The two branches of the left coronary artery are the
left anterior descending, left posterior descending
circumflex, right coronary artery
circumflex, left anterior descending
left lateral artery, circumflex
The heart's muscular layer that allows the heart to contract is the
endocardium
myocardium
epicardium
pericardium
The chamber that receives blood from the vena cavas is the
LA
RA
LV
RV
Atrial kick supplies the ventricles with about ________ blood volume
20%
50%
80%
100%
During ventricular systole, the
aortic and tricuspid valves close
tricuspid and pulmonic valves close
mitral and aortic valves open
pulmonic and aortic valves open
The curcumflex artery mostly supplies the
lateral wall of the RV
septal wall of the LV
lateral wall of the LV
Cardiac Output equals
heart rate x stroke volume
heart rate x venous pressure
heart rate x systemic pressure
heart rate x atrial kick
Vessels that supply the heart's structures with oxygenated blood are the
pulmonary arteries
coronary arteries
systemic arteries
vena cavas
Spread of depolarization to the LA travels along
the internodal tracts
the bundle of HIS
the L bundle branch
Bachmann's bundle
The right side of the heart pumps blood into the
pulmonary circulation
aorta
systemic circulation
Preload refers to the ventricular stretch
at the start of atrial systole
at the end of atrial diastole
at the start of ventricular diastole
at the end of ventricular diastole
Intrinsically, the SA node can normally initiate ______ impulses each minute
29-40
40-60
40-80
60-100
The PMI (point of maximum impulse) is best heard
at the apex of the heart
at the base of the heart
over the aortic area
over the pulmonic area
Ventricular depolarization/systole
propels blood to the atria
coincides with atrial systole
results from electrical stimulation
prevents blood flow into the coronary arteries
Mitral stenosis can
increase preload
decrease preload
increase afterload
decreases afterload
Atrial systole can also be called
atrial relaxation
atrial kick
atrial pressure
atrial repolarization
Rupture of a papillary muscle can
lead to valve regurgitation, thereby affecting SV and CO
decreases electrical stimulation
occlude a coronary artery
ensure electrical impulses conduct regularity
Which coronary artery supplies the AV node in most people
the R coronary artery
The L coronary artery
the LAD artery
the circumflex artery
Fast heart rates can decrease CO because of
an increase in SV
the increased force of contraction
the shortened ventricular filling time
their relaxing effect on the heart valves
The conduction system refers to
the heart's mechanical system
the heart's electrical system
the AV node's function
ventricular contraction
Oxygenated blood returns to the heart via the
pulmonary veins
The tricuspid valve is located between the
RA and LA
LA and LV
RV and LV
RA and RV
Prior to the onset of late ventricular diastole (before atrial systole), the ventricles have
received about 20% of their blood volume
received about 80% of their blood volume
filled to full capacity
contracted
The CO can decrease with slow heart rates because
the SV cannot increase any further
of rapid AV conduction
of poor LV muscle contraction
of valvular dysfunction
The main property of the AV node is to
a forward 20% extra blood volume to the ventricles
slow impulse conduction velocity/speed
ensure a regular rhythm of impulse transmission
promote atrial systole
The cells' ability to initiate impulses is called
automaticity
excitability
conductivity
contractility
If the SA node fails, the AV junction can intrinsically generate ____ impulses per minute
20-40
60-80
80-100
The PMI is located at the
2nd R ICS (intercostal space)
2nd L ICS
5th R ICS
5th L ICS
An S3 can indicate
an atrial gallop
the apical pulse
heart failure
closure of the mitral valve
At the aortic area
S1 is louder than S2
S2 is louder than S1
S2 cannot be heard
S1 and S2 sound the same
Palpitations can be
sustained
insignificant
caused by the use of bronchodilators
any of the above
Pulsus alternans is characterized by
alternating regular and irregular rhythms
alternating strong and weak pulses
increased rate with expiration
decreased rate with expiration
Auscultation of the mitral valve is best heard at the
2nd R ICS, adjacent to the sternum
2nd L ICS, adjacent to the sternum
5th L ICS, medial to the mid-clavicle
lower L sternal border
Acute MI pain can radiate to
the jaw and neck
the left arm
the back
Unilateral leg edema can signify
left sided heart failure
superior vena cava syndrome
venous insufficiency
ventricular diastole
Auscultation of the pulmonic valve is best heard at the
2nd R ICS
During atrial systole, you might auscultate an
S1
S2
S3
S4
Elevated JVP might be visualized in the patient with
RV MI
RVF
cor pulmonale
During inspection of the chest , the pulsation of the apical pulse is always visible
Palpation of a normal pulse strength is documented as
1+
2+
3+
4+
The ____ valve is heard loudest at the 2nd R ICS, adjacent to the sternum
Aortic
Pulmonic
Tricuspd
Mitral
Which cardiac condition would most likely cause chest pain that eases by sitting up and leaning forward?
