Cardiology Flashcards Preview

Paramedic 2 > Cardiology > Flashcards

Flashcards in Cardiology Deck (132):
0

What are the three components of the heart?

Heart
Blood
Vasculature structures (Pipes)

1

What is the purpose of the cardiovascular system?

Circulate blood containing oxygen and nutrients, while also providing a means for waste removal

2

Veins carry blood towards where?

The heart

3

Arteries carry blood away from where?

Away from the heart

4

The circulatory system is closely tied to which system?

Pulmonary system, changes in one will quickly result in changes to the other

5

Almost every cell in the body lies adjacent to what?

A capillary

6

The entire system of blood vessels including arteries, veins and capillaries totals to about how many miles?

60,000

7

The main energy source in the body is what?

Oxygen

8

Oxygenated blood leaves from where in the heart?

Left ventricle

9

Oxygenated blood travels through where after leaving the left ventricle?

The aorta

10

After oxygenated blood arrives in the artery where does it go?

Arteriole then the capillary

11

Oxygen and nutrients are exchanged with what gas along with what other products?

CO2 and waste

12

If perfusion issues occur above the renal arteries what organs are compromised?

Kidneys, Urine output will be slowed and/or stopped

13

The apex of the heart is inferior or superior to the base of the heart?

inferior

14

Where is the tricuspid valve located in the heart?

The right side

15

Which side of the heart is higher pressure/has more muscle mass and why?

left side because it has to pump blood to the whole of the body while the right side only has to pump blood into the lungs

16

Where does oxygen poor blood enter the heart?

Through the superior and inferior vena cava into the right atrium

17

Where does blood go from the right atrium?

The right atrium contracts pushing the blood into the right ventricle through the tricuspid valve

18

Where does blood go from the right ventricle?

Leaves the right ventricle through the pulmonic valve into the pulmonary artery and then to the lungs where it is oxygenated

19

Where and how does oxygenated blood enter the heart?

Pulmonary vein empties oxygen rich blood from the lungs into the left atrium

20

As the left atrium contracts where does the blood go?

the left ventricle through the mitral valve

21

As the left ventricle pumps the blood where does it go?

Leaves the heart through the aortic valve into the aorta and to the body

22

If the left ventricle is backed up where does the blood back up in?

The lungs

23

True or false, blood backed up in the right ventricle backs up into the lungs

False

24

The heart is comprised of what three layers in order of most superficial to deep?

Epicardium
Myocardium
Endocardium

25

What is the myocardium?

The middle layer and muscle of the heart

26

What is the endocardium?

The inner lining of the heart

27

What is the pericardium?

Fibrous tissue that surrounds the heart which consists of the tough outer layer (Parietal Pericardium) and the inner layer (Visceral Pericardium or Epicardium) which lines the outside of the heart as well as the inner most section of the Parietal Pericardium

28

What is the space between the visceral pericardium and the epicardium filled with?

pericardial fluid

29

The pressure required to open the aortic valve is known as what?

afterload

30

In coronary circulation what two major vessels branch off the aorta

Left main coronary artery
Right coronary artery

31

The left main coronary artery divides into what two other arteries?

Circumflex
Left Anterior Descending

32

What is coronary circulation?

Circulation of blood through the heart muscle itself

33

The left anterior descending supplies blood to what structures?

The septum and the ventricular walls

34

If the left anterior descending is occluded what will happen?

Majority of the left ventricle will become ischemic

35

The right coronary artery supplies blood to what structures?

The SA and AV node

36

The right coronary artery also becomes what artery?

The posterior descending artery

37

Where do coronary veins deposit their blood?

Right atria

38

Where do coronary veins collect their blood?

From the capillaries into the coronary sinus

39

What are the two shockable rhythms?

vfib and pulseless vtach

40

Heart tissue is specialized and found nowhere else in the body, what are the three unique properties to heart tissue?

Automaticity
Excitability
Contractility

41

Define inotropy

Inotropy is the strength of the cardiac contraction

42

Define chronotropy

Influence on the heart rate

43

Define dromotropy

The excitability or willingness of the heart to conduct an impulse through the cardiac cells

44

What is the Frank-Starling Mechanism?

Mechanism that states the force of blood ejected by the heart is determined primarily by the length of the fibers of its muscular wall

45

When does atrial kick occur

Occurs just at the conclusion of the transfer between the atria and the ventricles

46

How much force is potentially lost without atrial kick?

up to 25%

47

Cardiac cells are connected end to end by what?

an intercalated disk.

48

What allows an impulse and blood flow to travel all the way down to the apex of the heart?

A system of conduction fibers

49

Where do contractions begin in the heart?

Contractions begin at the apex and moves towards the base

50

Where do impulses first occur in the heart?

