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What is the difference between ischemic and hemorrhagic strokes
ischemic strokes usually present with confusion, unilateral weakness or paralysis on the OPPOSITE SIDE of the stroke. facial droop and pupillary abnormalities usually happen on the same side.
hemorrhagic strokes usually present with a severe headache, rapid loss of consciousness, signs of ICP(bradycardia, hypotension, and breathing issues)
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What is the core part of the American heart assosciations chain of Survival?
- -early 911
- -early CPR
- -early advanced care
- -early defibrilation
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what is Considered a narrow puslse pressure?
anything close within 25 mmhg. is considered a narrow pulse pressure.
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signs and symptoms of
paroxysmal super-ventricular tachycardia
acute on set of palpitations light hotheadedness that resolves on its own.
syncope of cardiac origin is caused by a decrease in cerebral perfusion because of the decrease in cardiac output.
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parasympathetic control in the heart is controlled by the......
Vagus Nerve.
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sharp tearing pain in the chest and a rapid drop in blood pressure usually means?
An aortic dissection.
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what is the drug of choice for pediatric bradycardia?
Epinephrine 1: 10,000 0.01 Mg/kg IV/IO
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What happens in the electrical state when the heart is depolarizing
Fast sodium channels open up and sodium ions rush into the cell
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What does the circumflex artery supply?
supplies blood to the left atrium and the back of the left ventricle.
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what does the left anterior descending artery supply?
supplied blood to the front and bottom of the left ventricle. And the front of the septum.
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where does the coronary veins drop their blood off?
it blood that has been used up by the muscles and travels through to dump it off in the right atrium.
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what does the right coronary artery supply?
supplies blood to the right atrium, right ventricle, and bottom portion of the left ventricle and the back of the septum
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when a myocardial fiber is at rest, the cell is _____ charged inside the cells and ______ charged outside of the cell.
Negative....positive.
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what are some of the first signs you notice of a acute myocardial infarction?
T wave abnormalities
t wave inversion is probably the first one you should note. also st depression may be another sign.
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when a patient does not have a pulse during CPR. it is said that they be diagnosed with a
pulmonary embolisim.
while compressions are being performed you should be able to feel a pulse. if not it just may be a PE
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what are the layers of a blood vessel?
Tunica intima....then T media....then T adventia
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what is the role of the sodium electrolyte in cardiac function
it flows into the cell to initiate depolarization.
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what is the role of potassium in cardiac function?
Flows out of the cell to initiate RE- POLARIZATION
- low K+= increased myocardial irritibility
- high K+= decreased automaticity
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what is the role of the calcium electrolyte in cardiac function?
Has a major role in the depolarization of the pacemaker cells (maintains depolarization). and in myocardial contractlity.
low Ca++= decreased contractility and increased myocardial irritability.
high Ca++= increased contractility.
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what is the role of the magnesium electrolyte in the body?
it stabilizes the cell membrane and acts with potassium and opposes the action of calcium.
- low Mg++= decreased conduction
- high Mg++= increased myocardial irritability.
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Repolarization officially begins when...
Potassium channels open to allow the escape of potassium ions (K+) to help restore a negative charge to the inside of the cell.
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what is the difference between the relative refractory... Refractory period and the absolute refractory period?
Refrafractory period: when the cells are depolarized or are in the process of repolarizing
Absolute refractory: the heart is completly depolarized and cannot respond to any stimulus.
relative refractory: the heart is partially polarized allowing it to respond to electrical stimuli and can be depolarized.
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what does the J point on an ECG indicate?
the end of Ventricular depolarization and the beginning of ventricular re-polarization.
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If the brains senses the heart should slow its rate down it....
sends a message down the vagus nerve to where it slows down the SA node. that electrical impulse causes the release of naturally occurring acetylcholine.
the aCH crosses over to the SA to let it know to slow down. another ach molecule travels over to the AV to remind the SA to chill. it is then broken down by acetlycholinesterase.
