CEN - Cardiac Review
Which dysrthmia is characterised by: The atrial impulses are conducted through the AV node to the ventricles at a rate that is slower than normal, the P and QRS are usually nornal, the PR interval is greater than 0.2 seconds and the P:QRS ratio is 1:1.
First-degree AV block
What is the calculation to determine systolic hypotension for children age 1-10
(age x 2) + 70mmHg = hypotensive Systolic BP
What is the calculation to determine normal systolic blood pressure for children age 1-10
(age x 2) + 90mmHg = Systolic BP
How does sodium nitroprusside (Nipride) affect the cardiac system - What precautions need to be taken with this medication
potent venous and arterial dilator - protect from light (aluminum foil or opaque plastic
What 3 things determine stroke volume
preload, afterload, contractility
What is the treatment for: stable wide complex tachycardia
procanimide IV - monitor for hypotension, widening of QRS complex amiodarone - monitor for hypotension, nausea, bradycardia
Which dysrthmia is characterised by: Irregular pulse because of extra P-waves, Shape and duration of the QRS is usually normal but may be abnormal. PR intervat remailns brtween 0.12 an .02, P to QRS ratio is 1:1
PAC's - Premature Atrial Contractions
Describe Mobitz Type I
PR interval gets longer and longer until and QRS complex is dropped.
Describe Mobitz Type II
PR interval remains normal at 0.12 and QRS complex is dropped
Which dysrthmia is characterised by: Irregular heartbeat, QRS at leat 0.12 seconds and oddly shaped, P wave that may be absent, or may precede or follow QRS, PR inerval of less than 0.12 seconds id P wave is present, P to QRS ratio 0:1, 1:1
PVC - Premature Ventricular Contraction
What are the signs/symptoms of: Aortic Dissection
Pain - sudden tearing, ripping, sharp knife-like not relieved by analgesics, BP changes- difference of more than 10 mmHg when comparing SBP of various limbs, Spinal cord hypoxia- paresthigia, hemiplegia, paraplegia, Hypovolemia - hct, increased WBC
What are the signs/symptoms of: Hypovolemic shock
Pale, Cool, Clammy - Tachycardia - Flat Neck Veins - Tachypnea - Neurologic Deficit
How does norephinephrine bitartrate (Levophed) affect the cardiac system
Peripheral venous arterial vasoconstrictor and cardiac stimulant considered in the treatment of hypotension or shock
What is the treatment for: Bradycardia
Atropine: (via sub-clavian, internal juglar, brachail, or femoral vein)
What is Prinzmetal's Angina
Chest pain that results from coronary spasm causing severe pain - typically occurs at rest and at the same time every day (usually between 00:00 and 08:00)
How do chronotropes work
Chronotropic drugs may change the heart rate by affecting the nerves controlling the heart, or by changing the rhythm produced by the sinoatrial node.
What class of medications are: Quinidine, Procainamide
Class Ia Antiarrhythmic
What class of medications are: Flecanide
Class Ic Antiarrhythmic
What are the signs/symptoms of: STEMI
EKG shows ST Elevation of: > 2mm elevation V1, V2, and V3 (2 or more consecutive leads) and > 1mm in other leads)
What is the definition of MAP
The average pressure over the entire cardiac cycle
What are the normal intervals for the PR interval
0.12 to 0.20 ( 3 to 5 blocks)
What is the normal school age heart rate
100 bpm
What is the normal adult respiratory rate
12 - 16
What is the normal toddler heart rate
120 bpm
What is the normal neonate heart rate
140 bpm
What is the normal central venous pressure (CVP)
2 - 6 mmHg
What is the normal school age respiratory rate
20
What is the normal toddler respiratory rate
30
What is normal cardiac output
4-8 L/min
What is the normal neonate respiratory rate
40
What is the normal stroke volume
60 -130 mL/contraction
What is the normal adult heart rate
60-100 bpm
What is the normal range for MAP
70 to 100 mmHG
What are the normal intervals for the QRS complex
>0.06 to 0.10 (1 1/2 to 2 1/2 blocks)
How does diazoxide (Hyperstat) affect the cardiac system - What do you monitor for
Arterial dialator used for significant hypertension - Inhibits release of insulin (can cause hyperglycemia)
Which dysrthmia is characterised by: Atrial rates of 350 to 400, Ventricular rates of 75-150-with ventricular rate usuallyregular, P wave saw-toothed, QRS shape and duration usually normal, PR rate may be hard to calculate, P to QRS ratio is - 2:1, 3:1 or 4:1
AF - Atrial Flutter
Which dysrthmia is characterised by: Atrial rate of 150 to 200 with ventricular rate of 75 to 250, P wave that is difficult to see or absent, QRS complex that is usually normal, PR interval of less than 0.12 is a P wave is present, P to QRS ratio is 1:1, 2:1
AV nodal reentry tacycardia
Which dysrthmia is characterised by: A regular ventricular rate of 20 to 40, QRS complex has a very abnormal shape and the duration is at least 0.12 seconds.
