Chapter 18 Cardiology Flashcards
(330 cards)
1
Q
Sudden narrowing or complete blockage of coronary artery causes myocardial tissue death is called what?
A
Acute Myocardial Infarction (AMI)
2
Q
The cessation of cardiac mechanical activity is called what?
A
Cardiac Arrest
3
Q
Heart rhythm disturbances
A
Dysrhythmias
4
Q
The right atrium receives blood from where?
A
Superior vena cava, inferior vena cava, and the coronary sinus.
5
Q
Which part of the heart receives oxygenated blood from the pulmonary veins?
A
Left Atrium
6
Q
The ___________________ has much thicker walls than the ______________________.
A
Ventricles have much thicker walls than the atrium.
7
Q
Which part of the heart pumps deoxygenated blood to the lungs?
A
Right Ventricle
8
Q
What does the left ventricle pump blood to?
A
The entire body
9
Q
The L ventricle rotates forward as it contracts. PMI is the POINT OF MAXIMUM IMPULSE, where the heartbeat is most strongly felt. Where on the body can you feel the PMI?
A
Left anterior part of the chest, 5th intercostal space, midclavicular.
10
Q
What separates the heart into 2 functional pumps?
A
Septa
11
Q
Which is the “low pressure” side of the heart? Which is the “high pressure” of the heart?
A
Right is low pressure, as it pumps to lungs.
Left is high pressure, as it has to pump blood through the entire system.
12
Q
What is responsible for cardiac contraction and efficient ejection of blood from the heart?
A
Myocardium
13
Q
What supplies blood to the tissues of the heart?
A
Coronary arteries
14
Q
Which artery is the largest in diameter, shortest, and divides off into the LAD (Left Anterior Descending Artery) and the CX (Circumflex Artery)?
A
Left Main Coronary Artery (LMCA)
15
Q
Where does the LAD supply blood to?
A
L ventricles anterior, posterior, lateral, septum.
16
Q
The Cx artery supplies blood to the what?
A
Lateral and posterior of L ventricle and L atrium
17
Q
What supplies blood to the walls of the R Atrium and ventricle, a portion of the inferior part of the L ventricle, and portions of the conduction system (SA node and AV bundle)?
A
Right Coronary Artery (RCA)
18
Q
Four main components of the Cardiac Cells?
A
Automaticity
Excitability
Conductivity
Contractility - Calcium
19
Q
Name the components of the cardiac conduction system.
A
SA Node
AV Node
Bundle of His
R & L Bundle Branches
Purkinje Fibers
20
Q
A series of cardiac conditions caused by an abrupt reduction in blood flow through a coronary artery is called what?
A
Acute Coronary Syndromes
21
Q
The 3 major Acute Coronary Syndromes.
A
Unstable Angina
NSTEMI
STEMI
22
Q
Common chief complaints of someone experiencing ACS.
A
Chest pain/discomfort
Dyspnea
Fainting
Palpitations
Fatigue
23
Q
Best assessment technique for assessing cardiac related complaints.
A
O - Onset
P - Provocation
Q - Quality
R - Radiation
S - Severity
T - Timing
24
Q
What cause Angina Pectoris?
A
Ischemia, when the heart muscle does not receive enough O2.
25
Left Ventricular Failure cause fluid to build up where?
Lungs
(Left to Lungs, the rest is from Right)
26
Sudden onset of difficulty breathing in which the pt is suddenly woken from sleep, often associated with L sided heart failure.
Paroxysmal Nocturnal Dyspnea, often accompanied by coughing, wheezing, and sweating. Usually improves within 15-30 mins after sitting upright or standing.
27
A brief loss of consciousness caused by a temporary decrease in blood flow to the brain.
Syncope (fainting)
28
Common cardiac meds to ask about during assessments.
Antidysrhythmics - Digoxin, Amiodarone, Verapamil
Anticoagulants - Lovenox (enoxparin), Coumadin (warfarin), Plavix (clopidogrel)
Angiotensin converting enzyme inhibitors - (PRIL DRUGS) Lisinopril, Enalapril, etc
Beta Blockers - (LOL DRUGS) Atenolol, metoprolol, propranolol
Lipid lowering agents - (STATIN DRUGS) Lovastatin, Pravastatin, Rosuvastatin, etc
Diuretics - Lasix (Furosemide) Hydrochlorothiazide (HCTZ)
Vasodilators - Nitro, Isordil
29
Specific Diagnoses to inquire about during assessments.
Aneurysm
Atherosclerotic Heart Disease (MI, HTN, angina, heart failure)
Congenital Anomalies
CAD
DM / Renal Disease
Inflammatory Heart Disease
Previous heart surgeries/grafts/valve replacements
Pacemaker/Defibrillator
Pulmonary Disease
Valvular Disease
Vascular Disease
30
Bilateral pitting edema is a sign of what?
Right Ventricular Failure
31
Pitting edema to one side of the body is an indication of what?
A blockage in a major vein.
32
What occurs when the SBP drops 10 mm hg or more w/inspiration?
Pulses Paradoxus
33
What conditions could you find Pulses Paradoxus in?
AMI, Cardiogenic Shock, Cardiac Tamponade, and Constrictive Pericarditis
34
A beat-to-beat difference in the strength of a pulse is called what? Could be a sign of severe ventricular failure.
Pulsus Alternans
35
Heart sound on systole, when the tricuspid and mitral valve open.
S1
36
Louder S1 sounds can be heard in pts with what? Due to the valves opening when the ventricles contract.
Fever, Anemia, or hyperthyroidism
37
How many Amps of electricity does sit take to stop the heart?
