Adult Acute Exam 1 Flash Cards

Front 1

What generates the regular sinus rhythm that paces the heart?

Back 1

SA Node

Front 2

It is the ________of the SA node that generates the regular wave of depolarization.

Back 2

automaticity

Front 3

Normally the SA node discharges regular pacing impulses (60-100 per minute) that depolarize the _____.

Back 3

Atria

Front 4

The SA node generates pacing impulses at a constant unvarying rate, producing cycles of equal length, so that the rhythm of the heart is said to be _____. This characteristic is typical of SA node pacing.

Back 4

Regular

Front 5

Sinus arrhythmia is a normal, but extremely minimal ____in HR during inspiration (Why?________)

and extremely minimal ____in HR during expiration. (Why? _______)

Back 5

Increase on inspiration bc of sympathetic stimulation of SA node

Decrease on expiration due to parasympathetic inhibition of the SA node

Front 6

The atrial conduction system consists of 3 specialized internodal tracts ( ___, ___, ____) and one conduction tract known as _____ that innervates the _____.

Back 6

Anterior, middle, posterior

Bachman's bundle depolarizes the left atrium

Front 7

Depolarization of the atrial myocardium shows up as a ____ on an ECG.

Back 7

P wave

Front 8

When the depolarization stimulus passing down from the atria reaches the AV node, what happens?

Back 8

The impulse SLOWS DOWN in the AV node and creates a pause on the EKG.

Front 9

The AV node pause is represented as what on the ECG?

Back 9

the horizontal piece of baseline btw the P and the QRS complex

Front 10

After passing slowly through the AV node, depolarization proceeds RAPIDLY through the ____ --> ___ --> ____. When the impulse reaches the last part the _______ are finally depolarized, resulting in a ___on the ECG.

Back 10

bundle of His --> R/L bundle branches --> purkinje fibers

ventricles, QRS complex

Front 11

Ventricular depolarization initiates contraction of the ventricles, which continues until they are repolarized completely at the end of the ___.

Back 11

T wave

Front 12

Ventricular contraction begins and ends during the ____.

Back 12

QT interval

Front 13

Although the ventricles are totally repolarized by the end off the T wave the purkinje fibers do not repolarize until later, represented as a small hump, or ___ on the ECG.

Back 13

U wave

Front 14

Should the highest level of pacemaking fail, an automaticity focus from the next highest level (no longer overdrive suppressed by the SA node) begins to pace at its own inherent rate. This new pacer overdrive suppresses all automaticity foci below it.

What are the 4 levels of automaticity foci?

Back 14

1st: SA Node (60-100bpm)

2nd: Atrial foci (60-80bpm)

3rd: Junctional foci (40-60bpm)

4th: Ventricular foci (20-40bpm)

Front 15

Wandering pacemaker

Back 15

this occurs when the pacemaking activity wanders from the SA node to atrial foci, causing:
Cycle lengths to vary
P wave shape to keep changing
HR is still under 100.

Front 16

Multifocal Atrial tachycardia

Back 16

No single focus achieves pacemaking dominance so they all pace together, making a rapid rhythm over 100bpm.

P wave shape varies
Cycle length varies
HR over 100

Front 17

What heart rhythm is commonly seen in COPD patients?

Back 17

multifocal atrial tachycardia

Front 18

Atrial fibrillation

Back 18

No P wave, irregular R to R

This is caused by continuous firing of multiple atrial automaticity foci. Only some of these get through to the AV node, causing the irregular rhythm.

Front 19

When we see a premature beat we recognize that it was fired by ______, so we need to identify it as ___, ___, or ___.

Back 19

an irritable automaticity focus

atrial, junctional, or ventricular

Front 20

Which foci are the world's most sensitive O2 sensors? When they sense low O2 they become irritable!

Back 20

Ventricular automaticity foci

Front 21

What can cause atrial and junctional foci to become irritable?

Back 21

Epinephrine or NE release
Adrenergic chemicals
Caffeine/amphetamines/cocaine

Front 22

If there is a premature atrial beat what do you see on the ECG?

Back 22

One P wave that looks different from all the other ones.

