Midterm Flashcards
1
Q
Pericardium
A
-fibrous sac around heart
-Serous layers: Parietal (outer), visceral (on heart and contains fluid within space)
-Innervated by Phrenic Nerve (sensory)
2
Q
Diastole
A
-Relaxation
-Filling
3
Q
Systole
A
-contraction
-ejection
4
Q
Afterload
A
pressure needed to expel blood from the heart
-synonymous with BP
5
Q
Myocardium
A
Cardiac muscle fiber
-actin-myosin complex
-Automaticity: contract w/o external stimuli
-Rhythmicity: contract with rhythm
-Conductivity: nerve impulses from one cell to the other due to intercalated discs
-Intercalated disc junctions: Desmosomes (adhesion) and Connexins (conductivity)
6
Q
Endocardium
A
-Smooth muscle, innermost layer
7
Q
Pulmonary Artery
A
-only artery to carry deoxygenated blood
8
Q
Pulmonary vein
A
-only vein to cary oxygenated blood
9
Q
Right Coronary Artery
A
-Supplies right ventricle, AV node and SA node
-Right posterior descending
-Right marginal
10
Q
Left Coronary Artery (supplies)
A
-supplies left ventricle, L atrium, septum, SA node
11
Q
SA Node
A
-sets heart at pace of >100 without other input
-Susceptible to disease due to pericarditis, occulsion
12
Q
Sympathetic NS
A
-increase
-norepinephrine
13
Q
Inotropic
A
-strength of contraction
14
Q
Chronotropic
A
-speed of contraction
15
Q
Parasympathetic NS
A
-decrease
-vagus nerve
-acetylcholine
-60-90 bpm
16
Q
AV Node
A
-receive from SA
-to Bundle of His to bundle branches to perkinjie fibers
-40-60 bpm without exernal stimuli
-0.04s to contract Vs
Susceptible to disease due to RCA occlusion
17
Q
P Wave
A
atrial depolarization
18
Q
PR interval
A
-travel of impulse to Vs
19
Q
QRS Complex
A
ventricular depolarization
20
Q
T Wave
A
ventricular repolarization
21
Q
QT Internal
A
Ventricular systole
22
Q
Low K
A
Harder to depolarize, slower heart rate
23
Q
High K
A
Easier to depolarize as myocardium is excitable, higher heart rate
24
Q
Cardiac Output
A
-CO= HR x SV
-5-6L at rest, can increased 4-7x with exercise
-Effects systolic BP
25
Blood Pressure
BP=HR x SV x Total peripheral Resistance
TPR affects diastolic BP
26
Mean Arterial Blood Pressure
-average pressure in the systemic system, perfusion of organs and peripheral tissues
MAP= DBP + 1/3 (SBP-DBP)
-Normal: 70- 93 mmHg
-cautions <60mmHg
Determined By:
-BV, CO, Peripheral resistance, distribution of blood in veins
27
Pulse Pressure
SBP-DBP, difference
-how hard heart is working
>60 working too hard; HTN
<40 failing heart; cardiomyopathy;shock
28
Effect of Posture on BP
Standing: lower BP, blood pools in legs
Laying: blood evenly in veins, higher BP
29
BP Normal
<120/<80
30
BP Elevated
120-129/<80
31
High BP Stage 1
130-139/80-89
32
High BP Stage 2
>140/>90
33
Hypertensive Crisis
>180/>120
34
HR
-Beats per minute
->120bpm @ rest, not enough time to refill, decreases CO
-<45bpm @ rest not enough CO, low bp
Affected by: Baroreceptors, ANS, endocrine, integrity of the system, temperature, emotions
35
SV
-amount of blood pumped out each beat
-Afterload-Preload, heart contractility
-increases 40-60% during exercise
36
Cardiac Preload (& determinants)
-End diastolic volume: amount of left ventricular blood volume prior to contraction
Dependent on:
-venous return, BV, LA contraction, Starling law
37
Cardiac Afterload
-Amount of resistance encountered by left ventricle
38
Myocardial Contractility
-neural and hormonal influences
39
Ejection Fraction
Ejection Fraction= SV/EDV
-55-70%
