Term
| What are the three different types of cardiac cells |
|
Definition
| pacemaker, conduction, and muscle(worker) cells |
|
|
Term
| What are the three layers of the heart? |
|
Definition
| Myocardium, Endocardium, Pericardium |
|
|
Term
| What are the three prevention strategies for heart disease and preventible heart disease related deaths? |
|
Definition
| Early recognitino, education, and alteration of life style |
|
|
Term
| What are some possible contributing risks for heart disease? |
|
Definition
| Diabetes, cocaine use, oral contraceptives, personality type, psychosocial tensions |
|
|
Term
| What is the average stroke volume? |
|
Definition
|
|
Term
| What is starlings law of the heart? |
|
Definition
| The greater the heart fibers stretch, the greater the contraction. (Like a rubber band) |
|
|
Term
| What is the formula for cardiac output? |
|
Definition
| Stroke volume* heart rate= cardiac output |
|
|
Term
| What is the chemical mediator of the parasympathetic nervous system? |
|
Definition
|
|
Term
| What is the neurotransmitter of sympathetic nerve fibers? |
|
Definition
|
|
Term
|
Definition
| it refers to the strength of cardiac muscle contraction |
|
|
Term
|
Definition
| Refers to the regulatarity and rate of the heart rate |
|
|
Term
|
Definition
| it refers to the conduction velocity. |
|
|
Term
| The parasympathetic system primarly has nerve fibers in what part of the heart? and how do they affect the heart |
|
Definition
| They are primarly in the atria and generally only has a chronotropic affect. |
|
|
Term
| Where are the sympathetic nerve fibers primarly located? |
|
Definition
| In the atria and ventricles. They generally have a chronotropic and inotropic affect. |
|
|
Term
| In a tachacardic state, when does the heart rate efficency decrease |
|
Definition
|
|
Term
| what are the major electrolytes that the heart relies on |
|
Definition
| sodium, potassium, calcium, chloride, and magnesium |
|
|
Term
| What is the outer layer of the heart? |
|
Definition
|
|
Term
| What are the name of the coronary arteries |
|
Definition
| The left and right coronary artery |
|
|
Term
| What layer of the heart is the work horse? |
|
Definition
|
|
Term
| What is the purpose of the endocardium |
|
Definition
| it provides a smooth surface for the blood to flow easily |
|
|
Term
| What is the fluid called that is in the pericardial sac? |
|
Definition
|
|
Term
| What is the ejection fraction? |
|
Definition
| Its the percentage of blood ejected from the heart during contraction |
|
|
Term
| What type of muscle makes up the heart? |
|
Definition
| striated (similar to skeletal muscle) |
|
|
Term
| What is the basic protein unit responsible for contraction? |
|
Definition
|
|
Term
| What are the three types of specialized electrolyte channels on cardiac cells |
|
Definition
| Sodium, potassium, and calcium |
|
|
Term
| What "channel" reduces the hearts ability to contract? |
|
Definition
|
|
Term
| Why do cardiac markers work when trying to determine if cellular death has occured? |
|
Definition
| When the cardiac cell dies, the cell membrane leaks substances into the blood stream and the markers read that. |
|
|
Term
| What heart valves use "leaflets or cusps" |
|
Definition
| The atrioventricular valves |
|
|
Term
| what cardiac valves are shaped like half moons? |
|
Definition
| Semilunar valves (notice the word Lunar) |
|
|
Term
| Of the two types of heart valves, which type is thicker and why? |
|
Definition
| Semilunar valves are thicker because they do not have chordae tendineae |
|
|
Term
| What is the property called that allows cardiac cells to stimulate there own electrical impulse called? |
|
Definition
|
|
Term
| What muscles hold the chordae tendineae in place? |
|
Definition
|
|
Term
| What structures in the heart are also called heart strings? |
|
Definition
|
|
Term
| What is it called when a heart valve inverts? |
|
Definition
|
|
Term
| What physically happened to the heart when the patients develops a murmur? |
|
Definition
| Some of the papillary muscles ruptured or tore. This prevents the heart valve to close completely. |
