Chapter 28 Cardiology Pgs 1204-1224

Front 1

During synchronized cardioversion, when is the electrical discharge delivered?

Back 1

During the R wave of the QRS complex
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Front 2

Indications for emergency synchronized cardioversion in an unstable pt include?
(4 things)

Back 2

1-Perfusing V-tach
2-PSVT
3-Rapid A-fib
4-2:1 A flutter
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Front 3

The procedure for synchronized cardioversion is the same as _____?

Back 3

Defibrillation
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Front 4

Why would you want to turn off the synchronizer if V-FIB occurs and use the machine as a difibrillator?

Back 4

In V-FIB the heart produces no R wave and the machine will not discharge
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Front 5

What joules do you use for PSVT, Rapid A-fib, A-flutter, V-tach w/a pulse?

Back 5

PSVT- 50Joules
A-Flutter- 50 Joules
Rapid A-fib- 100 joules
V-tach w/a pulse- 100 joules
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Front 6

What does TCP stand for?

Back 6

Transcutaneous Cardiac Pacing
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Front 7

____ is beneficial in such cases of symptomatic bradycardia for example, high degree AV blocks, A-FIB w/SVR, and other bradycardias (icluding asystole)

Back 7

TCP
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Front 8

When setting the heart rate on the pacemaker, what is typically the range to set

Back 8

60-80 BPM
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Front 9

Increasing the rate above the heart's current rate in order to suppress ventricular ectopy is called?

Back 9

Overdrive Pacing
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Front 10

Overdrive Pacing is useful in what rythm?

Back 10

torsades de pointes
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Front 11

Carotid massage can convert _____ into sinus rhythm by stimulating the baroreceptors in the carotid bodies.

Back 11

PSVT
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Front 12

Carotid massage increases _____ and decreases ______

Back 12

Increases vagal tone and decreases heart rate
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Front 13

Do not attempt carotid massage if the pulse is diminished and if ______ is present

Back 13

Bruits
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Front 14

To perform carotid massage, what drug do you want to have available

Back 14

Atropine Sulfate
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Front 15

Asystole, PVC's, V-tach, V-fib, syncope, seizure, stroke are all ______

Back 15

Complications of carotid massage
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Front 16

____ is the second most common reason people seek care in Emerg. Depts.

Back 16

Chest Pain
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Front 17

Name the 4 causes of chest pain

Back 17

1- Cardiovascular causes
2- Respiratory Causes
3- Gastrointestinal Causes
4- Musculoskeletal Causes
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Front 18

A spectrum of disease process, from myocardial ischemia, and injury to myocardial infarction is called ?

Back 18

Acute Coronary Syndrome
(ACS)
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Front 19

Name the 3 clinical intities that ACS includes

Back 19

1- Stable Angina
2- Unstable Angina
3- Acute Myocardial Infarction
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Front 20

A transient, episodic chest discomfort resulting from myocardial ischemia is known as

Back 20

Stable Angina
P 1211

Front 21

Stable angina is usually provoked by

Back 21

Physical exertion or intense emotional stress
p 1211-1212

Front 22

Unstable angina is defined as angina that meets any one of the following three presentations

Back 22

1- Angina that lasts longer than 20 minutes
2- New-onset angina
3-crescendo(increasing) angina ( more frequent/longer lasting)
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Front 23

Irreversible injury (necrosis) of the myocardium defines?

Back 23

Acute Myocardial Infarction
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Front 24

Diagnosis of Acute MI usually relies on the combined presentation on 3 specific findings, name them

Back 24

1-Clinical history suggestive of coronary artery disease
2- evidence of ischemic changes on the ECG
3- elevated myocardial enzymes in the blood
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Front 25

Narrowing of the lumen of the coronary arteries caused by thick hard plaques

Back 25

Atherosclerosis
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Front 26

Myocardial ischemia is caused by an imbalance of _____ and _____

Back 26

oxygen supply and demand
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Front 27

_____ formation is considered an integral factor in coronary artery disease

Back 27

Thrombus
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Front 28

Angina pectoris literally means___ and happens when the heart's _____ exceeds its ________

Back 28

Pain in the chest
oxygen demand
blood supply
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Front 29