In the right atrium within a group of specialized cells called the SA (Sino Atrial) Node

51

The SA node is innervated by what two nervous systems?

Parasympathetic and Sympathetic systems

52

What is the Atrioventricular Node?

Acts as a gateway, electrically connecting the atria to the ventricles.

Also slows down the conduction to allow for atrial kick

53

What do the bundle branches do?

Transmit electrical impulses quickly into the apex of the ventricles

54

Where do impulses terminate in the heart?

In a network of small conduction fibers known as the Purkinje network

55

How are cardiac cells interconnected?

End to end through an intercalated disk

56

Does the body always want all electrical forces neutral?

Yes

57

How does the body attempt to maintain the number of particles in balance?

Diluting an area of higher concentration of particles with an area of lower concentration of particles

58

Where are Sodium and Potassium particles found in highest concentrations?

Sodium is found in high concentration outside the cell

Potassium is found in high concentration inside the cell

59

What are the two axis on a cardiac monitor represent?

Y axis: Millivolts

X Axis: Time in seconds

60

Which wave represents the movement of conduction from the SA node to the AV node

P wave

61

If the P wave is depressed below the isoelectric line, what does that indicate?

The AV node firing towards the SA node

62

The section of the wave after the P wave represents what?

The delay in conduction in the AV node to allow atrial kick to occur

63

A resting cell is polarized or depolarized?

Polarized

64

What does the QRS wave represent?

Ventricle depolarization

65

One small box on an ECG grid paper is how many seconds?

0.04 seconds

66

One large box on ECG grid paper is how many seconds?

0.20 Seconds (One large box is 5 small boxes lengthwise)

67

What is the PR interval normal duration?

between 0.12 and 0.20 seconds

68

What can a prolonged PR Interval indicate?

Delay in the AV node

69

How long does a normal QRS complex take?

between 0.04 and 0.12 seconds

70

If after the P wave there is only a single negative deflection what is that wave called?

QS Wave

71

What does the T wave represent and how long is the normal duration?

Represents the repolarization of the ventricles and duration is normally between 0.10 and 0.25 seconds

72

What is the J point?

The end of depolarization

73

What speed does ECG paper come out?

25mm per second

74

What does STEMI stand for?

ST ELEVATION MI

75

What are the five steps you follow when interpreting EKG strips?

1. Rate (Beats per minute)
2. Rhythm (including presence of ectopic beats)
3. Presence and shape of the P wave, and its relationship to the QRS
4. PR Interval
5. QRS Complex

76

How does an EKG count heart rate and what should you be conscious of?

An EKG only detects electrical impulses but DOES NOT notice if a heart beat is actually perfusing

77

What is a good method for counting beats in an irregular rhythm?

Count the number of R waves in a 6 second strip and multiply by 10

78

What is a method of estimating heart rate on an EKC strip?

Count the number of large squares between two consecutive R waves and divide into 300

OR

Memorize this scale:
1 large square = 300 bpm
2 large square = 150 bpm
3 large square = 100 bpm
4 large square = 75 bpm
5 large square = 60 bpm
6 large square = 50 bpm

79

What are the 4 regularities of rhythm?

Regular
Essentially regular
Regularly irregular
Irregularly irregular

80

If the length of a PR interval is longer than 0.20 seconds what could that potentially be?

Blockage in the AV node or junction

81

While inspecting the QRS complex you must look at:

The duration
The height
The presence of Q waves and their lengths and size
General configuration of the complex noting any slurring or notching

82

What is a Q wave?

Initial negative deflection on an EKG, lengthening of the Q wave may indicate myocardial infarction

83

Define Absolute Refractory period.

Period of time where a second action is unable to be started no matter how large of a stimulus is given.

84

Define relative refractory period.

Period of time where a second action can be initiated but is inhibited or requires a large amount of stimulus

85

heart rate is affected by what nervous system?

Autonomic nervous system, (parasympathetic and sympathetic branches)

86

How many millivolts are one small box equal to on an EKG strip equal to?

1/10th of a millivolt

87

How many millivolts are large boxes on an EKG strip?

0.5 millivolts

88

Define wandering pacemaker

Pacemaker site that wanders between the sinus node, the atria and the AV junction. Although each impulse originates from a different focus, the rate usually remains within normal ranges.

89

What are the rules for a Wandering Pacemaker?

Regularity: slightly irregular
Rate: Usually normal, 60-100
P Wave: Morphology changes from one complex to the next
PRI:Less than 0.20
QRS: Less than 0.12

90

Describe one Valsalva maneuver:

Ask the patient to bear down as if to move his/her bowels with his/her nose and mouth closed.

91

An increase in afterload results in a(n) ________ workload of the heart, especially in the ________ ventricle.

Increased; left

92

Define Premature Atrial Complex

The pacemaker is an irritable focus within the atrium that fires prematurely and produces a single ectopic beat.