|
|
Term
| What are normal heart sounds considered? |
|
Definition
|
|
Term
| What happens during S1 (lubb) sound? |
|
Definition
| The av valves close and the ventricles contract producing a lubb sound |
|
|
Term
| When happens during S2 (dubb) sound |
|
Definition
| This happens during the ventricular relaxation when the semilunar valves close |
|
|
Term
| What would be considered an abnormal heart sound? |
|
Definition
| Its known as the S3 sound. This is heard when the ventricle is filling. |
|
|
Term
| Why is an S3 lung sound considered abnormal? |
|
Definition
| Its associated with heart failure |
|
|
Term
| What is the largest vein that drains the heart? |
|
Definition
|
|
Term
| What is the purpose of atrial kick? |
|
Definition
| It is to pressurize the ventricles for a bigger contraction. Think of sterlings law. |
|
|
Term
| Where are the openings to the coronary arteries? |
|
Definition
| they are found at the base of the aortia beyond the base of the aortic SL valve |
|
|
Term
| When do the coronary arteries fill? |
|
Definition
| during the ventricle relaxation |
|
|
Term
| What layer of the heart has the coronary arteries in it? |
|
Definition
|
|
Term
| What portion of the hearts conduction system is supplied by the Right coronary artery? |
|
Definition
| The av node and in some, the sa node |
|
|
Term
| Where does the coronary vein drain into the heart? |
|
Definition
|
|
Term
| Where are Beta 1 receptor cites found |
|
Definition
| they are found in the heart and kidneys |
|
|
Term
| What does stimulation of the beta 1 receptor sites do to the kidneys? |
|
Definition
| It stimulates the release of renin which promotes the production of angiotensin which is a potent vaso constrictor |
|
|
Term
| What is the formula for Blood pressure? |
|
Definition
| it is cardiac output*peripheral vascular resistance |
|
|
Term
| What is the DEF of preload? |
|
Definition
it is left ventricular end-diastolic pressure
|
|
|
Term
|
Definition
| the volume of blood returning to the heart |
|
|
Term
| What is ultimately happening when a vagal maneuver is used? |
|
Definition
| Its applies pressure to the baroreceptors in the carotid arteries stimulating the vagal nerve thus slowing the conduction through the av node |
|
|
Term
| How does the vagal nerve partially control the heart rate? |
|
Definition
| It slows the conduction through the AV node |
|
|
Term
| The anterior surface of the heart is made up mostly of the ? |
|
Definition
|
|
Term
| How does the SA node maintain control over the conduction system? |
|
Definition
| It depolarizes faster than the other pacemaker sites not allowing them to fire on their own |
|
|
Term
| What is the unit of measurement for the amount of energy potental in cardiac cells |
|
Definition
|
|
Term
| Why does depolarization happen? |
|
Definition
| It happens when sodium moves into the cell causing it to be intracellularly positive causing depolarization |
|
|
Term
| When a cardiac cell is polarized, is it more negative or positive on the inside |
|
Definition
|
|
Term
| How many phases of the cardiac cycle are there |
|
Definition
|
|
Term
| Which phase is considered the electrical diastole. |
|
Definition
|
|
Term
| What are three basic reasons for dysrhythmias? |
|
Definition
| Enhanced automaticity, triggered activity, and reentry |
|
|
Term
| Where does the SA node normally get its blood supply from? |
|
Definition
|
|
Term
| Where is the AV node located |
|
Definition
| In the floor of the right atrium |
|
|
Term
| What artery supplies the AV node in most people |
|
Definition
|
|
Term
| What are the smaller portions of the left bundle branches called? |
|
Definition
|
|
Term
| The left bundle branch is responsible for what specific parts of the heart? |
|
Definition
| The septum and the left ventricle |
|
|
Term
| Fascicles eventually turn into? |
|
Definition
|
|
Term
| Why does the heart fire from the inside to the outside? |
|
Definition
| Its to contract in a twisting motion to wring out the blood in the ventricular chambers |
|
|
Term
| What are the three basic reasons for dysthythmias? |
|
Definition
