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What is the route of the electrical conduction of the heart?
1) SA Node 2) AV Node 3) Bundle of HIS 4) R&L Bundle Branch 5) Purkinje Fibers
What is the HR of the SA node?
60-100
What is the HR of the AV Node?
40-60
What is the HR of the Purkinje fibers?
20-40
What is the cardiac cycle?
Actual time sequence between ventricular contraction and ventricular relaxation
0.8 seconds = one cycle
What is the formula for determining heart rate of a regular rhythm?
Irregular rhythm count the # of QRS in a 6 second strip and multiply by 10.
REGULAR rhythm count the number of large boxes between QRS and divide into 300


How to determine a regular rhythm?
Use RR for ventricular rhythm and PP for atrial rhythm. If intervals are the same or less than 0.8 sec difference throughout the strip the rhythm is regular.
What is the Normal PR interval rate?
0.12-0.20 sec
What is the normal Length of a QRS complex?
Less than 0.12 seconds
What is the PR interval?
The time the impulse takes to travel through the AV node, the HIS-Perkinje system, and through the ventricles
Normal: 0.12-0.20 seconds
What is the QRS complex?
The electrical depolarization and contraction of the ventricles.
Normal: 0.04 to 0.12 seconds
Formula to be used for analysis:
1) Identify P Waves 2) Measure p-p intervales 3) Measure p-R intervals 4) measure QRS duration 5) measure R-R interval 6) determine rate 7) dtermine rhythm
What is the sign of Ischemia on an EKG?
Inverted T-Wave
What is the sign of Injury on an EKG?
Depressed ST Segment
What are signs of an MI or necrosis on an EKG?
ST segment elevation (heart not repolarizing or resting)
What drugs are in the class of Ace Inhibitors?
Captopril, Lisinopril, Enalapril
Captopril
Ace Inhibitor, Causes vasodilation, decrease systemic vascular resistance, prevents onset of heart failure, watch BP, urine output, Creatinine and electrolyte levels,  Possible SE: hypotensionCan cause possible toxicity by increasing lithium and digoxin. Can increase effects of insulin and oral antidiabetics causeing hypoglycemia. HERB: aconite/monkshod can cause toxicity and death
Lisinopril
Ace Inhibitor, Causes Vasodilation, decrease systemic vascular resistance, prevents onset of heart failure, watch BP, urine output, Creatinine and electrolyte levels, Possible SE: fatigue, Vertigo, Stroke Increases allopurinol and hyoptensive effects of diuretics and other hypertensives, nitrates
Enalapril
Ace Inhibitor, Causes Vasodilation, decrease systemic vascular resistance, prevents onset of heart failure, watch BP, urine output, Creatinine and electrolyte levels, Possible SE: Dizziness, MI, Dysrhythmias INCREASES potassium levels do not use with salt substitute, potassium sparing diuretics, potassium supplements, cyclosporin or indomethacin. Also increases levels of digoxin and lithium. With herb arginincan cause fatal hypokalemia.
Digitalis
(aka digoxin,lanoxin) Increases contraction of the heart, slows heart rate, Used in heart failure and dysrhythmias. Possible SE HA, hypotension, bradycardia, Monitor For Toxicity or overdose dt so many otc and herbs increaseing digoxin levels. Including: senna, aloe, castor, licorice, foxglove. Teaxch pt S&S of toxnicity: LOA, lower stomach pain, blurred or yellow vision, rash. DO not take with antacid. TX for Toxnicity: DC drug, give K+, monitor EKG, give adrenergic blocking agent, digoxing immune FAB
What are your beta blockers?
Dobutamine
Dobutamine
Beta Blocker, decreases cardiac workload, by increasing cardiac output without marked increase in HR, Careful use in COPD and asthma, Teach family to report trouble breathing, Sulfite sensitivity can be life-treatening. TX: Cardiac decompression dt organic heart disease or cardiac surgery
InAmrinone, Inocore
Inotropic, vasodilator properties, reduces preload and afterload bydirect relaxation of vascular smooth muscle, increases cardiac output. HIGH ALERT If platelets are below 150,000 mm 3 drug is usually discontinued and another drug started. Potential SE: hypoxemia, hypotension, ascities 
Natrecor (nesiritide)
Vasodilator, Used in Acute decompensated CHF HIGH ALERT Possible SE: Apnea, hypotension, tachycardia. PT teach report: dizziness, blurred vision, light headeddness, sweating, SOB
What are the names of the CA Channel Blockers?
