CSCT Exam Review Flashcards
1
Q
what conditions can alter ST segment causing false-positive ST changes
A
body position
hyperventilation
digoxin, quinidine
LVH
pre-exitation
smoking
conduction system abnormalities
2
Q
what is NOT a frequent or severe side effect of Beta adrenergic blocking agents
A
thyroid dysfunction
3
Q
what would be used to treat a pt with nocturnal angina
A
beta blockers and nitrate therapy
4
Q
identify the modified chest lead that is most useful in detection of ST segment change due to ischemia
A
modified lead 5
5
Q
most common cyanotic congenital heart defect IN infancy
A
transposition of the great vessels
6
Q
3 cardiac defects that obstruct LV and RV outflow
A
aortic stenosis
pulmonary stenosis
coarctation of the aorta
7
Q
which of the following is not a Class I antiarrhythmic:
quinidine, diltiazem, procainamide, mexeletine, propanolol….
A
diltiazem
8
Q
which classification of antiarrhythmics has the primary effect of slowing the AV conduction
A
Class IV calcium channel blockers
9
Q
most common side effect of amiodarone
A
pulmonary toxicity
10
Q
T/F - by the time a child is 3-8 y/o, the precordial leads will assume the adult QRS pattern
A
True
11
Q
T/F - episodes of sinus tachy/brady lasting longer than 15s is abnormal
A
True
12
Q
it can be said that most children who develop SVT have…
A
no associated cardiac disease
13
Q
the most common form of congenital heart disease
A
VSD
14
Q
the most common cyanotic congenital heart disease BEYOND infancy
A
tetralogy of fallot
15
Q
the danger of PVC’s in the presence of ischemia heart disease or cardiomyopathy is that they maybe the forerunner to…
A
sudden death, onset of VT/VFIB
16
Q
the danger of R on T is the potential of the development of
A
VT or VFIB
17
Q
what 3 drugs are associated with the development of torsades
A
quinidine, disopyramide, and trycilic antidepressants
18
Q
2 most common rhythm disturbances than can cause onset VFIB are
A
PVC and VT
19
Q
T/F - when the ventricles are fibrillating the heart muscle is able to eject only a small volume of blood
A
False, no circulation or even a small amount of blood
20
Q
aberrant ventricular conduction may either be RBB or LBB, although most of the time its _______
A
RBBB
21
Q
AFIB and PAC’s frequently are conducted w/ aberrancy bc aberrant ventricular conduction occurs due to a _____ cycle length
A
shortening
22
Q
T/F - QRS duration of a normal newborn is less than in adults
A
True
23
Q
T/F - T waves in V1 are upright throughout childhood as well as adulthood
A
False, T waves are usually inverted in childhood in V1
24
Q
T/F - amplitude of the R wave in V1 is usually greater than the S wave in V1 in an infant of less than one month
A
True, they are more dominant in the RV
25
mechanism in sinus arrest is depression of impulse _____ and mechanism of sinus block is depression of impulse ______
formation, conduction
26
if the pause in the rhythm is a multiple of the P-P interval, the diagnosis is
sinus block
27
the passive rhythm that develops in complete AV block may originate from an _____ focus or a ______ focus
idiojunctional, idioventricular
28
WPW syndrome can occur if the anomalous accessory pathway called the _______ exists.