The PAB originates in an irritable atrial focus (not the SA node).

Front 23

If the SA node is depolarized by a premature atrial beat then the SA node pacemaking is ____ in step with the premature stimulus so that the SA node will fire one cycle from that stimulus.

Back 23

reset

Front 24

A premature atrial beat may be unable to depolarize the AV node is the AV node is not fully repolarized from the last impulse. On an ECG this shows up as ________.

Back 24

an early unusual P wave with no QRS behind it

Front 25

When an irritable atrial focus repeatedly adds a Premature atrial beat to the end of each sinus cycle it is called ________.

Back 25

Atrial bigeminy

Front 26

Sometimes an irritable atrial focus may prematurely fire after 2 normal sinus cycles. This is called ________

Back 26

Atrial trigeminy

Front 27

If you see a premature QRS that is slightly widened you should consider that it may be due to a ________ with _______conduction.

Back 27

Premature junctional beat

Aberrant ventricular

Front 28

A ventricular focus can be made irritable (and thus cause a premature ventricular beat) by what circumstances?

Back 28

Low oxygen, low potassium, or pathologies

Front 29

What is a PVC?

Back 29

Premature ventricular contractions are when an irritable ventricular focus sends an impulse.

You see super wide, super tall wave flipped opposite of the direction the QRS complexes are going.

Front 30

What is the most likely reason for a ventricular focus to become irritable and cause a PVC?

Back 30

low oxygen

Front 31

How many PVCs per minute are considered pathological?

Back 31

6+

Front 32

When you see QRS, PVC, QRS, PVC what is it called?

Back 32

Ventricular bigeminy

Front 33

When you see QRS, QRS, PVC, QRS, QRS, PVC what is it called?

Back 33

Ventricular trigeminy

Front 34

When you see QRS, QRS, QRS, PVC, QRS, QRS, QRS, PVC what is it called?

Back 34

Ventricular quadrigeminy

Front 35

Paroxysmal tachycardia is how many bpm?

Back 35

150-250 bpm

Front 36

Flutter is how many bpm?

Back 36

250-350 bpm

Front 37

Fibrillation as a tachyarhythmia is how many bpm?

Back 37

350-450 bpm

Front 38

What does "paroxysmal" mean?

Back 38

Sudden

Front 39

Is sinus tachycardia a paroxysmal tachycardia?

Back 39

NO! Because it is not sudden and does not originate in an automaticity focus.

Front 40

Premature atrial tachycardia with AV block has what characteristics?

What should you expect if you patient has this dysrhythmia?

Back 40

Rapid rate, 2 P-waves before each QRS bc the AV node is blocking the conduction of every other atrial stimulus.

Suspect digoxin toxicity

Front 41

During Ventricular tachycardia the heart rate is ____bpm.

Back 41

150-250bpm

Front 42

Sudden runs of Ventricular tachycardia resemble a rapid series of ____, which they really are.

Back 42

PVCs

Front 43

Ventricular tachycardia often indicates coronary _____, causing poor oxygenation of the heart.

Back 43

insuficiency

Front 44

Torsades de pointe is a rapid ______ rhythm caused by low _____, which lengthens the ____ of the ECG. The rate is between ___ and ___bpm.

Back 44

ventricular
potassium
QT
250-350bpm

Front 45

Atrial flutter originates in what type of automaticity focus?

This focus fires at ____-___ times per minute, producing a rapid series of _____depolarizations.

Back 45

Atrial

250-350

atrial

Front 46

Ventricular flutter is when a ventricular automaticity focus fires at ___-___times per minute. This rhythm looks like what?

Back 46

250-350

A lot of sine waves back to back of similar amplitude

Front 47

True ventricular flutter almost invariably deteriorates into __________, which requires what 2 actions?

Back 47

Ventricular fibrillation

CPR and defibrillation

Front 48

Ventricular fibrillation is easily recognized by what characteristics?

Back 48

A totally erratic appearance and lack of any identifiable waves on the ECG. It looks different at every moment!

Front 49

Ventricular fibrillation is a type of __________. There is no effective cardiac output bc the ventricles are only _____.