Idioventricular rhythm
Which dysrthmia is characterised by: Very irregular pulse with atrial rate 300 to 600 and ventricular rate 120-200, Shape and duration of QRD is usually normal, PR interval cannot be measured, P to QRS ratio is highly variable
Afib - Aftrial Fibrillation
What is: Enocarditis
An infection of the endothelial surface and valves of the heart
EKG ST elevation in leads V3 and V4 suggests a MI in which area of the heart, affecting which coronary vessel
Anterior MI - Left anterior descending coronary artery
EKG ST elevation in leads V5 and V6 suggests a MI in which area of the heart, affecting which coronary vessel
Apex MI - Left circumflex coronary artery
Which medication: should you use sparingly in coronary ischemia or myocardial infarction, is unlikely to be effective after cardiac transplanttion, is not usefull in Type II second-degree or third-degree heart block
Atropine
What are the signs/symptoms of: Neurogenic shock
Bradycardia - Hypotension - Warm Dry Skin - Tachypnea - Hypothermia - Neurologic Deficit
What class of medications are: Diltiazem ,Verapamil
Calcium channel blockers: negative chronotropics, slows heart rate, vasodilates, prevents arterial vasospasm
How do dromotropes work
Dromotropic agent affect the conduction speed in the AV node and subsequently the rate of electrical impulses in the heart
What are the signs/symptoms of: Non ST Elevation
Elevation of CK-MB, Troponin, or both without ST Segment Elevation indicate STEMI or Non-STEMI MI
EKG ST elevation in leads V1 and V6 suggests a MI in which area of the heart, affecting which coronary vessel
Extensive Anterior - Risk of sudden death - Left main coronary artery
What are the signs/symptoms of: Left Side Heart Failure
Hemoptysis, crackles on auscultation, progressive dyspnea from blood backing up into the pulmonary system
What are risk factors for: Aortic Dissection
Hypertension, Connective tissue disease, (Marfan's syndrome), Pregnancy, Trauma
Hypertension is a severe elevation in blood pressure that can lead to:
Hypertensive encephalopathy, altered loc, dizziness, headache, stroke, seizures,Retinal hemorrhage with visual complaints, Chest pain and ischemia, Heart failure, (enlarged heart, S3/S4 heart sounds)
How does Isoproterenol (Isuprel) affect the cardiac system
Increases alpha, beta-one, and beta-two stimulation -can increase myocardial workload, can cause myocardial ischemia
How does Dopamine (Intropin, Dopastat) affect the cardiac system
Increases alpha, beta-one, and beta-two stimulation -doses: 2-10 mcg/kg/minute, increases cardiac output, 10mcg/kg/minute, increases blood pressure
EKG ST elevation in leads II, III and aVF suggests a MI in which area of the heart, affecting which coronary vessel
Inferior Mi - Right coronary artery
How do inotropes work
Inotropic agents alter the force or energy of muscular contractions
What are the signs/symptoms of: Right Side Heart Failure
JVD, Peripheral Edema, Hepatomegaly, Vascular congestion : Blood backs up into systemic vasculature
Which dysrthmia is characterised by: Regular atrial /ventricular rate of 40-60 bpm, QRS complex of usual size and duration, P wave may be inverted an may be absent, hidden, or after the QRS, If the P wave precedes the QRS, the PR inerval is less than 0.12 sec, P to QRS ratio is 1:1 or ):1
Junctional Escape rhythm
EKG ST elevation in leads I, aVL, V5 and V6 suggests a MI in which area of the heart, affecting which coronary vessel
Lateral MI - Left circumflex coronary artery
What is the drug of choice for digitalis toxicity resulting in ventricular arrhythmia
Phenytoin (Dilantin) and Digibind
Reciprocal changes in leads V1, V2 suggests a MI in which area of the heart, affecting which coronary vessel
Posterior - Right coronary artery
How does phenylephrine (Neo-Synephrine) affect the cardiac system
Pure alpha-agonist, vasoconstrictor
Which ekg wave form never develops with a small area of infarction
Q Wave
Which ekg wave form indicates mass injury of myocardium
Q Wave - Mass injury of myocardium
What is the treatment for: unstable wide complex tachycardia
cardioversion or precordial thump
Which dysrthmia is characterised by: Each atrial impluse in group of beats is conducted at a lengthened interval until one fails to conduct (the PR interval progressively increases), more P waves than QRS compleaxes, Qrs complex is of normal shape and duration
Second-degree AV block : Mobitz Type I aka Wenckebach
Which dysrthmia is characterised by: Only some of the atrial impluses are conducted unpredictably through the AV node, PR intervals are the same if impulses are conducted, P:QRS ratio varies 2:1, 3:1, 4:1
