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NUR2226 > WK 3: Cardiac Disorders B > Flashcards

WK 3: Cardiac Disorders B Flashcards

(93 cards)

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1
Q

What is the purpose of the electrical conduction system?

A

Coordinates the contraction of the heart muscle to effectively pump blood and nutrients around the body

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2
Q

Outline the 5 steps of the electrical conduction pathway

A
  1. SA node sets rhythm (60-100 bpm)
  2. Travels to AV node
  3. Through the bundle of His
  4. Left and right bundle branches
  5. Through the purkinje fibres (Supply 02 to cardium)
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3
Q

What does the P wave represent on an ECG?

A

Atrial depolarisation (Atria contracting(pumping))

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4
Q

What does the QRS complex represent on an ECG?

A

Ventricular depolarisation (Ventricles contracting (pumping))

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5
Q

What does the T wave represent on an ECG?

A

Ventricular repolarisation (Filling))

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6
Q

Where is atrial replorisation occurring within an ECG?

A

Within the QRS complex

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7
Q

Identify the 6 steps to ECG Interpretation

A
  1. Examine the P wave
  2. Measure PR interval
  3. Measure QRS complex
  4. Identify the rhythm
  5. Determine the heart rate
  6. Interpret strip
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8
Q

How do you examine the P wave in ECG interpretation?

A

Present and upright ?

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9
Q

How do you measure the PR interval in ECG interpretation ?

A

Distance between the start of the P wave and the start of the QRS complex. Count the little boxes in this space and multiply by 0.4 seconds. Should be between 0.12 and 0.20

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10
Q

How do you measure the QRS complex in ECG interpretation?

A

Count the little boxes within the QRS in this space. Should be between 0.06 and 0.12

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11
Q

How do you identify the rhythm in ECH interpretation?

A

Measure distance between the R’s in 6 second strip. Mark two on a piece of paper and identify as regular or irregular

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12
Q

How do you determine the HR in ECG interpretation?

A

Get a 6 second strip, find the major three lines, count the QRS complexes. If 6 exactly, HR=60bpm

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13
Q

Identify the place of V1 on the chest in ECG lead placement

A

4th intercostal space right sternal border

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14
Q

Identify the place of V2 on the chest in ECG lead placement

A

4th intercostal space left sternal border

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15
Q

Identify the place of V3 on the chest in ECG lead placement

A

Between V2 and V4

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16
Q

Identify the place of V4 on the chest in ECG lead placement

A

5th intercostal space left mid clavicular line

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17
Q

Identify the place of V5 on the chest in ECG lead placement

A

5th intercostal space left anterior axillary line

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18
Q

Identify the place of V6 on the chest in ECG lead placement

A

5th intercostal space left mid axillary line

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19
Q

Identify the 6 characteristics of sinus rhythm

A 
P wave: Present, upright 
PR interval: 0.12-0.2 ms
QRS complex: Proceeded by normal P wave, <120ms
Rate: 60-100bpm
T wave: Present upright 
Mechanical contraction: Present
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20
Q

What is a N-STEMI?

A

Occurs when ischaemia leads to an infarction due to narrowing leading to decreased oxygen supply and nutrients to the distal area

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21
Q

What is usually the cause of a N-STEMI?

A

Usually accompanied by modifiable risk factors e..g smoking

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22
Q

What is a STEMI?

A

A complete occlusion of coronary arteries (sometimes due to thrombosis) causes infarction. Extends distally and proximally

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23
Q

What is a subendocardial infarction?

A

Occurs when significant occlusion due to ruptured plaque results in poor oxygen supply to the myocardium with infarction distally, and ischaemia in proximally. Endocardium not affected.

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24
Q

What is a transmural infarction?

