Cardiovascular Emergencies

Risk factors for Heart disease

The heart is strong enough to circulate how much blood around the body daily

The wall of the heart consist of what three layers

The term used to describe the period of time when the atria or ventricles are resting

The term used to describe the period of time when the atria or ventricles are contracting

Deoxygenated blood enters the _________ from the__________and proceeds to the________, and travels to the lungs via the ________

Oxygenated blood enters the ________ from the ________, proceeds to the __________, and is pumped to the body via the _________

The amount of blood that is pumped out either ventricle
&
Normal range of an adult

The amount of blood pumped out by either ventricle in a single contraction (heartbeat)
&
Normal range

The number of cardiac contractions (heartbeats) per minutes
& Normal range for Adults

The percentage of blood that leaves the heart each time it contracts (usually taken from only the left ventricle;its the primary pump for the heart)
& 
Normal range

The smallest veins are called _______ that empty in to the largest veins of the body are called_________ & ___________

If a patient is found unresponsive and is suspected of being in cardiac arrest the primary assessment order is

In the context of Acute Coronary Syndromes (ACS), dyspnea may be the first clue to:

What can happen when CO suddenly declines, leading to reduction in cerebral perfusion

An excellent indicator of the adequacy of cerebral perfusion

External jugular veins reflect the

Refers to an ECG tracing that is the result of interference, such as patient movement, rather than the heart's electrical activity

Every patient taking antihypertensive drugs should have their blood pressure checked in what positions:
To detect:

EPINEPHRINE HCL (1st drug)
Pulseless Arrest: Adult Dosage

AMIODARONE 
VF/Pulseless VT: Adult Dosage

ADENOSINE 
Conversion of supra ventricular tachycardias 
Adult Dosage:

Restriction of cardiac contraction, failing cardiac output, and shock, caused by the accumulation of fluid or blood in the pericardium

What valves lies between right atrium and right ventricle

What valve has only two cusps – Lies between left atrium and left ventricle

Cardiac output (CO) equals

Up to a limit, the more a myocardial muscle is stretched, the greater the force of contraction (and stroke volume)

Records electrical voltages (potentials) generated by depolarization of heart muscle

ECG strip: Width of each small box =

ECG strip: Width of each large box (5 small boxes) =

ECG Strip: 
•  5 large boxes (consisting of 5 small boxes) =
•  15 large boxes = 
•  30 large boxes =

Represents atrial depolarization and is characterized by a smooth round, upright shape.

The process by which muscle fibers are stimulated to contract

Represents the amount of time it takes for the atria to depolarize and for the impulse to travel through the AV node. It is measured from the start of the P wave to the point at which the QRS complex begins.

Normal duration of the PR Interval

Consists of three waveforms that represents depolarization of 2 simultaneously contracting ventricles

The point in the ECG where the QRS complex ends and the ST segment begins; representing the end of depolarization and the apparent beginning of reploarization

The ST segment represents

The QT interval represents:

Five step method of interpreting an ECG strip

Three major classes of drugs used to relieve the pain of angina:

Delivering a current to the heart that is powerful enough to depolarize all of its component muscles cells; leading to a cardiac contraction

Indicated for rapid ventricular and superventricular rhythms that are associated with severely compromised CO

Medications commonly used to sedate when cardioversion is to be performed on a conscious patient would include

A small electrical charge that is passed through the patients skin across the heart between one externally placed pacing pad and another

A term associated with deplolarization of the ventricles, which appears as a wide QRS complex on the ECG and results in a corresponding pulse

TCP is the first line treatment if the patient is in what type of condition

If atropine and TCP are unsuccessful in a patient with symptomatic bradycardia you should consider administering:

To stimulate a patients vagus nerve who is in SVT; the most common technique is to have the patient:

Stimulating the vagal nerve does what

Four important properties that help the heart to function as an efficient machine:

The property that allows cells to respond to an electrical impulse

The electrical conduction system of the heart:
Impulses that originate in the____spread through the ____and along the internodal pathways to the____. From the _____, they travel down the ________ and right and left _______ and into the ______________

