Neonatal Chd Vandy

Front 1

Cyanosis, shock, congestive heart failure, murmurs and arrhythmias can be signs/symptoms of what in the newborn?

Back 1

Congenital Heart Disease

Front 2

In instances where an infant is given 100% O2 and if the PO2 remains below __________, one would strongly suspect a cardiac cyanotic lesion.

Back 2

150

Front 3

PCO2 is normal or low in the presence of congenital heart disease when the infant is given 100% O2. True/False

Back 3

True

Front 4

Family history of congenital heart disease, multiple congenital anomalies and ________ are at high risk for congenital heart disease.

Back 4

Infants of Diabetic Mothers (IDM)

Front 5

PO2 >150 on 100% FIO2, elevated PCO2, Abnormal lung exam and lung findings, no murmur would be findings of cyanosis related to the heart. True/False

Back 5

False

Front 6

PO2 <150 on 100% FIO2, normal or low PCO2, Abnormal heart on CXR, clear lungs and presence of a murmur would be findings of cyanosis related to the heart. True/False

Back 6

True

Front 7

There are three ways in which cyanotic congenital heart disease disease can present.
1) Lesions with obstruction of
pulmonary blood flow and a
site of mixing
2) Complete mixed lesions with
decreased pulmonary blood
flow
and
3)__________?

Back 7

Lesions with unfavorable streaming

Front 8

This is the most common cyanotic congenital heart lesion and is due to the underdevelopment of the right ventricular outflow tract.

Back 8

Tetrology of Fallot

Front 9

With Tetrology of Fallot, which is the most common cyanotic heart lesion, four things are present which are:
1) Right ventricular hypertrophy
2) Overriding aorta
3) Pulmonary stenosis
and
4) ________________?

Back 9

Ventral Septal Defect

Front 10

Palliation for this cyanotic congenital heart lesion consists of Prostaglandin E1, Blalock Taussig Shunt, Balloon Pulmonary Valvuloplasty

Back 10

Tetrology of Fallot

Front 11

Tetrology of Fallot is commonly repaired completely in one surgery, however in premature infants or infants with coronary artery abnormalities, palliation is done. True/False

Back 11

True

Front 12

This type of cyanotic heart disease has unfavorable streaming where there are two parallel circulations.

Back 12

d-Transposition of the Great Arteries

Front 13

d-Transposition of the Great Arteries has two parallel circulations. The systemic veins, right atrium, right ventricle to ___________. Pulmonary veins, left atrium, left ventricle to ________________.

Back 13

Aorta
Pulmonary Artery

Front 14

If there is not sufficient mixing of blood in the infant with d-Transposition of the Great Arteries, a balloon septostomy is done. True/False

Back 14

True

Front 15

When an arterial switch is done to repair a d-Transposition of the Great Arteries the coronary artery buttons must be removed from the aorta and transplanted to _____________ so that the cardiac muscle will have blood supply. It is possible to have kinks in the coronary arteries which can lead to cardiac ischemia.

Back 15

Neoaorta

Front 16

In any complete mixing lesion, there is going to be a/an ___________ of any valve.

Back 16

Atresia

Front 17

Complete absence of a communication is referred to as an atresia. True/False

Back 17

True

Front 18

Palliation for this congenital heart lesion which has unfavorable streaming is PGE1 and septostomy. Repair is an atrial switch (Mustard or Senning) and arterial switch.

Back 18

d-Transposition of the Great Arteries

Front 19

The arterial switch operation for d-TGA transects the aorta and pulmonary arteries above the valves, LeCompte manuver, reanastamosis of the aorta to the PA stump and PA to the aortic stump, remove coronary buttons from aorta and reimplant in the neoaorta and close the ASD and VSD(if present). True/False

Back 19

True

Front 20

This repair for d-TGA is intraarterial baffle directing, IVC & SVC to mitral valve, PV to tricuspid valve. RV is systemic ventricle and the risks associated with this Senning/Mustard operation is atrial arrythmias, RV dysfunction and ____________________?

Back 20

Venous obstruction

Front 21

In a complete mixing CHD lesion, there are two thing that determine how "pink" or how "blue" you are. What are these two things?

Back 21

Pulmonary blood flow
Systemic blood flow

Front 22

This ratio determines oxygen saturation (SaO2) and is referred to as what?

Back 22

Pulmonary to systemic blood flow ratio (Qp/Qs ratio)

Front 23

This complete mixing lesion is a single ventricle DILV (double inlet left ventricle) and pulmonary to systemic flow determines O2 sat. If there is unrestricted pulmonary blood flow, there will be excessive pulmonary flow and _________?