O.5 amps
38
Treatment for R sided MI
Fluids - Improve Preload
NO NITRO!! Will kill them!!
39
Treatment for L sided heart failure
Nitro
NO FLUID!! Do not want to overload them!!
40
How many joules do you use to cardiovert a ped pt?
Start w/2 joules, can go up to 10.
41
Average Adult Stroke Volume
70ml
42
Hypothermic CPR Rules
CPR, 1 shock, transport, NO DRUGS!!
43
Cold Blood doesn’t…..
Clot
44
CPR Pyramid
Early Recognition
CPR
AED
Airway
Drugs
45
How to treat SVT, VF, VT, AFib, A Flutter
1.) Narrow Complex, Start w/Vagal Maneuver/Cardioversion
A.) Shock at 50 Joules, up to 200J as needed
B.) PEDS - 0.5J per kg
2.) Wide Complex, Shock
A.) Shock at 100 Joules, up to 200J as needed
B.) PEDS - 1J per kg
46
Treatment for Sinus brady
1.) Atropine (if that doesn’t work)
2.) Epi (If that doesn’t work)
3.) Pace
47
A “widow maker” is a complete occlusion of which artery?
Left Anterior Descending Artery
48
What part of the heart does V1 capture?
Septum
49
Which artery supplies blood to the septum and anterior part of the heart?
Left Anterior Descending Artery
50
Which artery supplies blood to the lateral part of the heart?
Circumflex Coronary Artery
51
Which artery supplies blood to the inferior part of the heart
Right Coronary Artery
52
V1 and V2 capture which part of the heart?
Septum
53
V3 and V4 capture which part of the heart?
Anterior
54
Which part of the heart does V5 & V6 capture?
Lateral
55
An abnormal whooshing sound that is associated with turbulent blood flow through valves.
Murmur
56
A sequence of changes in the membrane potential that occurs when an excitable cell is stimulated.
Action potential
57
The process of discharging resting cardiac muscle fibers by means of an electrical impulse that stimulates contraction.
Depolarization
58
Cardiac Action Potential Phases
Phase 0 - Cardiac muscle receives impulse. The cell depolarizes and contracts. QRS complex on EKG.
Phase 1 - Inward sodium channels close and the cell begins to repolarize.
Phase 2 - Plateau Phase. Corresponds to the ST segment on EKG.
Phase 3 - Final phase of repolarization. Becomes increasingly negative. T wave on EKG.
Phase 4 - Resting Phase. Sodium and Potassium swap out in preparation for the next depolarization.
59
What cells are found in the tissue of the SA node, AV node, bundle of His, and Purkinje Fibers?
Pacemaker Cells
60
Depolarization of Atria. Normal duration is 0.08-0.11 secs (2-3 small boxes) and less than 2.5mm tall.
P wave
61
Distance from a P wave to the beginning of a QRS complex, indicates the amount of time it took for the impulse to traverse the atria and AV junction. Normal range is 0.12-0.20 secs (3-5 small boxes). Prolonged ones can indicate a heart block.
PR Interval
62
Represents ventricular depolarization. Should be narrow w/a duration of 0.08-0.11 secs.
QRS wave
63
1st negative deflection, indicates conduction through the interventricular septum. Should last no more than 0.04 secs.
Q wave
64
Wave that represents depolarization of the R & L ventricles (squeeze of heart).
R & S wave
65
Begins at J point, ends at T wave. Represents early ventricular repolarization. Period between ventricular depolarization and beginning of repolarization.
ST Segment
66
Represents ventricular repolarization. Upright, flat, or inverted wave following the QRS complex. Should be asymmetric and half the overall height of the QRS complex.
T wave
67
Time between 2 successful ventricular depolarizations.
R-R Interval
68
Represents all electrical activity of one complete ventricular cycle. Generally measures 0.40 & 0.44 secs.
QT Interval
Considered prolonged if longer than 0.47 in men and 0.48 in woman.
69
Elevated T wave indicates what?
Hyperkalemia
70
Decreased T wave indicates what?
Hypokalemia
71
Lead 1 provides tracing between what?
LA & RA
72
R Arm lead is always…..
Negative
73
L leg is always……
Positive
74
L Arm can be ______________ or _______________, depending on what?
Negative or Positive, depending on the lead and which part of the heart its trying to capture.
Lead 1: Tracing between RA & LA, L arm is positive, because R arm is always negative.
Lead 2: Tracing between RA & LL, L leg is positive, because R arm is always negative.
Lead 3: Tracing between LA & LL, L arm is negative, because L leg is always positive.
75
4 Leads Placement
R arm/Shoulder is white
R torso/leg is green
L arm/shoulder is black
R torso/leg is red
76
R arm is referenced against combination of L arm and L leg.
AVR
77
L arm referenced against combination of R arm and R leg.
AVL
78
Combination of L arm and R arm
AVF
79
1,500 method of determining HR
Count # of small boxes between any 2 QRS complexes. Then divide 1,500 by that number = HR
80
Sequence Rate Method of determining HR
R wave to R wave. R wave on line, next big box is 300, next big box is 150, next big box is 100, next is 75, next 60, next 50. Wherever the next R wave is, is where you get your HR.
81
Rules that determine a NSR
Rate: 60-100BPM
Regularity: Regular
P Wave: Present
P:QRS ratio: 1:1
PRI: Normal/Regular
QRS width: Normal
Grouping: None
Dropped Beats: None
82
This rhythm has all the normal qualifications of NSR, except it may be irregular d/t respirations.
Sinus Arrythmia
83
This rhythm has all the normal rules for NSR, except it has a rate of less than 60BPM.
