is Right bundle block. Exercise ramp ECG: contraindications RAMP:p. 31 Recent MI Aortic stenosis MI in the last 7 days Pulmonary hypertension Endocarditis FROM JANE: Fever Roth's spots Osler's nodes Murmur of heart Janeway lesions Anemia Nail hemorrhage Emboli Heart valve sequence Try Puling My Aorta:p. 3 Tricuspid Pulmonary Mitral (bicuspid) Aorta Heart blocks If the R is far from P, then you have a First Degree. Longer, longer, longer, drop! Then you have a Wenkebach. if some P's don't get through, then you have Mobitz II. If P's and Q's don't agree, then you have a Third Degree. Infarctions INFARCTIONSp. 34 IV access Narcotic analgesics (e.g. morphine, pethidine) Facilities for defibrillation (DF) Aspirin/ Anticoagulant (heparin) Rest Converting enzyme inhibitor Thrombolysis IV beta blocker Oxygen 60% Nitrates Stool Softeners JVP: wave form ASK MEp. 32 Atrial contraction Systole (ventricular contraction) Klosure (closure) of tricuspid valve, so atrial filling Maximal atrial filling Emptying of atrium MI: basic management BOOMAR:p. 32 Bed rest Oxygen Opiate Monitor Anticoagulate Reduce clot size MI: signs and symptoms PULSE:p. 32 Persistent chest pains Upset stomach Lightheadedness Shortness of breath Excessive sweating MI: therapeutic treatment O BATMAN!p. 32 Oxygen Beta blocker ASA Thrombolytics (e.g. heparin) Morphine Ace prn Nitroglycerin MI: treatment of acute MI COAG:p. 32 Cyclomorph Oxygen Aspirin Glycerol trinitrate Murmur attributes "IL PQRST" (person has ill PQRST heart waves):p. 32 Intensity Loccasion Pitch Quality Radiation Shape Timing Murmurs: innocent murmur features 8 S's:p. 32 Soft Systolic Short Sounds (S1 & S2) normal Symptomless Special tests normal (X-ray, EKG) Standing/ Sitting (vary with position) Sternal depression Murmurs: louder with inspiration vs expiration LEft sided murmurs louder with Expiration RIght sided murmurs louder with Inspiration.p. 32 Murmurs: questions to ask SCRIPT:p. 32 Site Character (e.g. harsh, soft, blowing) Radiation Intensity Pitch Timing Murmurs: systolic vs. diastolic PASS:Pulmonic & Aortic Stenosis=Systolic. PAID: Pulmonic & Aortic Insufficiency=Diastolic.p. 32 Pericarditis: causes CARDIAC RIND:p. 34 Collagen vascular disease Aortic aneurysm Radiation Drugs (such as hydralazine) Infections Acute renal failure Cardiac infarction Rheumatic fever Injury Neoplasms Dressler's syndrome Pericarditis: EKG PericarditiS:p. 34 PR depression in precordial leads. ST elevation. Peripheral vascular insufficiency: inspection criteria SICVD:p. 34 Symmetry of leg musculature Integrity of skin Color of toenails Varicose veins Distribution of hair Pulseless electrical activity: causes PATCH MED:p. 34 Pulmonary embolus Acidosis Tension pneumothorax Cardiac tamponade Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia Myocardial infarction Electrolyte derangements Drugs ST elevation causes in ECG ELEVATION:p. 34