Module 9 Cardiovascular Flashcards by Megan Manasco

Phase 0 of cardiac cycle ion movement

Depolarization

Na in

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Phase 1 cardiac cycle ion movement

Brief repolarization

Cl in and K out

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Phase 2 cardiac cycle ion movement

Plateau

Ca in

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Phase 3 cardiac cycle ion movement

Delayed repolarization

K out

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Phase 4 cardiac cycle ion movment

RMP

Na-k pump maintains

K leak

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SA or AV action potential differences from ventricular AP

No phase 1 or 2

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Change in what phase leads to a change in HR

Phase 4 depolarization

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Absolute refractory period of ventricular AP

Phase 2 plateau

Sodium channel is in inactive state

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Relative refractory period for ventricular AP

Phase 3 repolarization

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What leads do you look at for BBB

V1 and V6

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QRS results from what phase of ventricular AP

Phase 0- depolarization

Na influx

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T wave results from what phase of ventricular AP

Phase 3 repolarization

K efflux

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QT interval reflects what phase of ventricular AP

Phase 2 plateau

Ca influx

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How do changes in serum Ca levels effect EKG

Hypocalcemia- prolonged QT

Hypercalcemia- shortened QT

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EKG changes seen with K+ abnormalities

Hyperkalemia peaked T

Hypokalemia U waves

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Leads V1-V2 monitor which area/vessel

Posterior

Left circumflex

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Leads II, III, and aVf monitor what area/vessel

Inferior

RCA

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Leads 1, aVL, V1-V4 monitor which area/vessel

Septum, anterior wall

LAD

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Leads 1, AVL, V5-V6 monitor which area/ vessel

Lateral

Left circumflex

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What is the major determinant of intravascular volume in the body

Sodium

**aldosterone

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Concentric Hypertrophy of LV develops in response to what

Pressure overload

Coarctation of aorta

Chronic HTN

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Eccentric hypertrophy develops in response to what

Volume overload

Morbid obesity

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In response to acute increase in afterload (neo) the PV loop shifts how

Up and right (greater pressures and greater volumes)

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In response to acute decrease in afterload the PV loop shifts where

Down and left (smaller pressure and smaller volumes)

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When contractility increases acutely how does PV loop change

Up and left (greater pressure and smaller volumes) Dig or Ca++

When contractility decreases acutely how does PV shift

Down and right (lower pressure and higher volume) CHF

HOCM shifts PV loop how

Left and up Smaller volume and larger presssure

SVR formula

((MAP-CVP)/CO) x 80

SVR normal value

900-1500 dynes/sec/cm-5

BRR afferent and efferent limb

Afferent- vagus from aortic arch Hering’s (glossopharyngeal)from carotid efferent- vagus to SA SNS nerves to ventricles and systemic vasculature

MOA for Inamrinone and milrinone

Block breakdown of cAMP = increased myocardial contractility and decreased SVR

If newborn has systolic and diastolic murmur what is the problem

PDA More intense during systole- machinery murmur

What are the 2 determinants of BP. Whose law applies

SVR and CO Ohms law

Bainbridge reflex receptor location

RA and great veins

Afferent and efferent limb of bainbridge reflex

Afferent- vagus to medulla Efferent- SNS nerves to increase HR

What is the most potent local vasodilator released by cardiac cells?

Adenosine

What are the 2 most significant risk factors for non cardiac surgery

MI S3 Gallup

What inhalation agent can cause myocardial depression. Especially with opioids

N20

Becks triad

Hypotension JVD Distant, muffled heart tones

Induction agent of choice for cardiac tamponade

Ketamine- maintains high sympathetic tone

Where is the J point on ECG Significance

Where QRS ends and ST begins Point to measure ST elevation or depression

Which lead assesses a majority of the LV? Best detects LV ischemia

identifying features of LBBB on ECG

Notched R wave in Left side leads (I, AVL, V5, V6) Deep S in right leads

Identifying features of RBBB

Notched R wave in Right side leads (aVR, V1) Wide S on Left leads

Which is more ominous LBBB or RBBB

LBBB does not occur normally Associated with ischemic heart diseases, HTN, and valvular heart disease

Clonidine is what drug class MOA

A2 agonist. Stimulates inhibitory neurons in medulla inhibiting SNS outflow

MOA A2 receptors in periphery

Decrease release of NE from presynaptic nerve terminal

What category of drugs are helpful for shivering (other than Demerol)

A2 agonists inhibit thermoregulatory vasoconstriction

Direct acting vasodilators NTG and Nipride MOA

Donate NO which activates soluble guanylate cyclase = increased cGMP = relaxes vascular smooth muscle

Cyanide toxicity with nipride results in what ABG changes

Metabolic acidosis Look at BE

Treatment for cyanide toxicity from nipride

Sodium thiosulfate

NTG works where

Venous dilator

Hydralazine works where

Greater dilation of arterioles than veins

Class I antidysrhythmics

Sodium channel blockers Stabilize membranes- delays phase 4 depolarization 1A- procainamide and quinidine 1B- lidocaine, tocainide, phenytoin

Class II antidysrhythmics

Beta-blockers

Class III antidysrhythmics

Potassium channel blockers (prolong repolarization) Amiodarone, ibutilide, dofetilide Prolong effective refractory period in SA and AV node

Class IV antidysrhythmics

Slow calcium channel blockers Verapamil and diltiazem Slow phase 4 depolarization

How does adenosine work for dysrhythmias

Hyperpolarizes AV node = decreases excitability

MOA for inocor and primacor

PDE inhibitors- increase cAMP in cells Aka inodilators

Glucagon MOA on cardiac

Increases contractility and heart rate Binds to own receptor to increase cAMP

Digoxin MOA

Inhibits NA-K pump Increases contractility, decreases HR, slows impulse propagation through AV node (enhances PNS)

3 electrolyte disturbances that enhance digoxin toxicity

Hypokalemia Hypercalcemia Hypomagnesemia

CVP would be higher than PCWP in what conditions

RV failure Pulmonary HTN PE

Most common complication of CVC

Infection

Most common complication of PAC

PA perforation and hemorrhage

How is cardiac output related to area under thermodilution curve

Inversely related Smaller area = higher CO

Insufficiency of what 2 valves may lead to falsely high thermodilution cardiac outputs

Tricuspid or pulmonic regurgitation

If pt has mitral stenosis or pulmonary HTN does PCWP over estimate or under estimate CVP

Overestimates

In patients with AI does PCWP over or underestimate CVP

Underestimate

Over dampening of arterial line results in what false interpretation of BP

Underestimates SBP Overestimates DBP

For every inch cuff is above heart how does pressure change

1.8mmHg