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71 Cards in this Set
- Front
- Back
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What effect does hyperventilation have on K?
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decreases it-driven intracellularly
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A pt with BP of 110/60 has a brady rythmn. Does this need tx'd?
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No-no hemodynamic issue
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Which of the following indicate a dysrythmia that needs treated?
A. hemodynamic compromise B. a harbinger of a worse dysrythmia C. cant be corrected by removing cause D. Lets hope my pts never have nay |
A, B, C
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What % of dysrythmias in aneshtetized pts need treated?
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1%
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What % of anesthetized pts have dysrythmias?
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15-85%
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Automaticity definition?
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Ability to spontaneously generate actionpotential
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Enhanced automatcity does which of the following?
A. brings the RMP closer to TP B. ^ slope of phase 4 C. depolarized the TP D. hyperpolarizes the RMP |
A, B. ( it actually depola. the RMP and hyperpol the TP)
"The end result: Increased HR" |
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depressing the automaticity does what to the RMP and TP?
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makes them further apart
-decreases slope of phase 4 -Hyperpolarizes the RMP -Depolarizes the TP "End result: Decreases HR" |
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Cardiac muscle APs are also known as?
A. fast APs B. Na+ mediated APs C. Ca+ mediated APs D. phase 4 APs |
a, b
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Pacemaker cells APs are also known as?
A. Slow APs B. Ca+ mediated APs C. Na+ mediated APs D. phase 4 APs |
A, B, D
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Excitability is defined as?
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ability of a cardiac cell to respons to stimulation by depolarizing
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The SNS does what to excitability?
A. Increases B. decreases |
A
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The PSNS does what to excitability?
A. increases B. decreases |
B
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The refractory period of the heart is:
A. beginning of QRS to top of T B. phases 0, 1, 2 and early 3 C. the time when a stimulus, no matter how strong, does not elicit a depolarization |
All are correct
( the absolute refractory period) |
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Which receptors are responsible for increasing automaticity?
A. B1 B. B2 C. alpha D. Dopmine |
A
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Conduction is defined as?
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ability to cause adjoining cell to depolarize and the speed at which this happens
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reexcitation is what?
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SAME impulse comes back and reexcites cardiac tissue
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Two things are necessary for reexcitation to occur:
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1. imbalance between conduction and refractoriness
2. unidirectional block |
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Reexcitation is the mechanism for which kind of dysrythmias?
A. bradycardic B. tachycardic C. ventricular |
B
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chamber enlargement leads to reexcitation by:
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elongating the conduction pathway
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MI can lead to reexcitation by:
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decreasing the velocity of conduction of cardiac implulse
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Ischemia does what to AP?
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prolongs it
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to determine rate
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A QRS of <0.12 means the impulse originates where?
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above the ventricles
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A QRS or >0.12 means what?
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IVCD or BBB
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Atrial and nodal rythms are very common in anesthetized pts. Why?
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Volatile agents are Na channel blockers
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Which lead is best used to assess for flutter waves?
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Lead II
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Which lead is best to assess for ischemia?
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V5
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What is the most common dysrythmia under general anesthesia?
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accelerated junctional
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Which of the following drugs should you never give to a WPW pt?
A. lidocaine B. sux C. verapamil D. cardizem E. digoxin |
C, D, E
(all CCBs are out, so is dig) |
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The only electrical connection between the atrial tissue and ventricular tissue in the heart is?
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the AV bundle ( goes through valve ring)
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The Na-K pump depends on what other electrolyte to function properly?
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Mag
(that is why we use Mag for dysrythmias-membrane stabilizer) |
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The #1 cause of PEA in general anesthesia is?
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hypovolemia
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Which lead is best to look at for determining BBB?
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V1
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If you determine a pt has a LBBB, what does that mean for dx'ing anterior MI?
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You cant dx an ant MI if LBBB present
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RBBB has a classic pattern of?
