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75 Cards in this Set

  • Front
  • Back
The amplitude of the pulse is described on a scale of 0 to 4 Describe 0 to 4.
a) 4 Bounding, aneurysmal
b) 3 Full, increased
c) 2 Expected
d) 1 Diminished, barely palpable
e) 0 Absent, not palpable
Acute myocardial infarction or ST-segment elevated MI (STEMI) results from what?
Lack of blood flow leads to tissue ischemia and irreversible cell death.
occlusive coronary thrombus at the site of a preexisting atherosclerotic plaque.
Coronary Artery Disease
In the management of a patient with acute myocarditis/pericarditis that presents with normal vs with Pericardial friction rub (velcro / crunching snow) what might you see on the EKG?
diffuse ST-segment elevations
There are four (4) components to a heart examination and must be completed in what order?
(a) Inspection
(b) Palpation
(c) Percussion
(d) Auscultation
What is the likely diagnosis for the following symptoms:
1) Pain similar to angina but more severe
2) Sternal CRUSHING chest pain with radiation to shoulder, arm, neck or jaw
3) Pain commonly described as pressure on chest (elephant sitting on chest)
4) Occurs at rest, commonly in the morning
5) Diaphoresis
6) Nausea and vomiting
7) Anxiety
8) Weakness or dizziness
9) 1/3 of patients with not have typical chest pain (older, female, diabetes) and have worse outcomes due to delayed treatment
Acute myocardial infarction AKA: Acute Coronary Syndrome (ACS)
Up to 2/3 of patients experiencing there 1st episode of A-fib will spontaneously revert to sinus rhythm within how many hrs?
24 hrs
The external jugular vein drains into what?
the subclavian vein
Check answer Chapter 16, pg 416
How do you calculate a heart rate from a 6 sec rhythm strip?
1. count the number of large squares between R waves with the following rates: 300 - 150 - 100 - 75 - 60 for regular QRS complexes
2. For a rough estimate on irregular rhythms add the QRS complexes in a strip
What is the likely diagnosis for the following symptoms:
1) Claudication: cramping pain or tiredness in the thigh, calf or foot with walking or exercise and relieved by rest
2) Pain unrelieved by rest are at high risk for amputation
3) Diminished femoral, popliteal or pedal pulses
4) Tissue ulceration and gangrene, NECROSIS
5) Erectile dysfunction
7) Thinning and cool skin
8) Atrophy of muscles
Lower Extremity Occlusive Disease
If the patient is in a tachy rhythm or hemodynamically unstable what is almost universally successful
synchronized electrical cardioversion preferred over vagal manuevers
Auscultate what in cardio exam for bruits or murmurs
The carotid arteries
NOT the angle of the mandible
In the chamber of the heart blood is transported by the pulmonary veins and it returns to the what?
Left atrium
Blood pressure measured with a patient supine tends to be higher than when measured when what?

Blood pressure may be elevated in patients with hypertension or decreased in low output states

Anything that increases blood volume, i.e. water retention will increase blood pressure
Complications: in chronic aflutter is the same as chronic atrial fibrillation. What complication?
Embolic event and should not be cardioverted until anti-coagulated
What separates the upper chambers of the heart?
Atrial septum
Ankle Brachial Index (ABI) Ratio of SBP at ankle
compared to brachial artery
< 0.9 (Normal is 1.0 - 1.2)
What is the thickest tissue of the heart?
DESCRIBE how venous blood returns to the heart
a. 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.
b. These pressure generated pushes blood in one direction, to the right atrium where the pressure is around O mm Hg
What are some causes for sinus tachycardia?
(1) AMI
(2) Cardiac Tamponade
(3) Aortic Dissection
Identify a 3rd degree heart block
P waves are consistant and QRS complexes are consistant but they do not communicate with each other
What are the smallest vessels?
During a cardio exam what do you inspect for indication of good venous return?
Inspect for cyanosis of the skin and cyanosis of the nailbeds and capillary refill
What medication is treatment for bradycardia
Administer Atropine .5mg bolus and repeat q3-5 mins, Max dose 3mg
1) If atropine is ineffective prepare for transcutaneous pacing
2) Or Dopamine IV 2-10mcg/kg min
3) Or Epinephrine IV 2-10mcg/kg min, use 1:10,000 solution
All systemic blood vessels filter into What?
the aorta
What are some typical causes of a heart murmur?
