Cardiac Monitoring Summer 25 Flashcards
(108 cards)
1
Q
Bipolar Limb leads use how many electrodes?
Positive or Negative ?
A
“bipolar” = two electrodes
1 Positive
1 Negative
2
Q
Name this triangle
A
Eintohven’s triangle
3
Q
Augmented Limb Leads use what kind of electrodes ?
A
Positive Unipolar limb leads
- these leads intersect between limbs.
4
Q
Name these type of leads
A
Pericordial (chest) Leads
V1-V6
5
Q
what are the limb leads ?
A
|,||,|||
aVR, aVL, aVF
6
Q
What are the chest leads?
A
V1,V2,V3
V4,V5,V6
7
Q
12 Leds are used to identify what 4 things?
A
Rhythm
Conduction Delays
Infection
Damage
8
Q
Describe a Right BBB
A
conduction delay
R/R1
QRS >0.12 seconds
QRS greater than three little boxes
Two R’s
9
Q
Name that Strip !
A
Right BBB
10
Q
Describe a Left BBB
A
QRS >0.12 seconds
may look like acute anteroseptal MI
No R/R1 but a huge negative deflection for S wave
Two hemi bundles - “bifursicular bundles”
11
Q
Name that Strip !
A
LEFT BBB
12
Q
How is Right Atrial Hypertrophy diagnose on a strip?
A
Initial component of P wave is larger in V1
Height is >2.5 mm in any Limb lead
limb leads = |,||,|||, aVR,aVL,aVF
13
Q
What are the causes of RIght Atrial Hypertrophy? What is the main valvular diseaase it is associated with ?
A
Causes:
All casues of LVH , LAE , and RVH
Valvular disease:
Tricuspid valve diseae
14
Q
How is LEFT Atrial Hypertrophy diagnosed?
A
Terminal portion of diphasic P in V1 is larger
15
Q
Left Atrial Hypertrophy occurs with which conditions (2) ?
A
occurs with **mitral stenosis **and systemic HTN
16
Q
What are the causes of Left Atrial Hypertrophy ?
which valvular disease is it associated with ?
A
Causes:
all causes of LVH
Valvular Disease:
Mitral valve disease
17
Q
RIGHT Ventricular Hypertrophy shows on EKG strip how ?
A
- more depolarization toward V1
- QRS in V1 is
positive - R wave gets
smaller
18
Q
Causes of Right Ventricular Hypertrophy ?
A
Primary Pulmonary Pathology
- COPD
- Pulmonary HTN
19
Q
Name that Strip !
A
Right Ventricular Hypertrophy
- more depolarization toward V1
- QRS in V1 is
positive - R wave gets
smaller
20
Q
Left Ventricular Hypertrophy can be seen on EKG how?
A
Large S wave in V1
Larger R wave in V5
Depth of V1 and Height of V5 = 35 mm
21
Q
Causes of Left Ventricular Hypertrophy?
A
HTN
Aortic Valve disease
CHF
Coarctation
22
Q
Name that strip
A
Left Ventricular Hypertrophy
23
Q
Define Myocaridal Ischemia
A
Reduced supply of O2 from the coronary arteries
24
Q
Myocardial Ischemia can show on an EKG how ?
In how many leads ?
A
Inverted Symmetrical T wave
in TWO continguous leads
25
Name that Strip !
myocardial ischemia
26
Myocardial Injury will show on an EKG how ?
in how many leads ?
**ST ELEVATION**
in TWO contiguous leads
27
ST elevation idicates MI is ___________ ?
**ACUTE**
28
If more electricity is flowing towards positive electrode , what type of deflection do you expect ?
more positive deflection
29
If more electricity is flowing towards negative electrode , what type of deflection do you expect ?
more negative deflection
30
Pericordial leads look more at which side of the heart ?
LEFT side of the heart
31
To see Right heart picture of heart , how would you arrange leads?
place pericordial leads on opposite side of the chest.
32
what does contiguous mean?
related to each other
33
Sick Sinus Syndrome occurs in elderly patients often, and indicates what?
Failure of SA node
34
How can Artifical Cardiac Pacemakers be placed ?
Transthoracic , Transcutaneous, and travnsvenous
35
Generic code for Pacemaker funciton
|,||,|||, |V, V
Paced
Sensed
Response to Sensed
Rate Modulation
Multisite Pacing
36
Artifical Cardiac Pacemakers consist of ________ __________ and ___________ ________ .
Pulse Generator and Electrode Leads
37
DDD Pacemaker means what ?
Dual Paced
Dual Sensed
Dual Response to Sensing
## Footnote
dual response is triggered and inhibitied
38
To see pacemaker spikes on EKG , what must you do ?
