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FlightBridgeEd > Cardiac Physiology > Flashcards

Cardiac Physiology Flashcards

(49 cards)

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1
Q

Heart valves

A

Tricuspid(R) and Mitral(L) = blood into the Ventricals
Pulmonic(R) and Aortic(L) = blood out of the ventricles

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2
Q

Why Pulmonic valve is important

A

Maintains diastolic pressure in pulmonary artery
MAP is made up of 2/3 diastolic pressure

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3
Q

Cardiac Output

A

> 4-8L/min
HR quickest way to increase CO(Q)
Stroke volume (SV) = preload, after load, contractility. Amount of blood ejected during systolic pressure
Tachycardia increases O2 use and decreases O2 supply. Tachycardia = 220-age
Are they hot, hypoxic, or hypovolemic?

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4
Q

Dicrotic notch

A

End of the T wave

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5
Q

Heart sounds

A

S1-closing of Mitral and tricuspid
S2-closing of the aortic and pulmonic
S3-ventricular filling sounds like “Ken-TUCKy”. Normal
S4-LV filling when non-compliant. Pathological sound. “Ten-nessee”

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6
Q

RCA

A

Feeds SA/AV node, RA, RV, and Inferior/Posterior wall

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7
Q

LAD

A

V1-V4

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8
Q

Pre-cordial leads

A

V-leads

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9
Q

How and when to perform a right side 12-lead

A

All patients with an Inferior STEMI should get a right sided 12-lead. Just move V4 to the right side of the chest. That’s all you need to do

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10
Q

Left circomflex artery

A

Leads 1-aVL(high lat)
V5-V6(low lat)

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11
Q

Hyper acute T wave

A

Early change suggestive if STEMI
Tall and peaked symmetrical
*Only seen in the affected area

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12
Q

Pathologic Q waves

A

> 25% of R wave height
2mm in depth
At least 40(0.04)ms wide
Associated with necrotic cells
Usually seen days or weeks after

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13
Q

aVL and Inferiors

A

If you see as little as 0.5mm of depression in aVL, it’s 97% predictive in identifying inferior MI.

If ACS patient has aVL depression, Inferior MI is likely coming soon

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14
Q

Where is WALDO and his SHIP

A

W-Wellen’s syndrome
A-aVR STE
L-LBBB
D-DeWinters T wave
O-out of hospital ROSC

S-subtle Inferior-High Lat wall
H-Hyper acute T wave
I-Isolated
P-Posterior

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15
Q

EKG with pericarditis

A

Global STE without reciprocal changes

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16
Q

Imitators of STEMI

A

LVH
Paced/Ventricular beats
Pericarditis
Early depolarization

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17
Q

LVH

A

> S wave depth in V1 + tallest R wave in V5-V6 = >35mm
aVL R wave >11mm
aVF R wave >20mm

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18
Q

Benign Early Repolarization(BER)

A

Normal
STE
Tall T waves
Often seen in Inferior/Lat leads
Males 20-40 yo and African American
ST segment “fish hook” sign

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19
Q

Patho Left axis deviation

A

LVH
Left Anterior hemi block
LBBB
Inferior MI
Paced

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20
Q

Causes of Right axis deviation

Study These Flashcards
A

RVH/COPD
PE
TCA OD
Lat wall MI
Left posterior hemiblock

21
Q

SCB with bifasicular block?

Study These Flashcards
A

No!!! No Amio, Lido, or Procainimide to runs of Vtach with a bifasicular block!! You will kill the patient

22
Q

Wellens Syndrome type 1 and 2

Study These Flashcards
A

> Type 1
Biphasic T waves in V2-V3(deep symmetric)
Common in Anterior but could be in any precordial lead
Can be pain free
No STE!
Type 2
Negative(inverted) symmetric T wave
**75% had LAD that will lead to AMI within weeks

23
Q

aVR diagnostic

Study These Flashcards
A

Anterior depression, aVR STE > STE V1 = left main insufficiency and 3 vessel disease process

24
Q

Sgarbossa Criteria(LBBB)