Back 23

CHF

Front 24

The goal for surgical repair in single ventricle (DILV) is to get all of the "blue" blood to the lungs without going to the heart and all of the "red" blood to go out to the body. True/False

Back 24

True

Front 25

Repair of a single ventricle (DILV) is done in stages with the first being a PA band to restrict pulmonary blood flow, a Bidirectional Glenn shunt with atrial septectomy at 4-8 months of age and the Fontan or Damus-Kye-Stansel procedure at 2-4 years of age. True/False

Back 25

True

Front 26

The repair of a single ventricle (DILV) can also be done within the 1st year of life IF all repair procedures are done consecutively and with no more than 1 month between procedures. True/False

Back 26

False

Front 27

This procedure to repair a single ventricle (DILV) provides a cardiac baffle from the IVC to PA +- fenestration.

Back 27

Fontan Procedure

Front 28

This procedure which may be used to repair a single ventricle (DILV) provides a connection from PA to aorta (if necessary).

Back 28

Damus-Kay-Stansel

Front 29

By maintaining an open PDA with PGE1, you are increasing the Qp/Qs the ratio. True/False

Back 29

True

Front 30

This CHD is complete mixing and all systemic venous flow must cross the ASD and pulmonary blood flow must cross the ________ or ________.

Back 30

Ventricular Septal Defect (VSD) or Patent Ductus Arteriosis (PDA)

Front 31

For repair of Tricuspid Atresia a Blalock-Taussig shunt may be needed as well as ______________. It may/may not be proceeded by a Glenn procedure.

Back 31

Fontan

Front 32

There are several forms of TAPVR. The two discussed by Dr. Johns in the lecture were ___________ which may be obstructed or unobstructed and _________________ which is usually obstructed.

Back 32

Supracardiac TAPVR
Infracardiac TAPVR

Front 33

In fetal development, the pulmonary veins arise from the lungs and join the back of the left atrium. True/False

Back 33

True

Front 34

In this complete mixing lesion the fetal connections between systemic and pulmonary will persist.

Back 34

Total anomalous pulmonary venous return (TAPVR)

Front 35

In supracardiac TAPVR the left common cardinal vein persists. True/False

Back 35

True

Front 36

Due to persistant streaming inn supracardiac TAPVR the highest SaO2 is likely to be where?

Back 36

Feet

Front 37

There are two CHD that you will have greater O2 saturations in the feet. One is a complete mixing lesion and is __________________, the other is one with unfavorable streaming which is ____________?

Back 37

Supracardiac Total Anomalous Pulmonary Venous Return and
Transposition of the Great Arteries (TGA)

Front 38

This complete mixing lesion is due to the persistence of the fetal vitelline system.

Back 38

Infracardiac Total Anomalous Pulmonary Venous Return (TAPVR)

Front 39

Infracardiac TAPVR is a complete mixing lesion in which both pulmonary edema and pulmonary obstruction are present. Infants with this CHD often have profound cyanosis and need emergent surgical intervention. True/False

Back 39

True

Front 40

Inadequate systemic perfusion with cardiogenic shock will present with lethargy, poor feeding, irritability, decreased urine output, poor cap refill, cool extremities, tachycardia, normal or increased BP (early), hypotension (late) and _____________ on an ABG?

Back 40

Acidosis

Front 41

What 3 mechanisms contribute to shock in CHD?

Back 41

Left sided obstructive lesions
Sustained tachycardia
Profound bradycardia

Front 42

This three forms of CHD present with left sided obstruction?

Back 42

Coarctation of the Aorta
Critical Aortic Stenosis
Hypoplastic Left Heart Syndrome

Front 43

Inadequate systemic perfusion is known as what?

Back 43

Shock

Front 44

When supraventricular or ventricular tachycardia is persistant and sustained for a few hours the infant will go into shock. True/False

Back 44

False
Must be persistent and sustained for 24-48 hours

Front 45

Bradycardia is most often the response rather than the cause of shock in CHD. True/False

Back 45

True

Front 46

This CHD lesion is a left sided obstruction, has LA pressures which are increased, pulmonary edema, poor perfusion, shock, acidosis and decreased pulses and BP in the lower extremities.

Back 46

Coarctation of the Aorta

Front 47

The majority of Coarctation of the Aortas occur juxtaductally which is right at the site of the ductus. True/False

Back 47

True

Front 48

Infant's with Coarctation of the Aorta typically present between 10 days and ______ weeks of age.