Turn Filter OFF on cardiac monitor
39
Perioperative Care of Pacemakers (3)
Turn fiter off
groudning pad distant from pacemaker
Interrogation pre/post op
40
Bi V Pacing involves which chambers?
**Right** Atrium
**BOTH** Ventricles **(trans-septal)**
41
Bi V Pacing improves what ? (2)
Cardiac Resynchronication
- improves RV -LV activation time
- Increases EF%
42
What are the requirments for Bi-V pacing ? (4)
**EF 30-35%** Moderate/Severe heart failure
**Intraventricular Conduction Delays** BBB - QRS duration > .12 sec
**NYHA class 3 or 4** despite optimization - severe HF symptoms; limited ADL's
**History of Cardiac Arrest**
43
Magnets prevent what ?
disable anti-tachycardia therapy
by preventing inappropriate shocks
44
Perioperative Care of AICD/BiV ( 5)
**Optimize patient condition**
**Turn filter off on cardiac monitor**
**Bipolar Cautery** - directs current between electrodes instead of through body , minimizes EMI
**Back up pacing ability**
**Interrogation Posoperatively**
45
Implantable Cardioverter-Defibrillators are capable of what ?
**Terminating VF or VT**
**Measure R-R Intervals** - 10% inappropriate , SVT most common
other criteria:
- onset abrupt or gradual
- R-R interval consistnet or variable
- QRS width normal or wide
- amplitude
46
CVP measures pressure where ?
pressure measured at the **junction of Vena cava and Right Atrium**
47
CVP measurement is highly dependent on what ? (2)
highly dependent on **blood volume and vascular tone**
48
What is CVP used for ?
CVP is used for assessment of **blood volume and RIGHT heart function**
49
What is normal CVP range ?
1-7 mmHg
## Footnote
awake and spontaneously breathing
50
Circumflex supplies what portions of the heart?
Posterior Wall of LV Lateral Wall of LV
SA and AV nodes
51
RCA supplies what portions of the heart ?
RV
SA and AV node
L Bundle Branch
Inferior LV
Posterior LV
52
LAD supplies what portion of the heart ?
Anterior wall of LV
Bundle of His
Septal wall LV
53
Inferior infarct occulde which artery ?
Which leads are these seen in ?
RCA
||,|||,aVF
54
What are the indications for CVP lines ? ( 9)
CVP monitoring
PA catheter placement
Transvenous Cardiac Pacing
Temporary Hemodyalysis
Drug Administation
Rapid Infusion of Fluids/Blood
Aspirtion of air emboli
Inadequate peripheral access
Repeated blood testing
55
# CVP waveform:
what does the **a** wave mean and when does it happen ?
**Atrial Contraction**
occurs **after P wave**
Atrial pressure increases
provides atrial kick
**End Diastole**
56
# CVP waveform:
what does the **c** wave mean and when does it happen ?
Early Systole
- Interrupts the decreasing atrial pressure
- **isovolumetric contraction of the ventricle**
- result of AV valves bulging toward atria
- **Tricuspid Valve closed**
**Follows R wave**
57
# CVP waveform:
what does the **x descent** mean and when does it happen ?
happens mid-systole called ** Systolic collapse**
decrease in **atrial pressure from a wave through ventricular sytole**
58
# CVP waveform:
what does the **v** wave mean and when does it happen ?
Late ventricular systole
**venous filling of the atrium**
**Tricuspid valve remains closed**
**Peak's after T wave**
- after ventricular repolarization
59
# CVP waveform:
what does the **y** descent mean and when does it happen ?
**Tricuspid valve opens**
initial blood flow into ventricle
**Diastolic Collapse**
- pressure in atria is at its lowest
60
# Abnormal CVP Waveforms
**Absence of a wave** and **larger c wave** indicate what ?
Atrial Fibrillation
## Footnote
no atrial kick, atria fluttering etc.
61
# Abnormal CVP Waveforms
**No x descent** indicates what ?
Tricuspid Regurgitation
- valve is incompetent
## Footnote
valve is incomoetent
pressure never falls completlely , but never nothing
62
# Abnormal CVP Waveforms
**Tall A wave** indicates what ?
Tricuspid stenosis
63
Pulmonary Artery Catheter has how many lumens ?
4 lumens
Most Distal
30 cm - proximal
3rd lumen
4th lumen
64
Most distal lumen of PA catheter monitors what ?
PAP
65
The balloon of a PA catheter remains deflated until when?
until reaching the Right Atrium
| about 15 cm from Right IJ
65
30cm Proximal lumen of PA catheter measures what ?
CVP
66
3rd lumen of PA catheter goes where?
leads to a balloon near tip
67
4th lumen of PA catheter goes where?
Lies promixal to balloon
Houses temperature thermosatat
68
Preferred site of placement for PA Catheters
Right IJ
## Footnote
balloom deflated until reaching RA
69
what are the three things magnets do?