Acute Paricarditis
CHF
A pneumothorax can potentially to displace the PMI
The S1 heart sound
represents closure of the mitral and tricuspid valves
signifies the end of ventricular diastole
is heard loudest at the apex
all of the above
The S3 and S4 adventitious heart sounds
are best heard with the stethoscope's diaphragm
can indicate heart failure
correspond with ventricular systole
To observe the JVP
turn the patient's head away from the side being examined
elevate the head of the bed to 90 degrees
auscultate the 2nd L ICS
ensure dim lighting to distinguish the JVP shadows
An adventitious heart sound heard during atrial diastole would be
When discussing the dorsalis pedis pulse
palpating the R and L simultaneously is safe
it should always be easily palpable in normal adults
it is located just below the malleolus
its detection requires very deep palpation
An S4 heart sound
is called a ventricular gallop
is heard during ventricular diastole
is heard during atrial diastole
occurs before S2
Pulsus paradoxus is characterized by
decreased amplitude with expiration
decreased amplitude with inspiration
When listening over the mitral area, S1 is louder than S2
Normally, pulsations of the internal jugular veins
change in response to positioning
are visualized at 10cm above the suprasternal notch
are noticeable when the patient stands
Syncope can be a symptom of
vasodilatation
a slow heart rate
excessive vagal activity
When documenting a pulse's strength, a weak pulse is
0
In which of the following conditions might the patient's chest heaviness ease if s/he rests?
acute pericarditis
dissecting aneurysm
stable angina
pulmonary embolism
Palpating both carotid arteries simultaneously can decrease the HR and produce syncope
An irregular pulse is always detected in patients with
cardiac tamponade
MI
aortic dissection
atrial fibrillation
In Lead I
RA is negative, LL is positive
LA is negative, LL is positive
RA is negative, LA is positive
RA is negative, RL is positive
CK elevation will be detected with
elevated HDLs
CVA
depolarization
decreased CO
After MI, the following LDH isoenzymes can be expected
LD1 and LD2 are absent
LD1 = LD2
LD1 < LD2
LD1 > LD2
Depolarization
is a state of excitability
coincides with discharge of electricity
results from ionic activity
Oral anticoagulation dosing is determined by assessing the
CK
AST
PTT
PT or INR
The normal PR interval measures
less than 0.12 seconds
0.12 to 0.20 seconds
0.20 to 0.40 seconds
more than 0.40 seconds
The Q wave is the first ____ of a ventricular complex
first negative deflection
first positive deflection
second negative deflection
second positive deflection
To calculate an irregular ventricular rate
divide the # of small boxes between 2 QRSs into 1500
divide the # of large boxes between 2 QRSs into 300
count the # of QRSs in a 6 second strip, and x 10
The QT interval represents the time frame for
ventricular depolarization to occur
ventricular repolarization to occur
ventricular depolarization and repolarization to occur
In lead III
The cardiac cycle includes
The P wave
the QRS complex
the T wave
the PQRST
An MI can be safely diagnosed with the CK-MB result because this isoenzyme
represents atrial depolarization
is specific to cardiac tissue
reflects the CO
causes the ventricles to contract
Cholesterol is carried on
LDL
myoglobin
An impulse travelling toward the area where a positive electrode is placed is recorded as
a positive deflection
negative deflection
flat line
Torsades de Pointes can result from
short PR intervals
long PR intervals
short QT intervals
long QT intervals
Normally, the majority of cardiac electrical activity travels to the electrode placed on the
Rl
LL
The P wave represents
atrial depolarization
ventricular depolarization
ventricular repolarization
conduction through the AV node
The QT interval
starts at the onset of the QRS complex
ends after the T wave
should be less than half the R-R interval
Prior to obtaining lipid studies
the CK-MB must be elevated
patients must be fasting
the INR must be within normal range
CO must be satisfactory
The QRS complex
should measure more than 0.10 seconds
reflects ventricular depolarization
always has a Q, an R, and an S wave
Heparin dosing is determined by assessing the
PT
INR
The PR interval is measured from the
start of the P wave to the start of the QRS
start of the P wave to the end of the QRS
end of the P wave to the start of the QRS
end of the P wave to the end of the QRS
Which troponins can be evaluated to detect myocardial damage?
