Cardiac

Front 1

Which part of stethoscope is used for high pitched sounds? Give examples of sounds in

Back 1

Diaphragm

(S1 & S2)

Front 2

Which part of stethoscope is used for low pitched sounds? Give examples of sounds in

Back 2

Bell ( S3 & S4)

Front 3

Which ❤️ sound indicates closure of the tricuspid & mitral (AV) valves? Signals beginning of systole (ventricular contraction)? Best heard w/ diaphragm? Soft “lub” sound

Back 3

S1

Front 4

Which ❤️ sound indicates closure of the aortic & pulmonic (semilunar) valve‘s? Signals the beginning of diastole? High-pitched best heard w/ diaphragm? Sharp dub or dup sound?

Back 4

S2

Front 5

What is an abnormal 💓 that has extra 💓 heard in early diastole? Heard close after S2 known as “ventricular gallop”? Maybe normal in young adults (🏋🏻‍♂️🏃🏻‍♂️), considered pathologic in pts w/ 💔 failure or mitral valve regurgitation?

Back 5

S3

Front 6

Explain the Kentucky gallop.

Back 6

[S1(Ken) S2(tuc) S3(ky)]

The rhythm & stress of S1 followed by S2 & S3 together

Front 7

What is an abnormal extra 💓 heard in late diastole? Precedes S1 Of next cardiac cycle (atrial gallop/presystolic gallop)? Low pitched/frequency vibration caused by atrial contraction, maybe normal inolder adults w/o CAD? Pathologic in pts w/ CAD, cardiomyopathy, aortic stenosis, L-ventricular hypertrophy

Back 7

S4

Front 8

When does the S4 💓 occur?

Back 8

Just after atrial contraction at the end of diastole & immediately before S1 producing a rhythm sometimes referred to as the “Tennessee gallop” were S4 represents the “Tenn” syllable

Front 9

What is generated by turbulent flow blood, can be physiologic (benign) or pathologic (abnormal), characterized by loudness, pitch, quality, timing, duration, grades?

Back 9

Heart murmurs

Front 10

High-pitched scratchy sound heard during S1/S2 at the apex of the heart? Transient or intermittent, may last several hours/days?

Back 10

Pericardial friction rub

Front 11

When is pericardial friction rub best heard?

Back 11

When the patient is sitting and leaning forward at the end of expiration

Front 12

How is pericardial friction rub caused?

Back 12

By friction that occurs when inflamed surfaces of the pericardium move against each other (pericarditis)

Front 13

6 Things to include in abnormal heart sound documentation when heard?

Back 13

-if occurred during systole/diast

-anatomic location where heard loudest

-Heard with diaphragm or bell?

-position of pt (recumbent/leaning forward)

-characteristics of sound (soft/musical)

-other abnormal findings (irregular rhythms, palpable chest wall heaves)

Front 14

How do you remember where heart valves & auscultation points are located?

Back 14

Aortic valve

Pulmonic valve

Erb’s point

Tricuspid valve

Mitral valve

Front 15

Where is the aortic valve auscultated?

Back 15

2nd intercostal space, right sternal border

Front 16

Where is the pulmonic valve auscultated?

Back 16

2nd intercostal space, left sternal border

Front 17

Where is Erb’s point auscultated?

Back 17

Left intercostal space, close to sternum

Front 18

Where is the tricuspid valve auscultated?

Back 18

5th Intercostal space, close to the sternum

Front 19

Where is the mistrial valve auscultated?

Back 19

5th intercostal space, left midclavicular line

Front 20

What are the symptoms of sinus bradycardia?

Back 20

Pale cool skin

Hypotension

Weakness

Angina

Dizziness/syncope

Confusion/disorientation

SOB

Front 21

What are the nursing interventions for a patient with symptoms of sinus bradycardia?

Back 21

-give IV atropine

(If ineffective, transcutaneous pacing or a dopamine or epinephrine infusion)

-permanent pacemaker therapy maybe needed

(if bradycardia due to drugs, may be held/DC/reduced)

Front 22

What are the symptoms of sinus tachycardia?

Back 22

Dizziness

dyspnea

hypotension

⬆️myocardial O2 consumption

Angina

Front 23

What are the nursing interventions for sinus tachycardia?

Back 23

From pain=pain meds

Stable=vagal maneuvers

⤴️HR/O2= IV bblockers (metoprolol, lopressor), calcium channel block (cardizem)

Unstable= synch cardioversion

Front 24

What are the symptoms of premature atrial contractions (PAC)?

Back 24

-palpitations

-heart “skipped a beat”

-May indicate enhanced automaticity of the atria or a reentry mechanism (Supraventricular tachycardia)

Front 25

How do you treat premature atrial contractions (PAC)?

Back 25

Stop caffeine or sympathomimetic drugs

-use beta blockers

Front 26

What are the symptoms of paroxysmal supraventricular tachycardia?

