Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
What is the first sign of ischemia?
|
Swelling --> inflammation --> Na/K pump stops working
|
|
|
What happens when the Na/K pump stops working?
|
K still leaks out of the cell
Cell becomes more neg-->less likely to depolarize |
|
|
What other ion gets trapped inside the cell when Na gets trapped inside the cell?
|
Ca also gets trapped in the cell - increases contractility
|
|
|
What is the first EKG change that is seen when the Na/K ATPase pump shuts down? Why?
|
ST wave depression because cells are more negative 2/2 K+ leaking out
|
|
|
What is an ST-wave depression indicative of? What is the treatment?
|
70% stenosis of vessel --> early ischemic changes
Stable angina (starts with exertion, stops with rest) Tx: vasodilators |
|
|
What are the steps to take in the management of angina?
|
If pain goes away -
-hospitalize for 24 hours -serial EKGs and Card enzyme checks q6h for 24h -If neg then send home -Reg stress test in 6 wks -If neg - Thallium stress test (look for cold areas = no flow) |
|
|
What test can I do if I think my patient had an MI?
|
Ca-Pyrophosphate scan b/c cells that die take up calcium
-look for hot spot |
|
|
What are the alternatives for a stress test if patient physically unable to do it?
|
Dobutamine stress test or dipyridamole stress test
|
|
|
What physiology causes MI symptoms in my patient? What changes do I expect to see on EKG?
|
Na gets trapped in the cell --> more likely to depolarize --> more positive at baseline therefore ST segment increases
|
|
|
What is the definition of unstable angina? What is the pathological cause of angina?
|
90% stenosis of vessel
rupture of plaque and clotting by platelets occluding the vessel |
|
|
What angiogram findings result in taking patient straight to surgery?
|
70% or more stenosis of 3 vessels or 90% stenosis of 1 vessel
|
|
|
If angiogram findings aren't suggestive of surgery, what should I do?
|
Place stent +/- coated with clopidogrel
|
|
|
What events occur during inflammation from the first 24 hours to 6 months?
|
< 24h - swelling
24h - neutrophils arrive, peak at 3 days 4 days - macrophages and T cells show up, peak at 7 days 7 days - fibroblasts show up, peak at day 30, cause fibrosis until 6 months |
|
|
What happens when too much Na+ gets trapped within a cell?
|
Na begins to leak out down it's concentration gradient using the Na/Ca pump --> pulls all Ca into cell
Cells needing extracellular Ca to depolarize, now can't b/c extracellular Ca is low |
|
|
How long is a normal PR interval?
|
< 0.20 sec
|
|
|
What is the pathology causing 1st degree heart block? What is the treatment?
|
SA node dysfunction or dysfunction of tissue between SA and AV node
|
|
|
What is the pathology causing Wenckebach's heart block?
What is seen on EKG? What is the treatment for it? |
Early ischemia of AV node
progressive lengthening of the PR interval untili a QRS is dropped 2/2 K leaking out of cells so they repolarize more slowly If asymptomatic - do nothing; if symptomatic - pacemaker |
|
|
What are the two types of 2nd degree heart block?
|
Mobitz Type I: Wenckebach
Mobitz Type II |
|
|
What is the pathology causing Mobitz II heart block?
What is seen on EKG? What is the treatment for it? |
Late ischemia at the AV node
PR interval "appears" normal b/c impulse is averaged by the lead recording it All must have a pacemaker |
|
|
What is the pathology causing 3rd degree heart block?