-Low EF indicates systolic heart failure: <40
-EF can be preserved with overall decrease in BV, weak heart increases backflow that increases SV
40
Hypoxia
O2 concentration of tissues
41
Hypoxemia
O2 concentration of blood
42
ESV
End Systolic volume: volume of blood in a ventricle at the end of a contraction
43
Right Shift in O2 Concentration
-reduced affinity for for O2, higher po2 will result in lower hemoglobin concentrations
-high temp, high acidity
44
Left Shift in O2 concentration
-increased affinity for O2, lower po2 will result in higher hemoglobin concentrations
-low temp, basic environment
45
Fick equation
-VO2= HR x SV x (a-vO2 diff)
46
a-vO2 Diff
-difference in O2 between arteriole and venule
47
CO Distribution
Muscles: 10-15% (80-85% with exercise)
Trunk: 20-30%
Brain and heart: 5%
48
Oxygen Extraction
-tissues utilize the same relative amount of o2 in relation to blood o2
49
Pulmonary O2 Exchange Factors
-Area of capillary membrane
-Diffusion capacity of alveoli
-Pulmonary Capillary volume
-Ventilation to perfusion ratio
50
Area of Capillary Membrane
invaginations increase the surface area
51
Diffusion capacity of alveoli
-changes in surface area
-changes in membrane
-gas uptake issues
52
Pulmonary capillary volume
-increases with exercise
53
Ventilation to Perfusion Ratio (V/Q)
-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8
Reduced: decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2
Increased: increased ventilation to perfusion, vasodilation to increase BV, dead space
54
Arteriole Vasoconstriction Mechanism of Action
-alpha receptors
Shunt blood to muscles, from skin and mesenteric
55
Arteriole Vasodilation Mechanism of Action
-induced by increased vessel stretch
-induced by low O2 or high H+, CO2, metabolites
Beta Receptors
-increased blood flow to Skeletal muscle
-increase ventilation and alveolar perfusion
56
Cardiac Muscle Dysfunction
-most common cause of Congestive Heart Failure
Symptoms:
-dyspnea
-fluid buildup
-fatigue at rest
57
Most common cause of pulmonary congestion
-heart failure
-mostly right side affected
58
Causes of Cardiac Muscle Disease: Hypertension
Increased BP
-increased workload w/o increased blood supply
-decreased BV
-hypertrophy of myocardium that cannot relax well
-BV damage
59
Causes of Cardiac Muscle Disease: Coronary Artery Disease
-2nd most common cause of CMD
-supply and demand issue
-lipid deposits: atherosclerosis
-scar formation: decreases contractility
60
Causes of Cardiac Muscle Disease: Myocardial Infarction
-irreversible myocardial necrosis
-most commonly affects left ventricle
PT
-Increased Troponin, CK-MB that needs to come down
-ST elevation on ECG "Stimmy"
61
Causes of Cardiac Muscle Disease: Cardiac Arrhythmias
-abnormal rate of contractions
-can cause sudden cardiac arrest from SA node
-can lead to decreased CO
-Sick Sinus node syndrome
-Suprasventricular tachycardia
-V fib
62
Lab Values: Sodium
Increased
-dehydration
Decreased
-overhydration
63
Lab Values: Potassium
Increased
-Renal retention, decreased insulin
Decreased
-Excess renal secretion, aldosterone, burns
64
Lab Values: Calcium
Increased:
-hyperparathyroidism, hyperthyroidism
Decreased: hypoparathyroidism, renal failure
65
Causes of Cardiac Muscle Disease: Renal Insufficiency
-contributes to CMD due to increased fluid triggered by low BP or low BV
-RAAS
-maintains Na and K balance
66
Causes of Cardiac Muscle Disease: Cardiomyopathy
