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What are the 2 parts of the pericardium & their locations?
- Visceral (epicardium) – inner
- Parietal – outer, fibrous layer
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The 2 main heart sounds are what?
- S1 – “lubb” caused by the closing of the AV valves
- S2 – “dupp” Caused by the closing of the SL valves
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The R coronary artery branches into what 2 parts?
- Posterior Descending Artery
- Marginal Artery
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The left coronary artery branches into what 2 parts?
- Left anterior descending
- Left circumflex Artery
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Give 5 facts about the L anterior descending.
- Originates on left side of aorta
- “widow maker” associated w/sudden death
- Part of R ventricle
- Intraventricular septal artery (septum)
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Give 2 facts about the L circumflex artery
- Lateral wall of L ventricle
- Posterior wall of L ventricle
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Define cardiac cycle
Period of time fr end of 1 contraction to the end of the next
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Define diastole.
Period of time when myocardium is relaxed & cardiac filling & coronary perfusioni occur
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Define systole.
Period of cardiac cycle when myocardium is contracting
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What is “atrial kick?”
When the atria contract filling ventricles to capacity. This kick accounts for 30% of output
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Define stroke volume & what is it equal too?
- Amt of blood ejected fr 1 ventricle w/each heart beat usually 60-100ml
- SV = HR x Cardiac output
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Define preload.
Pressure in filled ventricle @ end of diastole
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Define Frank Starling Law & what drug effects it.
- Greater the vol of blood in heart during diastole causing myocardial muscle stretch, the more forceful the contraction
- Dopamine works directly on this principle
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What is afterload?
Resistance against which ventricle must contract to eject blood
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If we increase peripheral vascular resistance we will ____ stroke vol.
Decrease
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Decreasing peripheral vascular resistance will ____ stroke vol?
Increase
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Define venous return.
Amt of blood flowing into R atrium each min fr systemic circulation
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What is cardiac output?
Amt of blood pumped each minute by the heart
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How many ml in an avg stroke vol?
70
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Define systemic vascular resistance.
Resistance to the flow of blood determined by vessel diameter & tone
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The sympathetic nervous sys influences both the atria & ventricles. T or F
True
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The parasympathetic nervous sys primarily influences what part of the heart?
Atria
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Where are alpha receptors in the heart?
Located in peripheral blood vessels & responsible for vasoconstriction
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Where are Beta 1 receptors located?
Primarily in the heart to increase HR & contractility
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Where are Beta 2 receptors located?
Lungs & peripheral blood vessels to cause bronchodilation & peripheral vasodilation
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What is cardiac excitability?
The ability of cardiac muscle cells to respond to an external stimulus (chemical, electrical, mechanical
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What is cardiac conductivity?
The ability of cardiac cells to receive an elec stimulus & conduct that impulse to an adjacent cell
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What is cardiac autiomaticity?
Ability of cardiac pacemaker cells lto spontaneously initiate an elec impulse
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What is cardiac contractility?
Ability of cardiac cells to shorten causing muscle contraction in response to electrical stimulus
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Normal ejection fraction is greater than ____ %.
50
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The avg cardiac stroke vol is ____?
70 ml
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The resistance against which the ventricle must pump blood is called what?
Peripheral vascular resistance
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The formula for cardiac output is _______?
Stroke vol (ml) x HR
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The formula for BP is _____?
Cardiac output x systemic vascular resistance
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What type of receptors cause bronchodilation & peripheral vasodilation?
Baroreceptors
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Na's major role in the cardiac cell is ____?
Depolarization
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Resting membrane potential is measures @ around ____ mV.
- 70
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The Na/K exchange pump exchanges ____ Na for every ____ K taken into the cell
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What are ions?
Atom or grp of atoms w/ an elec charge
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What is diffusion?
Movement of ions fr high concentration to area of low concenttration
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What is a gradient?
A force which drives diffusion
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When Na rushes into a cell rapidly & the inside of the cell is more pos tan the outside this is called ____?
Depolarization
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How many P waves must be noted in order for a rhythm to be considered to have a wandering pacemaker?
3
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When a wandering atrial pacemaker rhythm >100 bpm is considered to be what?
Multifocal Atrial Tach
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The term that applies to any tachycardic rhythm originating above the ventricle is called ____?
Supraventricular
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What are the 6 "H"s for reversible causes?
- Hydrogen Ion
- Hypovolemia
- Hypoxia
- Hypothermia
- Hypo/hyper kalemia
- Hypo/hyper glycemia
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What are the 6 T reversible causes?