Back 48

Three

Front 49

In Coarctation of the Aorta when the ductus closes, there is a decrease of blood to the aortic arch, decrease blood to the LV, increase in afterload in LV leading to decreased cardiac output. This increase pressure in the LA and PA forces fluid from the intracellular space to the interstitium and alveoli and causes pulmonary edema. True/False

Back 49

True

Front 50

Any infant who presents in cardiogenic shock should be ______________ to decrease their work of breathing.

Back 50

Intubated

Front 51

What percentage of babies who are on PGE1 will have apnea?

Back 51

15%

Front 52

When using PGE1 to maintain a patent ductus with cyanotic lesions you increase/decrease pulmonary blood flow?

Back 52

Increase

Front 53

In CHD where there is obstruction of systemic blood flow by maintaining patency of the ductus with PGE1, you allow the RV to pump blood out to body to decrease/increase systemic perfusion.

Back 53

Increase

Front 54

________________ is used to improve LV function in Coarctation of the Aorta.

Back 54

Dobutamine

Front 55

It is important to consider Coarctation of the Aorta when an infant presents in shock the first month of life and Dr. John's recommends being adamant about checking ____________ ______________ when infants are in the nursery.

Back 55

Femoral pulses

Front 56

When there is a consistent >20mmHg difference in upper and lower pulses, one should consider what CHD?

Back 56

Coarctation of the Aorta

Front 57

Treatment for Coarctation of the Aorta is PGE1 and surgery. True/False

Back 57

True

Front 58

Infants with this left sided obstructive lesion will often present the same as an infant with Coarctation of the Aorta.

Back 58

Critical Aortic Stenosis

Front 59

In Critical Aortic Stenosis when the ductus closes, there is a decrease of blood to the aortic arch, decrease blood to the LV, increase in afterload in LV leading to decreased cardiac output. This increase pressure in the LA and PV forces fluid from the intracellular space to the interstitium and alveoli and will decrease pulmonary edema. True/False

Back 59

False
It causes pulmonary edema

Front 60

Treatment of Critical Aortic Stenosis would include PGE1, balloon valvotomy, surgical valvotomy and if the left ventricle is not large enough would need a ______________ procedure.

Back 60

Norwood

Front 61

The ultimate left sided obstructive CHD is _____________ ________ _________ according to Dr. Johns.

Back 61

Hypoplastic left heart

Front 62

Two goals in performing the Norwood procedure are #1 To provide limited pulmonary blood flow and #2 to provide a way to get blood from the _________ ________ out to the aorta.

Back 62

Right Ventricle

Front 63

Because the shunts do not grow as the infant with HLHS after the Norwood procedure is done, a second stage surgical procedure will be done. True/False

Back 63

True

Front 64

Use of oxygen in infant who have had the Norwood procedure for HLHS must be very judicious due to the fact that it is a potent pulmonary vasoconstrictor.True/False

Back 64

False
O2 is a potent pulmonary vasodilator.

Front 65

The use of oxygen must also be used very judiciously in infants not only in infant with HLHS which has been repaired, but also with complete mixing lesion. True/False

Back 65

True

Front 66

Failure of the heart to pump adequately is known as what?

Back 66

Congestive Heart Failure (CHF)

Front 67

Infants in CHF typically have deficient systemic perfusion. True/False

Back 67

False
Systemic perfusion is adequate

Front 68

Infant with CHF present with the following; increased respiratory effort, tiring with feedings, poor growth, sweating and an ___________ _____________.

Back 68

Enlarged liver

Front 69

Lesions with large L to R shunts present with CHF. These are a VSD, AVSD, Truncus Arteriosus, Single Ventricle __________ Pulmonary Stenosis.

Back 69

Without

Front 70

Left sided obstructive lesions that present with CHF because there is adequate systemic blood flow are Aortic Stenosis, Coarctation of the Aorta and __________ __________ ___________ _____________.

Back 70

Hypoplastic Left Heart Syndrome

Front 71

In this defect, there is communication between the LV and the RV.

Back 71

Ventricular Septal Defect (VSD)

Front 72

Due to the continued decreased in pulmonary vascular resistance as the infant gets older they are also developing physiologic _______________. This contributes more and more blood crossing the VSD.

Back 72

Anemia

Front 73

Holosystolic murmur, possible diastolic rumble at apex, increased LA pressure, pulmonary edema, increased work of breathing and poor growth is seen in what CHD?

