Cardiology Test

Front 1

Know the definitions of the Q wave, R wave, S wave, and J point.

Back 1

Q Wave-1st negative deflection after P Wave. R wave-1st positive deflection after P wave. S wave-1st negative deflection after either Q or R wave. J point-Exact point at which QRS complex stops and where ST segment starts.

Front 2

Know the 2 criteria for pathological Q waves.

Back 2

Wider than 40 milliseconds, depth below isolectric line more than 1/3 of the height of the R wave.

Front 3

Know which leads look at the lateral, inferior, septal, anterior, & posterior walls of the left ventricle & the right ventricle.

Back 3

Lateral- I, aVL, V5 & V6

Inferior- II, III, aVF

Septal- V1 & V2

Anterior- V3 & V4

Posterior- V8, V9 (15 Lead)

R. Ventricle- V4r

Front 4

Know the 3 reasons for running a 15 lead.

Back 4

1. Inferior wall MI.

2. Lateral wall MI.

3. ST segment depression in 2 or more anterior septal leads.

Front 5

Know the turn signal method for finding a bundle branch block (all steps).

Back 5

1. QRS greater than 120 milliseconds in diameter.

2. You have ruled out a ventricular rhythm. (Atrial Rhythm)

3. Find the J point.

4. J point below baseline = LBBB.

5. J point above baseline = RBBB.

Front 6

Know how to fill in the QRS directions on an axis chart and what pathological left & right axis each indicate.

Back 6

AXIS. I. II. III. MEANS

NORMAL. ⬆️ ⬆️ ⬆️. Normal

(0-90)

PHYSIO L. ⬆️ ⬆️ ⬇️ Okay

0-Neg 40

PATHO L. ⬆️ ⬇️. ⬇️ Anterior Hemiblock

Neg 40-Neg 90

RIGHT. ⬆️. ⬆️⬇️= Posterior Hemiblock

90-180

ERAD. ⬇️. ⬇️. ⬇️. Ventricular?

Front 7

Know the limits for the PR interval.

Back 7

120 milliseconds

Front 8

Know the reasons a QRS may be wide and how to determine why a QRS is wide.

Back 8

1. BBB.

2. Originated in the ventricles.

3. If it is a BBB it will show evidence of atrial origin.

Front 9

Know the 3 reasons to call a pt unstable and cardiovert.

Back 9

1. Altered Mental Status.

2. Pulmonary Edema.

3. Acute Coronary Syndrome (ACS).

Front 10

Know the Bradycardia algorithm from top to bottom and where to start in different situations.

Back 10

1. 02, Monitor, IV

2. Atropine .5mg Rapid IV Push every 5 minutes to a max of 3mg total.

3. Pacing

4. Dopamine 2-10mcg/kg/min

5. Epi 2-10mcg/min

Front 11

Know what each of the 3 large coronary arteries perfuses.

Back 11

R. Coronary Artery- most of the atria (SA node 50-55%)

R. Ventricle- Inferior wall of the L. Ventricle & bottom third of the posterior wall (AV node 90-95%)

L. Circumflex- Rest of the atria, top 2/3 posterior wall of lateral wall of L. Ventricle (SA node 45-50%)

LAD- Anterior & Septal walls.

Front 12

Know the 2 most commonly used calcium channel blockers in EMS, to include doses & contraindications.

Back 12

1. Cardizem- .25mg/kg given over 5-10 min/ repeat after 20 min at .35mg/kg given over 5-10 min.

2. Verapamil- 5mg given over 5-10 min/ repeat after 20 min at 10mg given over 5-10 min.

Front 13

Know how to treat stable SVT.

Back 13

1. 02, Monitor, IV, 12 Lead, Vagal Maneuvers.

2. Adenosine- 6mg Rapid IV push.

3. Adenosine- 12mg Rapid IV push.

4a. Beta Blockers- Labatilol or Metoprolol at 10-20mg 4-5 min IV

4b. Cardizem or Verapamil

4c. Amio 150mg over 10 min.

Front 14

Know what an ECG consistent with pericarditis looks like.

Back 14

Global ST elevation or almost global ST elevation (all 12 leads or most of the 12 leads) with no reciprocal changes.

Front 15

Know the different antiarrythmics work (sodium, calcium, or potassium blocker).

Back 15

Lidocaine- sodium channel blocker (ventricular rhythms).

Verapamil & Cardizem- calcium channel blockers (Atrial rhythms).

