Cardiology

Question Answer
What are the two major components of the cardiovascular system? The heart and the peripheral blood vessels.
What are the three layers of the heart? The Endocardium, Myocardium and the Pericardium.
How much pericardial fluid does the heart contain in the pericardial sac on a normal healthy individual? 25-30mlThe fluid is straw colored
_______________ is the volume of blood that the heart pumps in one minute. Cardiac Output
What is the first phase of the cardiac cycle? Diastole
What is the second phase of the cardiac cycle? Systole
What is afterload? Afterload is the resistance against which the ventricle must contract.
What is Starling's Law of the Heart? Starling's Law states the more the myocardial muscle is stretched, the greater its force of contraction will be – up till a certain point. In other words, the more blood that fills the ventricle, the more forceful the next cardiac contraction will be.
The sympathetic nervous system has two principal types of receptors, they are _____ and _____. Alpha and Beta
________ receptors are located in the peripheral blood vessels and are responsible for vasoconstriction. Alpha
________ receptors, primarily located in the heart, increase the heart rate and contractility. Beta 1
________ receptors, principally located in the lungs and peripheral blood vessels, cause bronchodilation and peripheral vasodilation. Beta 2
Parasympathetic control of the heart occurs through the ________ nerve. Vagus nerve (Cranial Nerve #10)
The term __________ refers to heart rate. Something that has a positive affect to this term will increase the patient's heart rate. Chronotropy
_____________refers to the strength of a cardiac muscular contraction. Something that has a positive affect to this term will strengthen the cardiac contraction. Inotropy
_____________refers to the rate of nervous impulse conduction. Something that has a positive affect to this term will speed up impulse conduction. Dromotropy
What hormone is secreted by the heart when the heart is in CHF? Brain Natriuretic Peptide (BNP) – it is secreted by the ventricles in response to excessive stretching of the myocytes.
Within the cardiac muscle fibers are special structures called ___________. These structures connect muscle fibers and conduct electrical impulses quickly – usually 400 times faster than the standard cell membrane. Intercalated Discs
What is the inherit rate of the SA Node? 60-100 beats per minute.
What is the inherit rate of the AV Node? 40-60 beats per minute.
What is the inherit rate of the Purkinje System? 15-40 beats per minute.
The right atrium and right ventricle is separated by what valve? Tricuspid
The right ventricle and the pulmonary artery are separated by what valve? Pulmonic
The left atrium and left ventricle are separated by what valve? Mitral – other wise known as the bicuspid valve
The left ventricle and the aorta are separated by what valve? Aortic
The coronary vessels receive their blood supply during what part of the cardiac cycle? Diastole
What are anastomoses? Communications between two or more vessels
The inner layer of a blood vessel is termed the __________. Tunica intima
The middle layer of a blood vessel is termed the __________. Tunica media
The outer layer of a blood vessel is termed the ___________. Tunica adventitia
What are the three primary factors that affect the stroke volume? Preload, Cardiac Contractility & Afterload
The chemical neurotransmitter for the sympathetic nervous system is _____________. Norepinephrine
The chemical neurotransmitter for the parasympathetic nervous system is _____________. Acetylcholine
What are the three primary factors that affect the blood pressure? Stroke Volume, Heart Rate & Systemic Vascular ResistanceBlood Pressure = SV X HR X SVR
_____________ is a peptide hormone that is secreted by the heart ventricles following excessive stretching of the cardiomyocytes. Brain Natriuretic Peptide (BNP)
______________ is a peptide hormone that is secreted by the atriums that in pharmacological doses promotes sodium and water excretion and lowers the blood pressure. Atrial Natriuretic Peptide (ANP)
When the Sodium/Potassium Pump is activated, it moves ____ from the inside the cell to the outside and _____ from the outside of the cell to the inside. Sodium, Potassium
The resting potential for an autorhythmic cell is _____ mV. -60
The action potential for the autorhythmic cell is _____ mV. -40
The resting potential for a cardiac contractile cell is _____ mV. -90
The action potential for a cardiac contractile cell is _____ mV. -85 to -80
The ___________ is the ratio of blood pumped from the ventricle to the amount remaining at the end of diastole. Ejection Fraction
The amount of blood ejected by the heart in one cardiac contraction is known as the __________. Stroke Volume
____________ is the pressure within the ventricles at the end of diastole; it is commonly called the end-diastolic volume. Preload
____________ are specialized bands of tissue inserted between myocardial cells that increase the rate in which the action potential is spread from cell to cell. Intercalated Discs – They speed up the process 400 times faster.