| Enhanced automaticity, triggered activity and reentry |
|
|
Term
| What is meant by enhanced automaticity? |
|
Definition
| Cardiac cells that are not normally associated with a pacemaker function begin to depolarize spontaneously |
|
|
Term
|
Definition
| an impulse originating from a source other than the SA node |
|
|
Term
|
Definition
| is the spead of an impulse through tissue already stimulated by the same impulse |
|
|
Term
| What are examples of an reentry rhythm |
|
Definition
| tachycardias and premature beats |
|
|
Term
| What is meant by and escape beat or rhythms |
|
Definition
| It is when the SA node fails to fire properly and a lower part of the conduction system has to take over to produce electrical impulses |
|
|
Term
| How are escape beats protective to the body? |
|
Definition
| They try to maintain cardiac output |
|
|
Term
| What does the EKG truely measure? |
|
Definition
| It measures the activation and recover of working cells of the heart? |
|
|
Term
| True or false- Try to place the EKG pads over bony areas? |
|
Definition
| False. Putting the pads over bony areas will cause artifact |
|
|
Term
| What are bipolar leads and examples of them |
|
Definition
They are leads that have both a postive and a negative electrode
Leads I, II, III |
|
|
Term
| Standard limb leads are also known as? |
|
Definition
|
|
Term
| What is a lead that consists of a single positive electrode and a reference point? |
|
Definition
|
|
Term
| What are examples of Unipolar leads |
|
Definition
|
|
Term
| Unipolar leads are also known as? |
|
Definition
|
|
Term
Why are leads being put on the patients chest now in days?
Is this the proper way? |
|
Definition
To minimize artifact,
No, the proper way is putting them on the patients limbs |
|
|
Term
| Does it matter where the leads are placed on a patients extremity? |
|
Definition
| No, just as long the bony areas are avoided |
|
|
Term
| What lead is commonly used for cardiac monitoring? |
|
Definition
|
|
Term
| Lead I views what part of the heart? |
|
Definition
|
|
Term
| Lead II views what part of the heart? |
|
Definition
|
|
Term
| Lead III views what part of the heart |
|
Definition
|
|
Term
| When using a augmented limb lead, what is the negative electrode? |
|
Definition
|
|
Term
| Are the precordial leads unipolar or bipolar? |
|
Definition
|
|
Term
| Are all unipolar leads negative or positive? |
|
Definition
|
|
Term
| Why are modified chest leads usefull? |
|
Definition
| they are usefull indetecting bundle branch blocks, differentiating right and left premature beats, and differentiating supraventricular tachycardia from ventricular tachycardia |
|
|
Term
| What precodial leads are used to determine bundle branch blocks? |
|
Definition
|
|
Term
| What does the horizontal axis on ekg paper represent? |
|
Definition
|
|
Term
| What does the vertical axis on Ekg paper represent? |
|
Definition
| voltage or amplitued expressed in millivolts |
|
|
Term
|
Definition
|
|
Term
| Each 1mm box represents how much time? |
|
Definition
|
|
Term
| What is the width of one large box? |
|
Definition
|
|
Term
| How much time is expressed by a large box? |
|
Definition
|
|
Term
| How many large boxes on EKG paper does it take to equal one second? |
|
Definition
|
|
Term
| One small box is equall to how many millivolts? |
|
Definition
|
|
Term
| What is the isoelectric line? |
|
Definition
| It is the flat horizontal line indicating no measurable voltage |
|
|
Term
| What does the P wave represent? |
|
Definition
|
|
Term
| Why is Atrial repolarization normally not seen? |
|
Definition
| Because it would be small and buried in the QRS complex |
|
|
Term
| Will the Q wave always have a positive or negative direction on the EKG paper? |
|
Definition
|
|
Term
| What does the Q wave represent? |
|
Definition
| It represents depolarization of the interventricular septum |
|
|
Term
| If a certain EKG wave from is normal it is also considered ______? |
|
Definition
|
|
Term
| Abnormal EKG wave forms are called _____? |
|
Definition
|
|
Term
Patients with a suspected MI, what part of the QRS wave form should be monitored and trended?