Sinus Bradycardia
84
Rhythm that presents with 100BPM or higher, other rules fall within sinus rhythm.
Sinus Tachycardia
85
Varied Rate
Regular, except for area of dropped beat
P wave, except in areas of pause/dropped beats
P:QRS ratio 1:1
Normal PRI
Normal QRS width
Sinus Pause/Sinoatrial Block
86
Approx 100bpm
Irregularly irregular
3 different morphologies of P waves
PRI varies
Wandering Atrial Pacemaker
87
Greater than 100bpm
Irregularly Irregular
At least 3 different morphologies of P waves
PRI varies
Multifocal Atrial Tachycardia
88
Commonly 250-350bpm (ventricle rate 125-175)
Usually regular
“Saw tooth” appearanced P waves
P:QRS ratio 2:1
Atrial Flutter
89
Rate: Variable, can be slow or fast
Irregularly Irregular
P Wave: none or chaotic activity
PRI: None
Atrial Fibrillation
90
Rate depends on underlying rhythm
Irregular
Variable; P waves on regular beat, none on early beat
PRI: None or shortened
Premature Junctional Contraction
91
No P Wave
Irregular
No PRI
Dropped Beats
Junctional Escape Beat
92
No P wave
No PRI
HR 60-100
Accelerated Junctional Rhythm
93
Irregular Beat
No P Waves
Wide QRS
Premature Ventricular Contraction
94
Irregular
No P Wave / No in PVC
Wide QRS
Later than expected beat
Ventricular Escape Beat
95
HR 20-40 BPM
No P Wave
No P: QRS Ratio
No PRI Interval
Wide QRS
Idioventricular Rhythm
96
HR 40-100
P Wave None
P:QRS ratio: None
PRI Interval: None
QRS Wide
Accelerated Idioventricular Rhythm
97
HR 100-200
No P Wave
Wide QRS
Ventricular Tachycardia
98
200-250HR
Irregular
No P Wave
No P:QRS ratio
No PRI Interval
Tornadoes de Pointes
99
200-300HR
Regular
No P Wave, P:QRS ratio, or PRI
Ventricular Flutter
100
Indeterminate Rates
Chaotic Rhythm
No P wave, QRS ratio, no PRI
V-Fib
101
Which rhythm do you check lead placement before treatment?
Asystole
102
PRI consistently prolonged
1st degree heart block
103
Regularly Irregular
P:QRS ratio: Variable
PRI: VARIES
Dropped Beats
Type 1 2nd degree heart block
104
Rate varies
Regularly Irregular
P:QRS ratio: Varies
Dropped Beats
Type 2 heart block
105
P:QRS ratio: varies
PRI: Varies, no pattern
P waves does not match QRS
3rd degree heart block
106
If the R is far from P, you have a…..
1st degree a
107
Long PRI, longer PRI, longer PRI, dropped QRS, you have a……
Type 1 2nd degree heart block
108
P-P stays the same, dropped QRS waves
Type 2 2nd degree heart block
109
R-R Intervals match
PRI’s vary
Dropped QRS Waves
3rd Degree Heart Block
110
How to treat Sinus Brady?
Scene Safe/BSI
ABC’s
Cardiac Monitor/IV/O2
Hx - Pacemaker? Beta Blocker?
Fluid Bolus
Asymptomatic - Atropine 1-1.5mg up to 3mg
Epi 2-10mcg/min titrate to effect
Symptomatic - Hemodynamically unstable - Not perfusing - Pace starting at 50ma, can increase by 10ma until you have capture (Electrical capture when pacer spike hits QRS) then increase 10ma until i have mechanical capture (when you can feel a radial pulse) Once mechanical capture has been obtained, increase 10ma and set it.
111
How to treat Sinus Tach? Concern is decreased preload.
Scene Safe/BSi
ABC’s
Vitals / O2 SAT
Cardiac Monitor/IV/O2
Find the underlying cause and treat it (H’s & T’s)
112
How to treat Sinus arrhythmia? Common is children & young adults, until hormones balance out.
Scene Safe/BSI
ABC’s
Vitals / O2 SAT
Cardiac Monitor/IV/O2
If you can link it to respirations, supportive care.
Monitor pt for underlying, worsening condition, and treat.
113
How to treat Sinus Arrest & Sinotrial Break?
Scene Safe/BSI
ABC’s / O2 SAT
Cardiac Monitor/IV/O2
Supportive Care & Monitor.
114
How to treat PAC’s? Premature Atrial Contraction. Irregular looking P wave.
Scene Safe/BSI
ABC’s / O2 SAT
Cardiac Monitor/IV/O2
Treat underlying H&T’s
115
How to treat PVC’s? Premature Ventricular Contractions
Scene Safe/BSI
ABC’s / O2 SAT
Cardiac Monitor/IV/O2
Supportive Care & Monitor.
116
How to treat SVT? Supraventicular (above the ventricles) Tachycardiac. No P waves d/t accelerated rate, but has narrow QRS complex, so it originates in the atria.
Scene Safe/BSI
ABC’s / O2 SAT
Cardiac Monitor / large bore IV / O2 / Vitals
Vagal Maneuver
Adenosine 6mg Fast IVP, flush w/20ml nacl. Can repeat once at 12mg.
Sedate w/Versed 1-2mg IV, up to 10mg, if BP is WNL.
Cardiovert: Apply 4 leads and pads, change to Lead 2 for better overall picture of heart. 50J, sync. Charge/Shock. Increase Joules as needed.