troponins I and C
troponins I and T
troponins T and C
troponins I, T, and C
Ventricular repolarization is reflected by the
P wave
QRS complex
T wave
PR interval
In lead II
Six seconds on ECG paper includes
15 small boxes
15 large boxes
30 small boxes
30 large boxes
Which of the following ST segments is abnormal?
0.5mm below the baseline
0.5mm above the baseline
the iso-electric ST segment
2mm above the baseline
The normal ventricle requires ____ to contract
< 0.02 seconds
< 0.10 seconds
> 0.12 seconds
> 0.20 seconds
The CK begins to elevate ____ after muscle damage
4-6 hours
10-15 hours
12-24 hours
24-36 hours
The patient with a prosthetic mechanical valve, whose INR is 1.2 needs
to increase his warfarin dosage
to decrease his warfarin dosage
to maintain his same/usual warfarin dose
to withold the next warfarin dose
In lead II, normal ventricular depolarization produces a
P wave with a positive deflection
P wave with a negative deflection
QRS with a positive deflection
QRS with a negative deflection
The normal CK-MB
varies according to the HDL
is less than 5% of the total CK
will elevate with cerebral injury
Spinach and other foods rich in Vitamin K can
increase the CK and AST
decrease the CK and AST
increase clotting times
decrease clotting times
Repolarization
represents a state of excitability
is a state of relaxation
indicates that the ventricles are contracting
is reflective of myocardial damage
The time reflected between each darkened 'bold' line on ECG paper is
0.02 seconds
0.04 seconds
0.12 seconds
0.20 seconds
The R wave
is positively deflected
indicates that the atria are contracting
measures > 0.20 seconds
reflects conduction through the AV node
When QRS complexes occur at intervals with slight variances of < 0.12 seconds
extra P waves are always seen
the ventricles are not depolarizing
the rate is always rapid
the rhythm is considered regular
In the heart with a normal conduction system
extra P waves are seen
each P wave is followed by a QRS
P waves differ in morphology (appearance)
the absence of P waves is expected
The negatively deflected wave indicates that the impulse
has not been generated
is travelling toward a positive electrode
is travelling away from a positive electrode
requires stronger electrical current
U waves
should deflect in the same direction as the T wave
are only 1/4 the height of the T wave
may be absent on the normal rhythm strip
Colour of RA
Black
Green
Brown
White
Red
Colour of LA
black
green
brown
red
Colour of RL
white
Colour of LL
Colour of Precordium (V lead)
Sinus tachycardia can be caused by
excessive vagal stimulation
beta-blockers, digoxin
verapamil, adenosine
fever, anxiety, atropine
Syncope can be a manifestation of any tachycardia because
the HR is too slow
ventricular depolarization does not occur
ventricular filling times are shortened
vagal activity is excessive
Carotid sinus massage can lead to
sinus bradycardia
sinus block
sinus arrest
In atrial flutter
all atrial impulses always reach the ventricles
the AR is always slow
the PR interval is not measurable
the QRS complexes are always wide
The initial energy level required to convert PAT is
50 joules
100 joules
200 joules
300 joules
Junctional escape rhythm can deteriorate to
IVR
VT
junctional tachycardia
The distinguishable features of Wenckebach are
constant PR interval, AR = VR
constant PR interval, AR > VR
variable PR interval, AR = VR
variable PR interval, AR > VR
Multifocal PVCs are reflected as
frequent beats
different looking beats
beats occurring regularly
missing beats
A regular rhythm with an AR of 110, VR of 110, constant PR interval of 0.12 seconds, QRS complexes of 0.08 seconds is
sinus tachycardia
PAT
The most distinguishable feature of atrial fibrillation is
a rapid ventricular rate
an irregular rhythm
variable PR intervals
wide QRS complexes
Lidocaine is often effective in treating ventricular rhythms because it
enhances ventricular depolarization
improves atrial automaticity
suppresses ventricular irritability
blocks PSNS activity
A defibrillator should be quickly accessible for the patient in third degree AV block because this block can deteriorate to
Wenckebach
Sinus arrest can be caused by
atropine
excessive SNS stimulation
caffeine, nicotine
digoxin toxicity
PAT with an AR of 240 beats/minute would always have
a slower VR
regular rhythm