Asynchronous pacing with no rate modulation
Disable anti-tachycardia therapy
Detects battery life response
70
Where is the magnet placed when not in use ?
sterile field
71
Battery Life Response for Magnets can show what? What follow up is required ?
Decrease pulse amplitude or width, inadequate capture
Intensified follow - every 4 weeks.
Elective replacement for end of life.
72
What are the 5 views of TTE ?
1. Parasternal Long
2. Parasternal Short
3. Apical Four Chamber
4. Subcostal Four Chamber
5. Subcostal IVC
73
What are the three windows of a TTE ?
1. Parasternal 3-5 ICS
2. Apical @ PMI
3. Suncostal - below xiphoid
74
In which chamber will you notice a large volume wave change while advancing a PA catheter?
Right Ventricle
| advance catheter from right atria to ventricle with blood flow
75
In which chamber will the dicrotic notch appear on your PA catheter?
Once you reach the pulmonary artery
| smaller volume wave form here
76
PAC is how long in total ?
110 cm
- marked at 10 cm intervals
77
# Advancing PAC
Advance how many cm to get to :
Right Atria ______
Right Ventricle _______
Right Atria **20-25cm**
Right Ventricle **30-35cm**
78
# Advancing PAC
Advance how many cm to get to :
Pulmonary Artery ______
wedge _______
Pulmonary Artery **40-45cm**
Wedge **45-55cm**
79
Complications of PAC (7)
1.Pulmonary Artery Rupture
-Sudden Hemoptysis or hypotension
2.Pulmonary Infart
3.Endocarditis
4.TRANSIENT RBBB or Complete heart block
5.Valve Injury
6.Catheter knots
7.Dysrhythmias, PVC/V-Tach
80
Treatment of PA Rupture ?(5)
1. 100 % oxygen
2. PEEP
3. Reverse Anticoagultion
4. Float balloon into rupture
5. Definitive Surgical Therapy
## Footnote
3-5 minutes to try these things
81
What Pressures are monitored with PAC?(3)
1. PAP
2. PAWP
3. LVEDP
82
LVEDP's can be affected by what complications ?
Compliance
Aortic Regurgitation
PEEP
VSD
Mitral Stenosis/Regurgitation
83
# Abnormal PAC waveform
Tall V wave , C wave fused with V wave , no X descent indicates which valve disease ?
Mitral Reurgitation
84
# Abnormal PAC waveform
Slurred, early Y descent , where a wave may be absent can indicate which valve condition?
Mitral Stenosis
85
# Abnormal PAC waveform
Tall A wave, increased LVEDV, LVEDP, and PAWP can indicate what ?
ACUTE LV MI
86
# as
S V O 2
mixed venous Hgb saturation
87
SaO2
Arterial Hgb Saturation
88
VO2
Oxygen consumption
89
Q
Cardiac Output
90
Oxygen combing Capacity of Hgb ?
1.34
91
Global Assessment of circulation can be obtained how ?
PAC
92
Gold Standard of circulation assessment is what ?
Bolus thermodilution
93
Describe the bould thermodilution assessment ?
10 ML of COLD water is injected into proximal (RA lumen ) port and the temperature is measured at the distal port by thermister
## Footnote
3 attempts averaged
CO inversely proportionate to degree of change
94
The area underneath a thermodilution curve is what ?
inverely proportional to the CO
95
What are the inaccuracies of thermodilution methods? ( 5)
Mishandling of Injectate
Rapid infusion
Shunts
Tricuspid/Pulmonic Regurgitation
Temperature fluctuation
96
What is used with pulse contour devices?
Arterial Lines
## Footnote
estimates CO, PP, and SVV
97
What are Pulse Contour Inaccuracies ? (4)
tA- fib
Recalibration - frequently required
Quality of arterial trace
Site of Arterial puncture
98
What are the three modes of Echocardiography ?
M-Mode - basic picture
2-D - real time motion & function
Doppler -speed, direction & color
99
Parasternal Long Axis view will show what ?
overall view
measures LA, LV, and Aortic root
100
Parasternal Short Axis will show what ?
LV Function
LV volume assessment
101
Apical Four Chamber will show what ?
RV and LV size
TV and MV function
Descending Aorta
102
Subcostal Four Chamber view will show what ?
Four Chambers
Pericardial Effusion , next to right heart
103
Subcostal IVC will show what ?
Diameter , collapsibility , with spontaneous respiration
104
What are Intraoperative TEE for ?(4)
Intraoperative monitoring
Rescue tool
Assessment of Valvular function
Decision making
105
What are TEE contraindications
?(2)
Esophageal Varicies
Laproscopic Banding
106
How did Kane say we could identify Aortic valves ?
looks like mercedez benz sign
107
