Test #1 Flashcards
1
Q
what phase does depolarization start?
A
starts in phases 1-4
2
Q
what can innervate to stimulate the AV node?
A
Epi (B1) and acetycholine
3
Q
Where do Dissections in the vessel take place.
A
Dissections are within the walls of the vessel
Treat with pain control and drop the pressure.
4
Q
Preload is the measure of what side before contraction
A
Right ventricle
Also diastolic number
5
Q
Myocardium
A
The heart tissue
6
Q
where does V3 go?
A
Between V2 and V4 (straight line)
7
Q
what is the intrinsic rate of the SA node?
A
60-100
- it will override all other pacemakers in the heart as long as it is functioning.
- Can go as low as 0, and as fast as 170
8
Q
Mediastinal or mediastinum
A
Division of the thoracic cavity (Mid, middle, sternum)
-where the heart, lungs, and trachea live
9
Q
Bruits (carotid bruits)
A
Turbulent blood flow
Also can be in the femoral/renal
10
Q
what is dangerous about phase 3?
A
this is where the cell is ready to accept a stimulus, but the electrolytes aren’t ready
11
Q
what if electricity delivered on relative refectory period?
A
not a desired effect, can cause arrhythmias
12
Q
where does V5 go?
A
Between V4 and V6 (straight line)
13
Q
what is digitalis?
A
Cardiac glycosides are a class of organic compounds that increase the output force of the heart and increase its rate of contractions by inhibiting the cellular sodium-potassium ATP pump
ex: digoxin, digitoxin, and digitonin
14
Q
what is phase 4?
A
Resting Membrane Potential. Sodium/potassium pump
15
Q
what does Ascites mean?
A
Marked abdominal swelling from a buildup of fluid in the peritoneal cavity
16
Q
where is visceral on the heart?
where is the parietal?
A
visceral against the organ
parietal outside
17
Q
Coronary
A
Is derived from Spanish word corona (upside down crown)
18
Q
what is the conduction path of the bundle of His?
A
if normal it goes from posterior to anterior and right to left.
It is the only conduction path between atria and ventricles.
19
Q
how does adenosine work?
A
chemical cardioverter - forces the sodium and potassium pump (cell reset).
20
Q
What diastolic pressure is too low to perfused the heart?
A
40mmHg
21
Q
Conduction path ways of the heart are found where?
A
Inside of the heart
22
Q
Pericardium (epicardium)
A
Outside layer of the heart (enclosing the heart)
23
Q
that phases are the action potential?
A
phase 0- phase 1
24
Q
How much does cardiac output drop with A-Fib?
A
30%
25
Adventitious Lung Sounds
Abnormal
26
what is phase 1
Early Repolarization phase (+20mV) (overshoot). Sodium gates partially close slowing the entry of sodium, potassium leave
27
what rate can SA nodes not sustain tachycardia?
| what must you do as a medic?
170, can't maintain that rate
figure out why it is sustained sinus tach before you treat it. Compensatory mechanism- must treat the underlying cause
28
Diastolic measures
The pressure back on your ventricles
29
Biphasic
Waveform that is partly Positive and partly Negative
30
what makes up the atrioventricular junction?
AV node and bundle of His.
31
Anasarca
Massive generalized body edema
32
Where does V1 go?
angle of Louis (2nd rib), between 4th and 5th rib, 1” to right of sternum
33
what happens when pulmonary pressure increases?
cardiac output decreases
| CPAP, can lead to this
34
Atherosclerosis
Deposit of buildup of fats, cholesterol
35
Atrial kick
The hard squeeze of the heart to get the rest of the blood out of the atrial.
36
what does lead II, III, and aVF show?
- inferior wall MI
| Feeds Vagus Nerve, AV node, right ventricle
37
what coronary artery sends blood to the SA node?
RCA- right coronary artery
38
What is after load?
The residual pressure the heart has to pump against.
Left ventricle has to have enough pressure to overcome the aorta
This is systolic pressure
39
when the electrical conduction is moving to the positive electrode what will the deflection be?
postitive
40
where is the blood supply for the AV node?