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How does the medication atropine work.
it works by blocking the actions of the parasympathetic nervous system and increase the heart rate. its a Category C. its used for all bradycardia's except mobitz type 2 block and 3rd degree.
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the heart only has one receptor for _____agents
Beta
ALL BETA AGENTS- Increase the heart rate the Force and the automacity.
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Arteries have both alpha and beta agents. what do they do?
Alpha= vasoCONSTRICTION
Beta=vasoDIALATION
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the lungs have both alpha and beta receptors. what do they do?
Alpha= does not have too much of an effect on lungs except minor broncoconstriction
beta=adrenrgic agonist trigger significant broncodilation.
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what is the difference between the two groups of beta sympathetic agonist agents
Beta 1 adrenergic agonists = cardiac beta receptors
beta 2 adrenergic agonist= works with pulmonary beta receptors such as albuterol and the rest of the buterol family.
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What makes up the blood pressure?
CO X PVR
blood pressure can be increased by increasing cardiac output, periphreal resistance or both.
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Those taking digitalis will be sensitive to_____ and will cause a decline in serum _______ levels
Calcium preperations....potassium
be careful giving diuretics that will reduce the bodys potassium stores.
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how does calcium channel blockers stop angina?
Calcium channel blockers block the influx of calcium ions into cardiac muscle and relieve angina by preventing coronary artery spasm and by weakening cardiac contractions.
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how do diuretics work?
Diuretics trick the kidneys into excreting more sodium and water than usual.
the kidneys also secrete more potassium so they may be potassium depleted.
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what medications are normally used as anti hypertensive agents?
Diuretics and Beta blockers.
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cold, sweaty skin may indicate
massive peripheral vasoconstriction.
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what is a ejection click?
Ejection click—a high-pitched sound just after the S1 sound that may indicate a dilated pulmonary artery or septal defect
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what is a pericardial friction rub?
Pericardial friction rub— a to-and-fro sound heart in both systole and diastole heard in pericarditis from the visceral and parietal surfaces rubbing together
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What causes a murmer?
Murmur—an ambiguous sound from turbulent blood flow through the valves, caused by:
(1) Increased blood flow across a normal valve
(2) Flow across an irregular or constricted valve
3) Blood flow into an enlarged heart chamber
(4) Backwards blood flow through a compromised valve
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what is pericardial knock?
Pericardial knock: High-pitched sound during diastole indicating a thickened pericardium limiting ventricle expansion during the diastole phase
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depolarization officially occurs when
sodium that is positivly charged on the outside of the cell , rush into the cell and make the enviorment more positive than outside.
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what is the sodium potassiums pumps job
its job is too normally transport three sodium ions out for every two potassium ions taken in. it helps return the cell to its resting state.
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what is automacity?
is the cardiac cells ability to spontaneously generate an electrical pulse (depolarize)
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what is excitability?
the ability of a cell to respond to a stimulus by depolarizing and firing an action potential.
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what is conductivity?
is the ability t transmit action potentials from cell to cell
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what is contractility
is the intrinsic ability of the heart/ myocardium to contract
changes in the ability to produce force during contraction results from incremental degrees of binding between myosin and actin filaments.
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How many millivolts is a small box..or a big box?
One small box=o.1 millivolts
Large box=0.5 mv
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what is wolff- parkinson -white syndrome?
A syndrome in which an extra electrical pathway in the heart causes a rapid heartbeat.
signs and symptoms are a fast heartbeat, light headedness and dizziness.
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on your EKG how will you notice wolff parkison white syndrome?
the delta wave indicates early departure from the PR- segment because of the conduction thru the bundle of kent.
these patients are susceptible to tachydysrhythmias.
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what is lown-ganong-levine syndrome?
its a pre-excitation of the heart due to abnormal electrial communication between the atria and ventricles. patients will present with a short PR-interval and a normal QRS complex.
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on the EKG...If the ventricle is enlarged then....
the R wave will be wide.
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if ventricular hypertrophy is present on a EKG...
the R wave will be abnormally high.