bundle of kent
29
the rapid rate caused by WPW can cause the risk of development of
VFIB
30
will vagal maneuvers be effective in WPW
No
31
will WPW respond to cardioversion
Yes
32
what drug therapies may be used in WPW (8)
quinidine
procainamide
disopyramide
aprinidine
amiodarone
encainide
propaferone
sotalol
33
AV re-entry tachycardia caused by WPW may be treated with (6)
digitalis
propanolol
diltiazem
amiodarone
verapamil
encainide
34
structures of the conduction system innervated by the PNS
SA node, AV node, atria
35
3 methods by which ions may move across a cell membrane
diffusion
osmosis
active transport pumps
36
what part of the action potential curve represents cell activation or depolarization
phase 0
37
which cell possess spontaneous diastolic depolarization
SA node, AV junction & purkinje's
38
which cell has the LEAST negative RMP
SA node
39
which cardiac cell has the most perpendicular phase 0 slope
ventricular myocardium
40
which cardiac cell typically has the steepest rise in phase 4
SA node
41
which cardiac cell typically has the longest refractory period
purkinje cell
42
atrial depolarization is
posteriorly, downwards and to the left
43
depolarization in the ventricular septum is
from left to right, anteriorly to inferiorly
44
late depolarization of the ventricles
to the left, posteriorly and superiorly
45
normal septal depolarization is from
left to right
46
what conditions cause enhanced automaticity
hypokalemia
hypocalcemia
dig toxicity
fever
hypoxia
trauma
MI
47
atrial flutter is believed to be most commonly due to
intra-atrial re-entry
48
2 passive escape rhythms
junctional and idioventricular
49
Name 3 areas of the conduction system where a block can occur
SA node, AV node, bundle branches
50
has a phasic variation of rate due to changes in vagal tone typically affected by respiratory cycle
sinus arrhythmia
51
what is the most controllable function of the ECG
output
52
3 main differences between single and multichannel ECG
1. all precoridal leads must be connected at the same time
2. when tracing is complete it doesnt need to be mounted
3. cost and time effective
53
define voltage
amount of pressure in an electrical loop which is measured in volts (V)
54
what can increase when the ECG is subject to corrosive and humid environments
leakage current
55
what is the function of the fat prong or neutral pin
provides a direct path back to the power source
56
define bipolar leads
a recording of electrical differences between 2 points of reference
57
what is einthovens law
sum of amplitude of the recorded complexes in Lead I and Lead III is = to amplitude recorded in Lead II
58
where is zero potential located
center of the heart
59
recording the third dimension of the heart is the function of the
chest leads
60
the small bump felt where the manubrium meets the sternal body is known as the
sternal angle
61
what are the qualities of a technically and clinically acceptable ECG
standardization - 1mV 10mm High
Clarity - visible deflection
Baseline - constant
Leads - approx. 3-6 complexes
Tracing - centered, coded and labelled
62
Causes of single artifact
loose electrode connection
lead switch over
operation induces static electricity
metallic particles in skin or in electrode cream
surgical implanted metal plate or screw
63
causes of wandering baseline
muscle tension
pt. not comfortable
pt. physical or mental condition
tech incomplete patient prep/attitude
64
Causes of somatic tremor
lack of relaxation
poor electrode contact
loose electrode connection
breathing
conversation
cable swinging/dangling
65
An invasive procedure using a unipolar lead to identify atrial activity or P waves
esophageal lead
66
emergency procedure to terminate VFIB or VT
defibrillation
67
used to diagnose and correct SVT caused by re-entry
vagal maneauvers or carotid massage
68
Some conditions where it may be impossible to acquire the exact anatomical position of the precordial leads
chest or thoracic surgery
chest trauma
presence of skin growth
monitoring equipment
69
when should a rhythm strip be obtained for evaluation of arrhythmias
HR below 40BPM
multifocal or frequent ectopy
any pt. who is not in sinus rhythm
70
when should double standard be used
voltage is too low
71
conditions associated w/ tamponade
trauma
infection
post CPR
neoplastic dx
myocardial rupture
post cardiac surgery
72
why is a 15-lead ECG done
posterior & RVMI
73
define electrocardiography
process of recording the variations of electrical potential produced by the heart
74
who published the first well known textbook of electrocardiography
thomas lewis
75
who invented the first sensitive and reliable instrument for measuring and recording cardiac potential
William Einthoven
76
What decade was the first portable ECG available?
1950
77
Name 3 basic functions of the ECG
input
output
signal averaging
78
Electrical signal collected by the ECG is amplified by ____ before it is transmitted to the galvanometer
20 000 000 000
79
Resting potential of a pacemaker cell
-60mV
80
resting potential of a cardiac cell
-90mV
81
Ashmans beat
a premature beat with a RBBB morphology
82
what BBB has the longest refractory
RBBB
83
Irregular rhythms
Sinus arrhythmia
WAP
MAT
AFIB
VFIB
84
Baye's Theorem
describes the probability of an event, based on conditions that may be related to the event
85
2 main effects to sodium-channel blocker poisoning are:
seizures
ventricular dysrhythmias
86
What coronary artery supplies the Sinus node
RCA
87
what coronary artery supplies the AV node
90% RCA and 10% LCA
88
what coronary artery supplies the atria
RCA and LCA
89
what coronary artery supplies the right ventricle
RCA
90
what coronary artery supplies the left ventricle
LCX and LAD
91
Layers of the heart
epicardium
myocardium
endocardium
92
Most common cause of CAD
athlerosclerosis
93
S1 resembles
tricuspid and mitral valves closing
94
S2 resembles
semilunar valves closing
95
Galvanometer
amplifies current
96
5 nonpathological conditions for ECG changes
less than 30 years
advanced age
large body
athletes
thin women
97
Bachmans bundle is the _______ conduction system
inter-atrial
98
State the conduction system in order
SA node
internodal pathways
AV node
Bundle of His
Left bundle
right bundle
Purkinje fibres
99
Major ECG sign of an anterior wall infarction is
loss of normal R wave progression in the chest leads
100
SVT and PAT are the same. Treat with _______
Adenosine
101
What is the more common fasicular block?
