Cardiology Cards fr 10-25

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medic11
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Cardiology Cards fr 10-25
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2010-10-27 12:38:47
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Cardiology cards for 10-25
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  1. The left anterior descending artery supplies the ____ ____ .
    Intraventricular septum
  2. Ischemia involving the L anterior descending artery can be seen in what EKG leads?
    • 1, AVL, V1-V6
    • V2 – V4
    • V1 – V3
  3. Probs w/the left anterior descending artery cause infarct in what part of the heart?
    • L ventricle, anterior wall
    • Anterior apical
    • Anteroseptal
  4. Probs w/ the L anterior descending artery cause what 3 hemodynamic consequences?
    • Typically HYPERDYNAMIC
    • Papillary muscle rupture
    • Pump failure
  5. What dysrhythmias are common to the L anterior descending artery?
    • 2nd degree Mobitz 2 or 3rd degree blocks
    • Sinus Tach
  6. The L circumflex artery supplies what parts of the heart?
    • L atrium & ventricle
    • 40-50% of the SA Node
    • 8-10 % of the AV Node
    • Bundle of his
  7. Infarct locations related to the L circumflex artery are what?
    • Lateral wall, L ventricle
    • Posterolateral
  8. Issues w/ the L circumflex show up in what leads?
    • 1, AVL, V4-V6
    • V4-V6
  9. The hemodynamic consequences of a problem w/the L circumflex are what?
    Typically NORMODYNAMIC
  10. What common dysrhythmia can be related to the L circumflex?
    Sinus dysrhythmia
  11. The R coronary artery supplies what parts of the heart?
    • R atrium & ventricle
    • Posterior L ventricle
    • 50-60% of the SA node
    • Bundle of His
  12. Infarct locations related to the R coronary artery are what?
    • Inferior Wall
    • Posterior Wall
    • R ventricle
  13. Ischemia related to the R coronary artery can be seen in what EKG leads?
    • 2,3,AVF
    • V2,V3
  14. Hemodynamic consequences related to the R coronary artery include. . . .
    • Typically HYPODYNAMIC
    • Vasovagal response
    • Hypotension
  15. Some unique findings that show w/a prob w/ the R coronary artery are what?
    • Nausea/vomiting
    • Can present w/isolated R failure
  16. Common dysrhythmias caused by a prob w/R coronary artery are what?
    • 1st degree or 2nd degree mobitz I blocks
    • Sinus Brady
  17. Hemiblock is short for ____ ____ & occurs when?
    • Left Hemiblock
    • When 1 or more fascicles of the LBB is/are blocked
  18. Hemiblocks increase the risk for complete heart block under what 2 circumstances?
    • When combined w/1st or 2nd degree block
    • 2 hemiblocks aka bifasicular
  19. Leads V1-V6 are know as ____ leads & view the chest in a ____ ____.
    • Precordial leads
    • Transverse plane
  20. Posterior precordial leads (V8,V9) are located where?
    • V8 = 5th IC space Mid scapular
    • V9 = 5th IC between V8 & spine
  21. A TCA OD presents how & in what lead?
    Wide QRS in AVR
  22. What are the 6 rules for interpreting a 12 lead?
    • Identify underlying rhythm
    • Determine the axis
    • Locate & ID ectopic beats
    • Eval clinical & EKG evidence for cardiac ischemia &/or infarct
    • Localize cardiac ischemia/infarct
    • Look for BBB, Hemiblocks, Hypertrophy
  23. What does the axis of the heart indicate?
    Predominant flow of electricity thru the heart
  24. Give 6 causes of left axis deviation. . .
    • Mechanical shift of the heart
    • LBBB
    • WPW syndrome
    • Emphysema
    • Hyperkalemia
    • Ventricular Ectopy
  25. Give 6 causes of right axis deviation. . . .
    • Mechanical Shift of the heart
    • Right ventricular hypertrophy
    • RBBB
    • Dextrocardia
    • WPW syndrome
    • Ventricular Ectopy
  26. A normal axis is between ____ & ____.
    0 & +90
  27. A left shoulder axis is between ____ & ____.
    0 & -90
  28. A right shoulder axis is between ____ & ____.
    + - 180 & -90
  29. A right axis is between ____ & ____.
    +90 & + - 180
  30. A normal axis presents in Leads I, II, III as what?
    • Lead I = up
    • Lead II = up
    • Lead III = up
  31. A physiologic L axis presents how in Leads I, II, III?
    • I = up
    • II= up/ even up & down
    • III = down
  32. Pathological L axis presents what in Leads I, II, III & shows an ____ ____.
    • I = up
    • II = down
    • III = down
    • Anterior Hemiblock
