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70 Cards in this Set
- Front
- Back
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Describe the flow of blood through the heart:
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- Deoxygenated blood enters the heart through the superior/ inferior vena cava or coronary sinuses
- Drains into the right atrium, which then travels to the right ventricle - It is then pumped into the lungs to be oxygenated - Then the blood travels through the pulmonary vein into the left atrium and draining into the left ventricle - It is then pumped through the body via the aorta |
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How is each heartbeat initiated and maintained?
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An electricle pulse is sent through the:
- SA node to the - AV node through the - Bundle of His passing through the - Right and Left bundle branches to the - Purkinge fibers |
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What are the phases of the cardiac cycle?
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- Relaxation period: indicated by the T wave on an EKG; ventricles relaxing
- Atrial systole (contraction): indicated by the P wave on an EKG; atrial depolarization - Ventricular systole (contraction): QRS complex on an EKG; Ventricles repolarize and contracts |
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What is Cardiac output (CO)?
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The amount of blood ejected from the left ventricle into the aorta
(1) The same is ejected from the right ventricle, during ventricular contraction. (2) Formula = stroke volume x heart rate = 70 ml/beat x 75 beats/min = 5250 ml/min or 5.25 L/min |
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How does venous blood return to the heart?
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- Veins transport blood back to the heart via pressure generated by:
(1) Contractions of the heart. (2) The skeletal muscle pump. (3) The respiratory pump. - These pressure generated pushes blood in one direction, to the right atrium where the pressure is around O mm Hg |
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What are the 4 principle branches of the aorta?
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- Ascending aorta
- Arch of the aorta - Thoracic Arch - Abdominal arch |
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What are the 3 main veins that drain blood away from the head?
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- Internal jugular
- External jugular - Vertebral veins |
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What are some important past medical history you want to ask the patient?
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Ask about:
- past cardiac surgery or hospitalizations - rheumatic fever or inflammatory problems - rythym disorders - chronic illnesses, such as hypertension or diabetes |
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What are you looking for during the inspection step of a cardiac exam?
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- Inspect the chest wall for pulsations, lifts, heaves, and thrusts
- Inspect for cyanosis of the skin and nailbeds and also capillary refill |
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What is the significance of percussion during a cardiac exam?
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- You can estimate the size of the heart
- The change from a resonant to a dull note marks the cardiac border |
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When auscultating the heart, what are you listening for?
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- Bruits or murmurs in the carotid arteries
- Venus hums in the jugular veins |
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Which pulses are you palpating for?
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- temporal
- brachial - radial - femoral - popliteal - posterior tibial - dorsalis pedis |
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Describe the amplitude of pulse scale:
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- 4: Bounding, aneurysmal
- 3: Full, increased - 2: Expected - 1: Diminished, barely palpable - 0: Absent, not palpable |
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Describe the pitting scale:
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* 1+ Slight pit, disappears rapidly
* 2+ Somewhat deep pit, disappears in 10 to 15 seconds * 3+ Noticeable deep pit that lasts more than a minute * 4+ Very deep pit that lasts 2 to 5 minutes |
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What is cardiac arrythmias?
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Abnormalites in cardiac rhythm and conduction
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Define normal sinus rthym:
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- Originates in the SA node
- Rate is 60-100 bpm and the rhythm is regular |
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What will the EKG show for sinus bradycardia?
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- Heart rate slower than 60 bpm
- Normal and consistent P wave morphology, normal PR interval |
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What is the treatment for a patient with sinus bradycardia?
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- Follow ACLS protocol:
1. Identify and treat any underlying causes 2. Maintain airway, O2, IV, monitor 3. Administer Atropine 0.5 mg bolus and repeat every 3-5 min, max dose 3mg 4. If atropine fails, use transcutaneous pacing, or Dopamine IV 2-10 mcg/kg min, or Epi IV 2-10mcg/kg min |
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What often causes sinus tachycardia?
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- Fever
- Exercise - emotion - Pain - anemia - Heart failure - Shock - Thyrotoxicosis - Alcohol or drugs withdrawal |
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What will the EKG show if a patient is sinus tachycardia?
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- Heart rate of greater than 100 bpm
- Generally regular but may vary with changes in position, breath hold or sedation |
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What is the treatment for a patient with sinus tachycardia?
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- IV, O2, Monitor
- Follow ACLS protocal - If stable: vagal maneuvers, adenosine 6mg IV push if necessary - If unstable: Synchronized Cardioversion - universally successful (100J) |
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What are some predisposes to embolic events during Atrial Fibrillation?
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- Stroke rate is approximately 5 events per 100 patient years of follow up
- Patients with risk factors (htn, dm, chf, prior hx of emoli) 20 events per 100 years of follow up - Frequently anti-coagulated with coumadin |
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What will an EKG show if a patient has A-fib?