normal PR intervals
visible P waves
In atrial fibrillation, reduced CO can result from
the rapid SA node rate of impulse formation
the irregular ventricular rhythm
disorganized, chaotic atrial quivering
shortened PR intervals
Initial shock treatment of pulseless VT is
cardioversion, starting with 200 joules
cardioversion, starting with 300 joules
defibrillation, starting with 200 joules
defibrillation, starting with 300 joules
The ____ generates impulses in all heart blocks
SA node
atria
AV junction
ventricles
Treatment is rarely needed for first degree AV block because
the CO is usually satisfactory
the PR intervals are normal
the AV junction is initiating all impulses
the ventricles are using their property of automaticity
The P wave may be difficult to distinguish with a PAC, but the P wave occurs because the ____ depolarize
Ventricles
SA Node
Atria
AV Node
Symptoms associated with junctional escape rhythm result from
shortened ventricular filling time
shortened atrial filling time
slower heart rate
rapid heart rate
A regular rhythm with an atrial rate of 68, VR of 68, constant PR intervals of 0.28 seconds, QRS complexes of 0.08 seconds is
first degree AV block
second degree, Wenckebach
second degree, Mobitz II
third degree AV block
A ventricular rate of less than 100 beats/minute can be seen in
The initial energy level required to cardiovert atrial flutter is
The P waves in junctional beats and rhythms can
be inverted
be buried/lost in the QRS complexes
follow the QRS complexes
Decreased CO in AIVR is due to
loss of atrial kick
slow AV conduction
the excessively rapid HR
rapid AV conduction
The patient in VF has
inverted P waves
normal QRS complexes
none of the above
The PR interval in Mobitz II can be normal or prolonged
Treatment for frequent PVCs might include
verapamil, adenosine, pacemaker
carotid sinus massage
atropine, epinephrine
lidocaine, pronestyl, potassium
Potential for clot formation in atrial fibrillation is due to
atrial quivering
excessive stimulants
increased CO
ventricular automaticity
Atrial and ventricular contractions are not synchronized at all in
Symptoms of decreased CO can potentially be experienced with
JT
any arrhythmia
Cells in the AV junction have the property of ____ which allows cells in the AV junction to initiate/generate junctional beats/rhythms
conduction
regularity
electricity
Repolarization in ventricular beats/rhythms is reflected as T waves that
are absent
deflect in the same direction as the QRS
deflect opposite to the QRS deflection
are peaked
VT with a pulse is treated with
cardioversion, starting with 100 joules
defibrillation, starting with 100 joules
The term SVT can be used to describe
uncontrolled atrial fibrillation
any rapid rhythm that originates above the ventricles
A rhythm with an AR of 86, a VR of 30, variable, erratic PR intervals with no pattern, and QRS complexes measuring 0.14 seconds is
sinus arrhythmia
The PR intervals cannot be measured in ventricular rhythms because of
absent atrial depolarization
shortened conduction through the AV node
If a PR interval can be measured in junctional beats/rhythms, it characteristicly measures ____ seconds
<0.12
>0.12
<0.08
>0.08
Which patient has the more serious block?
AR 96, VR 48, constant PR 0.24 seconds, QRS 0.20 seconds
AR 80, VR 40, constant PR 0.22 seconds, QRS 0.10 seconds
AR 90, VR 45, constant PR 0.26 seconds, QRS 0.08 seconds
Initial treatment of pulseless VT is
lidocaine
procainamide
cardioversion
defibrillation
When each and every impulse from the SA node is blocked at the AV node, the rhythm is
third degree block
junctional escape rhythm
Mobitz II
The drug treatment of choice for symptomatic IVR is
Atropine
Lidocaine
Epinepherine
Adenosine
Absent P waves in junctional beats/rhythms result from
rapid atrial depolarization
the excessively slow ventricular rate
simultaneous atrial and ventricular depolarization
atrial contraction that occurs after ventricular contraction
Decreased CO in VT is due to
prolonged PR intervals
the rapid ventricular rate
the AV node's slow rate of impulse conduction
In Wenckebach
P waves occur at regular intervals
there are more P waves than QRS complexes
P waves are normal and all look the same
The arrhythmia on this link is called ____
A Fib
Sinus Tachycardia
SVT
VF
sinus rhythm
First degree AV block
A flutter
Mobitz !!