Any new onset heart murmur with fever is endocarditis until proven otherwise
Note: Obesity is NOT a primary cause of a heart murmur
What would you identify on the EKG with the following;
(a) Irregularly, irregular (R-R interval is irregular)
(b) Atrial rate 400/mins presenting as fibrillation waves (Wavy Baseline)
(c) Ventricular varies from brady to tachy and can be up to 170-180/min
What is identifed on an EKG with the following;
(a) Wide QRS complex
(b) Tachycardia, usually 160-240 beats/min
(c) Moderately regular
What has EKG with heart rate < 60 beats/min, normal and consistent P wave morphology, normal PR interval
What has;
(a) Sawtooth flutter waves
(b) Atrial rate between 250-350 beats/min
Atrial Flutter
What has premature and wide QRS without preceding P-wave and are very common, even in patients without heart disease, but occur most in patients with ischemic disease and are universally found in patients with AMI
Premature Ventricular Contraction (PVC)
The amount of blood ejected from the left ventricle into the aorta is defined as what?
(1) NOTE: 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
Cardiac output (CO)
What physical exam finding would be most helpful in diagnosing Left sided Heart failure
symptoms of low Cardiac Output and elevated pulmonary venous pressure; dyspnea
Which blood vessels have the lowest concentration of oxygen
Pulmonary artery
Pertinent data when your talking to someone with cardiovascular symptoms what is going to be pertinent in their PMHx
MI, HTN, Heart Dx, Diabetes ect...
Cardiac arrhythmias that originate from where have the potential to be the most dangerous
What is common complication associated with atrial-fib
coagulating blood in the atria that can cause a stroke or clot
What is identified as an EKG with heart rate 140-240 beats/min (commonly 160-220 beats/min) and has a regular rhythm. P wave may be buried in narrow QRS.
Paroxysmal Supraventricular Tachycardia (PSVT)
What are some age specific findings in older adults IRT Cardiac conditions
Generally older pts will have a slower heart rate making them less tolerable to tachycardia
Describe how pitting edema is scaled
a) 1+ Slight pit, disappears rapidly
b) 2+ Somewhat deep pit, disappears in 10 to 15 seconds
c) 3+ Noticeable deep pit that lasts more than a minute
d) 4+ Very deep pit that lasts 2 to 5 minutes
What Originates in the SA node and follows the appropriate conduction pathways. The rate is 60-100 beats/min and the rhythm is regular. Every beat has a P wave, and every P wave is followed by a ventricular response and what is the treatment for it?
Normal Sinus Rhythm. No treatment neccessary
What is defined as an abnormality in the cardiac conduction system
What is the appropriate treatment for a pt with the following rhythms are unstable;
V-Tach w/pulse
Cardio version at 100-200J for A-fib and SVT
Cardioversion at 25-50J for A-flutter and V-Tach w/pulse
What is the most appropriate treatment for stable wide and unstable narrow bradycardia rhythms?
Transcutanous pacing
What is the most appropriate treatment for pulseless V-tach or V-fib
1) CPR 2 mins/IV access
2) Check rhythm if shockable: shock
3) CPR 2mins, give 1mg Epinepherine IV
4) Check rhythm if shockable: shock
5) CPR 2mins, give Amiodarone 300mg IV bolus
6) Repeat
What is the most approriate treatment for Asystole or PEA
1) CPR 2 mins/IV access/Epinepherine 1mg q3-5 mins
2) Check rhythm: not shockable
3) CPR 2mins, give 1mg Epinepherine IV
4) Check for reversible causes
5) Repeat
What is defined as Heart rate faster than 100 beats/min caused by rapid impulse formation from the sinoatrial node.
Sinus Tachycardia
What is defined as Heart rate slower than 60 beats/min due to increased vagal tone on normal pacemaker or organic disease of the sinus node
Sinus Bradycardia
What is the appropriate treatment for a stable pt who has narrow tachycardia
Vagal Maneuvers
If vagal maneuvers fail IV agents will terminate up to 90% of episodes
a) Adenosine 6mg IV push, follow with saline flush, repeat with 12mg (x2) if
b) Β-blocker or calcium channel blocker to decrease HR
c) Verapamil 2.5 IV over 2 mins, followed by 2.5-5mg q1-3mins up to 20mg if
BP and rhythm are stable
What is the appropriate treatment for a pt with stable wide tachycardia
1) Lidocaine 1mg/kg IV bolus
2) Amiodarone 150mg IV over 10 mins, then 0.5mg/for 18-24hrs
3) Amiodarone may cause cardioversion back to SR
4) Procainamide IV 20mg/min up to 1000mg followed by 20-80mcg/kg/min
What is the appropriate treatment for a pt with A-fib or A-flutter
Patients with AF >48hrs are at risk for cardioembolic events and should not be cardioverted until anti-coagulated, unless they are unstable
1) Metoprolol 5mg IV bolus, can repeat q5mins (x2) or PO for total daily dose 50-400mg
2) Amiodarone 150mg IV over 10 mins, then 1mg/min infusion for 1st 6 hrs
How is a second degree type 1 heart block identified on an EKG?