Snuggly enclosed within the mediastinum, the heart extends obliquely from the ____ rib to the _____ intercostal space. 2nd, 5th
The ability for pacemaker cells in the heart to self-depolarize is called __________. Automaticity
A group of cardiac cells that physiologically function as a unit is called __________. Syncytium
__________ is the reversal of charges at a cell membrane so that the inside of the cell becomes positive in relation to the outside. Cardiac depolarization
What ion causes depolarization of an autorhythmic cell? Calcium
The __________ is the normal electrical state of a cardiac cell. Resting potential
The __________ is a depression in the right atrium septal wall, it is the remnant of the fetal blood shunt that goes from the right atrium to the left atrium during fetal development. Fossa ovalis
The __________ are cord-like tendons that connect the papillary muscles to the tricuspid and mitral valves in the heart. Chordae tendineae
What ion causes depolarization of a cardiac contractile cell? Sodium
How many pulmonary arteries and pulmonary veins are located in the human body? 2 Pulmonary Arteries, 4 Pulmonary Veins
When during the cardiac cycle is the heart fed blood through the coronary vessels? During diastole
What ion causes the cardiac contractile cell to contract? Calcium
What heart valves are opened during diastole? Tricuspid and mitral valves
Located in the right atrium, the __________ muscles are found on the inside of the anterior chamber wall. These muscles closely resemble the teeth of a comb and help contract the atrium pushing the blood into the right ventricle. Pectinate
What coronary vessel feeds blood to the anterior portion of the left ventricle? Left Anterior Descending (LAD)
What coronary vessel feeds blood to the majority of the right ventricle? Right Coronary Artery (RCA)
What heart valves are open during systole? Aortic & Pulmonary
Where is the best place to auscultate heart sounds of the pulmonary valve? 2nd intercostal space – left of the sternum
Where is the best place to auscultate heart sounds of the aortic valve? 2nd intercostal space – right of the sternum
____________ control of the heart occurs through the vagus nerve. Parasympathetic
Where is the best place to auscultate heart sounds of the tricuspid valve? 5th intercostal space – left of the sternum
Where is the best place to auscultate heart sounds of the mitral valve? 5th intercostal space – left of the sternum
According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead I? Negative on the right arm (RA), Positive on the left arm (LA)
What ion causes the autorhythmic cell to go from its resting potential to its action potential? Sodium
According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead II? Negative to the right arm (RA), Positive to the left leg (LA)
According to Einthoven’s Triangle – where would the negative and positive leads be placed when looking at Lead III? Negative to the left arm (LA), Positive to the left leg (LL)
What is the standard speed for the ECG paper to move at? 25 mm/sec
One small box on the ECG paper represents what? (both horizontal and vertical) Horizontal = 0.04 sec, Vertical = 1 mm
The PRI interval should be at least ___ but no longer than ___seconds. 0.12, 0.20
During the ________ refractory period, no amount of cardiac stimulation can produce the cardiac cells to depolarize – this interval starts at the __________ and ends at the __________. Absolute, QRS and ends at the apex of the T wave.