-disease of heart muscle leading to heart failure
-impaired contractility
-HTN, MI, metabolic disorders, heart valve issues
67
Causes of Cardiac Muscle Disease: Dilated Cardiomyopathy
Heart failure with reduced ejection fraction (<40)
-systolic dysfunction: less effective pump, decrease CO, fluid back up
-increased LV EDV
-lead to electrical issues
68
Causes of Cardiac Muscle Disease: Hypertrophic Cardiomyopathy
-enlarged heart that cannot relax
-Heart failure with preserved EF
-diastolic dysfunction: less compliant
-increases left EDP
-rapid ventricular emptying
-muscle cells disorganized
-common cause for sudden cardiac arrest in young athletes
69
Causes of Cardiac Muscle Disease: Restrictive Cardiomyopathy
-cannot relax
-EF preserved
-diastolic dysfunction; decreased filling
-scar tissue in myocardium (sarcoidosis/radiation) OR defect in myocardial relaxation
-hypertrophy
70
Heart Valve Abnormalities Consequences
-contracts more forcefully
-induces myocardial hypertrophy
-deceases ventricular distensibility
-decreases CO and BP
71
Pericardial Effusion
-buildup of fluid compress the heart
Cardiac Tamponade
-pressure on heart leads to decreased heart function
-worse when lying down
-relieved when standing
72
Pulmonary Embolism
-lung infarction due to decreased BV
-increased pulmonary hypertension
-increases load to right side of heart
-presence of ascities, bilateral LE edema and jugular vein distension
-increases V/Q ratio
73
Pulmonary Hypertension
-risk for cardiac disease
->20mmHg
-increased R ventricle work (Swangan's Catheter)
74
Heart Disease Vitals
-pO2: hypoxia (92-96%)
-RR: tachypnea
-HR: tachycardia
-BP: orthostatic hypotension
75
Congestive Heart Failure
-decreased CO
-LV failure
-increased BNP (stretch protein in heart)
-attempts compensatory strategies (sympathetic, RAAS, heart receptors, EPO)
76
Skeletal Muscle Function and CHF
-decreased type 1 fibers
-less contraction strength
77
Pancreas and CHF
-impairs blood flow
-impairs insulin release
78
Hematologic function and CHF
-polycythemia (thick blood)
-thrombocytopenia (low platelets)
Anemia
-can cause CHF
-can harm or help
-shifts curve to right; more o2 needed
79
Neurohumoral Function and CHF
-SNS overstimulation and downreg of B1 receptors
B1: myocardial inotrophy and chronotrophy
B2: arteriole vasodilation and bronchodilation
a1: vasoconstriction
a2: arterial vasodilation (constriction of coronary)
80
Renal Function and CHF
-RAAS
-a receptor activity
-decreased renal activity
81
Rate Pressure Product
-SBP*HR
-exercise threshold
-myocardial o2 demand
->10,000 @ rest, increase risk of angina
82
Stethoscope Diaphragm
-high frequency sounds
83
Stethoscope Bell
-low frequency sounds
84
S1
-first heart sound (higher frequency)
-closure of M1 and T1
-best heard in Mitral Area
85
S2
-second heart sound (lower frequency)
-closure of semilunar valves valves
-best heard in Aortic Area
86
Aortic Area
-right sternal border
-2nd intercostal space
-S2 best heard
87
Pulmonic Area
-left sternal border
-2nd intercostal space
88
Tricuspid Area
-left sternal border
-4th intercostal space
89
Mitral Area
-left side under nipple
-apex of heart
-5th intercostal space
-S1, S3, S4 best heard
90
Apical Pulse
Listen to apex of heart for 1 min
91
S3
-dilated/large ventricle causes rapid flling causes loud sound
-systolic issue
-could be abnormal (heart failure, dilated cardiomyopathy, late diastole) or normal (pregnancy/children, athletes)