Study These Flashcards
A

Concordant STE >1mm = 5
STD >1mm in V1-V3 = 3
Discordant STE >5mm =2

25
DeWinters T waves
Tall T waves Upsloping STD >1mm Absence of STE in precordial leads STE 0.5-1mm in aVR Normal ST morphology
26
Slow Vtach Tx
QRS duration >200ms or 0.20? It’s hyper K Killer drugs- CCB Na+ blockers **Tx with Calcium and Bicarb
27
Brugada syndrome
Seen in Asians and young males 20-30 yo Sodium channel issue Normal QT Painless Ventricular arrhythmias. Biphasic T wave in V1-V2 S/S: dizzy, syncope, SOB, palpitations, young person sudden cardiac arrest
28
FP-C pharm Qs
Will be solely based on the following: >Generic vs Trade name >use and indication >mech of action >contraindication *doses will be pretty standard, nothing out the normal
29
Agonist vs antagonists
>Agonist: activate receptors >Antagonists: block receptors from being activated
30
Beta Blockers(BB)
-lol drugs >Antagonists of the beta receptors in the heart and lungs >cause decreased Ino/Chromo/Dromo effects on the heart(good); bronchospams in the lungs(bad)
31
Esmolol
Action: (BB) Selectively antagonizes Beta-1 adrenergic receptors > Rapid onset and short acting >decreases force, rate, and BP Indications: SVT and uncontrolled HTN Precautions: Asthma/bronchospasm, hypersensitivity, bradycardia, AV blocks, CHF, and Cardiogenic shock *seen with aneurysm patients Dose: 500mcg/kg/min
32
Labetalol
Action: (BB) anti-HTN w/ selective Alpha-1 and non-selective beta-antagonist effects. Indications:patients with HTN issues(head bleed) Precautions: Bronchial asthma, cardiogenic shock, >1st degree heart block, severe bradycardia Dose: 10-20mg slow IVP q 10min max of 300mg
33
Calcium channel blockers(CCB)
-pine drugs >acts by blocking Ca++ influx into vascular smooth muscle casuing relaxation especially in the coronary arteries >negative dromo, slows impulses through SA and AV nodes, and casues vasodilation.
34
Nicardipine(Cardene)
Action: (CCB) Relaxes cardiac, smooth, and vascular muscle cells Indications: HTN Precautions/contraindications: Pregnancy, CHF, advanced aortic stenosis, and hypersensitivity Dose: 5mg/hr *Nicardipine(Cardene) preferred prehospital drug
35
Vasopressors and Inotropes
Vasopressor causes vasoconstriction Inotropes increase force of contraction Meds: Dopamine, Epi, Norepi, Dobutamine, Phenylephrine(Neosynephrine), Vasopressin, and Methylene Blue
36
Norepinephrine(Levophed)
**Gold standard vasopressor** Action: stimulates alpha adrenergic receptors resulting in vasocontrictions, increased peripheral vascular resistance, increase in BP. Indications: Vasogenic shock with tachycardia, sepsis, and neurogenic shock Dose: 2-12mcg/min and titrate to effect. Peds- 0.1mcg/kg/min titrate to effect.
37
Dopamine(Intropin)
Alpha/Beta (5-10mcg/kg/min) mixed stimulation increased CO, contractility, BP, HR Loss of renal action *5-10mcg/kg/min is the theraputic range
38
Inodilators(Dobutamine and Milrinone)
Sympathomimetic(adrenergic) agents Action: stimulation of beta-1 receptors, higher ino than chrono, increase contractility, and vasodilation Indications: actue LV failure, pulmonary vasocontriction, high pulmonary vascular constriction, and low Q states-low perfusion states
39
Dobutamine
synthetic catecholamine with beta-1 effects some beta-2 as well causing vasodilation use caution with hypotensive patients(borderline) Dose: 2-20mcg/kg/min *always fill the tank first. If they are not volume responsive, go with Levo instead
40
Milrinone
*like Viagra* Action: increases contractitility and stroke volume Indications: Ischemic and non-ischemic cardiomyopathy, CHF, and Pulmonary HTN Precautions: Hypersensitivity, hypertrophic cardiomyopathy, WPW or other bypass tracts Dose: Adult and peds- 0.25mcg/kg/min max of 1mcg/kg/min
41
Vasopressors
Phenylephrine(neosynephrine), Vasopressin, Methylene Blue sympathomimetic (adrenergic) agents Action: stimulate Alpha-1 & Alpha-2 receptors >increase vasoconstriction >low beta properties Indications: Neurogenic shock, push dose pressors, vasogenic shock states, refractory septic shock
42
Phenylephrine(Neosynephrine)
Action: stimulates alpha, causes increased BP without tachycardia, and increases aortic root pressure and coronary artey perfusion pressure Indications: Vasogenic shock with tachycardia, sepsis, neurogenic shock Dose: 10-100mcg/min and maintenance 40-60mcg/min
43
Vasopressin
**2nd line drug Action: releases catecholamine receptors Indications: Vasodilatory shock/septic shock Dose: Sepsis-0.01-0.04units/min. Upper GI Blled- 0.5units/min Good for patients with norepi refractory hypotension
44
Methylene Blue
Action: Nitric oxide inhibitor. Combats vasodilation from nitric oxide release 2ndary to pro-inflammatory mediator release Indications: Vasodilatory shock/Septic shock Dose: 1.5-2mg/kg over 20min-1hr *decreases the need for other vasopressors or allow for lower vasopressor dosing. NOT SEEN IN PRE-HOSPITAL SETTING
45
Hydralazine
Vasodilator/ HTN emergencies Action: dilates arterial system and decreases afterload Indications: PIH(pregnancy induced HTN) and HTN Dose: 5-10mg IV max of 40mg **WATCH OUT- drops both systolic and diastolic pressure
46
Nitroglycerin
Action: Dilates venous system and arterial system at higher doses, decreases preload and afterload, relieves vasospasm, improves blood flow and myocardial O2 consumption Indications: Angina, MI, acute LV failure, coronary artery spasm Dose: 5-20mcg/min(or 5-200mcg/min)
47
Nitroprusside
Action: relaxes vascular smooth muscle, dilates arterial/venous system, and decreases aferload/preload. Indications: HTN(hemorrhagic stroke), acute LV failure, cardiogenic shock, acute aortic dissections Precautions: Pregnancy(cyanide toxicity) Dose: Adult and ped- 0.5-10mcg/kg/min titrate to effect
48
Heparin
Action: decreases the ability for the body to form blood clots Indications: any condition caused by a clot(DVT, ACS, CVA, PE, MI) Precautions: recent major surgery, ulcer, GI bleed Hx or renal dysfunction Dose: 60-80units/kg followed by infusion of 15-18units/kg/hr
49
Alteplase(Activase, t-PA)
Action: desolves formed blood clots Indications: Ischemic stroke, STEMI, PE Dose: Stroke- 0.9mg/kg over 1hr max 90mg STEMI <67kg- 15mg over 1-2min max total 100mg STEMI >67kg- same as above by all 100mg infused over 1.5 hrs PE- 100mg over 2 hrs

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