Back 26

-prolonged episode & HR greater than 180 beats/minute

-⤵️ CO

-hypotension

-palpitations

-dyspnea

-angina

Front 27

How is paroxysmal superventricular tachycardia treated?

Back 27

Vagal stimulation/drug therapy

(Valsalva/carotid massage, coughing)

-IV adenosine (plus bblockers/ccb diltiazem/Calan)

-synchronized cardioversion (if others dnt work/unstable)

Front 28

What is the ongoing treatment of recurring paroxysmal supraventricular tachycardia in pts w/ WPW syndrome?

Back 28

Radio frequency catheter ablation of the accessory pathway

Front 29

What are the symptoms of atrial flutter?

Back 29

-tachydysrhythmias (200-350b)

-⤴️ ventricular rates

-loss of “atrial kick”

(HF/Stroke) give warfarin

Front 30

How is atrial flutter treated?

Back 30

Radiofrequency catheter ablation

Slowing ventricular response by increasing AV block

(calcium channel blocker/beta blocker’s)

-electrical cardioversion

-anti-dysrhythmia drugs (ibutilide)

-maintain rhythm (amiodarone, flecainide)

Front 31

What are the symptoms of atrial fibrillation?

Back 31

350-600bpm

-⤵️CO

-thrombi clots form in atria

(Stroke)

Front 32

What are the nursing interventions for atrial fibrillation?

Back 32

-ventricular rate control (diltiazem, metoprolol, digoxin)

-electrical conversion

-antidysrhymia drugs (amiodarone/ibutilide)

-anticoagulation therapy (warfarin if longer than 48hrs)

-if nonvalvular=dabigatran, apixaban, rivaroxaban

-if nothin works= radiofrequency catheter ablation, maze procedure, AV nodal ablation (pace maker)

Front 33

What is a treatment strategy to prevent blood clot formation of patient who had atrial fibrillation?

Back 33

Left atrial appendage inclusion (LAA)

Front 34

What are the symptoms of junctional dysrhythmias?

Back 34

*61-100bpm accelerated or 101-180bpm tachycardia

-Safety mechanism when SA node is not effective

Junctional tachycardia (hypertensive-hemodynamically unstable, ⤵️CO) emergency

Front 35

How are junctional Dysrhythmias treated?

Back 35

Escape rhythm= atropine

Accelerating rhythm/tachycardia= stop drug causing

(Use bblockers, ccb if no toxicity) no cardioversion

Front 36

What are the nursing interventions for first degree AV block?

Back 36

No treatment

Monitor patient for any new changes in heart rhythm

Front 37

What are the nursing interventions for Second-Degree AV block type 1?

Back 37

Symptomatic=atropine ⤴️HR

-temporary pacemaker (MI)

Asymptomatic= observe closely, pacemaker on standby

Front 38

What are the symptoms of second-degree AV block type 2?

Back 38

(Poor prognosis)

-⤵️HR/CO/BP

-myocardial ischemia

(need permanent pacemaker)

Front 39

How is second degree AV block type 2 treated?

Back 39

-transcutaneous pacing or temporary pacemaker

Front 40

What are the symptoms of third degree AV block?

Back 40

⤵️CO/Subsequent ischemia HF and shock

-syncope, periods of asystole

Front 41

Kind of dysrhythmia?

Back 41

None, regular

Front 42

What kind of artifact is this?

Back 42

Muscle tremor

Front 43

What kind of artifact is this?

Back 43

Loose electrodes

Front 44

Name this ekg.

Back 44

Sinus bradycardia

Front 45

Name this ekg.

Back 45

Sinus tachycardia

Front 46

Name this ekg.

Back 46

(PAC) Premature Atrial Contraction

Front 47

What is this an example of?

Back 47

Atrial flutter

Front 48

What is this an example of?

Back 48

Atrial fibrillation

Front 49

Name this heart block.

Back 49

1st degree atrioventricular block

Front 50

Name this heart block.

Back 50

Second degree AV block type I (w/ progressive lengthening of PR interval until a QRS complex is blocked)

Front 51

Name this heart block.

Back 51

2nd degree AV block II (w/ constant PR intervals & variable blocked QRS complexes)

Front 52

Name this heart block.

Back 52

3rd degree AV block

Front 53

What are these various examples of?

Back 53

Premature ventricular contractions

Front 54

Which type of ventricular tachycardia is this?

Back 54

Monomorphic

Front 55

Which type of ventricular Tachycardia is this?

Back 55

Torsades de pointes (polymorphic)

Front 56

What is this an example of?

Back 56

Ventricular fibrillation

Front 57

How is 3rd degree AV block treated?

Back 57

-Transcutaneous pacemaker until temporary transvenous pacemaker inserted

-dopamine & epinephrine

-(need permanent pacemaker)