-extra heart sound after S2
-"kenTUCKy"
-listen with bell @ apex
92
S4
-rigid ventricle decreases filling, atria contract late to push past force
-diastole issue
-always abnormal (HTN, MI, atrial kick of blood into stiff ventricle diastolic bad)
-right before S1
-gallop
93
Respiratory Cycle
Inspiration: 1/3, faster and louder
Expiration: 2/3, slower and softer
94
Vesicular Breath Sounds
-most of lung area
-inspiratory longer than expiatory
-soft
95
Brocho-Vesicular Breath Sounds
-near midline around upper spine and sternum
-inspiratory equal expiatory
96
Bronchial Breath Sounds
-above manubrium
-loud
-inspiratory shorter than expiatory
97
RV Failure S/S
-venous insufficiency, edema, weightt gain, liver issues
98
LV Failure S/S
-pulmonary issues, effusion, S3, crackles, decreased O2, paleness, increased HR, increased Breathing
99
Ischemic heart Disease (Medications)
-restablish balance of o2 supply and demand
-decreasing HR or BP to reduce O2 demand
-increase artery size, remove thrombus,
100
Heart Failure (Medications)
-maintain CO, adress underlying issue, regulate fluids, decrease preload and afterload, increase conttractility, reduce workload, decrease SNS
101
Arrhythmias (Medications)
-inhibit abnormal impulses by affectting membrane permeabiliy to specific ions (Cl, K, Ca, Na)
-SA & AV node
-prelong refractory period
102
Hypertension (Medications)
-reduce fluid, limit SNS, decrease RAAS
103
Beta Blockers
-olol
-reduced beta receptor binding
-selective of nonselective
B1: increases HR and contractility
B2: bronchoconstriction and vasodilation
CI
-HTN, ischemic HD, heart failure, arrhythmias
SE
-sedation, may mask hypoglycemia, reduced thermoregulatry response, spasms, orthostatic hypotension
Max HR: 164 - (.7 x age)
104
Orthostatic Hypotension
decreased of BP 20 and HR increase of 30 when standing from sitting
105
Calcium Channel Blockers
-pine
-decrease HR & BP, conrtactility, O2 demand
-cause vasodilaiton of coronary artieries
CI
-reduce re-infarctions (dead tissue releases Ca), ischemic HD, heart failure, arrhythmias
SE
-negative inotropic effects, blunted HR responses to exercise
106
Nitrates
-nitr
-slows HR, reduce preload and afterload, decrease contrtactility, lower BP, vasodilation
CI
-HTN, ischemic HD, heart failure, angina
SE
-hypotension, dizziness, reflex tachycardia, skin flushing
107
Angina (Medications)
-chest pain due to ischemia
-lack of O2 stimulates pain receptors
-treated by nitrates, BB, CC blockers
S/s
-tightness and chest pain
-simular to MI
-ECG ST downward shift
108
Stable Angina
-pain free at rest
-relieved by nitrates
-predictable
109
Unstable Angina
-unpredictable
-at rest
->15mins
-progression of disease
110
Prinzmetal's Variant Angina
-only at rest; morning
-ST elevation
-cardiac vasospasm (CC blockers)
111
Thrombolyic Agents
-break clots up quickly
-goal to keep ischemic time <120min
SE
-arrhythmias due to rapid reperfusion (high K, reflex tachycardia), bleeding, hemorrhage CVA
112
Anti-Platelet Agents
-prevent platelet aggregation and thrombus formation
-decrease platele adverance to site of injury
113
Anticoagulants
-prevention of blood clots, inhibit thrombin
Common: heparin, pradaxa, xarelto, eliquis
114
Diuretics
-ide
-decrease blood volume by peeing
-improve cardiac contractility
-reduce cardiac demand
-act of kidneys (loop of henle most potent)
CI
-HTN, heart failure