  33. An R axis presents how in Leads I, II, III & shows a ____ ____.
    • I = down
    • II = up/ even up & down
    • III = up
    • Posterior Hemiblock
  34. An extreme R axis (aka ___ ___ ___) presents how in Leads I, II, III & is often __ __ __.
    • I = down
    • II= down
    • III = down
    • Ventricular in Origin
  35. How does a hemi block present anteriorly?
    • QRS is normal or RBBB
    • L axis deviation
    • Sm qR wave in Lead I
    • rS wave in lead III
  36. What are the clinical correlates of an anterior hemiblock?
    • Anterior & inferior MI
    • Lowest Mortality
  37. A posterior hemiblock presents with?
    • QRS normal or RBBB
    • R axis deviation
    • Sm qR wave in lead III
    • Lg rS wave in lead I
  38. What are the clinical correlates of a posterior hemiblock?
    • Has dual blood supply so requires extensive cardiac damage to injure
    • 71% mortality
  39. What exactly is a hemiblock?
    Block of 1 of the fascicles of the LBB
  40. What is a bifasicular block?
    Block where 2 fascicles are occluded; RBBB & anterior (most common) OR posterior hemiblock
  41. Until proven otherwise all axis deviations are assumed to represent a ____ so ____ ____ are contraindicated if the pt has what or what.
    • Hemiblock
    • Class I Antidysrhythmic
    • Anykind of AV block or BBB
  42. What are some problems (5) w/pts w/a bifasicular block?
    • Much sicker than an uncomplicated MI
    • May drop BP precipitously
    • May go into V Fib or tach w/o warning
    • May go into complete heart block
    • Should not receive Class I antidysrhythmics
  43. Describe a trifasicular block.
    A bifasicular block plus a 1st degree block
  44. What 3 things can cause damage to the bundles/
    • Myocardial infarction or ischemia
    • Congenital disorders
    • Post RF ablation
  45. Anterior/posterior myocardial infarction/ischemia cause bundle damage where?
    • Anterior MI  RBBB
    • Posterior MI  LBBB
  46. The ___ ___ ___ conducts across the rt ventricle.
    Right bundle branch
  47. The Left bundle branch is divided in to what 3 parts & conducts across where?
    • Anterior, posterior & septal (minor)
    • Across the left ventricle
  48. What happens in a bundle branch block?
    Branches of the bundle of his become damaged
  49. What could happen to conduction thru an area w/a BBB?
    It could be slowed, partially blocked or completely blocked
  50. What are the hallmarks of a bundle branch block?
    • QRS > 0.12 (widest in leads closest to block)
    • Abnormal QRS morphology
    • T polarity opposite of QRS
  51. How do we recognize BBB’s?
    • QRS >0.12 in V1
    • Circle J point
    • Draw line back into complex then up or down w/terminal deflection
    • Shade in triangle made by line
    • Arrow up = R turn signal = RBBB
    • Arrow down = L turn signal = LBBB
  52. What are the 6 steps in a V Tach algorithm?
    • ERAD + Pos V1 OR
    • QRS morphology in V1 or V6 OR
    • RAD + Neg V1 OR
    • Concordance OR
    • RS interval (V lead) is > 100ms OR
    • QRS > 0.14 sec
  53. What is the effect of cardiac ischemia on the Q waves?
    it creates a deep wide Q wave that is a permanent sign of the event
  54. An ST segment elevation is indicative of what?
    • Epicardial injury
    • May be associated w/ peaked T waves in acute state
  55. Abnormal T waves are ____, ____ & ____.
    • Inverted
    • Symetric
    • Pointed
  56. What is seen in deep T wave inversion?
    • Seen in leads reflecting ischemia
    • ST segment preceding T Waves is commonly coved upward
  57. Septal infarcts involve ___ ___ ___ & show where on the EKG?
    • Left Anterior Descending
    • Leads V1 & V2
  58. An infarct localized in an Anterior Wall involves the ___ ___ ___ artery and shows on leads ___ & ___.
    • Left Anterior descending
    • V3 & V4
  59. A lateral wall infarct shows in what arteries & what leads?
    • Left Anterior Descending &/or Left Circumflex
    • 1, V5, V6
    • AVL = High Lateral Wall
  60. Anterolateral wall infarct involves what 2 arteries & shows in what leads?
    • Left Anterior Descending & Left Circumflex
    • 1, aVL, V3-V6
  61. An inferior wall infarct affects what arteries & shows in what leads?
    • Rt coronary or Left Circumflex
    • 2, 3 & aVF
  62. A posterior wall infarct involves what arteries & shows how on EKG?
    • Distal Left block or posterolateral branch
    • Leads V1 - V4
    • ST depression

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