RCA- right coronary artery
41
The circulatory pathways (coronary) are found where on the heart?
outside
42
what phase is the resting phase?
4
43
when the electoral conduction is moving to the negative electrode what will the deflection be?
negative
44
what is phase 3
Repolarization (final rapid repolarization) relative refractory period. Closing of sodium and calcium gates, continued release of K+.
45
what are some characteristics of the left bundle?
short, then separates (branch or fascicles) bifasicular blocks occur here
46
what does lead I and aVL show
Superior Lateral Wall MI,
| Left circumflex, Left Atrium, Left Ventricle
47
Chronotropic
Chrono- Time
Tropos- turn
Heart Rate
48
what is Biphasic mean?
Waveform that is partly Positive (+) and partly Negative (-).
Electricity traveling perpendicular to electrode
49
when does absolute refectory period begin?
beginning of QRS to mid T wave. This is the time when the heart cannot respond to any impulse no matter how strong
50
where does V2 go?
Same level, 1” to left of sternum
51
pericardial sac properties?
```
It is very rigid and fibrous
Double walled:
-filled with serous fluid
-provides a smooth lubricated surface for heart to beat
-wraps around the coronary arteries
```
52
What is regurgitation?
the backwards flow of blood
53
What are some characteristics of the right bundle?
very long and skinny conduction network. Skinny, easily damaged. Responsible for whole right ventricle.
54
What is excitability?
stimulated by extrinsic/ intrinsic force. (they respond to stimulus (episodes, electricity, trauma to chest, hypoxia.)
55
The circulatory system is a closed system
Doesn’t depend on gravity
56
Why is there a long and slowing conduction of action potential for the AV node?
This is shown where on the ECG?
to allow for atrial kick and filling.
The PR interval
57
When are the coronary arteries perfused?
During diastole
58
Is sodium a intra or extracellular ion?
Is potassium a intra or extracellular ion?
Sodium - extracellular
Potassium - intracellular
they have equally but opposing values
59
Ligamentum Arteriosum
Anchors aorta to heart
60
Endocardium cells are supplied when?
When the blood is sitting in ventricles
61
when do the coronary arteries prefuse?
during diastole
62
where does V6 go?
Mid axillary same level as V4
63
conductivity
the ability of a cell to receive an impulse from an adjoining cell. This signal will continue until there are no more cells, or it reaches a cell that has already been depolarized
64
can you see an infarct in the heart off the limb leads?
NO, only way to detect an infarct is with a 12-lead diagnostic
65
what can you expect with slow rhythms?
more irregular rhythms.
66
what is phase 2
Plateau phase (0mV) (absolute refractory period). Opening of calcium gates, leaving of K, ends with calcium gates closing. (Phase with which Calcium Channel Blockers mess with)
67
What prevents the prolapse of valves?
Papillary muscles and charade tendineae
68
If the chest pain is to last longer than 30 min?
Think MI
69
is there an upper limit for a junctional rhythm?
no, it can go to 0 and has no upper limit.
70
What does lead V5, V6, aVL show?
interior lateral wall MI,
| left circumflex, left atrium, left ventricle.
71
what does V3 and V4 show?
Anterior Wall MI,
| LAD, left ventricle
72
When is the coronary artery perfused?
During diastole (blocked during systole)
73
The atrial and ventricle are two separate compartments, what is the only thing that connects them?
the bundle of HIS
74
what can an antidysrhythmic that works on potassium (k) cause?
Long QT
75
what does aberrant mean?
Abnormal
76
where does V4 go?
V4- Midclavicular line between 5th and 6th rib
77
what does idio mean?
within
78
Can we cardiovert people who are on Digg?
NO
79
Bachmanns bundle or branch
internal atrial pathway
| sends a signal to the left atrium.
80
What is phase 0
depolarization, rapid influx of sodium. (class 1a ventricular antidysrthythmics, sodium channel blockers work here)
81
what are the 3 best practices for Cardiac Arrest?
1) good quality CPR
2) Defibrillation
3) Post resuscitation cooling (therapeutic hypothermia)
82
do atrial drugs effect the ventricles? and vise versa?
NO
83
Inotropic
Ino - force
Tropic- effecting
Force
84
If the chest pain is said to last less than 30 min?