Back 49

Cardiac arrest

twitching

Front 50

What is an Automated External Defibrillator? (AED)

Back 50

A small portable defibrillator.

Front 51

What is an implantable cardioverter defibrillator (ICD)?

Back 51

A defibrillator implanted under the chest skin of patients likely to develop VFib. Wire leads from the ICD unit are attached to the heart to detect VFib and deliver a shock.

Front 52

What problem do AV blocks cause?

Back 52

They retard or eliminate conduction from the atria to the ventricles.

Front 53

The heart derives its own blood supply from the ____arteries, so when one of these (or its branches) is occluded an area of the myocardium is without blood supply.

Back 53

coronary

Front 54

What part of the heart that suffers MI (the majority of the time)?

Back 54

The thick left Ventricle bc it uses the greatest blood supply from the coronary arteries.

Front 55

Infarctions usually involve an area of the wall of the _____. An area of infarction cannot be depolarized (_____) bc the cells are ______.

Back 55

Left ventricle.

Contract

Necrotic/dead

Front 56

The MI triad is ____, ____, and _____. Any of the three can occur alone, however. This triad is the basis for recognizing and diagnosing a MI.

Back 56

Ischemia, injury, necrosis

Front 57

The characteristic sign of ischemia is the _______. This can occur without an MI resulting from it.

Back 57

inverted symmetrical T wave

Front 58

What on an ECG indicates injury? This is the earliest consistent sign of scute MI.

Back 58

ST elevation above the baseline

Front 59

During an angina attack the ST segment may become ______.

Back 59

depressed below the baseline

Front 60

When a patient with narrowed coronary arteries excercises the myocardium demands more blood flow than its arteries can deliver. A stress test will record the _________ on an ECG when the patient is exercised.

Back 60

depression in ST segment.

Front 61

Digoxin can cause ____of the ST segment, however it looks unique like a curve of Dali's mustache.

Back 61

depression

Front 62

The diagnosis of MI is usually based on the presence of significant ____ waves produced by an area of necrosis in the wall of the Left ventricle. A significant Q wave is at least how wide?

Back 62

Q

1 small box wide (0.04s)

Front 63

Significant Q waves in V1 through V4 means what type of infarction?

Back 63

Anterior wall of the Left ventricle

Front 64

If there are significant Q waves in the LATERAL leads ____ and ___ there is a lateral infarction.

Back 64

1 and AVL

Front 65

Inferior infarction is diagnosed by the presence of significant Q waves in the inferior leads ___, ___, and ___.

Back 65

2, 3, AVF

Front 66

Always check V1 and V2 for

1. Anterior infarct
2. Posterior infarct

Back 66

1. Anterior: ST elevation, Q waves

2. Posterior: ST depression and large R waves

Front 67

The left coronary artery has 2 major branches: ____ and ____.

Back 67

Circumflex branch, anterior descending branch

Front 68

Where is the Right coronary artery?

Back 68

It curves around the right ventricle

Front 69

The circumflex branch of the left coronary artery distributes blood to where?

Back 69

The lateral portion of the left ventricle.

Front 70

The anterior descending branch of the left coronary artery distributed blood to where?

Back 70

the anterior portion of the left ventricle

Front 71

The right coronary artery wraps around the right ventricle to supply blood where?

Back 71

the posterior portion of the left ventricle

Front 72

Hypertension

Back 72

140/90

Front 73

Prehypertension

Back 73

120-139/80-89

Front 74

Normal BP

Back 74

120/80 or under

Front 75

How do you measure orthostatic hypotension?

Back 75

Move from supine to sitting to standing. A drop of 20/10 or more between any position indicates orthostatic hypotension

Front 76

What is acute pericarditis?

Back 76

inflammation of the pericardium, the membranous sac that encloses the heart

Front 77

What are the assessment findings in someone with pericarditis?

Back 77

Substernal pain that radiates to the Left side of the neck/shoulder/or back.

Pain aggravated by inspiration, coughing, swallowing, laying flat.

You may hear a pleural friction rub at the L lower sternal border

Front 78

What is the major complication of pericarditis?