SE
-hypotension, arrhyhmias (K+)
115
Carbonic Anyhyrase Inhibitor Diuretics
-mild diuretics
-proximal tubules of kidney
116
K+ Sparring Diuretics
-mild
-collecting tubules and ducts
117
Thiazides Diuretics
-moderate
-can cause low K+ and glucose intolerance
118
Sodium-Glucose Transporter Inhibitors
-ozin
-lower blood sugar, reduce CV deaths and kidney disease, reduce BP, weight loss
SE
-hypoglycemia, Hypotension, UTIs, diabetic ketoacidosis
119
ACE Inhibitor
-pril
-prevents conversion of ang 1 to 2
SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia
120
Angiotension II
-vasoconstriction
-water and Na retention
-aldosterone and ADH stimulation
121
Angiotensin Receptor Blockers (ARBs)
-sartan
-limits effects of ang 2
SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia
122
Neprolysin Inhibitor
-reduces abnorrmal remodeling
-diuresis
-vasodilation
123
Aldosterone Antagonists
-suppresses aldosterone
-decreased fluid retention (diuretic)
ex: spironolactone
SE
-hyperkalemia, Orthostatic hypotension
124
Positive Inotropes
-increase contractions and HR
-opposite of BB
CI
-heart failure
125
Cardiac Glycosides
-positive inotropes
-increase Ca+
-decrease HR
-increase delay from SA to AV
-increase PR interval
-anti arrhythmics
ex: digoxin
CI
-dilated cardiomyopathy
-a fib
NOT FOR 2nd or 3rd Heart Blocks
SE
-lots of symptoms of digitalis toxicity
126
Sympathomimetics
-positive inotropes
-mimic SNS, treat shock, heart failure
-short term use only to prevent downrreg
CI
-parenteral use for hheart failure
127
Phosphodiesterase Inhibitors
-positive inotropes
CI
-severe CHF, strengthen contractions
128
Vasodilators
-decrease bv, vascular resistance
-Arterial: reduce afterload
-Venous: reduce preload
CI
-HTN, HF, ischemic heart disease
SE
-compensatory SNS actitvation
129
Alpha Adrenergic Antagonists
-vasodilator
-manage HTN
SE
-reflex tachycardia
-increase in BV
130
Morphine
-vasodilator
-decrease preload via venodilation
-reduce anxiety and effort during heart failure
131
Anti-Hypertensive
-regulate BP, decrease HR and CO
-BB, Ca blockers, ACE inhib, vasodilators, diuretics
132
Anti-Arrhythmics
Membrane stabilizers
-v tach and a fib
-reduces Na+ in cell
SE
-arrhythmias, bradycardia, photosensitivity, hepatotoxicity, hypothyroidism
133
Risk factors of Critical Illness Weakness
-bed rest
-immobility
-ventilatory suport
-sepsis
-organ failure
134
Bedrest
-harmful
-no motion against gravity
-skeletal muscle declines 1-1.5% per day
135
Immobility
-immobility due to meds
-skeletal muscle declines 5-6% per day
136
3 Causes of Motor Weakness in ICU
-pre-existting neuromuscular disorder
-new neuromuscular disorder
-CIP or CIM
137
Critical Illness Polyneuropathy
-sensory and motor nerves involved
-main contributor to persistent disability
-sepsis and organ failure
-chronic denervation
138
Critical Illness Myopathy
-diffuse flaccid weakness in all limbs
-can have complete recovery
-chronic denervation
-can be caused by steroid use
139
Causes of CIP and CIM
-critical illness and cytokine production lead to cascade of issues
140
Phase I of ICU Mobility and Walking
-restricted to bed
-unable to bear weight
141
Phase II of ICU Mobility and Walking
-able to stand
-cannot ambulate
142
Phase III of ICU Mobility and Walking
-able to ambulate
-improve endurance
143
Phase IV of ICU Mobility and Walking
-can walk at a high level
-ready to discharge
144
How much O2 in atmosphere?