117
Pre-Excitation - Wolf Parkinson White Syndrome
SA fires and Bundle of Kent -fires at the same time. It reenters into the AV node, giving another electrical impulse too soon. Slurred QR wave (called a Delta wave). If you see a Delta wave, DO NOT TREAT WITH ADENOSINE!!
118
Lown-Gangong-Levine syndrome
Reentry problem. Causes pre-excitation. Reenters into AV node from Bundle of Kent. Predisposed to tachy dysrhythmias. Do not treat with AV blockers, Adenosine. If you see a Delta Wave, DO NOT TREAT W/ADENOSINE.
119
How to treat A-Fib? Irregular Rhythm, No P Waves.
Scene Safe/BSI
ABC’s / O2 SAT
Vitals
Cardiac Monitor / large bore IV / O2 / Vitals
Vagal Manuever
Cardioversion.
Supportive Care, Transport.
120
How to treat A Flutter? Saw tooth pattern (F Waves)
Scene Safe/BSI
ABC’s / O2 SAT
Vitals
Cardiac Monitor / large bore IV / O2 / Vitals
Cardioversion.
Supportive Care, Transport.
121
How do you treat Wandering Atrial Pacemaker? Impulse is coming from different parts of the atria. 3 different looking P waves. Narrow QRS. Children and Athletes, d/t increased vagal tones.
Scene Safe/BSI
ABC’s / O2 SAT
Vitals
Cardiac Monitor / large bore IV / O2 / Vitals
Only treat symptomatic, bradycardiac.
Atropine 1mg IVP, up to 3mg.
Supportive Care and transport.
122
How to treat Multifocal Tachycardiac? WAP rhythm w/an accerlated rate.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Supportive Care and Transport.
123
How to treat Premature Junctional Contraction? Inverted P waves w/QRS, imbedded in a normal rhythm.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Supportive Care and transport.
124
How to treat Junctional Rhythm? No P wave or inverted. Does not return to normal rhythm. 40-60HR
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Atropine 1mg IVP.
Pacing.
125
How to treat Accelerated Junctional Rhythm? Most often associated with Digoxin poisoning. 60-100HR
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Supportive Care and Transport.
126
How to treat Junctional Tachycardia? HR over 100
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Treat underlying condition.
Depending on rate.
Adenosine, Cardioverting
127
How to treat Premature Ventricular Contraction? Wide Complex ventricular beat within a normal rhythm. Usually benign, until they begin coupling. Then they become Bigeminy, Trigiminy, or runs of V-Tach.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Supportive Care and Transport.
128
How to treat Idioventricular rhythms? 20-40HR, no P waves, wide QRS.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Pace
Prepare for CPR.
129
How do you treat Acceralted Idioventricular Rhythm? 40-100HR, no P wave, wide QRS.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Prepare for CPR
130
How to treat Torsades de Pointes? 200-250HR. If they have a pulse, they won’t for long.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Magnesium 1-2mg IVP
Defibrillate.
CPR
131
How to treat Ventricular Tachycardia? With a pulse.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Amiodarone 150mg in 100ml nacl, adm 10ml/min.
Cardioversion if needed.
132
How to treat Ventricular Fibrillation? Will not have a pulse.
Scene Safe/BSI
ABC’s
Cardiac Monitor / IV / O2
Defibrillate at 200 Joules, move up to 360 Joules if needed
CPR
133
How to treat 1st degree AV block? There is a block between SA node to AV node. Consistent, PRI will exceed 0.20 sec or 5 small boxes. Narrow Complex.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Supportive Care and transport.
134
How to treat Type 1 2nd degree heart block? A block keeping the ventricles from contracting, means you lose a QRS. Long, Long, longer PRI, drop’s QRS, then starts over at the beginning.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Treatment depends on HR.
Atropine 1mg every 3-5mins, up to 3mg.
Supportive Care and Transport.
135
How to treat Type 2 2nd degree block? Block is in the Bundle of HIs or Bundle braches, does not block every conduction. Normal PRI, w/dropped QRS’. Impulse from SA did not make it through the ventricles.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Will typically present w/low HR.
Pace.
Atropine will not work.
136
How to treat 3rd degree heart block? Complete heart block. SA impulse is not going to ventricles at all. PRI varies.
Scene Safe/BSI
ABC’s
Vitals
Cardiac Monitor / IV / O2
Pace.
Atropine won’t work.
137
Chest pain that is relieved w/rest or Nitro. Caused by myocardial ischemia.
Stable Angina
138
Varies in intensity. Not relieved w/rest or Nitro. Needs treatment.
Unstable Angina
139
Where does fluid build up in body in R sided heart failure?
Extremities and Abdomen
140
Where does fluid build up in body in L sided heart failure?
Lungs
141
Primary cause of R sided heart failure
L sided heart failure
142
R sided heart failure that is caused by chronic lung dz?
Cor pulmonale
143
Decreased blood flow from the kidneys stimulates the sympathetic nervous system, that stimulates RAAS, Renin Angiotensin Aldosterone System. Is system reaction for what?
To retain fluid, and sodium for better cardiac output.
144
Muffled heart sounds
JVD
Hypotension
Beck’s Triade - Cardiac Tamponade
145
Hypotension
Bradycardia
Cool/Clammy
Cardiogenic Shock - MI
146
Acute BP of 180/120 or higher BP, w/evidence of other organ damage (renal dz, heart dz)
Hypertensive Emergency
147
Infection of endocardium, caused by bacteria.
Endocarditis
148
Pain, cramping, muscle tightness, fatigue or weakness of the legs when walking or during exercise.
