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Paramedic Cardiology
| Question | Answer |
|---|---|
| What are the two major components of the cardiovascular system? | The heart and the peripheral blood vessels |
| What are the three layers of the heart? | The Endocardium, Myocardium and the Pericardium |
| How much pericardial fluid does the heart contain in the pericardial sac on a normal healthy individual? | 25-50ml |
| The fluid is straw colored | Straw colored |
| _______________ is the volume of blood that the heart pumps in one minute. | |
| What is the first phase of the cardiac cycle? | Diastole |
| What is the second phase of the cardiac cycle? | Systole |
| What is afterload? | Afterload is the resistance which the ventricle must contract against |
| What is Starling's Law of the Heart? | Starling's Law states the more the myocardial muscle is stretched, the greater its force of contraction will be - up till a certain point. In other words, the more blood that fills the ventricle, the more forceful the next cardiac contraction will be. |
| The sympathetic nervous system has two principal types of receptors, they are _____ and _____. | Alpha and Beta |
| ________ receptors are located in the peripheral blood vessels and are responsible for vasoconstriction. | Alpha |
| ________ receptors, primarily located in the heart, increase the heart rate and contractility. | Beta 1 |
| ________ receptors, principally located in the lungs and peripheral blood vessels, cause bronchodilation and peripheral vasodilation. | Beta 2 |
| Parasympathetic control of the heart occurs through the ________ nerve. | Vagus nerve (Cranial Nerve 10) |
| The term __________ refers to heart rate. Something that has a positive affect to this term will increase the patient's heart rate. | Chronotropy |
| _____________refers to the strength of a cardiac muscular contraction. Something that has a positive affect to this term will strengthen the cardiac contraction. | Inotropy |
| _____________refers to the rate of nervous impulse conduction. Something that has a positive affect to this term will speed up impulse conduction. | Dromotropy |
| What hormone is secreted by the ventricles of the heart when a patient is in CHF? | Brain Natriuretic Peptide (BNP) - it is secreted by the ventricles in response to excessive stretching of the myocytes. |
| Within the cardiac muscle fibers are special structures called ___________. These structures connect muscle fibers and conduct electrical impulses quickly - usually 400 times faster than the standard cell membrane. | Intercalated Discs |
| What is the inherit rate of the SA Node? | 60-100 beats per minute. |
| What is the inherit rate of the AV Node? | 40-60 beats per minute. |
| What is the inherit rate of the Purkinje System? | 15-40 beats per minute. |
| The right atrium and right ventricle is separated by what valve? | Tricuspid |
| The right ventricle and the pulmonary artery are separated by what valve? | Pulmonic |
| The left atrium and left ventricle are separated by what valve? | Mitral - other wise known as the bicuspid valve |
| The left ventricle and the aorta are separated by what valve? | Aortic |
| The coronary vessels receive their blood supply during what part of the cardiac cycle? | Diastole |
| What are anastomoses? | Communications between two or more vessels |
| The inner layer of a blood vessel is termed the __________. | Tunica intima |
| The middle layer of a blood vessel is termed the __________. | Tunica media |
| The outer layer of a blood vessel is termed the ___________. | Tunica adventitia (aka Tunica externa) |
| What are the three primary factors that affect the stroke volume? | Preload, Cardiac Contractility & Afterload. |
| The chemical postsynaptic neurotransmitter for the sympathetic nervous system is _____________. | Norepinephrine |
| The chemical postsynaptic neurotransmitter for the parasympathetic nervous system is _____________. | Acetylcholine |
| What are the three primary factors that affect the blood pressure? | Stroke Volume, Heart Rate & Systemic Vascular Resistance (SVR). |
| What is the formula for Blood Pressure? | (SV X HR) X SVR |
| _____________ is a peptide hormone that is secreted by the heart ventricles following excessive stretching of the cardiomyocytes. | |
| ______________ is a peptide hormone that is secreted by the atriums that in pharmacological doses promotes sodium and water excretion and lowers the blood pressure. | Atrial Natriuretic Peptide (ANP) |
| When the Sodium/Potassium Pump is activated, it moves ____ from the inside the cell to the outside and _____ from the outside of the cell to the inside. | Sodium, Potassium |
| The resting potential for an autorhythmic cell is _____ mV. | -60 |
