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Cardiology- CH 29
Mosby's Paramedic Textbook 3ED-R
212
Health Care
Undergraduate 1
12/03/2011

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Cards

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
70 mL 
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
Acetylcholine 
Term
What is the neurotransmitter of sympathetic nerve fibers? 
Definition
norepinephrine 
Term
Def of inotropic 
Definition
it refers to the strength of cardiac muscle contraction
Term
Def Chronotropic 
Definition
Refers to the regulatarity and rate of the heart rate 
Term
Def of dromotropic 
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
greater than 150 
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
epicardium 
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
Myocardium
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
Serous fluid 
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
Sarcomeres 
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
calcium
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
automaticity 
Term
What muscles hold the chordae tendineae in place?
Definition
papillary muscles 
Term
What structures in the heart are also called heart strings?
Definition
Chordae tendineae 
Term
What is it called when a heart valve inverts? 
Definition
prolapse 
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
S1 and S2 
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
Coronary sinus 
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
epicardial 
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
Into the right atrium
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
What increases preload
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
right ventricle 
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
millivolts 
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
negative 
Term
How many phases of the cardiac cycle are there 
Definition
5
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
Right coronary artery 
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
The right cornary artery
Term
What are the smaller portions of the left bundle branches called?
Definition
fascicles 
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
Purkinje fibers 
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
DEF of ectopic
Definition
an impulse originating from a source other than the SA node 
Term
DEF of reentry 
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
bipolar leads 
Term
What is a lead that consists of a single positive electrode and a reference point?
Definition
Unipolar leads 
Term
What are examples of Unipolar leads 
Definition
aVR, aVL, and VF
Term
Unipolar leads are also known as? 
Definition
Augmented limb leads 
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
Lead II
Term
Lead I views what part of the heart? 
Definition
the lateral surface 
Term
Lead II views what part of the heart? 
Definition
Inferior 
Term
Lead III views what part of the heart
Definition
Inferior 
Term
When using a augmented limb lead, what is the negative electrode?
Definition
The heart
Term
Are the precordial leads unipolar or bipolar?
Definition
They are unipolar 
Term
Are all unipolar leads negative or positive? 
Definition
They are all positive 
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
V1 and V6
Term
What does the horizontal axis on ekg paper represent? 
Definition
Time 
Term
What does the vertical axis on Ekg paper represent? 
Definition
voltage or amplitued expressed in millivolts 
Term
What does mV stand for? 
Definition
millivolts 
Term
Each 1mm box  represents how much time? 
Definition
0.04 seconds 
Term
What is the width of one large box? 
Definition
5 small boxes 
Term
How much time is expressed by a large box? 
Definition
0.20 seconds 
Term
How many large boxes on EKG paper does it take to equal one second? 
Definition
5 Large boxes 
Term
One small box is equall to how many millivolts? 
Definition
0.1 mV 
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
Atrial depolarization
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
Negative 
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
physiologic
Term
Abnormal EKG wave forms are called _____?
Definition
pathologic
Term

Patients with a suspected MI, what part of the QRS wave form should be monitored and trended?

(Excluding S-T segments)

Definition
Q waves 
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
II, III, aVF
Term
If the "QRS" complex is entirely negative its considered ______?
Definition
A QS complex 
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
Myocardial ischemia 
Term
What does a tall, pointed T wave typically represent? 
Definition
Hyperkalemia 
Term
Is a U wave normal or abnormal? 
Definition
abnormal
Term
Where would you most likely find a U wave?
Definition
After the T wave
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
Depressed 
Term
For myocardial injury, what would you expect the ST-segment to look like
Definition
elevated 
Term
If you saw ST-segment elevation in almost all leads, what would you suspect? 
Definition
pericarditis 
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
What is the PR-segment? 
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
0.10 seconds or less
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
negative 
Term
What is a electolyte 
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
What is a complex
Definition
its several waveforms 
Term
what is the formula for cardiac output? 
Definition
stroke rate x heart rate
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
it increases 
Term
What happens to the heart rate during expiration? 
Definition
it slows 
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
Sarin and VX 
Term

What is Cholinesterase? 




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
Calcium 
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
WPW syndrome 
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
15 large boxes 
Term
What are "F waves" 
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
48 hours 
Term
What are the three nonleathal reasons for angina pectoris
Definition
Aherosclerosis, Vasospastic (prinzmetals), ASCVD and vasopastic 
Term
What is ASCVD? 
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
It would be inverted 
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
abnormal q wave 
Term
Abnormal q waves typically indicate what type of cellular injury? 
Definition
Necrosis 
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
in the right ventricle 
Term
Where are the leads placed in a atrial implanted pacemaker
Definition
right atria 
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
lethal dysrhythmias
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
What causes most MI's 
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
fatal dysrhythmias 
Term
What do most patients blame there AMI symptoms on? 
Definition
fatigue
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
What is Becks triad?
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
Narrowing pulse pressure
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
DEF of aneurysm
Definition
dilation of a vessel
Term
What layer of an artery is the one that gets damaged forming a condition known as aneurysm
Definition
tunica media
Term
What type of infections is most likely to cause an aneurysm
Definition
syphilis
Term
What is Marfans syndrome?
Definition
Its a genitic disorder of connective tissue that can result in tearing of the aorta
Term
DEF- Claudication
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
DEF- Aortic dissection
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
DEF of survival
Definition
patient is resuscitated and survives to hospital discharge
Term
What is ROSC
Definition
Return to spontaneous circulation- patient is resuscitated to the point of having pulse without CPR
Term
DEF- Resuscitation
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

Term
What criteria should not be considered in deciding to terminate resuscitation
Definition

Advacned patient age- geriatric

time of collapse

presence of non official DNR order

"Quality of life" valuations

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