Claudication
149
Firing rate for SA node
60-100
150
Firing AV Junction rates
40-60
151
Firing rates for ventricles
Takes about 0.08 seconds from impulse to spread from Bundle of His across ventricles. 20BPM
152
Depolarization of atria. Duration?
P wave - 0.08-0.12 secs
153
Cations are half filled again, and can fire again, though will not be efficient if it does. Phase 3.5-4. Halfway through the T wave to the beginning of P wave.
Relative Refractory Period
154
Cations returning back to starting period, but has not made it to destination, nothing is able to fire again. Phase 0-3.5. Beginning of P wave to halfway through the T wave.
Absolute Refractory Period
155
Cations returning back to starting period, but has not made it to destination, nothing is able to fire again. Phase 0-3.5. Beginning of P wave to halfway through T wave.
Absolute Refractory Period
156
Positively charged ion, sits outside of cell, waiting to go in, more than Potassium. Starts depolarization, sends impulses to the Calcium.
Sodium
157
Controls contractility of the heart muscle.
Calcium
158
Moves to outside of cell, to move opposite of sodium to keep cell balanced (polarity).
Potassium
159
Helps w/cell permeability, stabilizes cell membrane. Works in conjunction w/Potassium, opposes the action of calcium.
Magnesium
160
Distance from the beginning of P wave to the beginning of QRS complex. Represents the amount of time required for impulse to traverse the atria & AV junction.
PRI - 0.12-0.20
161
Represents ventricle depolarization.
QRS - 0.08-0.12
162
Indicates conduction through the Septum. Lasts no more than 0.04 secs.
Q wave
163
Represents depolarization of R & L ventricles.
R & S Wave - should be 0.08-0.12
164
Represents early ventricular repolarization. Period between ventricular depolarization and beginning of repolarization.
ST
165
Represents ventricular repolarization.
T wave
166
Represents all electrical activity of one complete ventricular cycle. Considered prolonged if over 0.47/0.48
Q-T
167
Time between 2 successive ventricular depolarizations.
R-R Interval
168
AV node
Receives SA signal, delays signal by about 0.12 seconds, to allow atria to fully empty blood into ventricles, then sends signal to Bundle of His.
169
Rhythm’s you treat with Amiodarone
Cardiac Arrest
Ventricular Fibrillation
Ventricular Tachycardia
Stable wide complex tachycardia
170
When do you not use Amiodarone?
Cardiogenic Shock
Bradycardia
Heart Blocks
Zofran usage (prolongs QT interval)
171
Dosages for Amiodarone
Cardiac Arrest, VT/VF: 300mg IVP. May repeat 150mg IVP, once in 3-5 min, if no effect from 1st dose.
Stable Wide Complex Tachycardia: 150mg IVP (mix150mg in 100ml, run at 10ml/min)
172
What rhythms do we treat with Atropine?
Bradycardia
173
Dosage for Atropine
0.5mg-1mg IVP every 3-5mins, up to 3mg.
174
What is Adenosine used to treat?
Narrow Complex Tachycardia rate over 150, or SVT
175
Dosage for Adenosine
6mg rapid IVP, flush w/20ml NACL, elevate arm. If no effect in 1-2 mins, may repeat once @12mg.
176
When do we not use Adenosine?
Heart Blocks
Lung Disease
Drug induced tachycardia
AFIB w/WPWS
177
When do we not use Atropine?
Hypothermic Bradycardia
Hypotensive from hypovolemia
178
What do we use Lidocaine for?
Cardiac arrest
Ventricular Tachycardia
Ventricular Fibrillation
179
When do you not use Lidocaine?
Hypotension
Heart Blocks
180
Dosages for Lidocaine
Cardiac Arrest, VT/VF: 1-1.5mg/kg IVP. May repeat twice with 0.5-0.75mg/kg IVP every 5-10mins. Max dose 3mg/kg.
Stable VT: 1-4mg/min (after loading dose) (mix 1g in 250ml of D5W)
PVC’s: 0.5-0.75mg/kg
181
How long is each wave?
P- 0.08-0.11 secs - 2-3 small boxes
PRI- 0.12-0.20 secs 3-4 small boxes
QRS - 0.08-0.11 secs 2-3 sm box
QT - 0.40-0.44 secs 10 sm boxes
182
Strength of a cardiac contraction
Isotropic
183
The rate of muscle contractions
Chronotropic
184
Speed of cardiac muscle contractions
Dromotropic
185
Most HTN is the result of what?
Atherosclerosis or Arteriosclerosis, which narrows the lumen of the arteries and reduces their elasticity.
186
Stimulus that raises the pressure at which blood is ejected from the heart, in reaction to high after load on the heart from narrowed arteries.
Frank Starling Reflex
187
The hearts ability to spontaneously create & send electrical impulses w/o being told to by another source
Automaticity
188
Ability of heart to respond to stimuli
Excitability
189
How well the cells can conduct electricity
Conductivity
190
How hard and long the heart muscle can contract
Contractility
191
What vessel transports blood from the heart to the lungs?
Pulmonary Artery -
Blood goes from R ventricle, through the pulmonary artery, to the lungs.
192
Which phase does the heart receive blood?
Diastolic, Resting, Phase 4.
193
What is one thing a Cardiac monitor or EKG unable to measure?
Perfusion, which beats on EKG are actually perfusing
Mechanical function of heart
Imaging of heart
194
Where does the endocardium receive its blood flow?
From the blood it’s pumping
195
How does the endocardium return the blood it’s pumping?
Through the coronary sinus
196
What cells transmit signals from cell to cell?