You can think Angina
85
what is the Right Anterior fascicle
Left to right, anterior to posterior through septum. Depolarizes septum. Very short and thick. Very difficult to be damaged. Septum has a dual blood supply. Chemically stimulated with Beta.
86
what is the Left Anterior fascicle
very thin easily damaged, provides impulse to most of left ventricle.
87
how does Hyperkalemia cause problems?
it causes the potassium to not need to leave the cell.
| so no more cardiac function
88
what is the intracellular charge of a cell?
-90mv
even though both potassium and sodium are positive ions (remember that in cell is negative inside)
89
sympathetic response releases what? and where does it go on the heart?
Epi, hits the B1 sites (SA, AV, and woven thru the ventricles)
90
contractility
ability of a cell to shorten (contract) in response to an impulse. possible to have all the other properties but not have the cell contract (PEA)
91
how is the cardiac muscle made?
made of intercalated discs, cause the cell to depolarize rapidly so it contracts in unison
intercalated discs don’t have actin or myosin (can’t contract)
92
How much of our blood is pulled down by gravity? And the remaining is from what?
70% gravity
| 30% from atrial kick
93
what is the isoelectric line?
the line entering the p-wave
It is our baseline
94
What type of infarct do we not give nitro to?
Right inferior (decreases the preload)
95
True or False
Give 02 to a MI pt if SPO2 is 95%?
False
96
Bruit
Blowing or swishing sound created by the turbulence within a blood vessel
97
What are 5 life threatening causes of chest pain?
- MI
- PE
- Thoracic aortic dissection
- Esophageal rupture
- tension pneumothorax
98
The parasympathetic response does what to the heart?
release acetylcholine, effects the SA node and the chronotropic effects, slows the AV node, slows conduction through AV node dromotropic
Does not act on the ventricles zero inotropic effects (will not decrease force of contraction)
99
What neuro signals can effect the SA node?
epi and acetylcholine
-chemically interacted by Epi (B1) and acetylcholine
100
Pericarditis
Inflammation of pericardial sac
101
what are the three things that B1 receptors contribute when they are stimulated?
Chronotropic- rate (faster at the SA node)
Inotropic- stronger contraction
Dromotropic- conduction/ automaticity
102
What are the 4 properties of the cardiac cell?
- Excitability
- Automaticity
- conductivity
- contractility
103
what is stroke volume?
what get squished out with a squeeze (100ml)
104
Ejection fraction
% of total blood in the heart that get SQUEEZED OUT every beat
105
What is the top reason for missed cardiac alerts?
is a pt with EKG that suggest heart attack but has no symptoms.
-cause is usually associated with excitability.
106
Hematemesis
Gastric blood in emesis
107
Stenosis
Narrowing
108
what are pericardial leads?
the leads that wrap around the heart
109
Is the tricuspid on the right or left side of the heart?
Right
| Think right ventricular is bigger, less muscle, so three is a bigger number
110
Endocardium
Inside layer of the heart
| Think as you zoom into the heart, you end at the endocardium
111
Automaticity
All of our cardiac cells have automaticity, they beat on their own.
112
are there acetylcholine receptors in the ventricles?
No, (only Epi effects)
Ventricular bradycardia atropine will not help. Rate (20-40) upper limit is 170-180 (v-tach). Idio means from within.
113
what are some easily irritated (H's and T's)?
Irritants:
- hypoxia
- stimulants (drugs)
- Digitalis (cardiac glycoside)
- electrolytes
- acidosis
- infection
- caffeine
- other cardiac cells
114
Excitation
The disturbed or altered condition resulting from stimulation of an individual, organ, tissue, or cell
115
Where does the right coronary artery supply blood to?
supplies the posterior descending, the right ventricle, right atria, interior wall, SA/AV node, posterior septum.
116
• Ejection Fraction is about what %
70%
117
Automaticity
Cels ability to generate an impulse. Backup system in place but can cause problems.
Usually deals with the pacer cells
118
Mitral valve on right or left side of the heart
Left side.
119
The left coronary artery splits into two, what do they turn into?
