1
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
, 1
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
, 1
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
, 1
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
Β1-adrenoceptor - In the heart
Agonism causes ↑ HR, Contractility
Antagonist - Beta Blocker
Agonist - Epi, Norepi
Β2-adrenoceptors - Also in the heart
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
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
, 1
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
, 1
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
, 1
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
Β1-adrenoceptor - In the heart
Agonism causes ↑ HR, Contractility
Antagonist - Beta Blocker
Agonist - Epi, Norepi
Β2-adrenoceptors - Also in the heart
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
