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B SL ext. > 1 ECG Arrhythmias > Flashcards

1 ECG Arrhythmias Flashcards

1
Q

Ventricles are on the ____ of the heart.

A

Bottom

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2
Q

The atria empty into the corresponding______

A

Ventricles

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3
Q

The left ventricle provides for __________ circulation

A

Peripheral (body)

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4
Q

The right ventricle provides for _______ circulation

A

Pulmonary (lungs)

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5
Q

Describe the blood flow from Right atrium onward.

A

Right atrium> right ventricle> pulmonary artery> pulmonary circulation> left atrium> left ventricle> aorta> peripheral circulation> right atrium.

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6
Q

What is passive pumping?

A

The constant pressure of a distended arterial system wAnting to return to normal.

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7
Q

What is active pumping?

A

The actual pumping of the heart. Stroke volume, cardiac output

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8
Q

Cardiac Output=

A

Stroke volume x heart rate

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9
Q

A low stroke volume will lead to a _____ heart rate

A

Higher

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10
Q

What happens to the atria at late systole?

A

Atria are full, ventricles are empty

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11
Q

What happens during early diastole?

A

AV Valves open, blood goes to the ventricles

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12
Q

What happens during mid diastole?

A

The ventricles are full, atrial contraction forces the ventricles to distend, maximizing cardiac output.

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13
Q

A fast heart rate leads to ______ cardiac output, why?

A

Decreased The ventricles don’t have time to adequately fill or overfill to produce a decent contraction.

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14
Q

The AV Septum is a _______________ wall between the atria and the ventricles.

A

Non conductive

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15
Q

What is the function of the AV Septum in regard to electrical impulse?

A

Stops conduction before it reaches the ventricles.

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16
Q

What does the AV Node do?

A

It slows the atrial impulse down until the ventricles are ready to receive it, before opening and passing the impulse to stimulate the ventricles.

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17
Q

What is the slowing of the impulse at the AV Node called?

A

Physiologic blocking

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18
Q

How are the atrial myocytes innervated?

A

Direct cell to cell contact

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19
Q

Where is the Purkinje System located?

A

It encircles the ventricles and is the final component of the impulse system

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20
Q

Atrium are on the____ of the heart.

A

Top

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21
Q

What does the pacemaker of the heart do?

A

Determines the rate at which the heart will cycle through its pumping action. Creates an organized beating of all cardiac cells in a specialized sequence to produce effective pumping.

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22
Q

During excersize, the pace of the heart will____

A

Speed up

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23
Q

The main pacemaker of the heart is the_______ and is it located in the muscle of _______

A

SA Node. Located in the muscle of the right atrium.

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24
Q

What is the pacemaker of the heart controlled by?

A

Information from the nervous, circulatory and endocrine systems.

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25
Q

The main pacemaker of the heart paces at 60-100 BOM with an average of:

A

70 BPM

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26
Q

The fastest pacemaker of the heart is the:

A

SA node, then the AV node and so on

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27
Q

The fastest pacemaker sets the pace so all the slower ones can reset with each beat, what happens if the fastest pacer fails?

A

The next fastest will take over to try and return pacing to as normal as possible as quickly as possible.

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28
Q

What does SA node stand for?

A

Sinoatrial node

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29
Q

Where does the SA node get its blood supply in 59% of cases?

A

Right coronary artery

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30
Q

Where does the SA node get its blood supply in 38% of cases?

A

Left coronary artery

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31
Q

In the last 3% of cases where does the SA node get its blood supply?

A

Both coronary arteries.

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32
Q

Where exactly is the SA Node?

A

Muscle of the right atrium at its junction with the superior vena cava.

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33
Q

What are the three main internodal pathways?

A

Anterior, middle, posterior

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34
Q

What is the additional (fourth) internodal pathway?

A

Bachmans bundle which transmits impulses through the inter atrial septum

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35
Q

What is the function of the internodal pathways?

A

To transmit impulses through from SA to AV node.

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36
Q

Where are all of the internodal pathways found?

A

In the walls of the right atrium and inter atrial septum

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37
Q

Where is the AV node located?

A

Wall of R.A next to the opening of the coronary sinus, and septal leaflet of tricuspid valve.

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38
Q

Where does the Bundle of His start?