Back 73

Ventricular Septal Defect

Front 74

Murmur of a very large VSD may not be heard whereas a murmur with a small VSD may be _________ pitched.

Back 74

High

Front 75

The diastolic rumble which may be heard at the apex is best heard with the bell or diaphragm of the stethoscope?

Back 75

Bell

Front 76

Left to right shunt via atria and ventricles, increased blood pulmonary blood flow, common AV valve, increased pulmonary arterial pressure and normal saturations are all findings of what CHD.

Back 76

Atrioventricular Septal Defect

Front 77

Twice the amount of blood flow across the valve is present if you hear a diastolic rumble and the Qp/Qs is >2. True/False

Back 77

True

Front 78

The pathophysiology of an Atrioventricular Septal Defect is similar to __________ ________ ___________.

Back 78

Ventral Septal Defect

Front 79

This CHD is commonly misclassified as a cyanotic heart disease. It has a predominate L to R shunt, increased pulmonary blood flow, minimal cyanosis, common truncal valve, increase PA pressure, near normal O2 sat and low diastolic pressure.

Back 79

Trucus Arteriosis

Front 80

Infant with Trucus Arteriosis can present with myocardial ischemia and ____________ __________.

Back 80

Sudden Death

Front 81

Increase in myocardial __________ consumption and low diastolic pressure can lead to sudden death in infants with Truncus Arteriosis and PDA.

Back 81

Oxygen

Front 82

Repair of a Truncus Arteriosus consists of patching the VSD, committing truncal valve to LV, disconnecting MPA from truncus arteriosus and placing a conduit from RV to the distal PA. True/False

Back 82

True

Front 83

Single ventricle (DILV) which is a complete mixing lesion can present with excessive pulmonary flow and CHF when there is _______________ pulmonary blood flow.

Back 83

Unrestricted

Front 84

A __________ is defined as a feeling on the base of your fingers is placed on the chest over the heart and a "purring" feeling is felt.

Back 84

Thrill

Front 85

Any murmur which is a grade 4-6 that has a thrill is abnormal and should be investigated. True/False

Back 85

True

Front 86

According to Dr. Johns, ________ percent of children will have a murmur at some point in their lifetime and high percentage of normal newborns have murmurs.

Back 86

Eighty

Front 87

The difference between a 3/6 and a 4/6 murmur is that in addition to the murmur being loud a _____________ is heard.

Back 87

Thrill

Front 88

Murmurs classified as functional, innocent or __________ murmurs are typically systolic, less than a grade 4/6, increase with increase in cardiac output and are specific types.

Back 88

Normal

Front 89

With this common normal murmur in the premature infant, it is heard in the right axillae and is as loud/louder in the remainder of the chest and L axillae. Dr. Johns referred to it as diamond shaped, crescendo/decrescendo and gets softer and louder.

Back 89

Peripheral pulmonic stenosis murmur (PPS)

Front 90

Also diamond shaped, this is a short systolic ejection murmur heard at the L sternal border and increases with increased cardiac output.

Back 90

Pulmonary Flow Murmur

Front 91

There are two transitional murmurs that are heard. One occurs when there is a closure and the other is oftentimes seen in asphyxiated infants or infants with PPHN.

Back 91

PDA Closure
Transient Tricuspid Regurgitation

Front 92

This transitional murmur is heard at the upper L sternal border or infraclavicular area and is systolic or continuous and can be occasionally vibratory. It is heard at 12-48 hours of age and tends to get louder as this closes. Dr. Johns reminds that when this continuous murmur is heard it is most certainly this type.

Back 92

PDA

Front 93

This murmur is heard at the LL sternal border and is regurgitant, systolic and typically resolves over several days. It is often seen with asphyxiated infants or infants with PPHN. Dr. Johns referred to this as a retangular murmur.

Back 93

Transient Tricuspid Regurgitation

Front 94

When the murmur is loud, diastolic, don't fit into category of innocent murmurs or are accompanied by other signs such as CHF, cynosis or shock. What should the NNP do?

Back 94

Obtain a cardiac evaluation

Front 95

Septal defects (ASD, VSD), outflow tract obstruction (valvar, subvalvar and supravalvar or pulmonic stenosis) and PDA. These types of murmurs may present as __________________ murmurs.

Back 95

Asymptomatic

Front 96

This murmur is a systolic ejection murmur heard at the URSB and radiates to the neck. There is a systolic ejection click audible at the apex and a thrill may be felt at the suprasternal notch.