Intercalculated Disks
197
Blood flow through heart
R atrium from Superior & Inferior Vena Cava, & Coronary Sinus
R atrium through Tricuspid Valve into the R Ventricle
R Ventricle through the Pulmonary Valve, into Pulmonary Artery, to the lungs
Lungs through the pulmonary veins, into the L atrium
L atrium through Mitral valve into L ventricle
L ventricle through the aortic valve into the aorta
198
Neurotransmitter of the parasympathetic nervous system
Acetylcholine
199
Cardiac causes of syncope
Dysrhythmias
Increased Vagal Tones
Heart Lesions
200
Acute onset rapid heartbeat, no known underlying cause
SVT
201
Rapid HR that should have an underlying, treatable cause
Sinus Tach
202
#1 cause of chronic HTN
Atherosclerosis
203
Where does the S1 heart sound come from?
“Lub”
From the closing of the Mitral and Tricuspid valves
204
Where does the S2 sounds come from?
“Dub”
From the pulmonary & aortic valves closing (semilunar valves)
205
What does S3 sound like and what is it an indication of?
“Kentucky”
CHF
206
What does S4 sound like and what is it an indication of?
“Tennessee”
L ventricular Hypertrophy
207
S/S of R Sided Heart Failure/CHF
Pitting Edema
Pink Frothy Sputum
JVD
HTN
Crackles
208
Where would you listen for aortic stenosis?
Valves - R side of sternum, 2nd intercostal space
209
Stage 2 HTN reading
140/90
210
What is a late stage sign of shock?
Widened Pulse Presure
211
Narrowed Pulse Pressure is an indication of what?
Cardiac Tamponade
212
Cation responsible for depolarization.
Sodium (positively charged ion)
Lives outside of cell
Goes through Sodium/Potassium Channel, into cell, to begin depolarization.
213
What maintains baseline charge for cell?
Sodium/Potassium pump
214
What is a Q wave infarct?
A Q wave infarct is a type of myocardial infarction characterized by the presence of Q waves on an electrocardiogram (ECG).
## Footnote
Q waves indicate that there has been significant damage to the heart muscle.
215
Is the cell negative or positive during resting phase?
Negative
-70 to -90
216
Which phase takes cell from positive to negative
Phase 4, resting phase
217
Phase 1 (can’t be seen on EKG)
Inward sodium channels close and the cell begins to repolarize.
218
Phase 2:
Phase 2 - Plateau Phase. Corresponds to the ST segment on EKG. Depolarization is continuing. Cells used are still repolarization.
This phase is where Sodium+ and Calcium++ enter the cell, and Potassium+ goes out of the cell.
219
Taking cells from a negative state w/cations swapping, making it positive.
Depolarization
220
SA Node receives its blood from the…..
RCA
221
AV Node initiated impulses
40-60BPM
P Wave
Narrow QRS
222
Which nervous system transmits commands by releasing Norepinephrine? Fight or Flight, increases HR.
Autonomic Nervous System
223
Which nervous system transmits commands by releasing Acetylcholine, sending messages through the vagus nerve, decreasing HR?
Parasympathetic Nervous System
224
Lead 1 reads from what to what?
R Arm (-) to L Arm (+)
225
Lead 2 reads from what to what?
R Arm (-) to LL (+)
226
Lead 3 reads from what to what?
LL (+) to LA (-)
227
Which electrode will be the “camera”?
The positive electrode
228
Precordial (Unipolar) Leads
V1-V6
229
Augmented (Bipolar) Leads
AVR (checks lead placement)
AVL - Lateral Side of Heart
AVF - Inferior side of heart
230
How much time is each little box?
0.04
231
How much time is each bog box?
0.20 secs
232
How many big boxes does it take to make 6 seconds?
30
233
P wave is how long?
0.04 - 0.11 secs (2-3 sm boxes)
234
Time of normal PRI
0.12-0.20 (3-5 sm boxes)
235
What does inverted T waves indicate?
Ischemia
236
Time of QT Interval - All electrical activity in 1 completed ventricular cycle.
0.40-0.44secs or 390-460ms
237
Long QT Intervals can lead to ….
Dysrhythmias and cardiac arrest
238
What is the most common cardiac cause of hospitalizations in patients 65 and over?
Heart failure
239
Which type of artifact will make a paced rhythm unidentifiable?
Muscle Artifact
240
Most common cause of death from cardiogenic shock?
Myocardial Infarction
241
From a list what med he between the ages of 60-70 is seen 10x more in men than women?
AAA
242
is a type of chest pain caused by a spasm in the coronary arteries, leading to reduced blood flow to the heart muscle. It typically occurs at rest and is often cyclical, happening at the same time each day.
Prinzmetal Angina, AKA a variant angina
243
a type of chest pain caused by spasms in the coronary arteries. These spasms temporarily reduce blood flow to the heart muscle, leading to chest pain.
Vasospastic angina
244
Muscle cramps or spasms - Tingling in the fingers or around the mouth - Seizures - Fatigue - Anxiety or irritability - Tetany (involuntary muscle contractions)
Are S/S of what?
Hypocalcemia
245
Hypertension and arrhythmias, such as a shortened QT interval on an ECG.
Are S/S of what?
Hypercalcemia
246
Cardiac Tamponade - Beck’s Triad
Narrowed Pulse Pressure
Hypotension
JVD
Muffled Heart Sounds
247
How would you BEST describe cardiogenic shock
Condition in heart muscle function is severely impaired, decreasing cardiac output, inadequate tissue perfusion. S/s: Hypotension, Brady/tachycardia, JVD, narrowed pulse pressure, AMS, skin changes.
248
Called to assist patient with unilateral limb pain. You suspect a patient is having a peripheral vascular emergency. What would best support your field determination.
