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Cardiology
Full course notecards
| Question | Answer |
|---|---|
| most common arrythmias resulting in arrest? | a-fib |
| what areas of the heart does the LCA supply? | left ventricle, interventricular septum, part of right ventricle and lower conduction system |
| what are the 2 major branches of the LCA and what do they supply? | Left anterior descending (LAD) - everything the LCA supplies Left circumflex (LCX) - 15% posterior wall and left side ventricle |
| RCA supplies what areas of the heart? | right atrium and ventricle with the upper conduction system (SA/AV node) and inferior part of left ventricle |
| what are two major branches of the RCA and what do they supply? | posterior descending artery (PDA) posterior wall and right side of heart along with inferior marginal artery supplying right lateral wall of ventricles |
| most common heart attack location | inferior wall |
| what does stroke volume depend on? | preload, contractility, afterload |
| how much additional volume does the atrial kick give the heart for cardiac output? | 20%-25 |
| ratio of blood pumped from the ventricle to the amount remaining at the end of diastole | ejection fraction |
| what is a good ejection fraction %? what is considered heart failure and cardiac crippled? | good 60-70%, <45% heart failure, <30% crippled |
| what do the atria and ventricles release in response to increased afterload pressure and atrial/ventricular dilation, countering RAAS and sympathetic stimulation? | ANP by the atria and BNP by the ventricles |
| what is it called when P waves have a shark/peak configuration from increased pressure to the right side due to pulmonary hypertension? | p-pulmonal |
| a double humped p wave evidence of left ventricular sided heart failure and enlargement of left atrium is called what? | p-mitrial |
| what rate calculation method is this: Count # QRS complexes (R to R) in 6 second interval and multiply by 10. Most common way, can use on irregular rhythms too | 6 second method |
| RR interval method can only be used with regular rhythms; what are the 3 different measurements you can do with this method? | 1. measure duration between r waves in seconds, multiply by 0.04. Divide 60 by this total 2. count number of large boxes between R waves and divide 300 by this number 3. count number of small boxes and divide 1500 by this number |
| how do you use the triplicate method for calculating heart rate? | find r wave on big line, count number of large boxes to the next R; if 1 = 300 bpm, 2 = 150, 100, 75, 60, 50, 43, 38 |
| cardioversion for SVT, PSVT, and atrial flutter are at what joule setting? a-fib? | SVT/PSVT/a-flutter is 50-100 a-fib is 120-200J |
| if the R is far from the P | it's a first degree block; condition added to rhythm |
| longer, longer, longer drop | you have a Wenckebach; second degree type I AV block (Mobitz I) |
| if some p's don't get through | then you have a Mobitz II; second degree type II AV block or infranodal block |
| if P's and Q's don't agree | then you have a 3rd degree; AV-disassociation |
| what heart block can make a-fib regular in rhythm? | a-fib with a 3rd degree (only label as 3rd degree) |
| what does electromechanical dissociation mean? | PEA |
| v-tach start cardioversion at what Joule setting? | 100J |
| what is first setting for V-fib? unless specific setting on monitor | 200J |
| only rhythm defib with a pulse if unstable? | Torsades de Pointes |
| what is diagnostic mode Hz range vs monitor mode? | diagnostic: 0.05-150Hz with best 40Hz monitor: 0.05-30Hz |
| single most powerful predictor of right ventricular infarction | ST elevation in V4R |
| in order to have ST elevation you have to have full thickness injury what is it called? | transmural |
| Tall R waves with ST depression are indicative of what kind of MI? | posterior |
| patient's are 4x more likely to arrest with what hemiblock and chest pain? | pathological left axis anterior hemiblock |
| what criteria confirms VT? | 1: ERAD, upright QRS in aVR, negative QRS in V6 2: fusion p waves present? 3: Josephson's sign - notch near the nadir of S wave |
| what is the sokolowlyon index for LVH? | tallest R wave in V5 or V6 and deepest S wave in V1 added together >=35mm or R wave in aVL >> 11mm |
| When pacing the patient, what mode does the monitor need to be in? | demand mode |
| what can cause p waves to be inverted | leads are placed wrong, dextrocardia, or junctional rhythm, or trauma |
| what is the rhythm: impulse from SA, normal P wave before every QRS, PRI WNL, QRS narrow and WNL | Normal sinus rhythm |
| what is considered an arrythmia | any deviation from normal activity |
| what is the rhythm: firing from SA node <60, normal P-wave before each QRS, PRI WNL, QRS normal WNL following each p-wave | sinus bradycardia |
| whats the rhythm: firing from SA node >100, normal p-wave before each QRS, PRI WNL, QRS normal and WNL | sinus tachycardia |
| upper limit of heart rate calculation | 220-age |
| whats the rhythm: firing from SA node, variation of R to R, normal P waves, PRI WNL, QRS WNL | sinus arrhythmia |
| what can cause an arrythmia that is normal, #1 cause | respirations |
| this is not a rhythm but a condition: sinus node fires on time but impulse blocked before leaving the SA node, doesn't lose cadence and can drop one or more drops | sinus block |
| not a rhythm but condition: SA node fails to fire for brief period and drops a single PQRST and returns out of cadence | sinus pause |
| not a rhythm but condition: SA node fails to fire for multiple beats and resumes out of cadence | sinus arrest |