Vaerapamil, Procardia, Cardizem, Norvasc/amlodipine
Verapamil
CA Channel Blocker, inhibits ca ion influx across cell membrance during cardiac depolarization, produces relaxation of coronary vascular smooth muscle, dialates smooth muscle, decreases SA/AV node conduction, dialates peripheral arteries. Possible SE: Stevens-Johnson syndrome *I&O, Daily weight, CHF: crackles, weight gain, dyspnia, jugular vein distention, severe rash
Procardia
Calcium Channel Blocker. Uses: Chronic Stable Angina, hypertension. Possible SE: Stevens-Johnson syndrome, Educate to notify prescriber of dyspnes, edema of extremities, N&V, severe ataxia, severe rash
Cardizem
CA channel blocker, Angina pectoris dt coronary artery spasm. A Fib. Possible SE: dysrhythmia, heart block. Tteach to report dizziness, SOB, palpitations.
Norvasc / amlodipine
Ca Channel Blocker, Anti-anginal, Increases neurotoxicity with lithium. Increases hypotension with alcohol, antihypertensives and nitrates. Increases HYPOTENSIVE effect with GRAPEFRUITE JUICE and NSAIDS.
What medications are in the diuretics class?
Lasix, Bumex, Zaroxolyn, Aldactone
lasix / furosemide
action: inhibits reabsorption of Na+ and chloride at proximal and distal tubule in the loop of henle. possible SE: Stevens-johnson syndrome, low electrolytes, S&S of low K+: postural hypotension, tachycardia, leg cramps. Increases toxicity in Lithium and digoxin.
Bumex
Diuretic, SE: Stevens-johnson syndrome, low electrolytes, S&S of low K+: postural hypotension, tachycardia, leg cramps. Increases toxicity in Lithium and digoxin.
zaroxolyn / metolazone
dyuretic, antihypertensive. Acts on distal tubule by increasing excretion of H2O, Na+, Chloride, K+, Magnesium, bicarb. hypokalemia, toxicity in lithium, blood glucose may be increased in diabetics
Aldactone / spironolactone
K+ sparing dyuretic,Possible SE: hyperkalemia. Fatal Hyperkalemia can be caused by herb Arginine. Avoid foods with high K+ like banana, salt substitute, oranges, dried apricots, dates
Nitroprusside / Nipride
Class: antihypertensive/vasodilator, Action: directly relaxes arteriolar, venous smooth muscle-resulting in reduction in cardiac preload and afterload. Potential SE: Cyanide, thiocyanate toxicity S&S of thiocyonate toxicity includes: seizures. hyperreflexia, psychosis, tinnitus, coma, confusion, weakness. Cyanide levels daily in infusions.
What are the name of beta blockers?
Lopressor, Coreg, Toprol, Metoprolol
Lopressor / metoprolol / toprol
Beta BLocker, Decrease workload of heart, Decrease size of MI, controls ventricular dysrhythmias. CAREFUL use with COPD and ASTHMA. Possible SE: Broncospasm, insomnia, depression, Take immediatley after meals. Take @ bed to prevent orthostatic hypotension
Coreg / carvedilol
Beta blocker, Do not dc abruptly taper over 1-2 weeks or life threatening dysrhythmia can occur. Renal studies, If increased may indicate nephrotic syndrome
Apresoline / hydralazine
vasodilates arteriolar smooth muscle by direct relaxation Possible SE: shock refexive tachycardia
Isordil / Isosorbide dinitrate
Class: Vasodilator, antianginal Possible SE: collapse, vascular HA, postual Hypotension. Interactions: FATAL Hypotension with sildenafil, tadalafil, vardenafil.
Amniodarone / Cordarone / Pacerone
Class: Antidisrhythmic Action: Prolongs duration of action potential and effective refractory period. decreases sinus rate and decreases peripheral vascular resistance. Interactions: Toxicity with grapefruit juice.  Pulmonary signs are dyspnea, fatigue, cough, fever, & chest pain, DC drug. Teach pt no grapefruit juice and stay out of sun
Dopamine / Intropin / Revimine
HIGH ALERT Class: Adrenergic Action: Increased cardiac output, vasoconstriction in blood vessels, renal and mesentric dialation.  Uses: shock, hypotension, increased perfusion. Possible SE: necrosis, gangene, Tachycardia, palpitations, hypertension, HA, wide QRS complex.  DO NOT give with V FIB or tachydysrhythmias, Or pheochromocytoma (tumor on adrenal glands that produce epinepherine)
What is the most important phase of the heart beating and why?
Diastole, dt ventricles and srteries being refilled with oxygenated blood.
P Wave
Atrial depolarization and contraction
QRS
Ventricular depolarization and contraction
ST
Ventricular relaxation and repolarization (filling coronary arteries)
Stroke Volume
Volume of blood pumped out of one ventricle in a single beat or contraction
SV = ESV - EDV (End Systolic Volume - End Diastolic Volume)
Cardiac Output
Amount of blood pumped by Left ventricle in one minute.
CO = SVxHR unless hr gets too high.
Preload
Pressure in the ventricles at the end of diastole (volume coming into the ventricle) end diastole pressure
Which blood pressure meds with foods and which without?
WITHOUT FOOD- Ace inhibitors and Ca channel blockers  WITH FOOD-Beta BLockers and antihypertensives
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