21% O2
145
Nasal Cannula
-24-44% o2
-1-6L
146
Reservoir Cannula
-conserve o2, stored in reservoir
-100% o2 in each breath
-retains exhhaled air
147
High Flow Cannula
-1-15L w/ humidification
-24-75% o2
-not harsh on nose
148
Simple O2 Mask
-6-10L
-30-70%
-6L minimum to brevent rebreathing
149
Face Tent
-for mouth breathers or facial trauma
-8-15L
-21-40%
150
Aerosol Mask
-liquid medicatitons into mist
-must be able to see mist
-8-15L
-21-60%
151
Venturi Mask
-rroom air mixed with specific concentration
-color coded
152
Nonrebreathing Mask
-highest 02
-75-100%
-8-15L
-bag must be 1/3-1/2 full
-might be close to intubation
153
Tracheostomy Mask
-straight into tracheostomy tube
-35-60%
-10-15L
154
High Flow humidification Systems
-up to 60L
-up to 100% o2
-humidified and warmed air
155
Mechanical Ventilation
-meet physiological needs of pulmonary system
1. Rrespiratory failure
2. Protection of airway and lung
3. Relief of upper airway obstruction
4. Improvement of ulmonary toilet (unable to clear airways)
156
Paradoxical Breathing
-diaphragm fatigued from working hard
-must be inubated
157
Ventilator Settings to Know
-mode of ventilation
-FiO2: o2 concentration being administered (>60 concern)
-PEEP
158
Ventilator Patient Data to Know
-Minute ventilation
-respiratory rate
159
PEEP
-Positive End Expiratory Pressure
-resisdual pressure in alveoli after exhalation
-pressure required to inflate alveoli and prevent collapse
Low PEEP 3-5: normal
Moderate PEEP 5-15: treat refractory hypoxemia
High PEEP >15: severe lung injury
-put pressure on IVC and decreased CO
160
Mode of Ventilation
-how breath is delivered
1. Assist-Control
2. SIMV and Pressure Support
3. Pressure Support
161
Assist-Control
-non weaning: breathing for patient
-rate and tidal volume pre-set
-patient can trigger breaths with pre-set tidal volume
162
SIMV
-synchronized intermittent Mandatory Ventilation
-Weaning mode: starting to take them off
-rate and tidal volume pre-set
-patient can trigger breaths with pressure support instead of pre-set tidal volume
163
Pressure Support Ventilation
-weaning mode: 0-30cmH20 (10 normal)
-applies to spontaneous breaths
-tidal volume not pre-set
-NOT air, only pressure
164
CPAP
-constant positive pressure applied in airways
-noninvasive ventilation
165
BIPAP
-Bi-level pulmonary airway pressure
-noninvasive ventilation
166
SaO2
-actual o2 content in blood
167
SpO2
-estimated o2 content in blood
-<88 is concerning, drop in hemoglobin curve
SE
-syncope, dizziness, paleness, quick breathing (>30bpm at rest)
168
4 Steps to check EKG
1. Speed
2. QRS Wide or narrow
3. P wave
4. Regular or Irregular
169
Rule of 300
5 Boxes: 60bpm
4 Boxes: 75bpm
3 Boxes: 100 bpm
2 Boxes: 150bpm
1 Box: 300bpm
170
Length of EKG Components
P Wave: 2-3 boxes
PR interval: 3-5 boxes
QRS: 1.5-3 boxes
171
Lead I
-limb lead
Right arm to Left arm
-normal wave form
-Circumflex A.
-lat wall of LV
172
Lead II
-limb lead
Right arm to lower limb
-normal wave form
-Right Coronary A.
-Inferior portion of heart/apex
173
Lead III
-limb lead
-leftt arm to lower limb
-normal wave form (may have inverted P and t wave)
-Right Coronary Artery
-Inferior portion of heart/apex
174
aVF Lead
-augmented lead
Middle of body to lower limb
-Right coronary Artery
-Inferior portion of heart/apex
-normal wave form
175
aVL Lead
-augmented lead
From middle to Left arm
-Circumflex A.
-lat wall of LV
-normal wave form
176
aVR Lead
-augmented lead
From middle of body to right arm
-Top of RV
-inverted wave form
177
V1
On Right 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.
-inverted P-wave, deep S
-RV
178
V2
On Left 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.
-inverted P-wave, deep s
-RV, septum
179
V3
On left between 2 and 4
-Anterior Heart, precordial lead
-Right coronary A.