A

At the AV node

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39
Q

Where does the Bundle of His end?

A

The R and L bundle branches

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40
Q

The only route of communication between the atria and the ventricles is the_______.

A

Bundle of His

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41
Q

The left bundle branch starts at the bundle of His, and goes to the_______

A

Interventricular septum

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42
Q

The L.B.B is the first area to depolarize. True or false.

A

True

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43
Q

The R.B.B starts at the________ and ends at the ________.

A

Bundle of His Purkinje fibres

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44
Q

The left anterior fascicle travels through the R.V to the Purkinje fibres. True or false?

A

True

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45
Q

The left anterior fascicle is single stranded, true or false.

A

True

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46
Q

The left posterior fascicle is single stranded, true or false.

A

False, it’s fan shaped and harder to block because it is multi stranded.

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47
Q

What is the Purkinje system made of?

A

Cells beneath the endocardium

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48
Q

What are the 4 arrythmogenic zones?

A

1) SA node (sinus) 2) atrial 3) AV node (nodal) 4) ventricular

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49
Q

What are the rules for a wandering pacemaker?

A

Regularity: slightly irregular Rate: 60-100 P wave: morphology changes from one complex to the next PRI: less than .20 second QRS: less than .12 second

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50
Q

What are the rules for ectopic PAC’s?

A

Regularity: depends on the underlying rhythm; regularity will be interrupted by the PAC Rate: depends on underlying rhythm P wave: p wave of early beat differs from the sinus p waves; can be flattened or notched. May be lost in preceding t wave PRI: 0.12-0.20 seconds QRS: less than 0.12 second

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51
Q

What are the rules for atrial tachycardia?

A

Regularity: regular Rate: 150-250 bpm P wave: atrial p wave, can be lost in T wave PRI: 0.12-0.20 QRS: less than 0.12

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52
Q

What are the rules for atrial flutter?

A

Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block Rate: atrial rate 250-350, ventricular varies P wave: sawtooth pattern PRI: Unable to determine QRS: less than 0.12 second

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53
Q

What are the rules for atrial fibrillation?

A

Regularity: grossly irregular Rate: atrial rate greater than 350, ventricular varies P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves PRI: unable to measure QRS: less than 0.12 second

54
Q

What do you do for stable vtach with a pulse (wide QRS)

A

Drug therapy, amiodarone or lidocaine

55
Q

What do you do for unstable vtach with a pulse?

A

Synchronized cardiovert - 100 joules

56
Q

What do you do for witnessed v-fib?

A

Chest compressions then defibrillate at 360 joules when ready

57
Q

What do you do for unwitnessed vfib?

A

Chest compressions for 2 min before defibrillating

58
Q

What do you do for stable sinus bradycardia?

A

Drug therapy - atropine 0.5 mg every 3-5 min

59
Q

What do you do for unstable sinus bradycardia?

A

Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse

60
Q

What is a normal sinus rhythm with no pulse?

A

PEA

61
Q

What do you do for stable SVT?

A

Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine

62
Q

What do you do for unstable SVT?

A

Cardiovert

63
Q

What are the characteristics of SVT?

A

Over 160 bpm, tight QRS complex

64
Q

What is the first drug you give for clinical death?

A

Epi 1:10,000 @ 1mg every 3-5 min

65
Q

What are the rules for atrial tachycardia?

A

Regularity: regular Rate: 150-250 bpm P wave: atrial p wave, can be lost in T wave PRI: 0.12-0.20 QRS: less than 0.12

66
Q

What are the rules for atrial flutter?

A

Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block Rate: atrial rate 250-350, ventricular varies P wave: sawtooth pattern PRI: Unable to determine QRS: less than 0.12 second

67
Q

What are the rules for atrial fibrillation?

A

Regularity: grossly irregular Rate: atrial rate greater than 350, ventricular varies P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves PRI: unable to measure QRS: less than 0.12 second

68
Q

What do you do for stable vtach with a pulse (wide QRS)

A

Drug therapy, amiodarone or lidocaine

69
Q

What do you do for unstable vtach with a pulse?

A

Synchronized cardiovert - 100 joules

70
Q

What do you do for witnessed v-fib?