| whats the rhythm: multiple firing sites in atria, rate 60-100, rhythm slightly irregular, p waves at least 3 different morphologies, PRI varies, QRS WNL | wandering atrial pacemaker |
| rate and rhythm depends on underlying rhythm and this p wave will differ from others, pri usually normal, pacer ectopic focus in atrium with qrs normal | premature atrial contraction |
| how does the rhythm stay in cadence (compensatory) or lose cadence (non-compensatory) | if depolarizes the SA node it will be non-compensatory because it will start firing at the new rate |
| rate >100, irregular rhythm, at least 3 different p waves, pri varies and pacer site varies, QRS varies | multifocal atrial tachycardia |
| what disease causes 60% cases of MAT | pulmonary disease such as COPD or asthma |
| rate 150-250, rhythm regular except at onset or termination, p waves buried in T, no PRI, pacemaker in the atria outside SA node, QRS usually narrow | SVT, AVNRT |
| rate 150-250, rhythm regular except at onset or termination, p waves buried, pri WNL, pacer in atria outisde SA, QRS usually normal have to see sudden start and stop to diagnose | PSVT |
| most commone preexcitation syndrome, most commonly seen in children with delta wave, reentry loop is through bundle of kent and can be orthodromic or antidromic | WPW |
| rate 250-350, rhythm can be irregular, flutter waves sawtooth, pri constant but may vary, pacer outside SA node and QRS normal | atrial flutter |
| rate 350-750, totally irregular, non discernable p waves, no pri, pacer in numerous sites in atria, QRS normal | a-fib |
| what rhythm deprives the heart of a 20-25% boost from the atrial kick | a-fib |
| condition added to rhythm; rate depends on underlying rhythm, usually slightly irregular, p waves and be hidden within the QRS/inverted before or after, PRI if before QRS usually <0.12, pacer at the AV junction/node with narrow QRS | PJC |
| rhythm with rate of 40-60, regular, inverted or hidden p waves, pri if present before usually <0.12, pacer at AV junction/node, QRS normal | junctional escape |
| rhythm with rate of <40, regular, inverted or hidden p waves, PRI <0.12 if present, pacer is AV junction/node, QRS usually normal but can be wide | junctional bradycardia |
| rhythm with rate of 61-100, regular, inverted/hidden p waves with PRI <0.12, pacer at AV junction/node, usually normal QRS | Accelerated junctional rhythm |
| Rhythm with a rate of 100+, regular, inverted/hidden p waves, PRI usually <0.12 if present, pacer AV junction/node, QRS usually normal | juntcional tachycardia |
| most common cause of heart blocks | inferior wall MI |
| heart block added to underlying rhythm, p waves normal but PRI >0.20 with pacer in the SA node or atria, QRS normal usually | first degree AV block |
| heart block with variable rate and irregular rhythm, p waves normal but some p waves don't have QRS, PRI progressively longer until dropped beat, pacer in the SA node or atria with QRS usually normal | Second degree AV block Type I (mobitz I, Wenckeback) |
| heart block with unaffected p wave rate and QRS rate usually bradycardic, rhythm can be regular or irregular, PRI constant but some P waves don't have QRS, pacer SA node or atria and QRS may be normal or wide | Second Degree AV Block Type II (Mobitz II) |
| heart block with unaffected p wave rate and QRS rate brady, p and QRS waves are regular but do not coincide with each other, PRI no relationship from beat to beat, pacer in atria for p waves and AV node or ventricles for QRS | third degree AV block (complete heart block, AV disassociation) |
| rhythm with a rate of 15-40, regular, no p waves, pacer in ventricles, QRS >0.12 | idioventricular rhythm (IVR)/ ventricular escape |
| rhythm with rate of 41-100, regular, no p waves, ventricle pace site, wide QRS | AIVR (accelerated idioventricular rhythm) |
| rhythm with a rate <15 beats, irregular, no p waves, wide QRS with ventricular origin | agonal rhythm |
| single ectopic impulse arising from irritable foci in either ventricle occurring earlier than next expected beat | Premature ventricular contraction (PVC) |
| PVC > 6 in a minutes, R on T phenomenon (hits relative refractory = lethal dysrhythmia), couplets/triplets/runs of V-tach, multifocal, associated chest pain are all descriptions of what kind | malignant |
| another phrase for PEA | electromechanical disassociation |
| more than 3 PVC/ventricular complexes in succession, can be monomorphic or polymorphic; rate 100-250+, usually regular but can be slightly irregular, p waves if present don't associate, no PRi, ventricular origin, QRS >0.12 | VT |
| polymorphic VT, rate 100-250+, irregular, multiple sites in ventricles, QRS>0.12, only rhythm can defib with conscious unstable patient | Torsades de Pointes |
| death rattle, chaotic ventricular rhythm, no rate, rhythm ,p waves, PRI, or QRS; pacer site is chaotic firing of numerous sites in ventricles | VF |
| absence of all cardiac electrical activity; most common rhythm pediatrics go into with arrest | asystole |
| what is it called when you still see p waves with no QRS | p wave asystole or primary asystole |
| pacemaker fires continuously at preset rate regardless of heart's electrical activity | fixed-rate or non-demand |
| pacemaker sensing device fires only when natural HR drops below set rate | demand |
| time from first medical contact (FMC) to 12 lead, chemical reperfusion, and mechanical reperfusion should be less than what time frames? | 12 lead <10min, chemical <30, mechanical <90 |
Created by:
Lindsey.George