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- Irregularity, irregular R-R interval
- Atrail rate 400/mins presenting as fib waves - Ventricular varies from brady to tachy and can be up to 170-180 bpm |
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What do you want to consider before cardioverting a patient with A-Fib?
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- If a patient has been A-fib for greater than 48 hours are at risk for cardioembolic events
- Should be given an anti-coagulated, unless they are unstable |
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What are some complications A-fib?
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- Embolic event
- Rapid ventricular rate leading to myocardial dysfunction |
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What will you see on an EKG if a patient has Atrial flutter?
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- Sawtooth flutter waves
- Atrial rate between 250-350 bpm |
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What is treatment for a patient that is unstable and in A- Flutter?
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Consider cardioversion
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What will you see on an EKG when a patient has a PVC (premature ventricular contraction)?
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Premature and wide QRS without preceding P-wave
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What are some complications of a patient that has PVCs?
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Progression to sustained V-tach or V-fib
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What is the definition of ventricular tachycardia?
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- Non-sustained V-tach: 3 or more consecutive ventricular premature beats lasting less than 30 sec and terminating spontaneously
- sustained V-tach |
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What will you see on an EKG on a patient with V-tach?
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- Wide QRS complex
- Tachycardia, usually 160-240 beats/min - Moderately regular |
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What will you see on an EKG on a patient with V-Fib?
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Fine to coarse zigzag pattern without P waves or QRS complexes
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Describe a 2nd degree, type 1 AV heart block (Wenckeback)?
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- Progressive prolongation of AV conduction until impulse is completely blocked
- P-R interval gets longer with each beat until QRS is dropped |
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Describe a 2nd degree, type 2 AV heart block (Mobitz)?
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- P-R interval remains constant (< 0.2) and then dropped QRS complex
- Usually implies structual heart damage and is usually permanent |
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Describe a 3rd degree AV heart block?
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- Complete heart block, no AV conduction
- Complete diassociation of P waves and QRS waves - Occurs in up to 8% of MI - Usually inadequate to maintain cardiac output - Unstable with periods of ventricular asystole |
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What is the treatment for a 3rd degree AV heart block?
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- Prepare for transcutaneous pacing
- If pacing is unavailable, use Dopamine or Epi infusion 2-10mcg/min |
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What are some risk factors for atherosclerotic disease?
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- Hypercholesterolemia
- Hypertension - Diabetes mellitus - Male gender - Smoking - Family History |
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Descirbe metabolic syndrome in an atherosclerotic coronary artery disease:
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- Abnomal obesity
- triglycerides: >150 mg/dL - HDL: < 40 mg/dL for men and <50 mg/dL for women - Fasting glucose: >110 mg/dL - Hypertension |
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What labs should be ran for a patient with atherosclerotic coronary artery disease?
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- Lipid panel
- Blood glucose |
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What is the difinitive care for a patient with atherosclerotic coronary artery disease?
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Surgery: Coronary artery bypass graphting, percutaneous coronary intervention
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Define Lower Extremity Occlusive Disease:
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- Occlusive atherosclerotic leisons that develop in the legs and sometimes, not often, in the arms causing decreased perfusion of the extremities
- Symptoms of a systemic atherosclerosis process - May be diffuse but occur segmentally - High correlation in smoker and patients with diabetes |
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What are the physical findings of a lower extremity occlusive disease?
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- Claudication: cramping pain or tiredness in the thigh, calf or foot with walking or exercise and relieved by rest
- Pain unrelieved by rest are at high risk for amputation - Diminished femoral, popliteal or pedal pulses - Tissue ulceration and gangrene, NECROSIS - Erectile dysfunction - Loss of hair - Thinning and cool skin - Atrophy of muscles |
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What is the Ankle Brachial Index?
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- The ratio of SBP at ankle compared to brachial artery
- Normal is 1.0 - 1.2 |
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What is the treatment for lower extremity occlusive disease?
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- Smoking cessation
- risk factor reduction - Weight loss - Consistent moderate exercise - Trail of phosphodiestrerase inhibitor - Surgical bypass or Endovascular angioplasty/ stenting - Amputation |
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What is the treatment for acute arterial occlusion of a limb?
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surgical intervention or endovascular thrombolysis
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What are the physical findings of a patient with acute coronary syndrome?
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- Pain similar to angina but more severe
- Sternal CRUSHING chest pain with radiation to shoulder, arm, neck or jaw - Pain commonly described as pressure on chest (elephant sitting on chest) - Occurs at rest, commonly in the morning - Diaphoresis - Nausea and vomiting - Anxiety - Weakness or dizziness - 1/3 of patients with not have typical chest pain (older, female, diabetes) and have worse outcomes due to delayed treatment |
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What is the treatment for a patient with acute coronary syndrome?