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hyertrophy of the ventricles on the EKG will present as...
an abnormally deep wave.
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what does Right atrial enlargement look like on an EKG?
its characterized by a p-Wave with an amplitude higher than 2.5 mm in lead 2 and higher than 1.5 in lead V1.
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how does left atrial enlargement look like?
p wave longer than 110ms in lead 2 and a p-wave with a notched appearence.
a peak to peak of a p wave longer than 40ms.
and a p wave in lead v1 predominantly negative.
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What does right ventricular hypertrophy look like?
large R wave in V1 and R wave in lead aVR with a amplitute taller than 5mm. QRST in V1.
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what is LVH and what does Left ventricular hyertrophy look like on a EKG?
it when the heart loses elasticity and fails to pump effectivly. on a EKG you will see a really Deep S wave in V1 and V2. and the tallest R wave in v5-v6
R wave in avl taller than 11mm
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what is the disease of arterial vessels marked by thicking, hardening and loss of elasticity in the artery walls
arteriosclerosis
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where is the point of maximal impulse? and where can it be felt?
you can feel it on the left anterior of the chest. in the mid-clavicular line at the fifth inter costal space.
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the volume of blood ejected from the left ventricle into the arterial system each minute is called
cardiac output
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a drug with positive chronotropic effec will have a direct on the
Heart rate
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the resitance that the heart must pump against is ....
afterload
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the amount of blood ejected from the heart in one contraction is called?
stroke volume
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hypocalcemia and hypomagnesmia will likey result in
hypocalcemia- results in decreased contractility and increased myocardial irritibility.
hypomagnesmia results in increased myocardial iritibility.
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which medication has a beta 2properties?
proventil, albuterol
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when asessing a 12 lead ecg if you suspect inferior infarct you would see
st segment elevation in leads 2,3 avf.
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what does a Q wave look like?
wider than 0.04 seconds and is seen in 2 or more contiguous leads.
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when looking at a 12 lead ECG leads V1-V3 is showing you the....
anteroseptal view of the heart
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if a patient is experiencing chest pain in the presence of Jugular vein distention.
right sided heart failure.
because the fluid is backing up thru the rest of the body.
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in lead 2 placement of the positive lead is located on the ....
left leg
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what is normal for the following segments and waves?
1- PR interval
2-QRS complex
3-QT duration
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the return of a cardac muscle to its resting state is called?
REPOLARIZATION
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what is the period where where stimulation will not produce a de-polarization/.
Absolute refractory period.
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what is the period of the cardiac cycle where stimulation may cause depolarization?
relative refractory period.
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stimulation of the vagus nerve results in
decrease in heart rate.
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which is normally not a sign or symptom in cardiogenic shock
hypertension. it usually results in dysrhythmias, HYPOtension, respiratory failure, and organ failure. the heart rate is initially elevated to compensate.
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the presence of Pulmonary congestion indicated by abnormal lungs such as crackles and complaining of chest pain may indicate.
left ventricular failure
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initial management of left ventricular failure in the pre-hospital setting include....
the application of (oxygen therapy)CPAP-
then the application of furosemide(20-40mg slow ivp) and morphine 2mg ivp
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management of cardiogenic shock includes using.....
Dopamine. to increase cardiac output. nitro and morphine will tank the blood pressure. too much fluid will worsen the situation.
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what do you do for ventricular tachycardia with a puse but severely unstable?
ABC's, high flow o2, cardioversion
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what is the immediate treatment for PSVT at 184 rate?
start a line...oxygen.....6mg adenosine.
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why is calcium chloride beneficial to dialysis patents?
for cardiac arrest with suspected hyperkalemia
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what is vasopressin indicated for and how much can you give?
it is indicated for V-fib and pulseless v-tach. you can give 40 units one time only
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what is the initial dose for sodium bicarb? and what is it used for?
1 meq/kg
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what is sodium bicarb useful to treat?
hyperkalemia and calcium channel blocker overdoses.
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what should you ALWAYS do before giving morphine or nitro?
assess the blood pressure.
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