3rd Degree AV block
Mobitz !I
3rd degree AV block
Wenckbach
The arrhythmia on this link is called ____ (include the entire strip, not just the abnormality)
Sinus arrhythmia with PJC
sinus bradycardia with PJC
V Fib
PEA
Conduction problem
Sinus bradycardia
1st degree heart block
Sinus rhythm
Passive junctional rhythm
A Flutter
Normal sinus rhythm with sinus pause
1st degree AV block
1st Degree AV block
Junctional
NSR with PVC's
NSR with PAC's
Ventricular Trigeminy
CAD modifiable risk factors include
smoking, diet
gender, age
exercise, genetics
diet, race
Occlusion of the LAD artery would result in
lateral wall MI
anterior wall MI
right atrial MI
posterior wall MI
Which one of the heart's layers is damaged with a non-Q wave MI?
Mesoderm
Endocardium
Epicardium
Myocardium
With angina and following MI, semi-fowler's position is preferred, to
reverse the necrotic destruction
increase autonomic nervous system activity
increase systemic oxygenation through lung expansion
reduce the Cardiac Output
Hepatomegaly occurs in RVF because
the spleen enlarges
the liver is necrotic
of increased pressure in the hepatic veins
of the development of arrhythmias
Following MI, the zone of injury
has irreversibly damaged cells
is necrotic
causes atrial depolarization
has jeopardized cell
The risk of CAD decreases with menopause
CAD indicates
decreased coronary artery blood flow
the presence of arrhythmias
Stable angina pain usually subsides with
rest, nitroglycerine
morphine, oxygen
nitroglycerine, morphine
morphine, ASA
Pathological Q waves are
reflective of tissue ischemia
reflective of tissue injury
25% the height of the R waves
Decreasing preload in LVF can be accomplished with the use of
diuretics
morphine
vasodilators
Obese people and patients who rarely exercise are more prone to
elevated HDL's
decreased HDL's
Cessation of pain following an 'anginal attack' indicates that
platelets are no longer adhering to the arteries
arrhythmias have developed
myocardial oxygen needs are met
myocardial tissues are fully necrotic
The LV lateral wall MI is secondary to occlusion of the
positive artery
lateral vein
RCA
circumflex artery
The ECG sign of tissue necrosis is
the development of ventricular rhythms
bradycardia
pathological Q waves
ST segment changes
Not monitoring the control and balance of systemic fluid can result in
hyponatremia
hypokalemia
dehydration
HDLs are
elevated in consumers of moderate amounts of wine
metabolized by the liver
sometimes called the 'good' lipoprotein
Following plaque rupture, the following components begin to adhere to the plaque
fibrin, thrombin
platelets, fibrin
thrombin, platelets
platelets, thrombin, fibrin
Chest pain experienced with unstable angina
is predictable and reproducible
is always relieved with nitroglycerine
occurs more frequently and with less effort
always lasts less than five minutes
Tachycardia in LVF develops
due to enhanced vagal activity
to improve the CO
to limit the SV
Isolated RVF is more common following
inferior wall MI
right ventricular MI
CAD symptoms generally begin to occur when the coronary arteries are about ____ % occluded
25
50
75
85
Nitroglycerine reduces afterload by
increasing venous capacitance
decreasing venous capacitance
increasing systemic vascular resistance
decreasing systeming vascular resistance
In left sided heart failure
blood flow from the RA to the LA is impeded
LA pressure decreases
the RV has injured cells
pulmonary venous pressure increases
Elevated HDL levels would most likely be found in
diabetics
pre-menopausal women
cigarette smokers
overweight patients
During the initial acute phase of an MI, oxygen is administered
when ventricular arrhythmias are imminent
when AV blocks develop
when the patient complains of chest pain
Always
Elevated JVP is seen in RVF because of
increased LV pressure
increased superior vena cava pressure
increased thrombi formation
increased pulmonary venous pressure
The personality type that is most prone to CAD is known as a type ____ personality
A
B
C
D
Provoking factors for MI can be
the same as those for stable angina
the same as those for unstable angina
absent (no obvious provoking factors)
Decreased CO in LVF results from
right ventricular failure