- Thromboembolism
- Trauma
- Toxins/tablets
- Tension pneumo
- Tamponade (AMI)
- Cardiac tamponade
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Name the bipolar leads.
I, II, III
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What is the proper placement of the V5 lead?
5th intercostal anterior axillary
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What happens -- physically -- when depolarization occurs?
Muscle contraction
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Ability of cardiac pacemaker cells to spontaneously initiate an electrical impulse is called?
Automaticity
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A "P" wave represents what actions of the heart?
Atrial depolarization and contraction
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The QRS represents what 2 actions of the heart?
Ventricular depolarization and contraction
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The "T" wave represents what action of the heart?
Repolarization
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What are the 2 valves that lie between the atria?
Tricuspid and Mitral
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What level of the heart do the terminal ends of the purkinje Fibers lay?
Spread out beneath the endocardium
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Ventricular conduction is composed of purkinje fibers that use fast moving ____ ions for conduction.
Na
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What are the 2 phases of ventricular repolarization & how are they represented on EKG?
- Plateau Phase & Rapid Phase
- ST segment & T wave
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Ventricualr systole begins @ the _____ & persists until the end of the ____ wave.
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Pt's w/long QT syndrome are in danger of developing _____?
Rapid ventricular Rhythms
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The release of free Ca++ ions into the interior of the myocytes produce myocardial ____?
Contraction
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Following depolarization, repolarization is due to the controlled outflow of ____ fr the myocytes.
CA ions
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What neurotransmitter activates the heart's B1 adrenergic receptors?
NorEpi
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Junctional foci have an inherent rate of ____ to ____.
40 to 60
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Ventricular foci have an inherent rate of ____ to ____.
20-40
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Lead V6 is placed where?
5th intercostal mid axillary
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If an impulse is moving toward a lead it will have a ____ deflection.
Positive
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Phase II of the cardiac action potential is?
Plateau
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Phase I of a cardiac action potential is?
Early repolarization
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The left anterior descending artery supplies which wall of the heart?
Anterior Wall
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What is the paper speed on the EKG?
25 mm/sec
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The left circumflex artery supplies which 2 walls of the heart?
Lateral Wall & Septum
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What is the period of time fr the end of 1 contraction to the end of the next is called?
Cardiac cycle
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The PR interval measures what?
Time for impulse to travel fr atria to ventricles
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Atrial kick accounts for what % of cardiac output?
30%
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Lead V3 is placed where?
Halfway between leads V2 & V4
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V4R lead placement is where?
V4 lead lead moved to right side, 5th intercostal, mid clavicular
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What is the compensatory pause?
Absence of an appropriate beat after a PVC as the ventricles repolarize
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Describe bigeminy.
A rhythm of 1 NS beat followed by an ectopic one
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Which is worse for an ectopic beat to fall on? The absolute refractory period or the relative refractory period?
Relative refractory period
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What lead looks at the high lateral wall?
aVL
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What lead looks at the base of the heart & can help diagnose a TCA OD?
aVR
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What is the criteria for a posterior hemiblock?
- Left axis deviation
- Sm "Q" in lead 3
- Big "R" in lead 1
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A left bundle branch has a ____ deflection b/f the J point.
Downward (negative)
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An extreme right axis and upright V1 equals ____.
V Tach
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An RSR pattern b/f the J point is what?
RBBB
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Two hemiblocks are also called what?
Bifasicular Block
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Which left hemibock has the highest mortality rate?
Posterior Hemiblock
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What rate determines rapid ventricular response in A Fib? A Flutter?
- Afib = >100 bpm
- A flutter = 200-250
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What is the deviation allowed in the R-R for a rhythm to still be regular?
0.06 sec
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What is a wandering atrial pacemaker w/a rate over 100 called?
Multi focal A Tach
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What is the preferred drug w/dosage for Torsades?
Mag Sulfate @ 1-2 g IV drip over 10 minutes
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Your pt is in an idioventricular rhythm, pale, diaphoretic, & unconscious. Do what?
PACE !
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What are five drugs for treating V Fib?
- Lidocaine
- Amiodarone
- Procainamide
- Vasopressin
- Bretyllium
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How does pericarditis present on an ECG?
- The ST segment is usually flat or concave
- Entire T may be elevated off baseline
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What is the effect of digitalis on an ECG?
Depressed ST segment looking like a scoop
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How does hyperkalemia present on and ECG?
W/ tall peaked T waves
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