Abnormal pulse on one side
Sign of thrombosis in the affected limb
Claudication - pain/weakness
Hx of afib
Or recent surgery
249
What is included in the Secondary Assessment?
Cardiac Monitor, Waveform Capno, SPO2, Vitals, HX
250
Normal QRS, normal P wave, PRI of 0.28, what rhythm?
1st degree heart block (consistent prolonged PRI)
251
specialized junctions that connect adjacent cardiac muscle cells (cardiomyocytes) in the heart
Intercalated Disks
252
Potassium (K+), Sodium (Na+), Calcium (Ca2+), Magnesium (Mg2+)
Electrolytes
253
specialized nerve fibers found in the heart that play a crucial role in the electrical conduction system of the heart, end of the bundle branches
purkinje fibers-
254
Which of the following would a 3 lead be the most useful, in what circumstances
patient with suspected heart disease.
255
Use of a defibrillation pad to obtain a single lead view is best used in which of the following circumstances?
When a quick assessment of heart rhythm is needed
256
Least likely to start resuscitative efforts-
obvious signs of death or major traumas(obvi sign of death) or a pt that has a pulse.
257
APE- acute pulmonary edema, what is it, what’s happening-
acute onset fluid in lungs, can appear suddenly, causes mild to severe difficulty breathing, cough, chest pain, and fatigue
258
a type of heart attack where the damage extends through the entire thickness of the heart muscle (myocardium) Infarct that extends through the entire ventricular wall
Transmural infarct-
259
a type of infarct in the coronary artery.
Coronary Infarction
260
infarct that affects only the inner layer of the heart muscle
Subendocardial infarction
261
Cyanosis, blue/gray tint of skin caused by….
Hypoxia, decreased O2
262
Flushing of skin can be caused by….
Fever, HTN, Burns, Allergic reactions, alcohol, carbon monoxide
263
Pallor/Pale skin can be caused by….
blood loss, anaphylaxis, hypoglycemia, anxiety
264
Cardiovascular (shock) embarrassment, decreased intra vascular coagulopathy can cause skin to look……
Mottled
265
What would account for bp differences between arms?
blood pressure difference between arms can be due to peripheral artery disease, anatomical variations, or the presence of atherosclerosis. Can also be caused by muscle compression or Aortic arch dissection.
266
Pathological Q wave
30% height of R wave (Infarct or Ischemia)
267
Physiological Q Wave
1/3 of the QRS height
268
Treatment for CHF
In the EMS setting, treatment for congestive heart failure includes ensuring ABCs, administering oxygen (CPAP), positioning the patient properly, establishing IV access, administering nitroglycerin and diuretics if indicated, monitoring vital signs, and transporting the patient to the hospital
269
Treatment for DKA
The treatment for DKA (Diabetic Ketoacidosis) includes fluid replacement, electrolyte correction, and insulin therapy
270
Treatment for Pulmonary Edema
Oxygen, nitrates, diuretics, and possibly CPAP.
271
Treatment for Hemorrhagic Stroke
-Supportive care, including stabilizing the airway, breathing, and circulation. Monitor vital signs, provide oxygen as needed, elevate the head of the bed to 30 degrees if tolerated to reduce intracranial pressure, and transport to an appropriate facility for further care. Avoid anticoagulants and antiplatelet drugs.
272
Treatment for Ischemic Stroke
Place patient in supine position. Ensure rapid transport to a stroke center for fibrolynic therapy, provide supportive care, and monitor vital signs. Administer oxygen if needed and establish IV access.
273
when does the coronary artery get fed, systole or diastole
Diastole
274
Which of the following degree of artifact will make paced rhythm virtually impossible to identify?
Muscle artifact
275
Why would it be a good idea to provide o2 to pt with an MI?
May improve o2 delivery to ischemic myocardial tissue
276
you arrive on scene w/ a family member telling you the pt is in cardiac arrest. Priority by pt side.
Determine if the pt is unresponsive and PULSELESS,
277
AAA what symptom would you expect
Urge to defecate along w/ back pain, abdominal pain
278
Pt 65 and over- leading causes of hospitalizations?
Heart Failure
279
RBBB
RBBB charaterized by widened QRS over 0.12 and a terminal r wave in V2. Rsr complex(R-prime). Terminal S wave in 1, aVL, and V6
280
LBBB
LBBB charaterized by widened QRS, >0.12, terminal S wave in V1. Terminal R wave seen in 1, aVL, and V6.
281
Anterior Block
Anterior block- characterized by rS complexes in leads 2, 3, and aVF and by qR complexes in leads 1 and aVL.
282
Posterior Block
Posterior block- rare and requires a DX of exclusion. Characterized by qR complexes in lead 2, 3, and aVF, and by rS complexes in lead 1.
283
FONA/ MONA
Fentanyl, O2, Nitro, ASA
Morphine, O2, Nitro, ASA
284
Asynchronous Cardioversion
Asynchronous- aka defibrillation, is a process in which enters may be delivered at any point in the cardiac cycle
285
which of the following ecg findings would confirm the conclusion that your pt is having angina?
ST depression
286
CHF patient takes potassium supplements, what other drugs would you expect the patient also have in their history?
Beta blockers (-lols) diuretics (lasix, hctz, Lozol) ACE inhibitors (-prils), angiotensin 2 receptor blocker- similar to ace inhibitor but don’t cause cough, digoxin- slows heart rate, helps w/ a fib, vasodilators- relax blood vessels, anticoagulants- prevent blood clots, statins- a gene cholesterol levels
287
Vasculitis
vascular inflammation.