(Excluding S-T segments) |
|
Definition
|
|
Term
| Patients with MI's, what will typically happen to the Q wave? |
|
Definition
| it becomes wider and deeper |
|
|
Term
| What leads look at the hearts inferior surface? |
|
Definition
|
|
Term
| If the "QRS" complex is entirely negative its considered ______? |
|
Definition
|
|
Term
| When does the relative refractory period begin? |
|
Definition
| At the peak of the T wave |
|
|
Term
| What does a negative T wave suggest? |
|
Definition
|
|
Term
| What does a tall, pointed T wave typically represent? |
|
Definition
|
|
Term
| Is a U wave normal or abnormal? |
|
Definition
|
|
Term
| Where would you most likely find a U wave? |
|
Definition
|
|
Term
| What does the ST-segment represent? |
|
Definition
| Early repolarization of the ventricles |
|
|
Term
| Where is the J point found on a ECG? |
|
Definition
| It is where the QRS complex and the ST-segment meet |
|
|
Term
| How would you expect the ST-segment to look if there was myocardial ischemia |
|
Definition
|
|
Term
| For myocardial injury, what would you expect the ST-segment to look like |
|
Definition
|
|
Term
| If you saw ST-segment elevation in almost all leads, what would you suspect? |
|
Definition
|
|
Term
| What is a normal PR interval |
|
Definition
| 0.12-0.20 seconds (3-5 boxes) |
|
|
Term
| Why is a prolonged QT interval dangerous? |
|
Definition
| It indicates a lengthened relative refractory period and puts the patient and a bigger risk for life threating dysrhythmias |
|
|
Term
| What affects stroke volume? |
|
Definition
| Preload, Afterload and contractility |
|
|
Term
| What are the steps in a systematic approach to the analysis and interpretation of cardiac rhythms? |
|
Definition
1) Determine regularity
2)Calculate Rate
3)Examine the P waves
4) Measure PR interval
5) QRS
6) ST segment
7) T wave
8) U wave
9) QT interval
|
|
|
Term
| How can you determine the cardiac rate for an irregular rhythm? |
|
Definition
| The only way is to use the six-second method |
|
|
Term
| What do the heavy lines represent using the 300 method for determining rate? |
|
Definition
| 300, 150, 100, 75, 60, 50 |
|
|
Term
| What is the division method? |
|
Definition
| Count the boxes between R to R and divide by 1500 |
|
|
Term
|
Definition
| it is the time that it takes for the spread of an electrical impulse through the AV node to the purkinje fibers |
|
|
Term
| What is the normal duration of a QRS complex? |
|
Definition
|
|
Term
| What portion of the ECG tracing is used to determine the degree of ST- segment displacement? |
|
Definition
| The answer must be segment.... Its the TP or PR segment |
|
|
Term
| In leads I and II the right arm is negative or positive? |
|
Definition
|
|
Term
|
Definition
| Its an element or compound that ,when melted or dissolved in water or another solvent, breaks into ions |
|
|
Term
| What does the QT interval represent? |
|
Definition
| Total ventricular activity |
|
|
Term
|
Definition
|
|
Term
| what is the formula for cardiac output? |
|
Definition
|
|
Term
| True or false-- True Tachycardia varies with age? |
|
Definition
| True, Age is related to specific heart range rates |
|
|
Term
| When do the coronary arteries fill? |
|
Definition
| when the ventricles are at rest |
|
|
Term
| What happens to the heart rate during inspiration? |
|
Definition
|
|
Term
| What happens to the heart rate during expiration? |
|
Definition
|
|
Term
| What are the two other terms for a sinus arrest? |
|
Definition
| A sinus pause or sinoatrial arrest |
|
|
Term
| What is a compensatory pause? |
|
Definition
| a delyay that occurs following a premature beat that resets the SA node |