Note: this is a single beat and not an entire rhythm, the underlying rhythm must also be identified

93

The PR interval reflects all _____ activity

Atrial

94

Define Atrial Tachycardia

The pacemaker is a single irritable site within the atrium that fires repetitively at a very rapid rate.

95

Define atrial flutter

A single irritable focus within the atria issues an impulse that is conducted in a rapid repetitive fashion. To protect the ventricles form receiving too many impulses from being conducted through to the ventricles.

Looks similar to a saw tooth

96

Define Atrial Fibrillation

The atria are so irritable that a multitude of foci initiate impulses, causing the atria to depolarize repeatedly in a fibrillary manner. The AV node blocks most of the impulses allowing only a limited number to go through to the ventricles

97

Define F waves

Fibrillatory waves associated with atrial fibrillation

98

What are key characteristics of PVC?

QRS complex longer than 0.12 secs
No preceding P wave
Commonly produces T wave that deflects opposite of the QRS
Compensatory pause

99

During a junctional rhythm the pacemaker site is located where?

At the AV Junction in the middle of the heart

100

During a junctional rhythm how will the P wave appear?

Inverted and in different locations dependent on if the atria are depolarized before, during or after the ventricles

101

During a junctional rhythm if the atria are depolarized before the ventricles how long will the PRI be?

less than 0.12 seconds

102

An inverted P wave may be what two kinds of rhythms?

Atrial or Junctional

103

When you see an inverted P wave after the QRS complex where is the origin of the rhythm?

AV Junction

104

If the inverted P wave occurs prior to the QRS complex what is an important clue to determine if the rhythm originates in the AV Junction or the Atria?

PRI for a junctional rhythm should be less than 0.12 while a rhythm occurring in the atria should take the normal length of time

105

Define Premature Junctional Complex

Irritable focus in the AV Junction that produces a single ectopic beat. P wave will be inverted if visible and if the P wave occurs prior to the QRS complex it will last shorter than 0.12 seconds.

106

Define junctional escape rhythms

Regular rhythm

Rate of between 40-60

P wave inverted before during or after the QRS complex

107

Define and differentiate Accelerated Junctional Rhythm and Junctional Tachycardia

Accelerated junctional is a junctional rhythm that has a rate between 60 - 100

Junctional tachycardia is a junctional rhythm that has a rate of between 100 - 180

108

What rhythms are classified under Supraventricular Tachycardia?

Sinus Tach
Atrial Tach
Junctional Tach
Atrial Flutter

109

How many degrees of heart blocks are there?

3 degrees

110

Define 1st degree heart block

AV Node holds each impulse longer than normal before conducting it to the ventricles. Each Impulse is eventually conducted.

111

How do you define a first degree heart block on an EKG?

Normal sinus rhythm except the PRI is greater than 0.20

112

Define second degree heart block type 2

The AV Node constantly holds PRI longer than normal and blocks some P waves

113

Define "wenckebach" type 1 second degree heart block

PR Intervals will get progressively longer until one is blocked and the cycle starts over

114

What is the difference in QRS between a third degree heart block with ventricular or junctional escape

Junctional escape QRS is under 0.12 while a ventricular escape will have a QRS of greater than 0.12

115

Define ventricular tachycardia

Irritable focus I the ventricles firing quickly and overriding higher sites In the heart

Regular
No p wave

116

Define ventricular fibrillation

Multiple focus sites become irritable in the ventricles

Completely chaotic with no patterns

117

Define idioventricular rhythm

Ventricles initiate a regular impulse at their inherent rate of 20 - 40 bpm

No p wave
Wide QRS
Bpm of 20 - 40

118

Define asystole

No electrical activity

119

What does a wide QRS duration indicate?

Ventricular rhythm

120

What does a narrow QRS duration indicate?

Atrial or junctional rhythm

121

Define artificial pace maker

Device used to provide artificial electrical stimulus to the myocardial tissue to stimulate depolarization

122

Every time a pacemaker fires, what is produced in an ekg strip?

Spike

123

What are two different types of pacemakers

Temporary and permanent

124

What are the two types of temporary pacemakers

Transcutaneous and Transvenous

125

Are pace makers able to stimulate different areas of the heart?

Yes

126

When would you classify a rhythm as SVT?

When a P Wave is not visible and the rate is common among other arrhythmia

127

Define interpolated PVC

A PVC that occurs and does not interrupt the underlying rhythm

128

Define unifocal PVC

PVC's that occur in the same spot, the morphology will be similar

129

Define R on T phenomenon

PVC that occurs during the preceding t wave

130

Define PVC Cooley and run

Two PVC's in a row is a couplet

More than that it's a run

131

Define bigeminy, trigeminy, quadrageminy

PVC's that occur consistantly on the specified beast