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Cardiac Study Guide

Estep's Study Guide

QuestionAnswer
What are the 7 steps to analyzing a rhythm? 1. Look at rate. 2. Analyze the rhythm 3. Analyze the QRS complex 4. Analyze the P waves 5. Analyze the PR interval 6. Determine axis. 7. Name that dog.
What are the indications for transcutaneous pacing? 1. Bradycardia, not responsive to meds - hemodynamically unstable 2. Witnessed bradyasystole arrests 3. IVR 4. BBB result from MI 5. BBB complicated by fascicular block, 1st, 2nd degree AV block or both, especially w/ MI 6. BBB progres to comp AV block
What are the contraindications for transcutaneous pacing? Significant hypothermia.
Why is the QRS complex wide with TP? Because the ventricles are being paced. The electrical conduction does not follow the standard pathway.
What do you do if you have loss of capture during pacing? Turn up the amperage until you gain capture again.
Concerning your patient, what is important to check once you have capture with pacing? You need to check mechanical capture by verifying pulses.
What are 3 things you need to verify with a paced rhythm when analyzing an EKG? 1. What is being paced? 2. What is the rate? 3. Is it working?
What can cause L axis deviation? 1. LAFB 2. Old inferior MI 3. LV hypertrophy.
What can cause physiological L axis deviation? Pregnancy, obesity.
What can cause R axis deviation? 1. LPFB 2. RV hypertrophy 3. Old lateral wall MI.
Why doesn't NTG completely relieve chest pain in AMI? Pain in AMI results from arteries still occluded by clot.
How do you treat a bradycardic patient with an MI? Treat symptomatic - follow bradyalgorhythm.
Why should you never call a cardiac alert with BBB present? Because a BBB (abnoral ventricular conduction) will cause elevated ST segments.
What is orthopnea? Positional dyspnea when lying down. Caused by the shift of pulmonary edema when supine.
List 5 possible causes for wide beat tachycardia: 1. Ventricular rhythms 2. LBBB or RBBB 3. Idiventricular conduction problem (Hypokalemia) - may or may not follow rules of BBB, toxins 4. WPW 5. SVT w/ aberrancy.
What should you always cosider a WBT to be if you cannot figure out what it is? Ventricular Tachycardia.
How would you describe SVT w/ abarrancy? Aberrancy - abnormal conduction into the ventricles, do to one bundle being in refractory phase or accessory pathway.`
If the rhythm of a wide beat tachycardia is irregularly irregular, what is it most likely to be? Afib with BBB.
If WBT has an extreme right axis deviation, what is it? Ventricular Tachycardia.
How is the delta wave produced in WPW? Conduction through an accessory pathway that skips conduction system thru the BBs causing the slur in the QRS and reduced PR interval - creates an abnormal ventricular depolarization at beginning.
Do SVTs caused by WPW produce a wide QRS? No. Some are narrow due to a reentery mechanism thru the AV node.
What are the 2 main causes of big peaked T waves? AMI (typically broader T wave), hyperkalemia (typically sharper T wave).
What type of patient is likely to have hyperkalemia producing a WPW? Dialysis patient.
What is the difference in treatment for WPW caused by VTach and that caused by drug overdose? VTach gets amiodarone, synchronized cardioversion - overdose gets sodium bicarb - hyperkalemia is treated with an albuterol n eb (temporarily shifts K+ into cells, buying time until definitive treatment).
Is WBT caused by VTach stable or unstable? Can be either.
Your patient has pressure-like chest pain, SOB, diophoresis, BP 110/P. Monitor shows VTach - what 2 treatment options do you have? Amiodarone, Cardoversion.
Rules for 1st degree heart block: 1. PRI greater than .20 sec 2. No dropped beats.
Rules for 2nd degree type I block: 1. More Ps than Qs, occasional dropped beat. 2. QRS usually narrow. 3. Widening PRI until dropped beat. 4. P-P interval equal.
Rules for 2nd degree type II block: 1. More Ps than Qs, occasional dropped beats. 2. P-P interval equal. 3. PRI constant for conducted QRS. 4. QRS typically wide.
Rules for high degree block: 1. Frequently dropped beats, 2 or more Ps for every Q$S. 2. Infra-nodal block, QRS is wide. 3. Nodal block, QRS is narrow.
Rules for 3rd degree heart block: 1. Dropped beats, more Ps than Qs, slow-reg escape rhythm. 2. AV disassociation.
Rules for left anterior fascicular block: 1. L axis deviation. 2. No evidence of inferior MI, left ventricular hypertrophy.
Rules for Left posterior fascicular block: 1. R axis deviation. 2. No evidence of lateral MI, right ventricular hypertrophy.
Rules for left BBB: 1. Wide QRS. 2. Negative terminal deflection in V1. 3. Opposing positive terminal deflection in I and V6.
Rules for right BBB: 1. Wide QRS. 2. Positive terminal deflection in V1. 3. Opposing negative deflection in I and V6.
Lead I angle: Zero degrees.
Lead II angle: 60 degrees.
Lead III angle: 120 degrees.
AVL angle: -30 degrees.
AVF angle: 90 degrees.
AVR angle: -150 degrees.
Range for extreme right axis deviation: -90 to 180 degrees.
Range for right axis deviation: 90 to 180 degrees.
Range for pathological left axis deviation: -30 to -90 degrees.
Range for physiological left axis deviation: 0 to -30 degrees.
What are the inferior leads? II, III, AVF.
What are the lateral leads? V5, V6.
What are the septal leads? V1, V2.
What are the anterior leads? V3, V4.
What are the high lateral leads? AVL, I.
What are correctable causes for asystole/PEA (H"s and T's)? Hypovolemia, hypoxia, H+ acidosis, toxins, tension pneumo.
What is Cor Pulomonale? Right sided heart failure.
Name the heart valves and their location: 1. Tricuspid -R atria to R Vent. 2. Pulmonary -R vent to pulmonary artery. 3. Mitral (bicuspid) -L Atria to L vent. 4. Aortic -L vent to Aorta.
Created by: 1300311346