CCRN Cardiovascular and Hemodynamics Comprehensive Review

Comprehensive practice flashcards in fill-in-the-blank style covering CCRN cardiovascular, hemodynamics, 12-lead ECG, shock states, pharmacological therapies, and mechanical circulatory support.

According to ECG diagnostic criteria, a Q wave is considered pathologic when its duration is __________ or longer and its depth is at least 25% of the height of the R wave.

$$\ge 0.04\,\text{seconds}$$

The ECG feature shown in the diagram, characterized by a short PR interval of less than $0.12\,\text{seconds}$ and a slurred upstroke of the QRS complex, is known as a __________.

delta wave

When leveling and zeroing a pulmonary artery or arterial catheter transducer, the air-fluid interface must be aligned with the phlebostatic axis, located at the __________.

4th intercostal space

During intra-aortic balloon counterpulsation, balloon inflation occurs at the __________ on the arterial waveform, which marks the closure of the aortic valve.

dicrotic notch

According to the Stanford classification system for aortic dissection, any tear that involves the ascending aorta is classified as __________.

Type A

On the chest wall, the aortic valve is best auscultated at the __________.

right second intercostal space

In a 12-lead ECG, ST segment elevation across leads II, III, and aVF indicates an acute myocardial infarction of the __________ wall.

inferior

ST segment elevation in leads V1 through V4 indicates an acute infarction supplied by the __________.

left anterior descending (LAD) artery

When reading an ECG with both ST elevation and ST depression present in different lead groupings, the rule is that __________.

ST elevation trumps ST depression

The standard STEMI door-to-balloon time goal for primary percutaneous coronary intervention (PCI) is __________.

$$\le 90\,\text{minutes}$$

For suspected right ventricular infarction accompanying an inferior STEMI, the single most sensitive lead on a right-sided 12-lead ECG is __________.

V4R

Preload-reducing medications such as nitroglycerin, diuretics, and morphine must be avoided in patients experiencing an acute __________ infarction.

right ventricular

An inferior wall myocardial infarction carries a high risk for heart block located high in the AV node, such as __________.

third-degree heart block or second-degree type I (Wenckebach)

Because the left anterior descending artery supplies the bundle of His and bundle branches, an acute anterior MI most commonly predisposes to __________.

second-degree AV block type II

A new, loud, harsh apical systolic murmur developing two days after an inferior STEMI is indicative of acute mitral regurgitation caused by __________.

papillary muscle rupture

A patient with fever and sharp pleuritic chest pain that worsens with deep inspiration and improves when leaning forward, occurring $2\text{--}10\,\text{weeks}$ post-MI, is presenting with __________.

Dressler's syndrome

Variant (Prinzmetal's) angina is caused by coronary artery vasospasm and is primarily treated with nitroglycerin and __________.

calcium channel blockers

The normal reference range for central venous pressure (CVP) / right atrial pressure (RAP) taught in the review is __________.

$$2\text{--}6\,\text{mm\,Hg}$$

The normal reference range for pulmonary artery occlusion pressure (PAOP / wedge) is __________.

$$8\text{--}12\,\text{mm\,Hg}$$

The normal reference range for systemic vascular resistance (SVR) is __________.

$$800-1200\,$$

The normal reference range for pulmonary artery pressure (PAP) is described mnemonically as a quarter over a dime, or __________.

$$25/10\,\text{mm\,Hg}$$

The normal reference range for true mixed venous oxygen saturation ($\text{SvO}_2$) drawn from the distal port of a pulmonary artery catheter is __________.

$$65\text{--}75\%$$

The hemodynamic hallmark of cardiogenic shock is a markedly reduced cardiac index below $2.0\,\text{L/min/m}^2$ accompanied by an elevated PAOP greater than __________.

$$18\,\text{mm\,Hg}$$

Unlike other shock states, early (warm) septic shock characteristically presents with an elevated cardiac output and an abnormally high $\text{SvO}_2$ exceeding __________.

$$75\%$$

In distributive anaphylactic shock, massive histamine release causes profound systemic vasodilation resulting in an SVR well below __________.