P-R interval gets longer with each beat until QRS is dropped
When you see a rhythm strip showing a NSR what is the appropriate treatment?
No treatment is necessary
How is a second degree type II heart block identified
P-R interval remains constant (<0.2) and then a dropped QRS complex
What are some examples of metabolic syndrome
What would the most likely diagnosis be for the following risk factors;
(a) Hypercholesterolemia
(b) Hypertension
(c) Diabetes mellitus
(d) Male gender
(e) Smoking
(f) Family History
atherosclerotic disease
What are some potential complications from DVT
Amputation if left untreated
55 y/o M w/ cc of cramping pn in L calf which pn started 3 months ago only hurts with excercise (poss lower extremity occlusion)
Now the pn comes w/rest. upon exam you note L calf smaller than R, has almost no hair, L dorsalis pedis pulse are absent. Takes Zocor for Hyperlipidemia, Smoker, Drinks every day. What is the definitive therapy
Select appropriate answer:
a) Diet and Excercise
b) Smoking Cessation
c) Anti-coagulation
When you have a patient with MI physiologically what are we trying to accomplish with MONA protocol
Trying to minimize the extent of the infarction.
Infaction is dead tissue
Ischemia is tissue without oxygen
What dose of asprin would you give a pt with an infarct
325mg chewed up
What does MONA stand for
What is an example of obstructive type shock
Emergent medical conditions preventing blood flow into and out of heart
(a) Cardiac tamponade
(b) Tension pneumothorax
(c) Pulmonary embolism
What is the best treatment for an obstructive type shock?
Treat reversible cause of obstructive shock
What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion. This leads to hypoxia, acidosis and eventual end organ damage and failure
1) Hypovolemic
2) Cardiogenic
3) Distributive
4) Obstructive
What is the appropriate treatment for anaphylaxis
1) ABCs (secure airway!), O2, IV, Monitor
2) Epinephrine (Epipen) 0.1-0.5mg SC/IM repeat q 10-15 mins
a) Epipen delivers 0.3mg IM dose
3) IV fluid (LR or NS) bolus
4) Ancillary Treatments
a) Benadryl IV 50mg
b) Zantac 50mg IV
c) Solumedrol 125mg IV
On a cellular level what is the following describe?
Massive release of histamine and other vasoactive substances cause systemic
vasodilation, potential airway compromise due to airway edema and bronchospasm
Packed red blood cells raises the hemaocrit level by what?
What is the complication for myocarditis
Heart failure
What is the most likely diagnosis for the following symptoms;
Substernal chest pain which is usually pleuritic (sharp), possible radiation to neck,
shoulder or arm
1) Pain is worse when supine and relieved by sitting
2) Febrile
3) Pericardial friction rub is most common sign (Sounds like: velcro/crunching snow)
What is the treatment for pericarditis
Aspirin 650mg q3-4hrs or NSAID (Indomethacin/Motrin) for 7 days to 3 weeks
What is an actual ausculitory finding in Mitral Regurgitaion
Pansystolic Murmur maximal at apex and radiating into the axilla
What are the complications for valvular heart disease
(1) Arrythmias
(2) Acute congestive heart failure
(3) Pulmonary edema
(4) Syncope
(5) Sudden death
1) Acute Myocardial Infarction / Unstable Angina
2) Pulmonary Embolism (PE)
3) Pericardial Tamponade
4) Esophageal Rupture
5) Tension Pneumothorax / Pneumothorax
6) Aortic Dissection / Rupture
Why do we rule out the "Big 6 +1"
If you can rule out these 6 etiologies, you can very likely feel that the patient will
survive the next 24 hours.
What is the difference between stable and unstable angina?
Stable angina: chest pain with exertion, relieved by rest

Unstable angina: chest pain while resting
Prinzmetals angina: rare, caused by what?
coronary vasospasm often without CAD (coronary constriction)
What are the long acting prophylactic therapies for angina
(a) Nitroglycrine SL or Spray
(b) Long acting nitrates
(c) Β-blocker
(d) Calcium channel blocker