A

Occurs when complete occlusion due to ruptured plaque leads to thrombosis and no blood supply to the cardium. Infarction extends distally and proximally. Endocardium affected

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25
What represents a N-STEMI on an ECG?
Depressed ST wave or T inversion | No progression to a Q wave
26
What represents a STEMI on an ECG?
Elevated ST wave | Progression to a deep Q wave
27
What are the 3 zones of injury?
1. Zone of ischaemia (partial occlusion): Inverted T wave 2. Zone of hypoxic injury (restricted flow): Elevated ST wave 3. Zone of infraction/necrosis: (Death of myocardial/cardiac cells): Deep Q wave
28
What is sinus tachycardia?
Sinus rhythm with a rate of >100bpm
29
What are the effects of sinus tachycardia?
Decreased filling times, Increased MAP, Increased myocardial demand
30
What is an example of someone who may experience sinus tachycardia?
Young adult undergoing exercise may reach 200 ppm
31
Identify the 6 characteristics of sinus tachycardia?
``` P wave: Present, upright PR interval: 0.12-0.2 ms QRS complex: Proceeded by normal P wave, <120ms Rate: 100>bpm T wave: Present upright Mechanical contraction: Present ```
32
What is sinus bradycardia?
Sinus rhythm with a rate of <60bpm
33
What are the effects of sinus bradycardia?
Increased preload, decreased MAP
34
What is an example of someone who may experience sinus bradycardia?
Athlete or fit person may have a HR as low as 40bpm when at rest or asleep
35
Identify the 6 characteristics of sinus bradycardia?
``` P wave: Present, upright PR interval: 0.12-0.2 ms QRS complex: Proceeded by normal P wave, <120ms Rate: <60bpm T wave: Present upright Mechanical contraction: Present ```
36
What is atrial fibrillation?
The result of abnormal electrical pathways in the atria often leading to an irregularly irregular ventricular contraction
37
What are the 3 types of AF?
1. Occasional (Paroxysmal): Symptoms come and go, last from mins to hours 2. Persistent: Lasts longer than a week, can become permanent 3. Permanent: Heart rhythm cannot be restored, meds required
38
Identify 3 causes of AF?
1. Excess catecholamines e.g. adrenaline infusion, stress 2. Increased atrial automaticity e.g. alcohol, caffeine, myocarditis 3. Abnormaility e.g. congenital Heart disease, ischaemic heart disease
39
Identify 2 potential complications of AF
1. Atrial thrombus formation | 2. Heart failure
40
Describe the pathophysiology of AF
No describable P wave due to abnormal erratic and disorganised electrical rhythm from SA node creates a "quivering" atria, AV node is bombarded meaning irregular activity and decreased CO
41
Identify 3 clinical manifestations of AF
Altered conscious state Irregular Palpitations Chest Pain
42
Identify 2 potential treatments of AF
Betablockers/Calcium channel blockers/Antiarrthymic agents | Electrical cardio version (Electrical shock to restore sinus rhythm
43
Identify the 4 characteristics of AF
P wave: Rate >300, non identifiable QRS complex: Normal or wide Rate: Variable with irregular rhythm Mechanical contraction: Present
44
Describe the pathophysiology of ventricular tachycardia
Impulse originates in ventricles outside of the normal conduction system
45
Identify 2 causes of Ventricular tachycardia
Anaesthesia | Ageing
46
Identify the 4 characteristics of ventricular tachycardia
P wave: Absent or independent of QRS QRS complex: Broad Rate: >180 bpm Mechanical contraction: Can have pulse or no CO
47
Describe the pathophysiology of ventricular fibrillation
Impulse originates in the ventricles outside of the normal system
48
Identify 2 causes of ventricular fibrillation
Anaesthesia | Ageing
49
Identify the 4 characteristics of ventricular fibrillation
P wave: Absent, non identifiable QRS complex: Not identifiable Rate: 150-500 bpm Mechanical contraction: No CO
50
Describe the pathophysiology of asystole
Has a wandering baseline, not compatible with life. No mechanical or electrical contraction
51
Identify 2 causes of asystole
Profound ischaemia | Acidosis
52
Identify the characteristic of asystole
"Flat line" or wandering baseline, No CO
53
What is PEA?
Pulseless electrical activity: Electrical activity and rhythm continues but there is no contraction or CO. No pulse but ECG may look normal
54
Describe the pathophysiology of PEA
Depolarisation and contraction not coupled
55
Identify the cause of PEA
4H's and 4T's or intercranial haemorrhage
56
Identify the 4H's
Hypovolaemia Hypoxia Hypo/Hyperkalaemia Hypo/Hyperthermia
57
Identify the 4T's
