs when significant occlusion due to ruptured plaque results in poor oxygen supply to the myocardium with infarction distally, and ischaemia in proximally. Endocardium not affected.

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24
Q

What is a transmural infarction?

A

Occurs when complete occlusion due to ruptured plaque leads to thrombosis and no blood supply to the cardium. Infarction extends distally and proximally. Endocardium affected

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25
Q

What represents a N-STEMI on an ECG?

A

Depressed ST wave or T inversion

No progression to a Q wave

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26
Q

What represents a STEMI on an ECG?

A

Elevated ST wave

Progression to a deep Q wave

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27
Q

What are the 3 zones of injury?

A
  1. Zone of ischaemia (partial occlusion): Inverted T wave
  2. Zone of hypoxic injury (restricted flow): Elevated ST wave
  3. Zone of infraction/necrosis: (Death of myocardial/cardiac cells): Deep Q wave
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28
Q

What is sinus tachycardia?

A

Sinus rhythm with a rate of >100bpm

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29
Q

What are the effects of sinus tachycardia?

A

Decreased filling times, Increased MAP, Increased myocardial demand

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30
Q

What is an example of someone who may experience sinus tachycardia?

A

Young adult undergoing exercise may reach 200 ppm

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31
Q

Identify the 6 characteristics of sinus tachycardia?

A 
P wave: Present, upright 
PR interval: 0.12-0.2 ms
QRS complex: Proceeded by normal P wave, <120ms
Rate: 100>bpm
T wave: Present upright 
Mechanical contraction: Present
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32
Q

What is sinus bradycardia?

A

Sinus rhythm with a rate of <60bpm

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33
Q

What are the effects of sinus bradycardia?

A

Increased preload, decreased MAP

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34
Q

What is an example of someone who may experience sinus bradycardia?

A

Athlete or fit person may have a HR as low as 40bpm when at rest or asleep

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35
Q

Identify the 6 characteristics of sinus bradycardia?

A 
P wave: Present, upright 
PR interval: 0.12-0.2 ms
QRS complex: Proceeded by normal P wave, <120ms
Rate: <60bpm
T wave: Present upright 
Mechanical contraction: Present
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36
Q

What is atrial fibrillation?

A

The result of abnormal electrical pathways in the atria often leading to an irregularly irregular ventricular contraction

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37
Q

What are the 3 types of AF?

A
  1. Occasional (Paroxysmal): Symptoms come and go, last from mins to hours
  2. Persistent: Lasts longer than a week, can become permanent
  3. Permanent: Heart rhythm cannot be restored, meds required
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38
Q

Identify 3 causes of AF?

A
  1. Excess catecholamines e.g. adrenaline infusion, stress
  2. Increased atrial automaticity e.g. alcohol, caffeine, myocarditis
  3. Abnormaility e.g. congenital Heart disease, ischaemic heart disease
39
Q

Identify 2 potential complications of AF

A
  1. Atrial thrombus formation

2. Heart failure

40
Q

Describe the pathophysiology of AF

A

No describable P wave due to abnormal erratic and disorganised electrical rhythm from SA node creates a “quivering” atria, AV node is bombarded meaning irregular activity and decreased CO

41
Q

Identify 3 clinical manifestations of AF

A

Altered conscious state
Irregular
Palpitations
Chest Pain

42
Q

Identify 2 potential treatments of AF

A

Betablockers/Calcium channel blockers/Antiarrthymic agents

Electrical cardio version (Electrical shock to restore sinus rhythm

43
Q

Identify the 4 characteristics of AF

A

P wave: Rate >300, non identifiable
QRS complex: Normal or wide
Rate: Variable with irregular rhythm
Mechanical contraction: Present

44
Q

Describe the pathophysiology of ventricular tachycardia

A

Impulse originates in ventricles outside of the normal conduction system

45
Q

Identify 2 causes of Ventricular tachycardia

A

Anaesthesia

Ageing

46
Q

Identify the 4 characteristics of ventricular tachycardia

A

P wave: Absent or independent of QRS
QRS complex: Broad
Rate: >180 bpm
Mechanical contraction: Can have pulse or no CO

47
Q

Describe the pathophysiology of ventricular fibrillation

A

Impulse originates in the ventricles outside of the normal system

48
Q

Identify 2 causes of ventricular fibrillation

A

Anaesthesia

Ageing

49
Q

Identify the 4 characteristics of ventricular fibrillation

A

P wave: Absent, non identifiable
QRS complex: Not identifiable
Rate: 150-500 bpm
Mechanical contraction: No CO

50
Q

Describe the pathophysiology of asystole

A

Has a wandering baseline, not compatible with life. No mechanical or electrical contraction

51
Q

Identify 2 causes of asystole

A

Profound ischaemia

Acidosis

52
Q

Identify the characteristic of asystole

A

“Flat line” or wandering baseline, No CO

53
Q

What is PEA?