What does it look like on EKG? What is the treatment for it? |
Complete atrial/ventricular dissociation
QRS and p waves have no relationship All must have a (dual chamber) pacemaker |
|
|
What are the types of pacemakers? For what indication should each be used?
|
On demand - used for heart block
Overdrive (used for arrythmias) |
|
|
What is the indication on EKG that patient is having premature ventricular complexes?
|
No p wave, wide QRS complexes, a pause following QRS complex
|
|
|
What is the definition of:
Bigeminy Trigeminy Ventricular Tachycardia Ventricular fibrillation |
Bigeminy: PVC every other beat
Trigeminy: PVC every third beat V-tach: 3 consecutive PVCs and HR 150 V-fib: No recognizable QRS complexes |
|
|
What protocol will be tested on the exam regarding treatment of patient with V-tach?
|
If patient stable - treat with meds
If patient unstable - shock with 200 joules - shock with 300 joules - shock with 360 joules - Lidocaine - shock - Bretylium or Amiodarone (intubate --> ICU) |
|
|
What should I do for my patient who is in V-fib?
|
1 - O2
2 - Na-cahnnel blocker 3 - K+ channel blocker Give epinephrine or ADH then treat like V-tach |
|
|
What is the treatment protocol for atrial arrythmias
|
1 - O2
2 - Ca channel blocker 3 - Adenosine (blocks C-amp) 4 - B-blocker (blocks SA node B receptor) 5 - K channel blocker 6 - digoxin |
|
|
How will I be able to discern a premature atrial contraction on EKG?
|
I'll see a pause afterwards
|
|
|
How do I treat A-fib?
|
If acute and stable: treat with medication
If acute and unstable: defibrillate If chronic: put on coumadin and may defibrillate after 2 weeks |
|
|
When should I use the synchronize button on the defibrillator?
|
When I see QRS wave
|
|
|
What is the CHADS score used for? What are the components of the score? When does my patient qualify for treatment?
|
Identifies which patients with A-fib should be on coumadin for the rest of their lives
C-CHF (1) H-HTN uncontrolled (1) A-Age>70 (1) D-Diabetes (1) S-Stroke (2) Start tx if score is 2 or > |
|
|
Will hypermagnesemia cause cells to be more/less likely to depolarize?
What is the treatment? |
Less likely to depolarize
Tx: IVF to dilute, loop diuretic to pee it off |
|
|
Will hypomagnesemia cause cells to be more/less likely to depolarize?
What is the treatment? |
More likely to depolarize
Tx: IVF to dilute; replace Mg |
|
|
Will hypercalcemia cause cells to be more/less likely to depolarize?
What is the treatment? |
Less likely to depolarize at first (neuron), then more likely (muscle)
Tx: IVF to dilute, loop diuretics to pee it off, mithramycin - binds Ca in GI tract - poop it out |
|
|
Will hypocalcemia cause cells to be more/less likely to depolarize?
What is the treatment? |
More likely to depolarize at first (neurons), then less likely to depolarize (muscle)
Tx: CaCl, CaGluconate |
|
|
Will hyperkalemia cause cells to be more/less likely to depolarize?
What is the treatment? What will I see on EKG? |
More likely to depolarize at first, then K will get stuck inside cells and repolarization will become slower
Tx: Push insulin-glucose EKG: peaked T waves, widened T waves, prolonged QT interval |
|
|
Will hypokalemia cause cells to be more/less likely to depolarize?
What is the treatment? What will I see on EKG? |
Less likely to depolarize b/c K will rush out of cells
Tx: Replete K EKG: narrow T waves, flat T wave, flipped and inverted T wave, exaggerated flipped T wave = U wave |
|
|
Will hypernatremia cause cells to be more/less likely to depolarize?
What is the treatment? |
More likely to depolarize b/c Na rushes into cells but after a while Less likely b/c Na/K pump pumps it out
Tx: IV normal saline - correct slowly |
|
|
Will hyponatremia cause cells to be more/less likely to depolarize?
What is the treatment? |
More likely to deplarize b/c Na leaks out of cell using Na/Ca exchange and cell becomes more +
Tx: 3% saline - correct slowly |
|
|
What tissues don't use insulin for uptake of glucose?
|
B - Brain
R - RBCs I - Intestine C - Cardiac K - Kidney L - Liver E - Exercising muscle |