LAFB
102
Fasicular blocks caused the ventricles to be...
innervated asynchronously and aberrantly
103
Intrinsicoid Deflection
amount of time it takes the electrical impulse to travel from purkinje -> endocardium -> epicardium under an electrode
104
RCA is dominant in ____ and Cirumflex is dominant in ___
90% and 10%
105
Hyperkalemia
suppression of SA node
reduces conduction of AV node/HIS system
Causes bradycardia, conduction blocks, cardiac arrest
106
Treat Prinzmetals angina w/
treat with nitrates and calcium channel blockers
107
Swelling or edema throughout the body
Anasarca
108
bifasicular block
RBBB combined with LAFB or LPFB
109
trifasicular block vs incomplete trifasicular block
Bifascular block + 1st or 2nd degree AV block
incomplete: Bifascicular block + 3rd degree AV block
110
Takotsubo syndrome
can be triggered by an intense emotional or physical stress. It causes sudden chest pain or shortness of breath. The symptoms of TCM can look like a heart attack.
111
Dilated cardiomyopathy
ECG changes include atrial and ventricular hypertrophy
Most common
112
Hypertrophic cardiomyopathy
usually genetic disease, can lead to sudden death bc of VT and VF, needs ICD
113
Restrictive cardiomyopathy
stiff and fibrotic ventricles, reduced compliance, usually needs transplant
ECG changes include low voltage QRS, Q waves, BBB, AVB
LEAST common
114
3 Stages of athlerosclerosis
development of fatty streak
plaque progression
plaque distribution
115
After an MI, go home w/
Beta blockers
ACE inhibitors
ASA (antiplatelet)
Statins
116
Heparin
inhibits thrombin, antidote is protamine sulphate
117
Warfarin
antidote is vitamin K
118
Persantine
anti-anginal agent and anti-platelet agent, antidote is aminophylline
119
INR
International Normalized Ratio
the time it takes normal blood to clot and coumadin blood to clot. Coumadin should have an INR btw/ 2-3
120
Alteplase
most effective if administered ASP following indications of a clot
121
Steptokinase
similar to alteplase but does not have any affinity for clots
122
If a lead conductor was partially fractured...
Impedance/resistance would inc.
Current would dec.
Battery energy would be conserved.
123
Complete fracture
infinite impedance and no current flow
124
Fractured conductor while insulation remains in tact
Resistance/impedance will inc.
125
Normal lead impedance values
300-1000 ohms.
126
Unipolar
lead tip to can
127
Bipolar
lead tip to ring on lead
128
Programming a lower sensitivity value in mV causes the pacemaker to do what?
become more sensitive to signals
129
Pacemaker implantation
generally implanted subcutaneously under the pectoral muscle in the infraclavicular region
Uses subclavian, internal/external jugular, and cephalic veins
130
Magnet response
Prevents sensing, resulting in asynchronous pacemaker operation
Allows assessment of pacemaker function during inhibition
131
Causes of Loss of Capture (7)
Lead dislodgement
Lead insulation break
lead wire fracture
battery depletion
electrical circuit failure
Pacing/sensing programmed too high/low
Pacemaker/lead connector issues
132
S3
Associated with CHF
133
S4
Associated with hypertrophy
134
What occurs during pulseless electrical activity
it is not palpable
135
What drugs does someone NOT need after leaving the hospital with a stent
anticoagulant, ace inhibitors, beta blockers and CCB
136
What phase does the ST segment represent
phase 2
137
Which stage would torsades be triggered at
Phase 3 (R on T)
138
Osborn J waves
Hypothermia
139
What rhythms do we NOT cardiovert?
VF
140
What MI is most commonly associated with death
Anterior
141
What 3 things close after birth?
Ductus arteriosus, ductus venosus, foramen ovale
142
What would happen in arm lead reversal?