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M pattern ( can be unequal, though)
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* broad QRS > .11 seconds
* rSR' pattern in V1 * broad terminal S wave in Leads I, aVL and V6 * there may be secondary T wave changes (inversion) |
RBBB criteria
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You have a new MI pt. They develop a new RBBB during your shift. Should you be worried?
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Yes, new RBBB is highly indicative of 3rd deg. HB -be ready to pace.
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You see a QS complex in V1. Can you dx MI from this EKG pattern?
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No
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Which BBB is this: R or L
* QRS>.12 no sEPtal q waves in I and V6 QS in V1 secondary T inversion in I & V6 |
LBBB
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Myocardial ischemia shows what on a 12 lead?
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classically-symmetrical T wave changes
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Myocardial injury shows what on a 12 lead?
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ST changes
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Myocardial infarction shows what on a 12 lead?
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Q wave changes
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Which of the following is the most common type of MI? Why?
A. Trasmural B. subendocardial |
B. 2 reasons:
1. subendo region is furthest away from takeoff of arterial supply. 2. subendo region has LV pushing back against it. |
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Systolic dysfunction is:
A. inability to contract B. has a decreased EF C. inability to relax D. has normal EF |
A, B
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Diastolic dysfunction is:
A. inability to relax B. can have normal EF C. involves ventrticles inability to accept volume D. AKA "supply ischemia" |
A, B, C.
known as demand ischemia |
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Angina is a reliable indicator of myocardial ischemia. T or F?
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F-affected by neuropathy from DM
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EKG changes are an early sign of ischemia. T or F?
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F-actually late sign
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List the following in order of occurence in the ischemia cascade:
angina EKG changes systolic dysfuntion diastolic dysfunction switch to anaerobic metabolism hemodynamic changes |
switch to anaerobic metabolism
diastolic dysfunction systolic dysfunction hemodynamic changes EKG changes angina |
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catecholamines can do which of the following?
A. induce tachycardia-decreases filling time(and coronary perfusion B. inhibit platelet aggregation C. cause coronary vasoconstriction |
All are correct
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the most sensitive test to detect ischemia is:
A. 12 lead B. Holter monitor C. echo D. PAC |
C. wall motion abnormalities
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Which leads show the inferior wall of LV?
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II, III, aVF
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Which leads are the lateral leads?
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1, aVL, V5, V6
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which leads are right heart or septal leads?
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V1, V2
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Which leads are anterior leads?
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V1-4, wiht V3 and V4 the main ones
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Which leads is best for detecting dysrythmias?
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Lead II
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How much change from baseline is suggestive of ischemia in a spontaneously breathing pt?
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1 mm elevation from baseline
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reciprocal changes are:
A. in leaads facing away from affected area of heart B. a mirror image of indicative changes C. in leads facing the affected area of the heart |
A, B
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Which is worse: ST elevation or ST depression?
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ST elevation
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How can you detect possible posterior MI from a 12 lead?
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V1 R wave > or = 6mm or >=S wave
V2 R wave >or=15mm or 1.5 x's S wave |
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Which coronary artery supplies inferior wall? Which leads do you look at?
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RCA, II, III, aVF
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Which coronary artery supplies the anterior wall? Which leads do you look at?
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LAD, V3, V4
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Which coronary feeds the lateral wall? which leads do you look at?
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circumflex-I, aVL, V5, V6
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Which is the correct term for complete interruption of blood supply leading to myocardial cell death?
A. injury B. ischemia C. infarction |
C
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Which is the correct term for prolonged interruption of blood supply leading to disruption of myocardial cell membrane integrity?
A. injury B. infarction C. ischemia |
A
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Which is the correct term for temporary interruption in blood supply?
A. infarction B. ischemia C. injury |
B
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To determine injury, look at what?
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T waves
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To determine ischemia look at what?
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ST segments
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To determine infarct look at what?
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Q waves
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Inferior MI has which complications?
A. VT/VF B. SA node blocks C. AV node blocks |
B, C
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Posterior MI involves which coronary artery?
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PDA branch of RCA
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