One large box on the ECG paper represents what? (both horizontal and vertical) Horizontal = 0.2 sec, Vertical = 5 mm
What ECG wave represents atrial depolarization? P Wave
During the ___________ refractory period, a sufficiently strong stimulus may produce the cardiac cells to depolarize – this corresponds to the downslope of the _____. Relative, T Wave
What ECG wave represents ventricular depolarization? QRS
The QRS complex should be at least ___ but no longer than ____ seconds. 0.04, 0.12
What is the average amount of volume that is ejected from the left ventricle during systole? This is known as the stroke volume – the average is 70ml (varies 60-100ml)
The resistance against which the heart must pump against is known as _________. Afterload
When the myocardial cell is stimulated, the membrane surrounding the cell changes instantaneously to allow sodium ions to rush into the cell, bringing with them their positive charge. This charge is so strong that it gives the inside of the cell a positive charge approximately _____________ greater than the outside of the cell. +30mV
What channels in the cardiac contractile cells bring about depolarization? Fast sodium
When the cardiac contractile cell starts to repolarize – what ion is actively leaving the cell membrane? Potassium
When using lead I – where in the heart is that lead looking at? The left side of the heart
When using lead II – where in the heart is that lead looking at? The inferior wall of the heart
When using lead AVF – where in the heart is that lead looking at? The inferior wall of the heart
When using lead AVL – where in the heart is that lead looking at? The left side of the heart
The normal axis of the heart should be between _____ and _____ degrees. 0 and +90
During the systolic phase, what valves inside of the heart are open? Pulmonic & Aortic
What electrolyte plays a major role in repolarization? Potassium
What channels in the autorhythmic cells allow ions to leak in, producing a pacemaker potential? Sodium
Threshold for the action potential in the SA Node is at ____ mV. What channels open, causing depolarization? -40 mV, Calcium
What is the average pressure found inside of the right atria? 4 mmHg
What is the function of the Chordae Tendineae? The chordae tendineae are cord-like tendons that connect the papillary muscles to the tricuspid and mitral valve in the heart – they prevent the valves from prolapsing back into the atriums.
Which of the heart valves are called the “semi-lunar” valves? Pulmonic and Aortic
Where is the correct placement for the V1 electrode? 4th intercostal space – 1 inch to the right of the sternum
Where is the correct placement for the V2 electrode? 4th intercostal space – 1 inch to the left of the sternum
Where is the correct placement for the V3 electrode? 5th intercostal space – between V2 & V4
Where is the correct placement for the V4 electrode? 5th intercostal space – mid-clavicular
Where is the correct placement for the V5 electrode? 5th intercostal space – between V4 and V6 – should be on the anterior axillary line
Where is the correct placement for the V6 electrode? 5th intercostal space – midaxillary
Where is the correct placement for the V4R electrode? 5th intercostal space on the right side – mid-clavicular
Where is the correct placement for the V7 (Posterior) electrode? 5th intercostal space on the back – mid-scapular
Where is the correct placement for the V8 (Posterior) electrode? 5th intercostal space on the back – between the spine and V7
Blood entering the left atrium arrives via the _________. Pulmonary Veins (There are 4 of them)
The coronary vessels are not fed blood during what part of the cardiac cycle? Systole
The great cardiac vein and the lateral marginal veins empty back into the heart via what structure? Coronary sinus
What are the two different types of modes that the cardiac monitor will give you when monitoring a patient’s heart rhythm? Monitor mode and Diagnostic mode
What is the average pressure inside the right ventricle during systole? 24 mmHg
What is the average pressure inside the left atrium? 8 mmHg
What is the average pressure inside the left ventricle during systole? 130 mmHg
What is the IV/IO dose of Epi for an adult patient in cardiac arrest? 1 mg
What is the first IV/IO dose of Amiodarone for an adult patient in cardiac arrest? 300 mg
The refractory period has two parts, an _________ refractory period and a __________ refractory period. Absolute and relative
What is the first IV/IO dose of Amiodarone for an adult patient in V-Tach with a pulse? 150 mg slow over 10 minutes
What is the first IV/IO dose of Adenosine for an adult patient in SVT? 6 mg
What are the two different types of WPW? Orthodromic and antidromic
How does Amiodarone work in the body to slow a ventricular rhythm? Slows the potassium to prolong the repolarization phase – this makes the cell harder to depolarize
What is the second IV/IO dose of Adenosine for an adult patient in SVT? 12 mg
What are the “Three I’s” of cardiac? Ischemia, Injury and Infarct
What wave is typically produced on an EKG with a patient that has a past medical history of WPW? Delta wave
How does Atropine work in the body to speed up a bradycardic heart rate? It blocks the parasympathetic nervous system
What is the second IV/IO dose of Amiodarone to an adult patient that is in a refractory ventricular rhythm? 150 mg
What are the contraindications for the administration of Nitroglycerin? Hypotension below 90mmHg, Bradycardia below 50 beats per minute & Tachycardia above 100 beats per minute, RV Infarction, Use of Phosphodiesterase Inhibitors within the last 48hours.