Toxicity Tension pneumothorax Tamponade (compression of heart by fluid) Thromboembolism
58
Identify the characteristic of PEA
Electrical activity variable, no mechanical contraction and no CO
59
What is mechanical contraction?
The relaxation and filling of the heart ready to pump to the pulmonary system for oxygenation and around the body
60
Define cardiac output
The volume of blood pumped out of the heart each minute
61
What are the factors affecting cardiac output?
CO = SV x HR
62
What is stroke volume influenced by?
Preload Afterload Contractility
63
Define preload
How much blood the ventricle fills up with, or End diastolic volume. Includes venous return and ventricular compliance
64
Define after load
How hard to ventricle has to work to push the blood out of the ventricle. The resistance the ventricle has to overcome to push blood into the arteries
65
Define contractility
Force of myocardial contraction. Influenced by stretching of the myocardium and oxygen supply to myocardium
66
Define ejection fraction
How hard the heart is pumping | (SV / ED ventricular volume) x 100
67
What is heart failure?
A condition with abnormal ventricular function causing the heart to be unable to pump sufficient blood to meet the body's needs.
68
What are 3 clinical manifestions of heart failure generally
Dyspnoea Orthopnoea Fatigue/weakness
69
What are the two types of heart failure
``` Systolic HF (Ventricles can't pump hard enough) Diastolic HF (Ventricles can't fill enough) ```
70
What is HFrEF
Reduced ejection fraction (Systolic) Cant pump hard enough
71
What is HFpEF
Preserved ejection fraction (diastolic) Cant fill enough
72
Describe the pathophysiology of HFrEF
Myocardium is weakened and unable to pump blood to meet demands, leading to fluid build up in blood vessels;s, leaking into interstitial spaces of the body and lungs causing oedema, SOB
73
Describe the further complications of HFrEF
Decreased contractility leads to the preload increasing and stretching the ventricles, leading to increased after load, increased oxygen demand and hypertrophy = decreased CO
74
Describe the frank starling law
Loading up a ventricle with blood during diastole and streching the myocardium makes it contract with more force = increasing stroke volume
75
Identify 2 causes of HFrEF
Family history Smoking Obesity Increasing age
76
Identify 2 potential complications of HFrEF
Cardiogenic shock | Arrythmias
77
Identify 3 clinical manifestations of HFrEF
Dyspnoea Orthopnoea Fatigue
78
Describe the pathophysiology of HFpEF
Impaired diastolic relaxation and decreased compliance = decreased filling and increased end diastolic pressure impacting pulmonary circulation and causes a buildup of fluid = pulmonary oedema
79
Identify 2 causes of HFpEF
Major cause is HTN induced myocrardial hypertrophy (stretch of myocardium due to increased blood)
80
Identify 2 potential complications of HFpEF
Angina/ ACS Arrythmias Oedema
81
Identify 3 clinical manifestations of HFpEF
Dyspnoea Orthopneoa Fatigue
82
What is right sided HF?
Failure of the right ventricle to fill and pump blood particularly against increased pressure in pulmonary vasculature
83
Describe the pathophysiology of RSHF
Impaired contractility of right ventricle caused by increased pressure, volume overload or myocardial contractile dysfunction
84
Identify 2 risk factors for RSHF
Age (men >50) Left sided HF Congential heart defects
85
Identify 2 causes of RSHF
Left sided HF COPD Cor pulmoanle
86
What is Cor Pulmonale
Increased pulmonary BP chronically = hypertrophy and failure to contract)
87
Identify 2 potential complications of RSHF
Arrythmia | ACS/Angina
88
Identify 3 clinical manifestations of RSHF
Peripheral oedema Increased urge to urinate Fatigue Sudden weight gain
89
Identify 3 forms of assessment for heart failure
Aim to determine/treat underlying cause Through HH and physical examination Chest Xray ECG
90
Identify 3 forms of management for heart failure
Maximise CO Alleviate symptoms Improve cardiac function/QOL (LSHF) Reduce fluid accumulation (RSHF)
91
Identify 3 areas of nursing management for Heart failure
Thorough nursing assessment Prioritise care Planning/goals
92
Explain what COACHED stands for
Compressions continue Oxygen away (if free flowing BVM bag valve mask) All others clear Charging defibrillator (200J) Hands off (Compressor should say I'm safe) Evaluating rhythm Defibrillate or Disarm
93
Define compliance
Hearts ability to relax and fill with blood

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