A

Pulseless electrical activity: Electrical activity and rhythm continues but there is no contraction or CO. No pulse but ECG may look normal

54
Q

Describe the pathophysiology of PEA

A

Depolarisation and contraction not coupled

55
Q

Identify the cause of PEA

A

4H’s and 4T’s or intercranial haemorrhage

56
Q

Identify the 4H’s

A

Hypovolaemia
Hypoxia
Hypo/Hyperkalaemia
Hypo/Hyperthermia

57
Q

Identify the 4T’s

A

Toxicity
Tension pneumothorax
Tamponade (compression of heart by fluid)
Thromboembolism

58
Q

Identify the characteristic of PEA

A

Electrical activity variable, no mechanical contraction and no CO

59
Q

What is mechanical contraction?

A

The relaxation and filling of the heart ready to pump to the pulmonary system for oxygenation and around the body

60
Q

Define cardiac output

A

The volume of blood pumped out of the heart each minute

61
Q

What are the factors affecting cardiac output?

A

CO = SV x HR

62
Q

What is stroke volume influenced by?

A

Preload
Afterload
Contractility

63
Q

Define preload

A

How much blood the ventricle fills up with, or End diastolic volume. Includes venous return and ventricular compliance

64
Q

Define after load

A

How hard to ventricle has to work to push the blood out of the ventricle. The resistance the ventricle has to overcome to push blood into the arteries

65
Q

Define contractility

A

Force of myocardial contraction. Influenced by stretching of the myocardium and oxygen supply to myocardium

66
Q

Define ejection fraction

A

How hard the heart is pumping

(SV / ED ventricular volume) x 100

67
Q

What is heart failure?

A

A condition with abnormal ventricular function causing the heart to be unable to pump sufficient blood to meet the body’s needs.

68
Q

What are 3 clinical manifestions of heart failure generally

A

Dyspnoea
Orthopnoea
Fatigue/weakness

69
Q

What are the two types of heart failure

A 
Systolic HF (Ventricles can't pump hard enough)
Diastolic HF (Ventricles can't fill enough)
70
Q

What is HFrEF

A

Reduced ejection fraction (Systolic) Cant pump hard enough

71
Q

What is HFpEF

A

Preserved ejection fraction (diastolic) Cant fill enough

72
Q

Describe the pathophysiology of HFrEF

A

Myocardium is weakened and unable to pump blood to meet demands, leading to fluid build up in blood vessels;s, leaking into interstitial spaces of the body and lungs causing oedema, SOB

73
Q

Describe the further complications of HFrEF

A

Decreased contractility leads to the preload increasing and stretching the ventricles, leading to increased after load, increased oxygen demand and hypertrophy = decreased CO

74
Q

Describe the frank starling law

A

Loading up a ventricle with blood during diastole and streching the myocardium makes it contract with more force = increasing stroke volume

75
Q

Identify 2 causes of HFrEF

A

Family history
Smoking
Obesity
Increasing age

76
Q

Identify 2 potential complications of HFrEF

A

Cardiogenic shock

Arrythmias

77
Q

Identify 3 clinical manifestations of HFrEF

A

Dyspnoea
Orthopnoea
Fatigue

78
Q

Describe the pathophysiology of HFpEF

A

Impaired diastolic relaxation and decreased compliance = decreased filling and increased end diastolic pressure impacting pulmonary circulation and causes a buildup of fluid = pulmonary oedema

79
Q

Identify 2 causes of HFpEF

A

Major cause is HTN induced myocrardial hypertrophy (stretch of myocardium due to increased blood)

80
Q

Identify 2 potential complications of HFpEF

A

Angina/ ACS
Arrythmias
Oedema

81
Q

Identify 3 clinical manifestations of HFpEF

A

Dyspnoea
Orthopneoa
Fatigue

82
Q

What is right sided HF?

A

Failure of the right ventricle to fill and pump blood particularly against increased pressure in pulmonary vasculature

83
Q

Describe the pathophysiology of RSHF

A

Impaired contractility of right ventricle caused by increased pressure, volume overload or myocardial contractile dysfunction

84
Q

Identify 2 risk factors for RSHF

A

Age (men >50)
Left sided HF
Congential heart defects

85
Q

Identify 2 causes of RSHF

A

Left sided HF
COPD
Cor pulmoanle

86
Q

What is Cor Pulmonale

A

Increased pulmonary BP chronically = hypertrophy and failure to contract)

87
Q

Identify 2 potential complications of RSHF

A

Arrythmia

ACS/Angina

88
Q

Identify 3 clinical manifestations of RSHF

A

Peripheral oedema
Increased urge to urinate
Fatigue
Sudden weight gain

89
Q

Identify 3 forms of assessment for heart failure

A

Aim to determine/treat underlying cause
Through HH and physical examination
Chest Xray
ECG

90
Q

Identify 3 forms of management for heart failure

A

Maximise CO
Alleviate symptoms
Improve cardiac function/QOL (LSHF)
Reduce fluid accumulation (RSHF)

91
Q

Identify 3 areas of nursing management for Heart failure

A

Thorough nursing assessment
Prioritise care
Planning/goals

92
Q

Explain what COACHED stands for

A

Compressions continue
Oxygen away (if free flowing BVM bag valve mask)
All others clear
Charging defibrillator (200J)
Hands off (Compressor should say I’m safe)
Evaluating rhythm
Defibrillate or Disarm

93
Q

Define compliance

A

Hearts ability to relax and fill with blood

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