FISDAP Cardiology Exam Study Guide latest updated

Intrinsic rates - ANSWER-SA node - 60 - 100 bpm AV junction - 40 - 60 bpm Purkinje network - 20 - 40 bpm Lidocaine doses - ANSWER-1-1.5 mg/kg, second dose 0.5-0.75 mg/kg Unstable VT tx - ANSWER-Should be treated with synchronized cardioversion Hypotension, decreased LOC, shock, chest pain Stable VT tx - ANSWER-IV/IO Adenosine 6mg; 12mg (followed by rapid saline flush) If ineffective, procainamide (20-50mg/min or amiodarone (150mg IV/10min) Consider antiarrhythmic infusion Definition of second degree type 2 (mobitz type II) - ANSWER-Conduction usually occurs in bundle of His (bundle branches); appears as one or more P waves not followed by QRS (indicates SA node impulse was not conducted by ventricles) Causes - ischemic heart disease, anterior wall MI, infectious heart diseases Action of nitroglycerin - ANSWER-Vasodilator; relaxes smooth muscle in vasculature, bronchial, uterine, and intestinal muscle; reduces preload and afterload, decreasing workload of the heart and myocardial oxygen demand Sino atrial dysrhythmias in lead 2 - ANSWER-Premature atrial complex (PAC), supraventricular tachy (SVT), preexcitation (early depolarization of ventricles), a-fib, a flutter, wandering atrial pacemaker (WAP), multifocal atrial tachy (MAT) ST elevation in V3 and V4 MI location? - ANSWER-Anterior wall MI S/S of thoracic aortic dissection - ANSWER-Abrupt onset of constant, unbearable pain described as tearing or ripping and sharp, stabbing, or knifelike Definition of CO - ANSWER-Cardiac output - amt of blood pumped by ventricle in 1 minute (normal 5-6 L/min) Stroke volume - amt of blood pumped by either ventricle in single contraction (normal 60 - 100 mL) CO = SV x HR(heart rate) Causes of CHF - ANSWER-Coronary artery disease (CAD, buildup of plaque in coronary arteries) *Left ventricular failure (left ventricle fails, blood backs up into the left atrium, left atrium swells {can cause atrial dysrhythmia}, pulmonary veins cannot pump into left atrium, pressure in pulmonary vessels increases, forcing fluid from pulmonary capillaries across alveolar walls into alveoli, causes pulmonary edema, impairs diffusion of oxygen and CO2) Right ventricular failure (right ventricle fails, blood backs up into right atrium, pressure rises in right atrium, blood backs up into superior & inferior venae cavae, delays venous return, causes organs to become congested with blood; as venous pressure increases fluid is forced thru the capillary walls into body's tissues, causing edema) Cor Pulmonale - ANSWER-RVF caused by pulmonary disease; usually result of COPD (pulmonary HTN is increased pressure in pulmonary arteries, so right ventricle has to work harder to overcome the pressure, causes RV to fail) S/S of pulmonary embolism and causes - ANSWER-Causes - blood clot (DVT common), fat embolism from broken bone, amniotic fluid embolism, air embolism S/S - sudden dyspnea and cyanosis that is not resolved with oxygen therapy, sharp chest pain Sodium Bicarb dose - ANSWER-1 mg / KG slow IVP; repeat 0.5 mg / kg ; same initial for peds, no repeat Management of CP, SOB and nausea - ANSWER-Decrease respiratory distress and work of breathing, maintain adequate oxygenation and perfusion, attempt to decrease workload of the heart OD of atenolol tx - ANSWER-IV glucagon Definition of sync cardioversion - ANSWER-Use of synchronized direct current electric shock to convert a tachydysrhythmia to a normal sinus rhythm Symptomatic bradycardia tx - ANSWER-Supportive (ABCs), Identify cause (Hs and Ts) Atropine (0.5mg q 3-5min, Max 3mg) If not effective, Transcutaneous pacing Dopamine infusion (2-10mcg / kg / min) or Epinephrine infusion (2-10mcg / kg / min ) Definition and appearance of sinus arrhythmia - ANSWER-irregular heartbeat that's either too fast or too slow Inferior MI with R side involvement tx - ANSWER-Aspirin Fluid challenge (TKO) Fentanyl (50mcg) OR Morphine Cardiogenic shock tx - ANSWER-Vasopressors and aspirin Epinephrine, Norepinephrine, dopamine Definition of QRS wider than 0.12ms - ANSWER-delay in the conduction tissue of one of the bundle branches (RBBB, LBBB) Propranolol class - ANSWER-beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. S/S