CCRN Exam Notes
Which of the following does not predispose the patient to digitalis toxicity? Hyponatremia.
Remember that potassium, calcium, and magnesium affect cardiac contractility,
Which single lead is the most valuable for the diagnosis of ventricular tachycardia? V1
Cardio
Sites of MIs
Inferior MI - Right Coronary (RC), associated with papillary
muscle ruputure
Indicative Changes: II, III, aVF
Reciprocal Changes: I, AVL
Anterior MI - Left Anterior Descending (LAD), associated with
ventricular septal ruputure (holosystic murmur)
Indicative Changes: V2, V3, V4
Reciprocal Changes: II, III, AVF
Septal Wall - Left Anterior Descending (LAD)
Indicative Changes: V1 , sometimes V2
Reciprocal Changes: V5, V6
Lateral MI - Circumflex Artery
Indicative Changes: I, AVL, V5, V6
Reciprocal Changes: II, III, AVF
Posterior Wall MI - Right coronary, if dominant
Indicative Changes: V7, V8, V9
Reciprocal Changes: V1, V2, V3
**Remember posterior Wall MI has leads that are high numbers, post means after so
associate these two
● murmur is loudest at the apex, and the clinical presentation is related to acute
pulmonary edema.
Cardiac Values
,Swanz gaz – measures pressure , cardiac output , and oxygen
PAOP 6-12mmHg (left atrial pressures = left ventricular end-diastolic pressure)(aka left
ventricular preload) PAWP (pulmonary artery wedge pressure) 4-12mmHG (in the pulmonary
artery), inflate for 3-5 seconds and will have direct measurement of from back pressure.
PAOP or PAWP <4 = hypovolemic patient
PAOP or PAWP >4 = hypervolemic patient
The PAd is normally 2 to 5 mm Hg higher than the PAOP. PAd may be more than 5 mm Hg
higher than the PAOP in patients with pulmonary hypertension. If the PAOP is higher than the
PAd, suspect that there is an occlusion in the catheter or that the catheter is not in the
correct area of the pulmonary vasculature. The RAP is normally lower than the PAOP.
RAP/CVP 2-6mmHg or 1-8( right atrium pressure)
Optimal in Critical Care Can be up to 10mmHg
PAP (pulmonary artery pressure) – could be systolic and diastolic
PAP systolic – 15-26 mmhG
PAD diastolic 5-15 mmHG
Cardiac tamponade would cause an increase in RAP, PAP, and PAOP.
SV02 –mixed venous saturation of oxygen.normal 60-80% It is basically the percentage of oxygen
remaining in the venous blood returning to the right side of the heart. This is the oxygen left over in the
blood after supplying all the parts of the body except the head.
Systolic – squeeze
Diastolic – relaxation and filing
CO 4-8 L/min
CI 2.5-4.3 L/min/m²
Stroke Volume 60-100 mL/beat
Stroke Volume Index 35-60mL/m²
Stroke Volume Variation 10-15%
SVmax-SVmin/SVmean x 100
LV Stroke Work Index 50-62gm-m/m²/beat
,RV Stroke Work Index 5-10gm-m/m²/beat
PVR (RV) <250 dynes/sec/cm⁻⁵
80 x (MPAP - PAOP)/CO
PVRI 255-285 dynes/sec⁻⁵/m²
SVR (LV) 800-1200 dynes
80 x (MAP - RAP)/CO
SVRI 1970-3900 dynes/sec/cm⁻⁵/m²
Coronary Artery Perfusion Pressure (CAPP) 60-80mmHg
Diastolic BP - PAOP at least 15 for ROSC
Cerebral Perfusion Pressure CPP=MAP-ICP
Ejection Fraction 55-70%
Cardiac Receptors
Β -adrenoceptor - In the heart
1
Agonism causes ↑ HR, Contractility
Antagonist - Beta Blocker
Agonist - Epi, Norepi
Β -adrenoceptors - Also in the heart
2
Agonism causes smooth muscle relaxation
Agonist - Epi, Norepi, Albuterol
Antagonist - Beta Blockers
Alpha 1 - lungs and peripheral arterioles
Agonism - Vasoconstriction of blood vessels(smooth muscle)
Agonists - Phenylephrine, Midodrine
Antagonist - Labetalol
Alpha 2 - in the brain
Certain antihypertensives can stimulate this to cause vasodilation
Dopaminergic receptors - renal and mesenteric beds
Agonism – vasodilation
Beck’s Triad - Sign of cardiac tamponade
Hypotension
Muffled Heart Sounds
Distended Neck Veins (JVD)
Pacer Codes
First Letter - Chamber Paced
D - Dual A+V
A - Atrial
, V - Ventricle
Second Letter - Chamber Sensed
D - Dual A+v
A - Atrial
V - Ventricle
O - None
Third Letter - Response after sensing
I - Inhibited
T-
Triggered
D - Dual (I+T)
O - None
Anterior wall - changes in leads V2, V3, and V4 indicate injury to the anterior wall.