| The action potential for the autorhythmic cell is _____ mV. | -40 |
| The resting potential for a cardiac contractile cell is _____ mV. | -90 |
| The action potential for a cardiac contractile cell is _____ mV. | -85 |
| The ___________ is the ratio of blood pumped from the ventricle to the amount remaining at the end of diastole. | Ejection Fraction |
| The amount of blood ejected by the heart in one cardiac contraction is known as the __________. | |
| ____________ is the pressure within the ventricles at the end of diastole; it is commonly called the end-diastolic volume. | Preload |
| ____________ are specialized bands of tissue inserted between myocardial cells that increase the rate in which the action potential is spread from cell to cell. | Intercalated Discs - They speed up the process 400 times faster. |
| Snuggly enclosed within the mediastinum, the heart extends obliquely from the ____ rib to the _____ intercostal space. | 2nd, 5th |
| The ability for pacemaker cells in the heart to self-depolarize is called __________. | Automaticity |
| A group of cardiac cells that physiologically function as a unit is called __________. | Syncytium |
| __________ is the reversal of charges at a cell membrane so that the inside of the cell becomes positive in relation to the outside. | Cardiac depolarization |
| What ion causes depolarization of an autorhythmic cell? | Calcium |
| The __________ is the normal electrical state of a cardiac cell. | Resting potential |
| The __________ is a depression in the right atrium septal wall, it is the remnant of the fetal blood shunt that goes from the right atrium to the left atrium during fetal development. | Fossa ovalis |
| The __________ are cord-like tendons that connect the papillary muscles to the tricuspid and mitral valves in the heart. | Chordae tendineae |
| What ion causes depolarization of a cardiac contractile cell? | Sodium |
| How many pulmonary arteries and pulmonary veins are located in the human body? | 2 Pulmonary Arteries, 4 Pulmonary Veins |
| When during the cardiac cycle is the heart fed blood through the coronary vessels? | During diastole |
| What ion causes the cardiac contractile cell to contract? | Calcium |
| What heart valves are opened during diastole? | Tricuspid and mitral valves |
| Located in the right atrium, the __________ muscles are found on the inside of the anterior chamber wall. These muscles closely resemble the teeth of a comb and help contract the atrium pushing the blood into the right ventricle. | Pectinate |
| What coronary vessel feeds blood to the anterior portion of the left ventricle? | Left Anterior Descending (LAD) |
| What coronary vessel feeds blood to the majority of the right ventricle? | Right Coronary Artery (RCA) |
| What heart valves are open during systole? | Aortic & Pulmonary |
| Where is the best place to auscultate heart sounds of the pulmonary valve? | 2nd intercostal space - left of the sternum |
| Where is the best place to auscultate heart sounds of the aortic valve? | 2nd intercostal space - right of the sternum |
| ____________ control of the heart occurs through the vagus nerve. | Parasympathetic |
| Where is the best place to auscultate heart sounds of the tricuspid valve? | 5th intercostal space - left of the sternum |
| Where is the best place to auscultate heart sounds of the mitral valve? | 5th intercostal space - left of the sternum |
| According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead I? | Negative on the right arm (RA), Positive on the left arm (LA) |
| What ion causes the autorhythmic cell to go from its resting potential to its action potential? | Sodium |
| According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead II? | Negative to the right arm (RA), Positive to the left leg (LA) |
| According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead III? | Negative to the left arm (LA), Positive to the left leg (LL) |
| What is the standard speed for the ECG paper to move at? | 25 mm/sec |
| One small box on the ECG paper represents what? (both horizontal and vertical) | Horizontal = 0.04 sec, Vertical = 1 mm or 0.1 mV |
| The PRI interval should be at least ___ but no longer than ___seconds. | |
| During the ________ refractory period, no amount of cardiac stimulation can produce the cardiac cells to depolarize – this interval starts at the __________ and ends at the __________. | Absolute, QRS and ends at the apex of the T wave. |
| One large box on the ECG paper represents what? (both horizontal and vertical) | Horizontal = 0.2 sec, Vertical = 5 mm or 0.5 mV |
| What ECG wave represents atrial depolarization? | |