Back 96

Aortic Stenosis

Front 97

This murmur is a systolic ejection murmur heard at the ULSB and radiates to the back. There is a systolic ejection click audible at the LLSB and a thrill may be felt at the suprasternal notch.

Back 97

Pulmonic Stenosis

Front 98

There is sometimes some confusion related to PPS (peripheral pulmonic stenosis) and Pulmonic stenosis murmurs. The distinguishing factor for Pulmonic stenosis Dr. Johns reiterated is that it is heard loudest at the ULSB. True/False

Back 98

True

Front 99

There are three things which Dr. Johns uses to define neonatal arrythmias. They are:

Back 99

Too fast
Too slow
Too irregular

Front 100

This tachycardia has a narrow QRS complex, P waves were visible, rate is &lt;230, has GRADUAL onset and termination, and is associated with pain, fever or hypovolemia.

Back 100

Sinus Tachycardia

Front 101

This distinguishing finding between Sinus Tachycardia and Supraventricular Tachycardia is found on L1 and aVF on 12 lead EKG.

Back 101

Positive P Wave

Front 102

Management of Sinus Tachycardia includes volume, antipyretics, and analgesics. What would you NOT want to give?

Back 102

Antiarrythmic Drugs

Front 103

This tachycardia has a narrow complex and P waves are often buried in the T wave, rate is >240 and monotonous. Onset and termination are SUDDEN.

Back 103

Supraventricular Tachycardia

Front 104

There are two mechanisms associated with SVT which are considered accessory connections. They are __________ __________ __________ and concealed.

Back 104

Wolffe Parkinson White (WPW)

Front 105

ORT refers to orthodromic reciprocating tachycardia in SVT. True/False

Back 105

True

Front 106

There are four mechanisms of SVT are accessory connections (WPW, concealed), AV Node reentry, Intraarterial reentry (atrial flutter, atrial fibrillation) and automatic _____________ tachycardia.

Back 106

Atrial

Front 107

In Wolff Parkinson White (WPW) this form of SVT a __________ ___________ is seen in sinus rhythm, but NOT in SVT.

Back 107

Delta Wave

Front 108

Acute treatment of SVT when shock is present is what?

Back 108

Synchronized DC cardioversion

SHOCK! 0.25-1 Joules/kg

Front 109

It is important to get this before, during and after termination of SVT to help with diagnosing origin of SVT.

Back 109

EKG

Front 110

Use of vagal maneuvers to provide transient resolution of SVT are gagging, performing rectal temp, pressing on infant's abdomen to elicit valsalva and placing a glove filled with ice/water. True/False

Back 110

True

Front 111

By utilizing water with ice in a glove and applying to infant's eyes and bridge of nose, there is improved __________ ___________.

Back 111

Thermal contact

Front 112

Vagal maneuvers are transient to convert to normal sinus rhythm only and not curative. True/False

Back 112

True

Front 113

If unable to convert utilizing vagal maneuvers, ____________ is the next treatment option.

Back 113

Adenosine

Front 114

Adenosine provides a transient AV block, slows the sinus node and has an extremely __________ duration of action.

Back 114

Short

Front 115

Dose of Adenosine is 0.05 to 0.25 mg/kg with 12mg being the maximum. True/False

Back 115

True

Front 116

Adenosine's effect on accessory connection mediated tachycardia (ORT(orthodromic reciprodcating tachycardia)) is that it blocks the AV node and terminates tachycardia. Tachycardia loop includes the AV node. True/False

Back 116

True

Front 117

Adenosine's effect on atrial flutter which does not include the AV node and the AV block does not terminiate tachycardia. True/False

Back 117

True

Front 118

This tachycardia is uncommon and the atria is slower than the ventricles. There is a wide QRS and it may only be slightly > than normal QRS, AV dissociation may been seen. Underlying cause of hyperkalemia, acidosis, drugs, abnormal myocardium or a long QT syndrome.

Back 118

Ventricular Tachycardia

Front 119

Drugs that would be an underlying cause of this arrythmia are antiarrythmics, tricyclics.

Back 119

Ventricular Tachycardia

Front 120

Abnormal myocardium conditions which would contribute to Ventricular Tachycardia would be CHD, myocarditis and _____________.

Back 120

Cardiomyopathy

Front 121

Acute treatment of Ventricular Tachycardia when shock is present is?

Back 121

Synchronized DC Cardioversion

SHOCK!! 0.5-2 Joules/kg

Correct underlying cause

Front 122

If infant is hemodynamically stable you would want to get a ___________ for Ventricular Tachycardia.