A

Chest compressions then defibrillate at 360 joules when ready

71
Q

What do you do for unwitnessed vfib?

A

Chest compressions for 2 min before defibrillating

72
Q

What do you do for stable sinus bradycardia?

A

Drug therapy - atropine 0.5 mg every 3-5 min

73
Q

What do you do for unstable sinus bradycardia?

A

Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse

74
Q

What is a normal sinus rhythm with no pulse?

A

PEA

75
Q

What do you do for stable SVT?

A

Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine

76
Q

What do you do for unstable SVT?

A

Cardiovert

77
Q

What are the characteristics of SVT?

A

Over 160 bpm, tight QRS complex

78
Q

What is the first drug you give for clinical death?

A

Epi 1:10,000 @ 1mg every 3-5 min

79
Q

What do leads 2,3, and AVF look at?

A

Left ventricle (inferior wall MI)

80
Q

What do leads v-1 and v-2 look at?

A

Septum

81
Q

What do leads v-3 and v-4 look at?

A

Anterior

82
Q

What do leads v-5 and v-6 look at?

A

Lateral

83
Q

What does ST elevation indicate?

A

Heart injury

84
Q

What does ST depression indicate?

A

Heart ischemia

85
Q

What is your treatment for a right sided MI?

A

Fluid

86
Q

What is your treatment for a left sided MI?

A

Nitro

87
Q

What does the right coronary artery feed?

A

SA node (60-100)

88
Q

Why do heart blocks occur?

A

Result of conduction disturbances in the av node

89
Q

What is a first degree heart block?

A

Not a true block, delay at the AV node but each impulse is eventually conducted through to the ventricles. Characterized by a PRI longer than .20 and constant. This will be the only abnormality in the arrhythmia.

90
Q

What is a key feature of second degree heart blocks?

A

Not every P wave is followed by a QRS complex

91
Q

What is the difference between wenckebach and type II second degree block?

A

The pattern in which the P waves are blocked, concentrate on the PR intervals

92
Q

What rate is a type II second degree heart block usually?

A

Bradycardia

93
Q

What is a key characteristic of type II second degree heart blocks?

A

Will always have more P waves than QRS complexes. It will be regular or irregular depending on the conduction ratio.

94
Q

What is a key characteristic of wenckebach second degree heart block?

A

Increasing long PRI’s followed by a blocked p wave

95
Q

Hypertension= what 3 possibilities?

A

Stroke, MI, Anuerism

96
Q

What is the pathophysiology of hypertension?

A

Caused by increase in cardiac output, stroke volume, or both

97
Q

What is the difference between primary hypertension and secondary hypertension?

A

Primary hypertension is usually treated early through medication and management and secondary hypertension usually develops secondary to another disease process. Secondary hypertension usually leads to hypertensive emergencies

98
Q

What is the most common cause of secondary hypertension?

A

Renal disease

99
Q

What is autonomic dysreflexia?

A

Person with neurogenic shock at t-6 loses sympathetic control distal to that. An unknown time period later they get a barrage of nerve stimulation usually in response to minor trauma or secondary insult

100
Q

What causes the issue in a hypertensive crisis?

A

The speed of the increase of pressure

101
Q

When there is an upside down or no p wave, what is the rhythm?

A

Junctional 1.) escape is 40-60 (unless QRS is too wide, then it is idioventricular) 2.) accelerated junctional is 60-100 3.) junctional tachycardia is above 100

102
Q

When there is pressure on the heart that causes a change in rhythm, what does this cause?

A

Sinus arrhythmia (will be normal sinus rhythm except it is irregular)

103
Q

If something is irregularly irregular, what are your options?

A

Afib, multi focal tachycardia

104
Q

What classifies a first degree heart block?

A

PRI that is constant but prolonged, greater than 0.20

105
Q

Fast, wide, regular?

A

Vtach

106
Q

Fast, narrow, regular?

A

SVT

107
Q

More P’s than QRS’s?

A

2nd or 3rd degree heart block

108
Q

What are the rules for a normal sinus rhythm?

A

1.) regular 2.) 60-100 3.) uniform and upright p waves, one for every QRS 4.) PRI 0.12-0.20 and constant 5.) QRS less than 0.12

109
Q

What are the rules for sinus bradycardia?