$$800\,\text{dynes/sec/cm}^{-5}$$

On pulmonary artery catheter monitoring, cardiac tamponade is characterized by equalization of CVP, pulmonary artery diastolic pressure, and PAOP to within __________ of each other.

$$5\,\text{mm\,Hg}$$

Beck's triad of cardiac tamponade consists of hypotension, muffled heart sounds, and __________.

jugular venous distension (JVD)

Pulsus paradoxus is defined as an inspiratory decrease in systolic blood pressure of greater than __________.

$$10\,$$

For initial resuscitation in septic shock, the Surviving Sepsis guidelines recommend an IV crystalloid fluid bolus of __________.

$$30\,\text{mL/kg}$$

The first-line vasopressor of choice to restore vascular tone and target a MAP of at least $65\,\text{mm\,Hg}$ in septic shock is __________.

norepinephrine

When dosing dopamine, an infusion rate of $5\text{--}10\,\mu\text{g/kg/min}$ primarily stimulates __________ receptors to increase myocardial contractility and heart rate.

beta-1

Dopamine infusion rates exceeding $10\,\mu\text{g/kg/min}$ stimulate __________ receptors, resulting in arterial vasoconstriction and increased afterload.

alpha-1

The antidote used for local infiltration to prevent tissue necrosis following vasopressor extravasation is __________.

phentolamine

The use of an intra-aortic balloon pump (IABP) is strictly contraindicated in patients with __________.

aortic valve insufficiency (aortic regurgitation)

An S3 heart sound (ventricular gallop) is indicative of __________ and is auscultated when preload is significantly elevated.

fluid overload

An S4 heart sound (atrial gallop) occurs in late diastole and represents atrial contraction ejecting into a __________.

non-compliant or stiff ventricle

According to the heart murmur mnemonic 'MRS ASS', mitral regurgitation and aortic stenosis both produce __________ murmurs.

systolic

According to the heart murmur mnemonic 'ARMS Down', aortic regurgitation and mitral stenosis both produce __________ murmurs.

diastolic

In patients with hypertrophic cardiomyopathy (HCM), inotropic agents like digoxin and dobutamine must be avoided because they __________.

worsen left ventricular outflow tract (LVOT) obstruction

For an unstable patient presenting with monomorphic ventricular tachycardia with a palpable pulse, the immediate ACLS treatment of choice is __________.

synchronized cardioversion

The initial pharmacological treatment of choice for polymorphic ventricular tachycardia (Torsades de Pointes) in an unstable or stable patient with a pulse is IV __________.

magnesium

The P2Y12 platelet inhibitor prasugrel (Effient) carries a black box warning and should not be administered to patients who have a history of __________.

stroke or transient ischemic attack (TIA)

The target low-density lipoprotein (LDL) cholesterol goal following a myocardial infarction is less than __________.

$$70\,\text{mg/dL}$$

In temporary or permanent cardiac pacing, an undersensing condition results in __________ because the pacemaker fails to detect intrinsic cardiac activity.

over-pacing (pacing spikes where they should not be)

During cardiopulmonary resuscitation (CPR), continuous end-tidal $\text{CO}_2$ ($\text{P}_{\text{ET}}\text{CO}_2$) monitoring is used to evaluate compression quality, and an abrupt jump exceeding __________ may indicate return of spontaneous circulation (ROSC).

$$40\,\text{mm\,Hg}$$

A hypertensive emergency is defined as an acute blood pressure elevation exceeding $180/120\,\text{mm\,Hg}$ with target organ damage, and the initial treatment goal is to lower blood pressure by __________ in the first $1\text{--}2\,\text{hours}$.

$$25\%$$

Patients receiving prolonged infusions of sodium nitroprusside for more than $72\,\text{hours}$ or in the setting of renal failure are at high risk for __________ toxicity.

thiocyanate

Following percutaneous coronary intervention via the femoral artery, a patient presenting with back pain, hypotension, tachycardia, and flank ecchymosis (Grey Turner's sign) should be immediately evaluated for __________.

retroperitoneal bleeding