|
|
Term
| What are two nerve gases that work on the Crainial nerve X? |
|
Definition
|
|
Term
|
Definition
| It breaks down acetocholine so it is no longer activating cholinerigic nerves |
|
|
Term
| What is the all-or-none principle? |
|
Definition
| If one cell reaches threshold and depolarizes, they all will. |
|
|
Term
| What electrolite is required for the cardiac muscle contraction to occur? |
|
Definition
|
|
Term
| What are the 3 structures of the autonomic nervous system that control the heart? |
|
Definition
| Medulla, carotid sinus and baroreceptors, and chemoreceptors |
|
|
Term
| What will happen if alpha receptors are stimulated |
|
Definition
| vasoconstriction and mild bronchoconsitriction |
|
|
Term
| What is pulsus alternans? |
|
Definition
| Its alternating strong and weak beats indicitive of CHF |
|
|
Term
| What is pulsus paradoxus? |
|
Definition
| an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10mmHg |
|
|
Term
| What is preexcitation syndrome also known as? |
|
Definition
|
|
Term
| What are Cannon "A" waves? |
|
Definition
| They are when the atria contract with the ventricles and causes a pulsating in the jugular veins |
|
|
Term
| Every 3 second contains how many large squares? |
|
Definition
|
|
Term
|
Definition
| AKA- flutter waves commonly seen with A-flutter |
|
|
Term
| When does the risk of "throwing a clot" go up with A-fib/flutter? |
|
Definition
|
|
Term
| What are the three nonleathal reasons for angina pectoris |
|
Definition
| Aherosclerosis, Vasospastic (prinzmetals), ASCVD and vasopastic |
|
|
Term
|
Definition
| Its arteriosclerotic cardiovascular disease AKA arteriosclerosis |
|
|
Term
| When a cornary artery is stuttering, what does that mean? |
|
Definition
| its an intermittent coronary spasm |
|
|
Term
| What is the problem with stuttering? |
|
Definition
| there is a high risk of arrest |
|
|
Term
| What is the classic description of a AMI? |
|
Definition
| crushing, aching, pressure, squeezing, burning |
|
|
Term
| What are atypical signs of a AMI? |
|
Definition
| pain in the arm/jaw with out chest pain, SOB, Syncope, acute fatigue, abd pn, new onset of CHF |
|
|
Term
| What type of people are most likely to have atypical AMI |
|
Definition
| women, diabetics, and elderly |
|
|
Term
| What are the biggest charcteristics of AMI's |
|
Definition
| Usually have chest pn lasting longer than 30 min and is unrelieved by rest and or nitroglycerin |
|
|
Term
| How would the T wave present with ischemia |
|
Definition
|
|
Term
| What are the three injury patterns for cardiac tissue |
|
Definition
| Ischmeic, injury, necrosis |
|
|
Term
| What is considered a significant/pathological Q wave |
|
Definition
| Greater than 5mm, 25% of the R wave and greater than 0.04 seconds |
|
|
Term
| What on the ECG might indicate an old MI |
|
Definition
|
|
Term
| Abnormal q waves typically indicate what type of cellular injury? |
|
Definition
|
|
Term
| What is the main goals for management of a AMI? |
|
Definition
Minimize o2 requirements of the heart
Prevent/minimize occurrence of complications |
|
|
Term
| Where are the leads placed in a implanted ventricular pacemaker? |
|
Definition
|
|
Term
| Where are the leads placed in a atrial implanted pacemaker |
|
Definition
|
|
Term
| In regards to heart failure, what side normally goes first? |
|
Definition
| left side than the right side |
|
|
Term
| what are the S&S of right sided heart failure |
|
Definition
|
|
Term
| What is a rate-responsive pacemaker? |
|
Definition
they respond to a patients need for increased cardiac output by increasing the heart rate.