A common drug used to block the actions of the parasympathetic nervous system; to block the vagus nerve and thereby causes an increase in the heart rate

Increase heart rate, strengthens the force of cardiac muscle contractions, and provides other adaptive responses to ensure that the tissues increased oxygen demands are satisfied with increased CO

Sympathetic agent (primarily alpha), causing vasoconstriction. It is used to increase the bloop pressure when the  hypotension is caused by vasodilation (as in neurogenic shock)

Sympathetic agent, used to increase renal perfusion, increase rate and force of myocardial contraction, and constrict peripheral blood vessels

In patients with ACS the most common chief complaints are:

Palpitations are often caused by:

Anticoagulant drugs are? Usage?

How do calcium channel blockers relieve angina

Drugs that are Calcium Channel Blockers

What are the two main groups of leads

_{If the distance is exactly the same between R waves, the rhythm is:}

In no two R waves are equidistant, the rhythm is:

If the R waves are irregular, but appear to follow a pattern the rhythm is:

The most common methods of determining the rate of a cardiac rhythm strip:

Defibrillation needs to be carried out as sson as possible in what two rhythms:

The use of a synchronized direct current (DC) electric shock to convert tachydysrhythmias (such as atrial fibrillation) to normal sinus rhythm

A mode available on automated external defibrillators, allowing the paramedic to interpret the cardiac rhythm and determine if defibrillation is needed

Algorithm for bradycardia
Persistent bradyarrhythmia
Does the patient have any of the following:

Drug administration for Symptomatic braycardia

Algorithm for Tachycardia
Persistent tachyarrhythmia
Does the patient have any of the following:

Precordial leads should be placed in what manner

The time frame that starts at the first moment of patient contact by EMS providers, and ends when definitive therapy occurrs

Which electrolyte flows into the cell to initiate depolarization?

Which electrolyte flows out of the cells to initiate repolarization?

When a impulse reaching the AV node is delayed and results in a PR interval longer than 0.20 seconds

A specialized structure located in the lower portion of the right atrium; 
Allows atria to contract & complete filling of ventricles before next ventricle contraction;
Slows conduction through the AV junction

The intrinsic firing rate for the AV node:

The SA node has an intrinsic rate of:

The intrinsic rate for the purkinje system is:

The bundle of his connects what structures

May assume responsibility for pacing the heart if:
–  The SA node fails to discharge
–  An impulse from the SA node is generated     but blocked as it exits the SA node
–  The rate of discharge of the SA node is         slower than that of the AV junction
–  An impulse from the SA node is generated
    and is conducted through the atria but is       not conducted to the ventricles

A term used to describe the AV node and the bundle of his structures

The electrical impulse travels backward (retrograde) to activate the atria when this structure is pacing the heart

Ectopic (irregular) complexes that occur out of normal location
Usually earlier than expected
R-R interval will be closer
P-wave may or may not be present; inverted, upside down, before or after QRS

Narrow with inverted "P" wave or without "P" wave
PR interval: 120ms>
QRS complex: 40 to 120 ms

* May be a predictor of future cardiac dysrhythmias

Causes of PJC's

Signs and symptoms of Pre mature junctional Complex (PJC)

Originates in the AV junction
Occurs when the SA node ceases functioning; 
after a conduction delay from the atria 
AV node takes over as pacemaker
Prevents cardiac stand still
Rhythm rate 40 - 60 bpm

How do you recognize a Junctional escape beat:

Junctional escape beats/rhythms causes:

Digoxin/Digitalis are:

Junctional rhythms signs & symptoms:

Signs & symptoms of slow Heart rate, or Decreased Cardiac output

An etopic rhythm caused by enhanced automaticity of the bundle of his
Rate: 60-100 bpm
Rhythm: regular
QRS: .10>

Treatment for Accelerated junctional rhythm:

Accelerated junctional rhythm Causes:

An inflammatory disease that may develop after an infection with group A Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain

A rhythm of slow onset with a heart rate that increases to more than 100 beats per minute; due to enhanced automaticity of the atrioventricular junctional tissue, often secondary to disease or trauma.