Angina is generally classified as what 2 categories

Back 29

Stable or Unstable
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Front 30

Stable angina VS. Unstable angina

Back 30

Stable-occurs during activity/stress when heart's demand is increased, often responds readily to treatment
Unstable-occurs at rest and may not respond to treatment, often indicates severe atherosclerotic disease
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Front 31

Angina Pectoris
Signs and Symptons

Back 31

Weak or absent peripheral pulse(indicating potential or pending shock)
paleness/cyanosis
B/P elevated during episode
may experience epigastric pain
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Front 32

Typical 12-lead findings in pts w/angina are limited to patterns of ischemia: ST ____ and/or T wave _____

Back 32

ST depression
T-wave inversion
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Front 33

Angina Pectoris
Management

Back 33

*High flow/concentration O2
*establish IV
*administer single ASA
*administer Nitro to dilate arteries
if symptons persist, administer calcium channel blocker
*consider morphine sulfate or fentanyl
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Front 34

Myocardial Infarction(MI) is the death of a portion of the heart muscle from ______

Back 34

prolonged deprivation of oxygenated arterial blood
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Front 35

Coronary arterty spasm, miocroemboli (cocaine use), acute volume overload, hypotension, acute resp. failure, trauma, can all cause

Back 35

Myocardial Infarction
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Front 36

Most infarctions involve the _____ ventricule

Back 36

Left
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Front 37

Transmural Infarct. VS Subendocardial Infarct.

Back 37

TI-entire thickness on myocardium is destroyed, ST elevation occurs immediately, Q-wave appears also called a STEMI
SI-affects only the deeper levels of myocardium, does not produce Q-wave also called NSTEMI
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Front 38

The original site of dysrhythmias is the _____

Back 38

ischemic area
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Front 39

The most common complications of MI

Back 39

dysrythmias
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Front 40

The destruction of a portion of the myocardial muscle mass can cause ______

Back 40

CHF
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Front 41

_____ exists as the heart's pumping ability is impaired but the heart can still meet the demands of the body

Back 41

Heart failure
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Front 42

Heart failure simply means the the heart is _____ but _____

Back 42

inefficient but adequate
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Front 43

In cardiogenic shock the heart is both ____ and _____

Back 43

inefficient and inadequate
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Front 44

The primary strategies in managing MI are ______ and _____

Back 44

pain relief
reperfusion
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Front 45

MI
Signs and symptoms

Back 45

*B/P elevated
*most common compalint is chest pain
*onset of pain is acute, severe, constant, unrelenting
*discomfort lasts longer than 30 min
*pain radiates to arms, neck, back, epigastric region
*pale, cool, diaphoretic
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Front 46

ST depression suggests ______ and ST elevation suggests ______

Back 46

Depression-ischemia
Elevation-injury
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Front 47

Name the 4 most serious dysrythmias

Back 47

Asystole
PEA
V-tach
V-fib
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Front 48

Administration of fibrinolytics, percutaneous coronary intervention, coronary artery bypass grafting are all examples of ____

Back 48

Reperfusion therapies
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Front 49

The window time that a fibrinolytic can be given is

Back 49

6 hours from the time of onset
p1216

Front 50

bleeding or clotting disorders, possible blood in stool, uncontrolled hypertension, recent trauma, recent hemorhagic stroke, or recent surgery are examples that

Back 50

preclude pts from recieving fibrinolytics
p1216

Front 51

When administering Meds for a MI follow your protocols. The following meds that might be indicated are

Back 51

ASA
Nitro
Morphine Sulfate
Fentanyl
Clopidogrel (Plavix)
Heparin
Beta-Blockers
Glycoprotein inhibitors
p1216

Front 52

MI Management

Back 52

High flow/cponcentration O2
IV access
Medication administration followin protocols
be prepared to defibrillation, cardioversion, or pacing
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Front 53

When myocardial cells are damaged, the heart releases certain chemicals which are called?