| During the ___________ refractory period, a sufficiently strong stimulus may produce the cardiac cells to depolarize – this corresponds to the downslope of the _____. | Relative, T Wave |
| What ECG wave represents ventricular depolarization? | QRS |
| The QRS complex should be at least ___ but no longer than ____ seconds. | 0.04, 0.12 |
| What is the average amount of volume that is ejected from the left ventricle during systole? | This is known as the stroke volume - the average is 70mL (varies 60-100 mL's) |
| The resistance against which the heart must pump against is known as _________. | |
| What channels in the cardiac contractile cells bring about depolarization? | Fast sodium |
| When the cardiac contractile cell starts to repolarize – what ion is actively leaving the cell membrane? | Potassium |
| When using lead I – where in the heart is that lead looking at? | The left side of the heart |
| When using lead II – where in the heart is that lead looking at? | The inferior wall of the heart |
| When using lead AVF – where in the heart is that lead looking at? | The inferior wall of the heart |
| When using lead AVL – where in the heart is that lead looking at? | The left side of the heart |
| The normal axis of the heart should be between _____ and _____ degrees. | 0 and +90 |
| During the systolic phase, what valves inside of the heart are open? | Pulmonic & Aortic |
| What electrolyte plays a major role in repolarization? | Potassium |
| What channels in the autorhythmic cells allow ions to leak in, producing a pacemaker potential? | Sodium |
| Threshold for the action potential in the SA Node is at ____ mV. What channels open, causing depolarization? | -40 mV, Calcium |
| What is the function of the Chordae Tendineae? | The chordae tendineae are cord-like tendons that connect the papillary muscles to the tricuspid and mitral valve in the heart – they prevent the valves from prolapsing back into the atriums. |
| Which of the heart valves are called the “semi-lunar” valves? | Pulmonic and Aortic |
| Where is the correct placement for the V1 electrode? | 4th intercostal space - 1 inch to the right of the sternum |
| Where is the correct placement for the V2 electrode? | 4th intercostal space - 1 inch to the left of the sternum |
| Where is the correct placement for the V3 electrode? | 5th intercostal space – between V2 & V4 |
| Where is the correct placement for the V4 electrode? | 5th intercostal space – mid-clavicular |
| Where is the correct placement for the V5 electrode? | 5th intercostal space – between V4 and V6 – should be on the anterior axillary line |
| Where is the correct placement for the V6 electrode? | 5th intercostal space - midaxillary |
| Where is the correct placement for the V4R electrode? | 5th intercostal space on the right side – mid-clavicular |
| Where is the correct placement for the V7 (Posterior) electrode? | 5th intercostal space on the back – mid-scapular |
| Where is the correct placement for the V8 (Posterior) electrode? | 5th intercostal space on the back – between the spine and V7 |
| Blood entering the left atrium arrives via the _________. | Pulmonary Veins (There are 4 of them) |
| The coronary vessels are not fed blood during what part of the cardiac cycle? | Systole |
| The great cardiac vein and the lateral marginal veins empty back into the heart via what structure? | Coronary sinus |
| What are the two different types of modes that the cardiac monitor will give you when monitoring a patient’s heart rhythm? | Monitor mode and Diagnostic mode |
| What is the IV/IO dose of Epi for an adult patient in cardiac arrest? | 1 mg |
| What is the first IV/IO dose of Amiodarone for an adult patient in cardiac arrest? | 300 mg |
| The refractory period has two parts, an _________ refractory period and a __________ refractory period. | Absolute and relative |
| What is the first IV/IO dose of Amiodarone for an adult patient in V-Tach with a pulse? | 150 mg slow over 10 minutes |
| What is the first IV/IO dose of Adenosine for an adult patient in SVT? | 6 mg |
| Orthodromic and antidromic | |
| How does Amiodarone work in the body to slow a ventricular rhythm? | Slows the potassium to prolong the repolarization phase – this makes the cell harder to depolarize |
| What is the second IV/IO dose of Adenosine for an adult patient in SVT? | 12 mg |
| What are the “Three I’s” of cardiac? | Ischemia, Injury and Infarct |
| What wave is typically produced on an EKG with a patient that has a past medical history of WPW? | Delta wave |
| How does Atropine work in the body to speed up a bradycardic heart rate? | It blocks the parasympathetic nervous system |
| What is the second IV/IO dose of Amiodarone to an adult patient that is in a refractory ventricular rhythm? | 150 mg |