Back 122

12 Lead EKG

Front 123

Administration of Lidocaine IV or Procainamide are drugs used to treat VT. True/False

Back 123

True

Front 124

Administration of Procainaminde IV should be done ONLY when the Neonatologist is present. True/False

Back 124

False
Cardiologist should ALWAYS be present

Front 125

Either in Supraventricular Tachycardia or Ventricular Tachycardia and shock is present what should you do?

Back 125

SHOCK, SHOCK, SHOCK!!!

Front 126

These are the two types of bradycardia.

Back 126

Sinus and AV block

Front 127

This bradycardia is almost always vagally mediated and can be caused from apnea, hypoxemia, pharyngeal or laryngeal stimulation. Good perfusion, normal BP and w/o symptoms may be normal.

Back 127

Sinus Bradycardia

Front 128

The P wave is seen ___________ the QRS in Sinus Bradycardia.

Back 128

Before

Front 129

Treatment of the underlying cause of Sinus Bradycardia is priority and if there is not response, medications may be used. The two medications used are ________________ and ____________________.

Back 129

Atropine
Isoproterenol

Front 130

Pacing may be done either tranvenous or transcutaneous in acute episodes of sinus bradycardia. True/False

Back 130

True

Front 131

AV Block can be congenital, surgical, infectious, vagal or ____________ induced.

Back 131

Drug

Front 132

Congenital AV Block is seen from structural heart disease and ___________ antibodies.

Back 132

Maternal

Front 133

In congenital AV block, maternal antibodies are passed in utero and cause AV block. True/False

Back 133

True

Front 134

Drugs which can cause AV Block are Digoxin, Ca2 blockers and for that reason, ACE inhibitors like Verapamil are almost NEVER used in neonates. True/False

Back 134

True

Front 135

Surgically, the _______ node may be damaged and contributes to block.

Back 135

AV

Front 136

Infections which would cause AV block is _______ ___________?

Back 136

Lyme Disease

Front 137

In infants with impaired renal impairment and was on ___________, the NNP would consider that as a culprit if AV block is seen.

Back 137

Digoxin

Front 138

To treat Ca2 blocker which is causing AV Block, what would be the antidote?

Back 138

Calcium

Front 139

To treat Digoxin toxicity causing AV block, what would be the antidote?

Back 139

Digibind

Front 140

Many times, no treatment is required on AV Block if there is adequate _____________. Many times a sustained heartrate of 70-80 may be acceptable.

Back 140

Perfusion

Front 141

Dr. John's mentions that ZOLL transcutaneous pacing pads can have ________ _________ ________ when used in neonates and cautions against having to use them.

Back 141

Fatal Tissue Necrosis

Front 142

Irregular rhythms include sinus arrythmia, premature atrial contractions (PAC), premature ventricular contractions (PVC's) and second degree _____ block.

Back 142

Atrioventricular

Front 143

This irregular rhythm has normal QRS morphology, normal sinus P waves are present, heartrate varies with respiration and often NO treatment is needed. Other escape rhythms may be present. May have PROFOUND arrythmia but this is a hallmark finding.

Back 143

Sinus Arrythmia

Front 144

These irregular premature contractions are very very common in the newborn (term and premature) and are benign and generally require no treatment. They have a normal QRS morphology, P waves are present (may be in T wave) and P wave may be blocked or conducted aberrantly.

Back 144

Premature Atrial Contraction

Front 145

This irregular premature contraction has wide QRS morphology, no preceeding P wave is present, may have a compensatory pause and is very common.

Back 145

Premature Ventricular Contraction

Front 146

Sometimes, presence of PVC may be indicative of electrolyte disturbances. In this instance one would order a __________ and __________ level.

Back 146

Potassium
Magnesium

Front 147

Metabolic contributions to PVC's may be hyperkalemia, acidosis, hypoxemia. Drugs such as Digoxin, tricyclics, caffeine, bronchodilators, etc. are responsible. Normal finding which is idiopathic and there is a mechanical stimulation which can cause, this is _____________?

Back 147

PICC or CVP catheter

Front 148

When there are paired and tripled PVC's there is a concern that this could lead to _______________ _____________.

Back 148

Supraventricular Tachycardia

Front 149

This second degree AV block (Type I) is often block PAC's, may be related to vagal tone and hypoxemia. May be a manifesation of congenital AV block and could possibly be drug related.

Back 149

Wenckebach