Back 53

Cardiac Enzymes
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Front 54

Name the 4 cardiac enzymes that are routinely monitored during an MI

Back 54

1- Creatine Kinase(CK) or Creatine Phosphokineae(CPK)
2-Lactic Dehydrodenase (LDH)
3-Myoglobin
4-Troponin
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Front 55

A clinical syndrome in which the heart's mechanical perfomance is compromised so that cardiac output cannot meet the body's needs

Back 55

Heart Failure
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Front 56

Name the 2 categories that heart failure is usually divided into

Back 56

Left ventricle failure
Right ventricle failure
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Front 57

List of factors that can contribute to heart failure

Back 57

dysrhythmias, excess fluid, salt intake, fever, hypertension, pulmonary embolism, excessive drug and alcohol use
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Front 58

Pulmonary edema is usually the cause of which ventricle failure

Back 58

Left
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Front 59

Since ____ is a common cause of left ventricle failure, consider all pts w/pulmonary edema may have had a ____

Back 59

MI
MI
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Front 60

Back pressure of blood into the systemic venous circulation and venous congestion is caused by ____ ventricle failure

Back 60

Right
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Front 61

the most common cause of right ventricle failure is _____

Back 61

Left ventricle failure
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Front 62

Pulmonary hypertension, cor pulmonale, COPD are related to increased pressure in the pulmonary arteries which result in ______, ______, and if untreated ________

Back 62

right ventricle enlargement
right atrial enlargement
right-heart failure
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Front 63

An increase in peripheral vascular resistance will _____ stroke volume

Back 63

decrease
p1221

Front 64

the heart's reduced stroke volume causes an overload of fluid in the body's other tissues is calles

Back 64

Congestive heart failure (CHF)
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Front 65

_____ (in an acute setting) can manifest pulmonary edema, pulmonary HTN, or MI

Back 65

CHF
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Front 66

In the chronic setting, CHF can manifest as cardiomegaly (enlargement of the heart), _______, or ________

Back 66

left ventricle failure
right ventricle failure
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Front 67

____ is the most common cause for hospitilazation in pts over 65

Back 67

CHF
1222

Front 68

CHF
Field assessment

Back 68

Cough (clear/pink sputum)
labored breathing
skin mottling
paroxysmal nocturnal dyspnea
Short of breath
edema
mild chest pain
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Front 69

CHF
possible prescribed meds

Back 69

*Loop diuretic (lasix, bumix)
*Digoxin (Lanoxon)
*Home O2
*ACE inhibitors
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Front 70

_____ is the most common sympton of CHF

Back 70

Labored breathing
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Front 71

Edema is usually found in the ______, and can be so severe that is obliterates ________

Back 71

lower extremities
distal pulses
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Front 72

BP may by _____ in CHF, but when pt is starting to decompensate the BP may be _______

Back 72

elevated
normal then suddenly drops
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Front 73

The most serious complication of heart failure is

Back 73

Pulmonary edema
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Front 74

Wheezing in pulmonary edema and CHF is often called ____

Back 74

Cardiac Asthma
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Front 75

Complications of pulmonary edema are pulsus paradoxus and pulsus ______

Back 75

Pulsus alternans-
pulse alternates between weak and strong
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Front 76

CHF
management

Back 76

High flow/concentration O2
CPAP
nitrates
ACE inhibitor (captopril or enalopril)
Albuterol
dopamine

Front 77

The difference between CPAP and PEEP is, PEEP is applied only during ______, whereas CPAP is applied during the entire respiratory cycle

Back 77

expiration
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Front 78

When CPAP/PEEP pressures exceed 10cm/H2O the risk of ______ begins to rise

Back 78

barotrauma
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Front 79

Indications for CPAP

Back 79

signs and symptons consistent with: asthma, COPD, pulmonary edema, CHF, pneumonia and who is awake and alert to follow commands
more than 12 years old
maintain open airway
exhibits 2 or more of the following: Resp Rate greater than 25, SPO2 less than 94%, use of accesory muscles
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Front 80

Contraindications for CPAP

Back 80

Pt in respiratory arrest or apnea
suspected pneumothorax/chest trauma
pt has tracheotomy
actively vomiting
upper GI bleed
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Front 81

True or False
Can a CPAP be used on a pt with a DNR

Back 81

True
CPAP is not considered a resuscitative device
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