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Administer MONA (Morphine, O2, Nitro, ASA 160-325 mg)
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What is the definition of shock?
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- Circulatory insufficiency that creates an imbalance between tissue O2 supply and demand resulting in global tissue hypoperfusion
- Leads to hypoxia, acidosis and eventual end organ damage and failure |
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What is the treatment for hypovelmic shock?
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- Fluid replacement: rapid bolus IV or Blood transfusions
- Vasopressors: Epinephrine or Dopamine IV infusion |
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What is Obstructive shock?
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- Emergent medical conditions preventing blood flow into and out of the heart
- Examples are: Cardiac Tamponade, Tension pneumothorax, pulmonary embolism |
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What is the treatment for obstructive shock?
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- ABCs, IV, O2, Monitor
- Treat reversible cause |
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What is anaphylaxis shock?
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- Severe systemic hypersensitivity reaction
- Massive release of histamine and other vasoactive substances casue systemic vasodilation, potential airway compromise due to airway edema and bronchospasm |
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How do you treat anaphylaxis shock?
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- ABCs, O2, IV, Monitor
- Epi 0.1-0.5mg SC/IM repeat every 10-15 min - IV fluid bolus - Ancillary Tx: Benadryl IV 50 mg, Zantac 50 mg IV, Solumedrol 125mg IV |
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What are the complications of acute myocarditis?
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Heart failure
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What are the physical findings of a patient that has acute inflammatory pericarditis?
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- Substernal chest pain which is usually pleuritic (sharp), possible radiation to neck, shoulder or arm
- pain worse when supine and relieved by sitting - febrile - pericardial friction rub is most common sign |
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What will you see on an EKG on a patient that has acute inflammatory pericarditis?
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Diffuse ST-segment elevations
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What is the treatment for a patient that has acute inflammatory pericarditis?
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- Viral pericarditis: ASA 650mg every 3-4 hours or NSAIDs for 7 days to 3 weeks
- If a specific cause is found therapy should be directed at underlying disease |
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What is the definition of valvular heart disease?
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Damage to any of the 4 heart valves (tricuspid, pulmonic, mitral, aortic) preventing blood from flowing forward (stenosis) or allowing blood to flow backwards (regurgitation)
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What are the signs and symptoms of mitral regurgitation?
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- Symptoms: Exertional dyspnea, fatigue
- Signs: Pansystolic Murmur maximal at apex and radiating into the axilla, Hyperdynmamic LV, and possible S3 |
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What is the treatment for valular heart disease?
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- Treat symptomatically
- Surgical repair is the definitive treatment |
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What are the complications for valular heart disease?
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- Arrythmias
- Acute congestive heart failure - Pulmonary edema - Syncope - Sudden death |
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What are the 6 etiologies you need to rule out to determine if the patient will survive the next 24 hours?
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- Acute MI/ Unstable Angina
- Pulmonary Embolism - Pericardial Tamponade - Esophageal Rupture - Tension Pneumothorax/ Pneumothorax - Aortic dissection/ rupture |
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Define Angina:
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Chest pain due to myocardial O2 demand exceeding delivery, commonly caused by atherosclerotic disease
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What are the 3 types of Angina?
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- Stable angina: chest pain with exertion, relieved by rest
- Unstable angina: Chest pain while resting - Prinzmetals angina: rare, caused by coronary vasospasm often without CAD |
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What are the symptoms of a patient with angina?
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- Chest pain behind the left sternum described as squeezing, burning, pressing or aching
- Often characterized as a fist over the mid- chest with radiation to the left shoulder or arm, back neck or jaw - Short duration, usually < 3 min, relieved by rest, attacks brought on by meals or anger may last 15-20 min - > 30 mins is unusual and suggest unstable angina, AMI or alternative diagnosis |
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What will the EKG look like in a patient that has Angina?
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ST- segment depression: unstable angina or NSTEMI with cardiac ischemia
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What is the long term prophylactic therapy for a patient with angina?
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- Nitro SL or Spray
- Long acting nitrates - B-blockers - Calcium channel blocker |
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Pulmonary embolism is the most common life threatening consequesnce for what?
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Deep venous thrombosis
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What are the complications for deep venous thrombosis?
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PE and death
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What is the definition of congestive heart failure?
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- Primarily a disease of aging
- Heart failure may be right sided or left sided - Left: symptoms of low CO and elevated pulmonary venous pressure; dyspnea - Right: signs of fluid retention predominate; peripheral edema, hepatic congestion |