288
Synchronized Cardioversion
Synchronous- aka synchronized cardioversion, delivers timed bursts of electrical energy and identifies the r waves.
289
claudication
pain, cramping, muscle tightness, fatigue weakness in legs during physical activity- sign of PAD
290
Arteriosclerosis
hardening of the arterial walls
291
atherosclerosis
narrowing of the arteries typically from a build up of plaque from diet, or clots
292
Lead 1
Looks at…
Is fed by…
High lateral
Circumflex Artery
293
arterial occlusions
Sudden disruption of arterial blood flow caused by many things, use your head.
294
Lead 2
Looks at…
Is fed by…
Inferior
Right coronary or circumflex
295
S/s of cardiogenic shock
hypotension, decreased hr first, then increased hr decreased cardiac output, pale cool clammy, crackles
296
S/s of anaphylactic shock
hypotension, tachy, warm flushed skin, wheezes
297
Lead 3
Looks at…
Is fed by…
Inferior
Right coronary or circumflex
298
S/s of hypovolemic shock
hypotension, tachy, pale cool clammy, clear lung sounds
299
S/s of neurogenic shock
hypotension, Brady, flushed dry warm skin, clear lungs
300
S/s of distributive shock
wide spread vasodilation
301
Junctional rhythm/junctional escape
No, inverted or retrograde p wave. Normal QRS complexes, regular, rate 40-60
302
Accelerated junctional rhythm
No, inverted, or retrograde p waves, regular QRS, regular, rate greater than 60 less than 100
303
AvR
Which Leads?
Looks at…
Is fed by…
R lead reflection between the LA and LL lead
Looks at nothing
304
Junctional tachycardia
No, inverted, or retrograde p waves, regular QRS, regular, rate greater than 100.
305
Premature junctional complex(PJC)
An early complex that appears within another rhythm. No, inverted, or retrograde p wave, narrow QRS.
306
EKG changes associated with cardiac tamponade
electrical alternans: beat to beat variation in the amplitude and axis of QRS complex, low voltage QRS, tachycardia
307
AvL
Which Leads?
Looks at…
Is fed by…
Reflection of the LA between the RA and LL
High lateral
CX artery
308
AvL
Which Leads?
Looks at…
Is fed by…
Reflection of the LA between the RA and LL
High lateral
CX artery
309
EKG changes associated with pulmonary embolism
sinus tach, t wave inversion, right axis deviation
310
EKG changes associated with AAA
ST elevation, ST depression, changes in polarity/morphology of T wave
311
Heart Blocks
1st degree - Consistently prolonged PRI
Type 1 2nd degree - Variable PRI w/dropped beats
Type 2 2nd degree - Normal PRI w/dropped beats
3rd degree - Irregular PRI’s w/extra P waves
312
AvF
Which Leads?
Looks at…
Is fed by…
Reflection of the LL between the RA and LA
Inferior
RCA or cx
313
EKG changes associated with tension pneumo
PR segment elevation in inferior lead, PR segment depression in aVR lead, St depression, elevation, or other changes
314
V1 & V2
Looks at…
Is fed by…
Septum
LAD
315
V3 & V4
Looks at…
Is fed by…
Anterior
LAD
316
EKG changes associated with hypokalemia
T wave amplitude decreases, diffuse ST depression, T wave inversion,
317
EKG changes associated with hyperkalemia
tall peaked T waves, widened QRS
318
V5 & V6
Looks at…
Is fed by…
Low Lateral
CX
319
V5 & V6
Looks at…
Is fed by…
Low Lateral
CX
320
AAA
AAA- Abdominal Aortic Aneurysm
present w/ back pain and abdominal pain, urge to defecate
”worst headache ever”- sign of cerebral bleeding from aneurysm
Difficulty swallowing/horseness can indicate thoracic aortic aneuryms
321
Thrombotic therapy
involves administering medications that convert Boyd’s clot dissolving enzymes from it’s inactive form (plasminogen) to it’s active form (plasminogen). Breaks down fibrinogen and fibrin clots. Can not be limited to coronary arteries and can cause uncontrolled bleeding.
322
Traumatic aortic disruption
inside wall of the artery becomes torn allowing blood to collect between the arterial wall layers. can occur w/ trauma or sustained hypertension, particularly when AAA is present. Thoracic dissection can produce chest pain that is difficult to differentiate from cardiac ischemia. Obtain BP in both arms and palpate HR in both arms. Systolic BP change of 15mmhg between arms suggest thoracic dissection
323
Contraindications with thrombotic therapy
bp 180-200/100-110, right/left arm bp change of 15mmhg, stroke longer than 3hrs or shorter than 3mo, trauma/blood loss/surgery, close head trauma in last 3mo, gi bleeding in last 2-4wks, other serious systemic disease like cancer liver or kidney disease, any prior history of brain bleed, pregnancy
324
Oxygenated blood reaches the heart through..
Coronary arteries
325
Oxygenated blood reaches the heart through..
Coronary arteries
326
Main coronary arteries
Left and Right coronary arteries
327
Left Coronary Ateries
Left Anterior Descending & Circumflex
328
LAD & Circumflex feeds what…
Left ventricle anterior and posterior, septum, lateral, part of R ventricle
Left= PALS
329
Right Coronary Artery
Where?
Feeds?
Travels between r atrium and r ventricle
Feeds R atrium, r ventricle, portions of L inferior ventrical, and parts of conduction system
R= RIP
330
Conduction system of the heart
SA, AV, BUNDLE OF HIS, BUNDLE BRANCHES R&L, PERKINJIE FIBERS
LEFT- ANTERIOR AND POSTERIOR FASICLES
