Cardiology

Question 1

Contraindications of Fibrinolysis

Answer 1

Systolic > 120-180 mmHg
Diastolic > 100-110 mmHg
Right vs Left arm BP difference > 15 mmHg
Stroke
Sign. Head trauma within 3 mo.
Major trauma within 2-4 weeks
Blood thinners/ blood condition
Serious systemic disease
Prego.
History of ICH

Question 2

inotropic

Answer 2

force of contraction

Question 3

chronotropic

Answer 3

rate

Question 4

dromotropic

Answer 4

electrical impulse conduction

Question 5

starlings law

Answer 5

rubber band theory of increasing the hearts ability to stretch and contract by adding fluids

Question 6

4 properties of cardiac cells

Answer 6

Excitability
Contractility
Conductivity
Rhythmicity

Question 7

Excitability

Answer 7

Ability to respond to electricity

Question 8

Conductivity

Answer 8

Ability to pass on electricity

Question 9

Rhythmicity

Answer 9

Ability to generate electricity spontaneously and rhythmically

Question 10

Do alpha receptors constrict or dilate

Answer 10

Constrict

Question 11

Do beta receptors restrict or dilate

Answer 11

Dilate

Question 12

Normal PR interval length

Answer 12

0.12-0.2

Question 13

Normal QRS length

Answer 13

0.12 or less

Question 14

Regular rhythm

Answer 14

R to R lengths are consistent

Question 15

Rhythms- Irregularly irregular vs regularly irregular

Answer 15

Irregularly irregular- unequal R to R distances with no pattern

Regularly irregular- unequal R to R distance with pattern

Question 16

P waves- what 3 things do you check for?

Answer 16

Are they present?

Is there 1 P wave for every QRS (and is there one QRS for every P wave)?

Is the morphology consistent?

Question 17

What’s 2 PVCs in a row called

Answer 17

Couplet

Question 18

What’s more than 2 PVCs in a row called?

Answer 18

Salvos or run of v-tach

Question 19

What’s bigeminal

Answer 19

Every other beat switches between a QRS complex and a PVC

Question 20

What’s Trigeminal

Answer 20

Every 3rd QRS is replaced with a PVC

Question 21

If a Q wave is present….

Answer 21

It should be less than 0.04 in height.
If it’s longer than 0.04 it’s probably an NSTEMI

Question 22

Define STEMI

Answer 22

Persistent complete occlusion of the myocardial

Question 23

What do you do different on an RVI and why

Answer 23

Don’t use nitro because the vasodilation will crash your preload

Diagnose an RVI by moving V4 to right if you see an inferior STEMI

Question 24

RCA

Answer 24

Right Coronary Artery

Breaks off the aorta to feed the right and inferior side of the heart crossing between the right ventricle and right atrium.

Will show up in lead 1, lead 2, AVF

Question 25

LMCA

Answer 25

Comes off the aorta and splits into the LAD and the Circumflex

Question 26

LAD

Answer 26

Left anterior descending Feeds the septal and then the anterior part of the heart showing in V1-V4 respectively

Question 27

LCX

Answer 27

Left circumflex Goes into the lateral part of the heart on the left side showing in leads V5, V6, lead 1, and AVL

Question 28

Bundle branch block left vs right

Answer 28

The QRS will be long down the a left and tall up for a right

Question 29

PE high risk pts

Answer 29

Female Smoker Sedentary Birth control pills Post surgery

Question 30

1st degree block

Answer 30

PRI is longer than 0.2 from beginning of P wave to

Question 31

2nd degree type 1

Answer 31

Wenkebach PRI gets longer and longer until there is a P wave without a QRS

Question 32

2nd degree type 2 block

Answer 32

Mobitz 2 PRI is in normal range and regular but you still loose QRS’s randomly Atropine won’t help

Question 33

3rd degree block

Answer 33

Atrial and ventricles are not communicating. Ventricular rate will be bradycardic. Both P waves and QRS march out but not together

Question 34

Cardiac arrest H’s and T’s

Answer 34

Hypovolemia Hypoxia Hydrogen ions (acidosis) Hypo/Hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis (cardiac) Thrombosis (pulmonary) Bonus point- hypoglycemia

Question 35

Start of CPR algorithm (step 1-3)

Answer 35

Compressions Oxygen Defib- shock or not shock?

Question 36

Shockable rhythm CPR algorithm

Answer 36

1st pulse/ rhythm check ASAP Other rhythm/pulse checks every 2 min Start Epi once there’s a line every other pulse check Consider Ami after min of 2 shocks

Question 37

CPR algorithms for non shockable

Answer 37

Pulse/rhythm check ASAP Obtain IV access Pulse check every 2 min Epi every other pulse check Continue until MC calls death after 40 min, there is a shockable rhythm, or you get ROSC

Question 38

ROSC ACLS tree

Answer 38

Get 12 lead, pulse ox, ETCO2, BP, RR Look for- STEMI Unstable cardiogenic shock Mechanical heart rate LOC Maintain BP with bolus then Epi Watch ETCO2 and rhythms

Question 39

Bradycardia ACLS algorithm

Answer 39

Maintain airway/ oxygen sats Identify rhythm/ BP Get IV, 12 lead, hx Are they stable? Yes- atropine No- pace

Question 40

Tachycardia ACLS algorithm

Answer 40

Only consider after 150!! Maintain airway/ ox sats Identify rhythm/ BP Iv access, 12 lead, hx Are they stable? Yes- vagal then adenosine then cardiovert No- cardiovert

Question 41

3 rhythms to cardiovert

Answer 41

Vtach with pulse SVT Afib with increased RvR

Question 42

3 rhythms to defibrillate

Answer 42

Pulses vtach Vfib Torsades

Question 43

What rhythm to pace

Answer 43

Symptomatic and unstable bradycardia (Blocks)