A rhythm with a rapid heart action that starts and stops abruptly
Rate: more than 140 bpm

Causes of junctional tachycardia:

Used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases

Junctional tachycardia associated with acute coronary syndrome may have what symptons:

Junctional tachycardia if symptomatic treatment:

• Originate in the AV junction
• Occur when the SA node is suppressed
   or conduction is blocked
• Impulses cause retrograde depolarization    and inverted P waves in leads II, III, and aVF

A beat that occurs before a normal beat and causes an irregular rhythm

A ectopic beat that occurs when an irritable location within the AV junction acts as a pacemaker and fires either prematurely or out of sequence 

The atria are depolarized in retrograde fashion, causing an in-
verted P wave.

The normal slowing of impulses as they pass through the AV node allows the atria to:

Define a junction rhythm:

If the ventricles are depolarized first in a junctional rhythm, the P wave will appear:

Ventricles assume responsibility for pacing the heart if:

The ventricles are the heart’s least
efficient pacemaker with a intrinsic rate of

Ventricular beats & rhythms originate from any part of the ventricles QRS complex's; and are typically characterized by QRS complexes that are:

This type of beat occurs earlier than the next expected sinus beat

– QRS is typically 0.12 sec or greater

– T wave is usually in the opposite direction of
the QRS complex

PVC patterns:

PVCs that look alike and may originate from the same ectopic focus are called

Ventricular escape beats are also known as:

Acts as safety mechanisms to prevent ventricular standstill when no impulses are conducted
The His-Purkinje system take over and act as the heart’s pacemaker

Three or more ventricular escape
beats occurring in a row at a rate of 20–40
bpm

Idioventricular rhythm should never be treated with:

Provides electrical links between the atrium and ventricles

If a delay or interruption in impulse conduction occurs within the AV node, Bundle of his, or His-purkinje system, the resulting dyrhythmia is called:

AV blocks are classified according to the:

The key to differentiating the type of AV block is:
(First-degree AV block)
(Second-degree AV block type I)
(Second-degree AV block type II)

The width of the QRS complex is the key in differentiating what about a block

The only heart block that is complete:

How do you recognize a 1st degree AV block

Treatment of 1st degree heart block:

When some, but not all, atrial impulses are
blocked from reaching the ventricles 

SA node generates impulses in a normal manner 

Not every P wave will be followed by a QRS

Second degree AV block Type I (the block) is located where:

Second degree AV block Type II (the block) is located where:

Impulses generated by the SA node take longer and longer to conduct through the AV node until a sinus impulse id blocked

How do you recognize a 2nd degree AV block type II

Prinzmetal's angina is; and treatment

Drug indicated for suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's); and
Dosages

EPINEPHRINE HCL
Dosage: Pulseless Arrest

EPINEPHRINE HCL 
Dosage: Continuous Infusion for Hypotension or Symptomatic Bradycardia:

Contraindications to NITROGLYCERIN

An abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.

NITROGLYCERIN Adult Dosage:
SL for Chest pain: 
SL for Pulmonary edema:

ATROPINE SULFATE Adult dosage
Symptomatic Bradycardia:

An abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.

a blood clot, a fat globule or a gas bubble in the bloodstream, which can cause a blockage.

Cincinnati Prehospital Stroke Scale

AEIOU TIPS

Seizures indicate:

When blood flow to a part of the brain stops for a brief period of time. A person will have stroke-like symptoms for up to 24 hours, but in most cases for 1 - 2 hours.
(Mini-stroke)

A condition when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body

Blood backs up behind ventricle
•  Blood builds up in lungs
•  Left atrium swells with blood
•  Atrial muscle fibers stretch
•  Pulmonary veins cannot empty into left atrium
•  Pressure within pulmonary muscles increases
•  Forces fluid from pulmonary capillaries across alveolar walls into lung alveoli

A failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart

• High-concentration O2 by mask
• Reduce preload
• Reduce afterload
• Improve myocardial contractility
• Position of comfort
• Sitting position with feet dangling 
Treatment for:

Heart failure medications that reduces preload:

Heart failure medications that reduce afterload

Hypertension damages the:

Uncontrolled hypertension increases risk of:

Treatment of seizure (drug):