Second-degree AV block : Mobitz Type II
EKG ST elevation in leads V1 and V2 suggests a MI in which area of the heart, affecting which coronary vessel
Septal MI - Left anterior descending coronary artery
What is the treatment for: Third-degree AV block
Symptoms: dyspnea, chest pain, hypotension Treatment: Atropine IV and transcutaneous pacing
Describe preload
The amount of blood coming into the heart through the vena cava, measured as CVP (central venous pressure)
What is: Heart failure
The heart can no longer producesufficient cardiac output at normal filling pressures to meet metabolic demand. Usuallywhen left ventricular ejection fraction falls below 40%
Describe afterload
The pressure the heart must eject against in the aorta measured by blood pressure, specifically MAP (mean arterial pressure)
What is automaticity
The rate at which electricity moves through the heart
Which dysrthmia is characterised by: More P waves than QRS complexes, with no clear relationship between the two, PR interval is irregular
Third-degree AV block
What is the treatment for: Second-degree AV block : Mobitz Type I aka Wenckebach
Treatment: transcutaneous pacing
What is the treatment for: Second-degree AV block : Mobitz Type II
Treatment: transcutaneous pacing
Which dysrthmia is characterised by: A rapid, very irregular rate greater than 300 bpm with no atrial activity observable on ekg, it is accompanyied by lack of palpable pulse, audible pulse, and respirations and is immediately life threatening
VF - Ventricular Fibrillation
Which dysrthmia is characterised by: A detectable rate of 100 to 200 is usually regular, QRS complex is at least 0.12 seconds and is usually abnormally shaped, P wave my be undetectable with an irregular PR interval if PR is present, P to QRS ratio is often difficult to ascertain because of absence of P waves
VT - Ventricular Tachycardia
How does Amiodarone, Milirone affect the cardiac system - What is it used for
Vasodilator, positive inotrope - Heart failure
What is the treatment for: Heart failure
Vasodilators, ACE inhibitors, Diuretics, Positive inotropes, Dopamine
How does nitroglycerin affect the cardiac system - What precautions need to be taken with this medication
Venous dilator (arterial dilator in higher doses)coronary artery dilator - Give via IV in glass bottles through PVC tubing
Which dysrthmia is characterised by: The absence of audible heartbeat, palpable pulse, and respirations
Ventricular asystole
What are the signs/symptoms of: Septic shock
Warm moist skin - Tachycardia - Hypotension - Tachypnea - Hypo or Hyperthermia - Neurologic Deficit
Mobitz Type I is also known as
Wenckebach AV Block
What is the equation used to determine MAP
[systolic + (diastolic x 2) ] / 3
What is the treatment for: tachycardia
cardioversion, internal cardiac defribillator, assess potassium, magnesium and digoxin levels
How do Negative dromotropes affect the cardiac system
decrease automaticity: alters rate at which electricity moves through the heart
How do Negative inotropes affect the cardiac system
decrease contractility: alters the force or energy of muscular contractions
How do Negative chronotropes affect the cardiac system
decrease heart rate: change the rhythm produced by the SA node
How do Angiotension Converter Enzymes (ACE inhibitors) affect the cardiac system - What do you monitor for
decrease preload and afterload through vasodilation and diuresis - dry cough, hyperkalcemia, angioedema
What is the equation used to determine cardiac output
heart rate x stroke volume = cardiac output
How do Positive dromotropes affect the cardiac system
increase automaticity: alters rate at which electricity moves through the heart
How do Positive inotropes affect the cardiac system
increase contractility: alters the force or energy of muscular contractions
How do Positive chronotropes affect the cardiac system
increase heart rate: change the rhythm produced by the SA node
What are the actions of: Calcium channel blockers
negative chronotropic slows heart rate vasodilates prevents arterial vasospasm
What is the most effective treatment for bradycardia, heart block, and idioventricular rhythms
pacing
Atropine has what affect on the heart
reverses cholinergic-mediated decrease in heart rate (increases heart rate)
What are the actions of: Negative chronotrope
slows heart rate
What is the treatment for: narrow complex tachycardia
vagal maneuver, adenosine, calcium channel blockers (-depine)