of CVA {Cerebral vascular accident (stroke)} - ANSWER-Ischemic stroke - caused by an occlusion (blockage); the tissue distal to the blockage will become ischemic Hemorrhagic stroke - "worst headache of my life"; caused by hemorrhage in the brain Symptoms - F.A.S.T (face, arms, speech, time) Indicators of increased ICP - increased BP, decreased HR and RR, posturing, unequal pupils, abnormal respiratory patterns EKG indications of hyperkalemia - ANSWER-"sharp" pointed T wave Q waves indicate - ANSWER-Ventricles received SA node signal Definition of TIA - ANSWER-Transient ischemic attack - episode of cerebral ischemia w/o any permanent damage; presents as a stroke; usually only lasts 1 hr Definition of DVT - ANSWER-Deep vein thrombosis - development of a blood clot in the deep vein of extremities ; high risk for clot to travel to lungs and cause PE Stimulation of Beta 1 in the heart - ANSWER-Increases sinoatrial (SA) nodal, atrioventricular (AV) nodal, and ventricular muscular firing, thus increasing heart rate and contractility. With these two increased values, the stroke volume and cardiac output will also increase. Relative refractory period - ANSWER-Heart muscle has been partially repolarized and may depolarize in response to electrical stimulus (some cells have repolarized enough to depolarize again); top of T wave (mid phase 3) to end of T wave (beginning phase 4) Criteria for hypothermia protocol - ANSWER-ROSC protocol Targeted Temperature Management 32-36C Acetylsalicylic acid - ANSWER-aspirin Class - platelet inhibitor, anti-inflammatory agent MOA - stops clots from forming Angina pectoris - ANSWER-the sudden pain that occurs when the oxygen supply to the myocardium is insufficient to meet demand, causing ischemic changes in the tissue Cardiac electrical conduction system - ANSWER-network of cardiac tissue that initiates and conducts electrical impulses Dominant pacemaker is SA node, impulse travels to AV node, to AV bundle (gatekeeper between atria and ventricles), to right and left bundle branches Cardiac action potential phases - ANSWER-0 - cardiac muscles receive an impulse (beginning of QRS) 1 - cells begin to repolarize (end of QRS) 2 - (plateau phase) depolarization (ST segment) 3 - repolarization is complete (T wave) 4 - resting phase (TP interval) Coronary circulation physiology - ANSWER-left main - splits into left anterior descending and circumflex; supply oxygenated blood to left ventricle and interventricular septum right - supplies oxygenated blood to wall of right atrium and right ventricle, inferior left ventricle Effects of intrathoracic pressure on cardiac output - ANSWER-squeezes heart, hypotension Increased intrathoracic pressure caused by positive pressure ventilation creates pressure against which the heart must pump Increases the afterload (amt of resistance against the ventricle when contracting) and can further decrease cardiac output effects of vagal nerve stimulation - ANSWER-bradycardia Pharmacology therapy for cardiogenic shock - ANSWER-Vasopressors (Epi, Norepi, Dopamine) ASA MOA for cardiac medications - ANSWER-Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the hearts work easier. Sputum - ANSWER-Thick green, brown, or yellow may indicate infection Pink, frothy indicates pulmonary edema Blood may indicate trauma or carcinoma (cancer) Starling's Law - ANSWER-stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction (rubber band) Identify and treat pulseless electrical activity - ANSWER-CPR Epi (1mg) q 3-5min until termination or change in rhythm Identify and treat wide complex tachycardia - ANSWER-QRS greater than 0.12ms 150+ BPM, palpable pulse Stable: Adenosine (6mg; 12mg RIVP) If ineffective, Procainamide (20-50mg / min) OR Amiodarone (150mg / 10min) Unstable: Cardioversion @ 100 joules AMS, Ischemic chest discomfort, acute heart failure, respiratory distress, hypotension or other signs of shock. (lack of perfusion) Treatment of ventricular fibrillation - ANSWER-CPR Defibrillate (120-200j biphasic or 360j monophasic) Epi (1mg q 3-5min) Amiodarone (300mg repeat 150mg IV) Treatment of Torsades de Pointes - ANSWER-Stable pt: IV Magnesium Unstable pt: Defibrillation