| What are the contraindications for the administration of Nitroglycerin? | Hypotension below 90mmHg, Bradycardia below 50 beats per minute & Tachycardia above 100 beats per minute, RV Infarction, Use of Phosphodiesterase Inhibitors within the last 48hours. |
| What is the most prevalent intracellular ion? | Potassium (K+) |
| What is the most prevalent extracellular ion? | Sodium (Na+) |
| You have a patient that presents with Torsades de Pointes – the patient is symptomatic but stable – what medication would be appropriate for this patient? | Magnesium Sulfate (1-2grams IV) |
| What is the correct dose of Atropine for a patient that is found to be in bradycardia? | 1 mg fast IV push – Max total dose of 3mg |
| What is the correct IV infusion rate of Amiodarone for a patient that is post cardiac arrest with ROSC? | 1mg minute for the first 6 hours, followed by 0.5mg min for the next 18 hours – not to exceed 2.2 grams in 24 hours. |
| After administering Diltiazem to a patient that was in A-Flutter with RVR you noticed that Pt’s blood pressure has dropped from 130 to 60 systolic – what medication would you administer to this patient in an attempt to correct this drop in B/P? | Calcium Chloride (250-500mg) |
| What is the antidote that you can administer to a patient that is found to be bradycardic after an apparent overdose of beta-blockers? | Glucagon |
| What are the four ending points of Procainamide? | Hypotension, Widening of the QRS by 50% of what you started with, Termination of the rhythm or you reach the max dose. |
| What is the correct dose of Procainamide for a patient that is found to be in reoccurring ventricular dysrhythmias? | 20-50mg minute |
| How many joules would you start with to cardiovert a patient that is found to be in Torsades de Pointes? | You wouldn’t cardiovert Torsade de Pointes – You would defib it! |
| What is the correct initial joule setting for cardioversion of atrial fibrillation? | 120-200 J |
| What drugs can be administered for a patient in cardiac arrest with an ECG rhythm of asystole? | Epi 1:10,000 - Also, remember to check the patient's blood sugar level - you may need to administer Dextrose if the patient is hypoglycemic |
| What is the correct dose of Diltiazem for a patient in A-Fib with RVR? | 0.25 mg/kg – Max dose of 20mg |
| What joule setting would you use for a patient in V-Fib while using a monophasic monitor? | 360J or the highest the monitor would go to |
| It what cases would warrant you to utilize a cardiac donut magnet? | Run-a-way pacer, AICD malfunctioning |
| How fast would you ventilate an intubated patient that is in cardiac arrest? | 1 breathe every 6 seconds |
| Phase 0 of the action potential represents what happening in the cell? | Fast sodium channels open – Sodium rushes into the cell |
| Phase 1 of the action potential represents what happening in the cell? | A little bit of K+ leaves the cell |
| What coronary vessel feeds the majority of the left ventricle muscle? | LAD |
| Phase 2 of the action potential represents what happening in the cell? | K+ leaving the cell while at the same time Ca+ is coming into the cell |
| Phase 3 of the action potential represents what happening in the cell? | K+ leaving the cell – this represents repolarization |
| What coronary vessel feeds the SA and AV node for most of the human population? | RCA |
| What does S1Q3T3 represent on an ECG? | Possible PE |
| During Phase 4 of the Action Potential, what is happening inside of the cell? | Everything is being put back to it’s original state – the sodium is being pumped out (3) and the potassium is being brought back into the cell (2) |
| What are the 5 Korotkoff Sounds when auscultating a blood pressure? | Snapping, Swooshing, Tapping, Thumping or Muting, & Silence |
| When using lead V1 – where in the heart is that lead looking at? | Septal Wall |
| When using lead V2 – where in the heart is that lead looking at? | Septal Wall |
| When using lead V3 – where in the heart is that lead looking at? | Anterior Wall |
| When using lead V4 – where in the heart is that lead looking at? | Anterior Wall |
| When using lead V5 – where in the heart is that lead looking at? | Left lower lateral wall |
| When using lead V6 – where in the heart is that lead looking at? | Left lower lateral wall |
| When using lead V4r – where in the heart is that lead looking at? | Right Ventricle |
| When using leads V8 & V9 – where in the heart are these leads looking at? | Posterior Wall |
| What can be used to recognize a STEMI in the presence of a LBBB or a ventricular paced rhythm? | Sgarbossa Criteria |
| When using leads I & AVL – where in the heart are these leads looking at? | High left lateral wall |
Created by:
kevinakers