decreased vagal activity and hyponatremia
ST segment and T wave changes
decreased LV compliance and SV
The first intervention in pulmonary edema should always be
diuretic therapy
oxygen therapy
controlling arrhythmias
The patient in PEA
requires CPR
displays electrical activity on the cardiac monitor
has no palpable pulse
The main goal in cardiac tamponade is to
enhance SNS dominance
decrease AV conduction
enhance AV node automaticity
decrease pressure within the pericardial sac
The compensatory SNS effect in cardiogenic shock is temporary because
all the heart's valves are necrotic
the SV cannot increase further to help improve the CO
pulses are not palpable
fluid interferes with oxygenation
Dopamine can be part of the treatment plan in cardiogenic shock to
improve systolic BP
cause vasoconstriction
improve myocardial contractility
Serious and sinister arrhythmias can occur in pulmonary edema because
electrical conduction structures are poorly oxygenated
of increased pressure in the pericardial sac
there is no electrical activity
of increased myocardial contractility
In cardiac tamponade, blood ejected during ventricular systole is decreased
Ventricular rupture can occur following
transmural inferior wall MI
transmural anterior wall MI
transmural lateral wall MI
any transmural MI
Heparin induced cardiac tamponade is treated with
heparin
protamine sulfate
In cardiogenic shock, urine volume
decreases
increases
remains unchanged
Blood tinged sputum in pulmonary edema results from
changes in clotting factors
hemorrhages in the pulmonary system
airway narrowing
increased pressure in the RA
The signs or features known as Beck's triad are
elevated JVP, muffled heart sounds, pulsus paradoxus
elevated JVP, hypotension, pulsus paradoxus
narrowed pulse pressure, hypotension, muffled heart sounds
muffled heart sounds, tachycardia, hypotension
Cardiogenic shock
results in extensive organ underperfusion
only develops secondary to MI
causes venous oxygenation to increase
Morphine is effective in pulmonary edema because it
alleviates arrhythmias
increases the HR
reduces preload
improves myocardial contractility
In cardiac tamponade
diastolic ejection is impaired
diastolic filling is impaired
systolic ejection is normal
systolic filling is normal
The patient in pulmonary edema will most likely develop
tachycardia
a slow ventricular rhythm
In cardiogenic shock, fluids are
limited to prevent marked hypotension
infused to maintain intravascular volume
limited to prevent overloading the kidneys
infused to counteract hypertension
Sodium bicarbonate might be administered in cardiogenic shock to
control the HR
reverse acidosis
reverse alkalosis
control ventricular ectopic activity
To improve CO in pulmonary edema
the SV increases
the HR increases
preload increases
afterload increases
Fluid accumulation within the pericardial sac leading to cardiac tamponade, can develop
very slowly
very rapidly
slowly or rapidly
In cardiogenic shock, the
systolic and diastolic BP increase concurrently
systolic and diastolic BP fall concurrently
systolic BP falls before the diastolic BP
diastolic BP falls before the systolic BP
Patients in cardiogenic shock develop anginal chest pain because of
the development of sinister arrhythmias
coronary artery underperfusion
hypertension
tachycardia secondary to SNS stimulation
Decreasing the respiratory rate in pulmonary edema will help to
decrease afterload
improve cardiac contractility
increase the HR
Myocardial injury associated with cardiac tamponade is reflected by
absent P waves
Q waves
Tachycardia occurs in cardiac tamponade to
encourage narrowing of pulse pressure
increase venous return
compensate for the decreased SV
promote ventricular ectopic activity
To promote healthy elimination following MI, the following is administered
stool softeners
enemas
suppositories
It is common to hear an ____ when auscultating the patient in pulmonary edema
Pulse pressure refers to the difference between the
standing and sitting blood pressures
arterial and venous blood pressures
systolic and diastolic blood pressures
Diuretics administered to the cardiac patient can
improve urinary output
cause hypotension
In pulmonary edema, airflow ____ the alveoli is diminished
to
from
to and from