-RV, septum, ant. heart
180
V4
On left 5th intercostal space mid clavicular line
-Anterior Heart, precordial lead
-Larger R, small s
-Right coronary A., ant heart
181
V5
On left 5th intercostal space anterior axillary line
-Lateral heart, precordial lead
-Larger R, small s
-Circumflex A., lat wall of heart
182
V6
On left 5th intercostal space mid axillary line
-Lateral heart, precordial lead
-Larger R, small s
-Circumflex A., lat wall of heart
183
Premature Ventricular Contraction
-random cell in ventricles fire out of sync of the rest, prematurely
-wide QRS
184
Ventricular Bigeminy
-PVCs occur every 2 beats
185
Ventricular Trigeminy
-PVCs occur every 3 beats
186
Ventricular Couplet
-PVCs occur in 2s
187
Ventricular Triplet
-PVCs occurr in 3s
-non sustained ventricular tachycardia
-STOP and check vitals
188
Ventricular Tachycardia
-fast/large/wide QRS with no p wave, regular
-emergency
189
Supraventricular Tachycardia
-fast/narrow QRS
-comes from atria not SA node
190
Junctional Rhythm
-slow (40bpm) /no p wave/inverted T wave
-originates away from atria but depolarizes ventricles
191
ST Elevation
-Acute MI
-Stimi
192
ST Depression
-Angina/ischemia/infarction
193
P Wave Inversion
-Heart block with junctional rhythm
194
T Wave Inversion
-MI or ischemia
-BBB
-hypertrophy
-pulmonary embolism
195
Ventricular Fibrilation
-dangerous, call code
-irregular/fast/small
196
Atrial Fibrilation
-chaos/irregular
-QRS present, no p wave
-multiple cells firing
-valve issues, ischemia, stroke, arrhythmia
197
Atrial Flutter
-saw tooth/bread knife
-1 cell going crazy
-QRS present and irregular
198
Torsades De Pointes
-V tach with prolonged QT, irregular
-Looks crazy...how are you alive
199
Right Bundle Branch Block
-delayed depolarization of RV
-right lead (V1): "M" in QR, deep S
-Left lead (V6): "W" in S wave
200
R-Wave to find HR
-add up r waves in one strip x 6= HR
201
Left Bundle Branch Block
-delayed depolarization of LV
-right lead (V1): "W" in R wave
-Left lead (V6): "M" in R wave
-anomally always at tip of QRS
202
1st Degree AV Block
-husband is late but comes home, long PR interval
-from SA node
-slow HR
203
2nd Degree AV Block : Type 1
-husband is later and later and then doesn't come home
-longer PR interval then dropped QRS
-AV node
204
2nd Degree AV Block : Type 2
-husband randomly doesn't come home
-normal PR intervals
-randomly dropped QRS
-Bundle of his
-DONT WORK WITHOUT PACEMAKER
205
3rd Degree AV Block
-normal p wave unrelated to QRS, no correlation of QRS
-random p waves
-DONT WORK WITHOUT PACEMAKER
206
Percutaneous Revascularization Procedures
-revascularize myocardium
1. Angioplasty
2. Arthrectomy
3. Stenting
207
Angioplasty
-balloon inflated to push plaque against lumen
-stent then put in
-prone to bleeding
-5-7days no exercise
208
Arthrectomy
-larger plaque buildup, cut out the plaque
209
Coronary Artery Bypass Graft
-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)
210
Cardiac Complications
-infection
-sternal precautions
-scar tissue
-Myocardial Stunning: low cardiac output
-Arryhmias
-Bleeding: migh need blood transfusions
-Neurologic Complications
211
CABG Complications
-Renal failure: 5-10%
-Pleural Effusions: 90%
-Pericardial Effusion
212
Sternal Precautions
-limit movement for 6-8 weeks
-gentle coughing
-move "in the tube": keep arms to the side
-infection control
213
Intraortic Balloon Pump
-severe heart failure; shock
-restore CO
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%
214
Valve Replacements
-aortic most common (pulmonary valve to replace aortic, aortic cannot be repaired)
-Metal: requires life long blood thinners
-Bovine: reduce stroke risk
215
Arrhythmia Procedures
-Ablation: burn off cells causing arrhythmias
-Pacemaker Implant: need to know rate, what makes it come off
-Defibrillator: prevent arrhyhmias
216
Peripheral Vascular Interventions
-Endarectomy: plaque removed
-Aneurysm repair