Back 78

Pericardial effusion (space btw the parietal and visceral layers of the pericardium fills with fluid). This puts the pt at risk for cardiac tamponade, which drops your cardiac output.

Front 79

Describe cardiac tamponade.

How can you treat this?

Back 79

Occurs when lots of fluid accumulates in percardium. CARDIAC TAMPONADE IS A MEDICAL EMERGENCY!!!

Treatment: Pericardiocentesis, where a catheter removes the excess fluid.

Front 80

Troponin levels in MI _____.

Back 80

increase

Troponin T should be below 0.2 in a healthy individual.

Front 81

Creatinine Kinase levels ____ in MI.

Back 81

increase

Females 135 or under is good
Males 170 or under is good

Front 82

Myoglobin in MI ________.

Back 82

Increases abt 2 hours after MI occurs and declines rapidly after 7 hours

90 or under is healthy normal

Front 83

If homocysteine is increased what is this a risk factor for?

Back 83

CVD

Front 84

Levels of C-reactive protein over _____ put you at high risk for heart disease.

Back 84

3 mg/dL

Front 85

What values do you look at if a pt is on coumadin?

Back 85

pt and inr

Front 86

What lab value do you look at if a pt is on heparin?

Back 86

ptt

Front 87

What is the most definitive but most invasive test in the diagnosis of heart disease?

Back 87

Cardiac catheterization

Front 88

Tricuspid valve

Back 88

separates R atrium from R ventricle

Front 89

Bicuspid (Mitral) valve

Back 89

separates L atrium from L Ventricle

Front 90

What are the 2 semilunar valves?

Back 90

Pulmonic valve and aortic valve

Front 91

Pulmonic valve

Back 91

Between R ventricle and pulmonary artery

Front 92

Aortic valve

Back 92

Between L ventricle and aorta

Front 93

To maintain adequate blood flow through the coronary arteries mean arterial pressure (MAP) must be___mmHg.

Back 93

60+ This is sufficient to perfuse major body organs and tissues.

Front 94

Diastole

Back 94

Relaxation and filling of atria and ventricles

Front 95

Systole

Back 95

Contraction and emptying of atria and ventricles

Front 96

How do you calculate cardiac output?

Back 96

CO = HR x Stroke Volume

Front 97

Stroke Volume

Back 97

Amt of blood ejected by L ventricle during each systole

Front 98

Preload

Back 98

The amount of cardiac muscle fiber stretch at the end of diastole

Front 99

What happens if stretching is too high during diastole?

Back 99

cardiac output decreases

Front 100

Afterload

Back 100

The resistance that the ventricles must overcome to eject blood through the semilunar valves.

Front 101

Hemodynamic monitoring

Back 101

an invasive system used in critical care areas to directly measure blood pressures in the heart anad great vessels

Front 102

Pulmonary artery catheter

Back 102

multilumen catheter that can measure right atrial and indirect left atrial pressures, as well as cardiac output.

Front 103

How do you hang blood products?

Back 103

With normal saline. NEVER add meds to the blood. Take vitals 1st (including temp). Begin transfusion. Stay with client for first 15-30mins. Retake vitals 15 mins after transfusion starts and then every hour.

Front 104

When are packed red blood cells given?

Back 104

To replace blood lost from trauma or surgery. Client usually has Hgb of less than 6 g/dL.

Front 105

When are platelets given?

Back 105

If a client has less than 20,000 platelets. Rigors (severe chills) during the transfusion is normal.

Front 106

When is fresh frozen plasma given?

Back 106

To replace blood volume in actively bleeding clients with a PT or PTT greater than 1.5 times the normal value.

Front 107

Where is lead V1?

Back 107

4th IC space, R sternal border

Front 108

Where is lead V2

Back 108

4th IC space, L sternal border

Front 109

Where is lead V3?

Back 109

Diagonally between V2 and V4

Front 110

Where is lead V4?

Back 110

5th IC space, midclavicular (Apical pulse)

Front 111

Where is lead V5?

Back 111

5th IC space, anterior axillary line

Front 112

Where is lead V6?

Back 112

5th IC space, midaxillary line