What is the most prevalent intracellular ion? Potassium (K+)
What is the most prevalent extracellular ion? Sodium (Na+)
You have a patient that presents with Torsades de Pointes – the patient is symptomatic but stable – what medication would be appropriate for this patient? Magnesium Sulfate (1-2grams IV)
What is the correct dose of Atropine for a patient that is found to be in bradycardia? 0.5mg fast IV push – Max total dose of 3mg
What is the correct IV infusion rate of Amiodarone for a patient that is post cardiac arrest with ROSC? 1mg minute for the first 6 hours, followed by 0.5mg min for the next 18 hours – not to exceed 2.2 grams in 24 hours.
After administering Diltiazem to a patient that was in A-Flutter with RVR you noticed that Pt’s blood pressure has dropped from 130 to 60 systolic – what medication would you administer to this patient in an attempt to correct this drop in B/P? Calcium Chloride
What is the antidote that you can administer to a patient that is found to be bradycardic after an apparent overdose of beta-blockers? Glucagon
What are the four ending points of Procainamide? Hypotension, Widening of the QRS by 50% of what you started with, Termination of the rhythm or you reach the max dose.
What is the correct dose of Procainamide for a patient that is found to be in reoccurring ventricular dysrhythmias? 20-50mg minute
How many joules would you start with to cardiovert a patient that is found to be in Torsades de Pointes? You wouldn’t cardiovert Torsade de Pointes – You would defib it!
What is the correct initial joule setting for cardioversion of atrial fibrillation? 120-200 J
What drugs can be administered for a patient in cardiac arrest with an ECG rhythm of asystole? Epi 1:10,000 – Also, remember to check the patient's blood sugar level – you may need to administer Dextrose if the patient is hypoglycemic
What is the correct dose of Diltiazem for a patient in A-Fib with RVR? 0.25mg/kg – Max dose of 20mg
What joule setting would you use for a patient in V-Fib while using a monophasic monitor? 360J or the highest the monitor would go to
It what cases would warrant you to utilize a cardiac donut magnet? Run-a-way pacer, AICD malfunctioning
How fast would you ventilate an intubated patient that is in cardiac arrest? 1 breathe every 6-8 seconds
Phase 0 of the action potential represents what happening in the cell? Fast sodium channels open – Sodium rushes into the cell
Phase 1 of the action potential represents what happening in the cell? A little bit of K+ leaves the cell
What coronary vessel feeds the majority of the left ventricle muscle? LAD
Phase 2 of the action potential represents what happening in the cell? K+ leaving the cell while at the same time Ca+ is coming into the cell
Phase 3 of the action potential represents what happening in the cell? K+ leaving the cell – this represents repolarization
What coronary vessel feeds the SA and AV node for most of the human population? RCA
What does S1Q3T3 represent on an ECG? Possible PE
During Phase 4 of the Action Potential, what is happening inside of the cell? Everything is being put back to it’s original state – the sodium is being pumped out (3) and the potassium is being brought back into the cell (2)
What are the 5 Korotkoff Sounds when auscultating a blood pressure? Snapping, Swooshing, Tapping, Thumping or Muting, & Silence
When using lead V1 – where in the heart is that lead looking at? Septal Wall
When using lead V2 – where in the heart is that lead looking at? Septal Wall
When using lead V3 – where in the heart is that lead looking at? Anterior Wall
When using lead V4 – where in the heart is that lead looking at? Anterior Wall
When using lead V5 – where in the heart is that lead looking at? Left lower lateral wall
When using lead V6 – where in the heart is that lead looking at? Left lower lateral wall
When using lead V4r – where in the heart is that lead looking at? Right Ventricle
When using lead V8 & V9 – where in the heart is that lead looking at? Posterior Wall
What can be used to recognize a STEMI in the presence of a LBBB or a ventricular paced rhythm? Sgarbossa Criteria

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