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Cardiac Study Guide
Estep's Study Guide
| Question | Answer |
|---|---|
| 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. |
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