Left anterior descending- 2/3 of left ventricle, inter ventricular anterior (front of heart)septum, small amount of right ventricle.
Left circumflex- rest of the left ventricle (1/3) on the posterior wall. Left atrium
120
what phase does digitalis work on?
phase 4.
“Digg scoop” on the T wave
121
what is the intrinsic rate for AV node?
40-60
122
what does V1 and V2 show
septal involvement
123
Dromotropic
Conductivity
| Drones are electric
124
what are James Fibers?
short circuits from the atria to the ventricle - can result in very fast rhythms.
125
what is the supernormal period?
when the little dip happens at the end of phase 3 before going up to baseline. Also known as the relative refractory period.
126
Apex of heart is where?
At the bottom
Apex means point
127
are there any parasympathetic receptors in the purkinje fibers?
NO
128
what side of the heart can we NOT give Nitro to?
right side
129
Hemoptysis
Coughing blood
130
Commotio Cordis
fatal Thoracic dissection
131
What is a common cause for someone in V-Tach?
They are hypoxic
132
Out of excitability, conductivity, automaticity, and contraction, what one is not seen by the ECG?
contraction.
| This is evaluated by looking at the pt skin, BP, and how they are perfusing. This is how we measure our CO.
133
How do Na+ and K+ resting potentials related?
They are inversely related.
| (
134
What causes Angina Pectoris?
Stable (starts with exertion, relief with rest and nitro, lasts no longer then 30 minutes)
135
Levine’s Sign
one hand on chest, one hand on stomach
136
Who are most prone for silent MIs?
diabetics, woman, and geriatrics
137
Pericarditis
nitro will vasodilate and increase HR, which will in turn increase pain due to increased irritation. Could result in sepsis, infection could transfer into blood.
138
Cardiac Tamponade
Trauma, usually penetrating. Fluid in pericardial sac, compresses heart, SOB, jugular venous distention. Beck’s triad signs. Pulse alternans, alternating pulses and swinging of the heart. Electrical alternans, swinging of electrical waves.
139
Troponin levels
myocardial damage
140
Hematocrit
amount of RBC’s 4.5-5.5 million per cubic mm
141
polycythemia
excessive RBC’s (emphysema)
142
Greater Vessels
Aorta, superior/inferior vena cava
143
Dressler’s Syndrome
Pericarditis caused by M.I.
144
Virchow’s Triad (3 things cause PE)
Local trauma to vessel wall (Epithelial injury)
Stasis of the blood
Hypercoagulability
145
What side of MI do we not give fluid to?
Left Anterior MI (cause flash pulmonary edema)
146
What side of MI do we want to give lots of fluid to?
Right Inferior MI (their preload is effected, give lots of fluid)
147
what is visceral pain?
organ generated, the organs don’t have lots of pain receptors. So the pain is referred.
148
what is Parietal pain?
where the parietal lining is irritated, the sharp, localized pain make breathing difficult.
149
Acute Coronary Syndrome
any condition brought on by a sudden reduction or blockage of blood flow to the heart.
150
the three layers of an artery?
```
Tunica Intama (inside)
Tunica Media (middle)
Tunica Externa (outside)
```
151
Cor Pulmonale
Through consolidation of the alveoli you take away blood vessels that decreases gas exchange. The heart still wants to pump blood to the lungs, but have less blood vessels to receive that blood. So you get hypertrophic right atrium.
152
Atherosclerosis
Narrowing and hardening or the arteries.
153
Phase 0
Depolarization. Influx of sodium - Overshoot
154
Phase 1
early rapid repolarization - (+20mV). Fast Na+ gates close, potassium
leave
155
Phase 2
```
Plateau phase (0mV). Opening of calcium gates, leaving of K+, ends with calcium gates
closing.
```
156
Phase 3
Repolarization. Closing of calcium gates, continued release of K+
157
Phase 4
Resting membrane potential - Sodium/potassium pump – when sodiumleaves cell it takes Ca++ with it. This is the most important phase for the
1a lengthens the action potential (right shift)
1b shortens the action potential (left shift)
158
Malignant hypertension
Hyper tensive crisis (acute on set) 120 diastolic