Amiodarone & Procainamide- both sodium and potassium channel blockers (ventricular & atrial rhythms).

Front 16

Know why NTG can drop pressure so profoundly in a right ventricular infarct.

Back 16

Lowers preload. (Vasodilator).

Front 17

Know the 3 ECG changes that occur as COPD progresses.

Back 17

1. Right Axis Deviation.

2. Right Atrial Enlargement.

3. Right Ventricular Hypertrophy.

Front 18

Know what synctium is.

Back 18

When all of the muscle depolarizes and contracts at one time. (How wide or long QRS duration).

Front 19

Know at what QRS duration you can assume a patient has lost 50% of his contractile force.

Back 19

When QRS is wider than 120 milliseconds (7 1/2 blocks).

Front 20

Be able to explain Starlings Law.

Back 20

The more you stretch a muscle during diastole phase (the relaxation & filling period) the greater the force during the systole phase (the contraction period).

Front 21

Know what A1, B1, & B2 receptors do.

Back 21

A1- Causes periphovasoconstriction (aterioles).

B1- Cause increased heartrate and contractile force (1 ♡).

B2- Cause bronchioldiolation (2 lungs).

Front 22

Know the dosing regimen of procainamide, to include the end points.

Back 22

Loaded at infusion rate 20-50mg/min to one of 4 end points:

1. You resolved the rhythm.

2. Neutral end point of max dose of 17mg/kg.

3. QRS widens by 50%.

4. Hypotension occurs.

Front 23

Know the preferred drug to treat hypotension with pulmonary edema (carcinogenic shock).

Back 23

Dobutamine 2-20mcg/kg/min

Front 24

Know the H's & T's.

Back 24

H's

Hypoxia

Hypovolemia

Hydrogen ion (acidosis)

Hypo/hyper electrolytes

Hypo/hyper thermia

Hypo/hyper glycemic

T's

Toxins (overdose)

Thrombosis

Tension pneumothorax

Tamponade

Trauma

Front 25

Be able to define intotrope, chronotrope, & dromotrope.

Back 25

Inotrope- something that pertains to conctrile force.

Chronotrope- something that pertains to heartrate.

Dromotrope- something that pertains to the electrical conduction.

Front 26

Know how atropine works.

Back 26

Blocks the vagus nerve.

Front 27

Know the firing rates for the SA Node, the AV Node, and a ventricular pacemaker.

Back 27

SA Node- 60 to 100 BPM.

AV Node- 40 to 60 BPM (Junctional).

Ventricular Pacemaker- 20 to 40 BPM (Idoventricular).

Front 28

Be able to list at least 3 vagal maneuvers.

Back 28

1. Bare down.

2. Blow through an occluded straw, or a syringe, or pinch nostrils & blow.

3. Ice packs to face or coughing.

Front 29

Know the drug of choice for the management of torsades.

Back 29

Magnesium: Torsades w/ pulse: 2-4g infused over 20-40 minutes.

Torsades w/o pulse: 2g IV push, repeat in 5 minutes as needed. Max dose of 4g.

Front 30

Know the voltage setting for cardioverting the different tacharrhythmias.

Back 30

Torsades: 360j or biphasic equivalent unsynchronized.

SVT: 100j synchronized.

A-Fib/A-Flutter: 100j synchronized.

Front 31

Know when to use bicarb and calcium early on a cardiac arrest.

Back 31

Use bicarb & calcium early on a cardiac arrest when a pt is on dialysis and is due or overdue for dialysis.

Front 32

Know the criteria for a new onset A-Fib and the danger of cardioverting A-Fib.

Back 32

New onset of A-Fib less than 48 hours.

Danger of cardioverting: may throw a blood clot and cause a pulmonary embolism or a stroke.

Front 33

Know the 2 most common STEMI imposters.

Back 33

1. Left Bundle Branch Block.

2. LVH.

Front 34

Know both methods for determining LVH.

Back 34

1. Sv1+Rv5 or Rv6=35 or greater.

2. R in I+ S in III=25 or greater.

Front 35

Know the criteria for calling a STEMI.

Back 35

ST elevation greater than 1mm in 2 or more contiguous leads.

Front 36

Know the antidote for calcium channel blockers.

Back 36

Calcium 1-2g Slow IV Push. (Titrate to effect)

Front 37

Know when the electricity is delivered in synchronized cardioversion.

Back 37

Delivered during the absolute refectory period.

Front 38

Know why medications are withheld in hypothermic arrest.

Back 38

Receptors do not work until the pt is rewarmed.