Lateral wall injury would be evident in leads V5 and V6, and/or I and aVL.
Inferior wall injury would be evident in leads II, III, and aVF. Posterior wall injury would
be evident in leads V7 to V9 if posterior leads are being used, or ST segment depression and
large T waves would be seen in leads V1 and V2.
●ICD is used for recurrent ventricular tachycardia or fibrillation, not for
supraventricular tachycardias such as those caused by Wolff-Parkinson-White
●Prominent v waves = mitral regurgitation/insuffiency , problem closing (VR, video
reality, v wave and reguiration
●prominent a waves = mitral stenosis. A/O, a wave and stenOsis
●Mitral regurgitation causes a holosystolic murmur loudest at the apex and
radiating to the axilla.syndrome.
●Tension pneumothorax shifts away from the affected side, and breath sounds are
diminished or absent on the affected side. Choose option b.
●holosystolic murmur at the lower left sternal border is a sign of ventricular
septal rupture.
●Cardiac tamponade, pneumothorax, and pulmonary emboli are possible
complications of electrophysiology testing and radiofrequency ablation.
Prepare the patient for surgery if patient has ripping chest pain and take blood
pressure on both arms, it is indicative of aortic dissection anuerysm
A patient with severe hypertension most likely would have which of the following? S4
Reciprocal changes in leads V1 and V2 in a patient with indicative changes in leads II, III, and
aVF indicate which of the following? A concurrent posterior infarction
Which of the following does not predispose the patient to digitalis toxicity? Hyponatremia.
Remember that potassium, calcium, and magnesium affect cardiac contractility,
Which single lead is the most valuable for the diagnosis of ventricular tachycardia? V1
Cardio
Sites of MIs
Inferior MI - Right Coronary (RC), associated with papillary
muscle ruputure
Indicative Changes: II, III, aVF
Reciprocal Changes: I, AVL
Anterior MI - Left Anterior Descending (LAD), associated with
ventricular septal ruputure (holosystic murmur)
Indicative Changes: V2, V3, V4
Reciprocal Changes: II, III, AVF
Septal Wall - Left Anterior Descending (LAD)
Indicative Changes: V1 , sometimes V2
Reciprocal Changes: V5, V6
Lateral MI - Circumflex Artery
Indicative Changes: I, AVL, V5, V6
Reciprocal Changes: II, III, AVF
Posterior Wall MI - Right coronary, if dominant
Indicative Changes: V7, V8, V9
Reciprocal Changes: V1, V2, V3
**Remember posterior Wall MI has leads that are high numbers, post means after so
associate these two
● murmur is loudest at the apex, and the clinical presentation is related to acute
pulmonary edema.
Cardiac Values
,Swanz gaz – measures pressure , cardiac output , and oxygen
PAOP 6-12mmHg (left atrial pressures = left ventricular end-diastolic pressure)(aka left
ventricular preload) PAWP (pulmonary artery wedge pressure) 4-12mmHG (in the pulmonary
artery), inflate for 3-5 seconds and will have direct measurement of from back pressure.
PAOP or PAWP <4 = hypovolemic patient
PAOP or PAWP >4 = hypervolemic patient
The PAd is normally 2 to 5 mm Hg higher than the PAOP. PAd may be more than 5 mm Hg
higher than the PAOP in patients with pulmonary hypertension. If the PAOP is higher than the
PAd, suspect that there is an occlusion in the catheter or that the catheter is not in the
correct area of the pulmonary vasculature. The RAP is normally lower than the PAOP.