P, QRS would be upright in AVR
Negative QRS in Lead I
143
What artery supplies the LATERAL leads
Circumflex
144
What artery supplies the INFERIOR leads
Right coronary artery
145
What artery supplies the ANTERO-SEPTAL leads
Left anterior descending
146
Long QT
hypocalcemia
hypokalemia
hypomagnesia
class ia and III antiarrhythmics
tricyclic antidepressents
CNS trauma
ischemia, myocarditis
147
What 2 congenital defects cause long QT
Romano-ward
Jervell-Lange-Nielsen
148
Hyperacute
ST elevation only
149
Acute
Significant Q wave and ST elevation
150
Old
Significant Q waves
151
Wenckebach & grouping
2nd Degree AV block type I
152
Requirements for re-entry
2 different pathways for conduction
conduction is slowed in one of the pathways and failure of conduction
conduction is slower than normal in the unblocked pathway
153
Examples of re-entry arrhythmias
AVRT
AVNRT
SVT
AFlutter
AFIB
VT
VF
154
What supplies the inferior wall of the left ventricle
RCA
155
What supplies the septal wall
LCA
156
What supplies the anterior wall of the LV
LCA - LAD
157
What supplies the lateral wall of the LV
LCA - Circumflex
158
Indications for ICD
VT/VF survivors w/ irreversible etiology
Sustained VT w/ structural heart disease
Syncope with VT/VF
LV ejection fraction of <35%
Post MI LV EF of <30%
Post MI LV EF of <40% with VT/VF
159
What is CHADS
a scoring system used by healthcare professionals to calculate a patient’s risk of having a stroke secondary to atrial fibrillation.
Congestive heart failure
Hypertension
Age
Diabetes
Stroke
160
Antidromic Tachycardia
Conduction goes down the accessory pathway and back up through the AV-node, causes retrograde conduction - wide QRS
161
Orthodromic Tachycardia
Conduction goes through the AV node and then back up through the accessory pathway (normal conduction), causes antegrade conduction - narrow QRS
162
Elevated cardiac enzymes
CPK, SGOT
163
What is in blood
platelets, serum, plasma (enzymes in plasma)
164
Subarachnoid Hemorrhage
will have deeply inverted T waves
165
Atrial flutter
one ectopic site in the atrium is firing, usually right atrium in an area called Crista Terminalis
runs counter clockwise
166
Stokes Adams Attack
Periods of syncope due to CHB (loss of consciousness)
167
Pacemaker Class 1 Indications
3RD DEGREE & ADVANCED SECOND DEGREE AVB:
➢ Symptomatic bradycardia due to AV Block
➢ Documented periods of asystole >3 seconds in duration
➢ Escape rate of <40 bpm while awake; symptom free patients
➢ Post AV junction ablation
➢ Post-OP AVB not expected to resolve
➢ 2nd degree AVB regardless of type or site with associated symptomatic bradycardia
168
Electrical Alternans
Pericarditis
Pericardial effusion
pulmonary embolism
cardiac tamponade
169
Dobutamine
used to treat shock
170
Aortic Regurgitation
Can also be called Water Hammer Pulse because the diastolic BP will decrease in the aorta and pulse pressure will widen
171
4 Components of TOF
VSD
Pulmonary stenosis
Overriding Aorta
RVH
172
Coronary Perfusion
epicardium to endocardium, ischemia will impair BF to subendocardial layer first
173
3 Major determinants of O2 Demand
Ventricular wall stress
HR
Contractility
174
Trendelenburg
the body is lain supine, or flat on the back on a 15–30 degree incline with the feet elevated above the head.
175
what test is least commonly ordered for CAD in CHF patients
regular gxt (stress test)
176
Cheyne-strokes
abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in temporary stop in reaching called apnea. the pattern repeats with each cycle usually taking 30 sec - 2 minutes
Cheyne-strokes is linked to HF + strokes
177
Sgarbossa Criteria
Concordant ST elevation > 1mm in leads with a positive QRS complex
Concordant ST depression > 1 mm in V1-V3
Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex
178
What mode should be used for a pt. with AFIB
VVI or VVIR
179
Pulseless Electrical Activity
7 H's
7 T's
Hyperkalemia
Hypoxia
Hypothermia
Hydrogen Ion access
Hypovolemia
Hypoglycemia
Tamponade
Tension Pseumothorax
Thrombosis (Pulmonary embolus)
Thrombosis (MI)
Toxins
Trauma
180
ICDS:
What stores energy?
capacitor
181
Arrhtyhmias caused by re-entry (4)
SVT, VT, Afib, AFlutter
182
Impulse formation disorders (3)
sinus arrest
sinus brady
brady/tachy
183
Impulse conduction disorders (2)
exit block, AV block
184
Causes of LVH
hypertension
aortic valve stenosis
hypertrophic cardiomyopathy
athletic training
185
RAE causes
COPD
pulmonary embolism
pulmonary hypertension
mitral, tricuspid, pulmonary valve disease
186
LAE causes
LV failure
restricted cardiomyopathy
HTN
aortic/mitral valve disease
187
What is seen with LAE
LBBB
LVH
LAFB
188
What MI is most associate w/ death
Anterior (LAD)