they do this by detecting patients movement to determine the best firing rate |
|
|
Term
| What is a asynchronous pacemaker |
|
Definition
| they are rarely used today, they continuously fire at a reset rate regardless of patients electrical activity |
|
|
Term
| Why does WPW look the way it does on a ECG |
|
Definition
| There is an assessory pathway that bypasses the av node and fires off the ventricles earlier than usual |
|
|
Term
| What type of wave will you find with WPW syndrome |
|
Definition
| Delta wave- its a rounding of the isometric line into the QRS |
|
|
Term
| What two affects does atherosclerosis have on blood vessels |
|
Definition
| it causes a loss of vessel elasticity and it reduces the diameter of the vessel lumen |
|
|
Term
| What is angina pectoris caused by? |
|
Definition
| its caused by an imbalance between myocardial o2 supply and demand. The burning sensation comes from the latic acid and Co2 build up |
|
|
Term
| When a patient is having a AMI, what do most patients die from? |
|
Definition
|
|
Term
| If you arrive on scene and the patient states that they have already taken their chest pain, what should the paramedic do next? |
|
Definition
| determine the age of the nitro |
|
|
Term
|
Definition
| Acute thrombotic occlusion- platelet response to a piece of plaque that broke off |
|
|
Term
| What is the most common cause of death from a AMI |
|
Definition
|
|
Term
| What do most patients blame there AMI symptoms on? |
|
Definition
|
|
Term
| When is it considered a sudden death? |
|
Definition
| death from a MI within two hours from the start of symptoms |
|
|
Term
| What are S&S of cardiac tamponade? |
|
Definition
| No pulse with CPR, Pulseless electrical activity, blue head and neck, JVD, muffled heart tones and no palpable pulse |
|
|
Term
|
Definition
It is three S&S of a cardiac tamponade
Narrowing of pulse presssure
Faint or muffled heart sounds
JVD |
|
|
Term
| What is an early sign of cardiac tamponade |
|
Definition
|
|
Term
| how do you know when cardiogenic shock is present? |
|
Definition
| it is present when shock persists after corretion of existing dysrhythmias, volume deficit or decreased vascular tone |
|
|
Term
| What is the treatment for pulmonary hypertension? |
|
Definition
| CPAP, Nitro, Furosemide, Morphine |
|
|
Term
|
Definition
|
|
Term
| What layer of an artery is the one that gets damaged forming a condition known as aneurysm |
|
Definition
|
|
Term
| What type of infections is most likely to cause an aneurysm |
|
Definition
|
|
Term
| What is Marfans syndrome? |
|
Definition
| Its a genitic disorder of connective tissue that can result in tearing of the aorta |
|
|
Term
|
Definition
It is a disease typically caused by PAD in which plauqe builds up in the legs causing decreased blood flow.
It is charcterized by pain in the legs while walking and stops during rest |
|
|
Term
|
Definition
| tear in the aortic intima allows blood to enter wall of aorta, pulling intima away from outer wall |
|
|
Term
| What are the S&S of an aortic dissection |
|
Definition
| Patient will discribe a ripping or tearing sharp pain and the pain may migrate from chest downward with progression |
|
|
Term
| What is the S&S of a aortic aneursm |
|
Definition
| Pulsating mass, pain from displacement of surrounding organs |
|
|
Term
| What is the S&S for a venous thrombosis |
|
Definition
| Pain/tenderness, distal edema, hot to the touch, red or bluish discoloration |
|
|
Term
| What are the biggest things to remember with any aneurysm? |
|
Definition
Consider treating hypotension
splint affected extremity
avoid manipulation of pulsatile mass
epeditious transport
|
|
|
Term
|
Definition
| patient is resuscitated and survives to hospital discharge |
|
|
Term
|
Definition
| Return to spontaneous circulation- patient is resuscitated to the point of having pulse without CPR |
|
|
Term
|
Definition
| to provide efforts to return spontaneous pulse and breathhing to the patient in full cardiac arrest |
|
|
Term
| What are some common criteria to continue resuscitation and transport |
|
Definition
patient is under 18,
arrest was witnessed by ems personnel
Persistent or recurrent ventricular tachycardia or fibrillation
FAMILY OR RESPONSIBLE PARTY OPPOSED TO TERMINATION |
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Term
| What criteria should not be considered in deciding to terminate resuscitation |
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Definition
Advacned patient age- geriatric
time of collapse
presence of non official DNR order
"Quality of life" valuations |
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