RAP/CVP 2-6mmHg or 1-8( right atrium pressure)
Optimal in Critical Care Can be up to 10mmHg
PAP (pulmonary artery pressure) – could be systolic and diastolic
PAP systolic – 15-26 mmhG
PAD diastolic 5-15 mmHG
Cardiac tamponade would cause an increase in RAP, PAP, and PAOP.
SV02 –mixed venous saturation of oxygen.normal 60-80% It is basically the percentage of oxygen
remaining in the venous blood returning to the right side of the heart. This is the oxygen left over in the
blood after supplying all the parts of the body except the head.
Systolic – squeeze
Diastolic – relaxation and filing
CO 4-8 L/min
CI 2.5-4.3 L/min/m²
Stroke Volume 60-100 mL/beat
Stroke Volume Index 35-60mL/m²
Stroke Volume Variation 10-15%
SVmax-SVmin/SVmean x 100
LV Stroke Work Index 50-62gm-m/m²/beat
,RV Stroke Work Index 5-10gm-m/m²/beat
PVR (RV) <250 dynes/sec/cm⁻⁵
80 x (MPAP - PAOP)/CO
PVRI 255-285 dynes/sec⁻⁵/m²
SVR (LV) 800-1200 dynes
80 x (MAP - RAP)/CO
SVRI 1970-3900 dynes/sec/cm⁻⁵/m²
Coronary Artery Perfusion Pressure (CAPP) 60-80mmHg
Diastolic BP - PAOP at least 15 for ROSC
Cerebral Perfusion Pressure CPP=MAP-ICP
Ejection Fraction 55-70%
Cardiac Receptors
Β -adrenoceptor - In the heart
1
Agonism causes ↑ HR, Contractility
Antagonist - Beta Blocker
Agonist - Epi, Norepi
Β -adrenoceptors - Also in the heart
2
Agonism causes smooth muscle relaxation
Agonist - Epi, Norepi, Albuterol
Antagonist - Beta Blockers
Alpha 1 - lungs and peripheral arterioles
Agonism - Vasoconstriction of blood vessels(smooth muscle)
Agonists - Phenylephrine, Midodrine
Antagonist - Labetalol
Alpha 2 - in the brain
Certain antihypertensives can stimulate this to cause vasodilation
Dopaminergic receptors - renal and mesenteric beds
Agonism – vasodilation
Beck’s Triad - Sign of cardiac tamponade
Hypotension
Muffled Heart Sounds
Distended Neck Veins (JVD)
Pacer Codes
First Letter - Chamber Paced
D - Dual A+V
A - Atrial
, V - Ventricle
Second Letter - Chamber Sensed
D - Dual A+v
A - Atrial
V - Ventricle
O - None
Third Letter - Response after sensing
I - Inhibited
T-
Triggered
D - Dual (I+T)
O - None
Anterior wall - changes in leads V2, V3, and V4 indicate injury to the anterior wall.
Lateral wall injury would be evident in leads V5 and V6, and/or I and aVL.
Inferior wall injury would be evident in leads II, III, and aVF. Posterior wall injury would
be evident in leads V7 to V9 if posterior leads are being used, or ST segment depression and
large T waves would be seen in leads V1 and V2.
●ICD is used for recurrent ventricular tachycardia or fibrillation, not for
supraventricular tachycardias such as those caused by Wolff-Parkinson-White
●Prominent v waves = mitral regurgitation/insuffiency , problem closing (VR, video
reality, v wave and reguiration
●prominent a waves = mitral stenosis. A/O, a wave and stenOsis
●Mitral regurgitation causes a holosystolic murmur loudest at the apex and
radiating to the axilla.syndrome.
●Tension pneumothorax shifts away from the affected side, and breath sounds are
diminished or absent on the affected side. Choose option b.
●holosystolic murmur at the lower left sternal border is a sign of ventricular
septal rupture.
●Cardiac tamponade, pneumothorax, and pulmonary emboli are possible
complications of electrophysiology testing and radiofrequency ablation.
Prepare the patient for surgery if patient has ripping chest pain and take blood
pressure on both arms, it is indicative of aortic dissection anuerysm
A patient with severe hypertension most likely would have which of the following? S4
Reciprocal changes in leads V1 and V2 in a patient with indicative changes in leads II, III, and
aVF indicate which of the following? A concurrent posterior infarction