A

1.) Regular 2.) rate less than 60 3.) upright and constant p waves 4.) PRI 0.12-0.20 5.) QRS less than 0.12

110
Q

What are the rules for sinus tachycardia?

A

1.) regular 2.) rate greater than 100 3.) uniform and constant p waves 4.) PRI 0.12-0.20 5.) QRS less than 0.12

111
Q

What are the rules for sinus arrhythmia?

A

1.) irregular 2.) 60-100 rate 3.) uniform, constant, upright p waves 4.) PRI 0.12-0.20 5.) QRS less than 0.12

112
Q

What is the key characteristic of wandering pacemaker?

A

Caused when pacemaker role switches from beat to beat between the SA node to the atria and back again

113
Q

What will help you identify a wandering pacemaker?

A

The morphology of the p wave changes based upon the pacemaker site. There is a p wave for every QRS, but it may be more difficult to see depending upon the pacemaker site

114
Q

What are the rules for PAC’s?

A

1.) regularity will be interrupted by PAC 2.) rate depends on underlying rhythm 3.) p wave of PVC WILL DIFFER from underlying p waves; may be flattened or notched 4.) PRI 0.12-0.20 5.) QRS less than 0.12

115
Q

What are the rules for atrial tachycardia?

A

1.) regular 2.) 150-250 3.) will have atrial p waves, can be lost in T wave 4.) PRI 0.12-0.20 5.) QRS less than 0.12

116
Q

What are the rules for Afib?

A

1.) grossly irregular 2.) atrial rate above 350, ventricular varies 3.) p waves are discernible/fibrillatory 4.) PRI is unable to measure 5.) QRS is less than 0.12

117
Q

What are the rules for Aflutter?

A

1.) atrial rate is regular 2.) atrial rate 250-350 3.) p waves are sawtooth 4.) PRI is unable to determine 5.) QRS is less than 0.12

118
Q

What is your treatment for Asystole?

A

BSI Check in 2 leads CPR O2 IV/Monitor 1 mg EPI every 3-5 Consider h’s & t’s

119
Q

What is your treatment for PEA?

A

BSI CPR 02 IV/monitor 1 mg EPI every 3-5 Consider h’s & t’s

120
Q

What is the MONA alogorhythm?

A

BSI ABC’s O2 IV/monitor/12 lead 325 mg aspirin 0.4 mg nitro 2-5 mg morphine

121
Q

What is your treatment for polymorphic vtach with a pulse (torsades)

A

BSI ABC’s O2 IV/monitor/12 lead Mag sulfate 1-2 g over 5-60 min *if unstable treat as unstable vtach (chap present?)

122
Q

What is your treatment for malignant PVC’s?

A

BSI ABC’s O2 IV/monitor/12 lead 1-1.5 mg/kg lidocaine 20-50 mg/min procainamide until QRS widens by 50% or 17 mg/kg is given or rhythm changes

123
Q

What is your treatment for sinus bradycardia with a pulse or Brady 2nd degree heart block (wenckebach)?

A

BSI ABC’s O2 IV/monitor/12 lead 0.5 atropine IVP/ 3mg max TCP (not for 2nd degree block) Dopamine 2-10 mcg/kg/min EPI drip 2-10 mcg/min

124
Q

What do you do for Brady 2nd degree heart block type II or 3rd degree heart block?

A

BSI ABC’s O2 IV/monitor/12 lead Consider 0.5 mg atropine IVP GO TO TCP

125
Q

What do you do for narrow tachy with a pulse that’s stable?

A

BSI ABC’s O2 IV/monitor/12 lead/vagal 6 mg adenosine IVP 12 mg adenosine IVP

126
Q

What do you do for narrow tachy with a pulse that’s unstable?

A

BSI ABC’s O2 IV/monitor/12 lead Sedation (midazolam 2-4 mg up to 10 mg) Synch cardioversion 100j Synch cardioversion 200j

127
Q

What do you do for wide tachy with a pulse that’s stable?

A

BSI ABC’s O2 IV/monitor/12 lead Unknown origin? Consider 6 mg adenosine Lidocaine 0.5-0.75 mg/kg IVP or 150 mg amiodarone over 10 min

128
Q

What do you do for wide tachy with a pulse that’s unstable?

A

BSI ABC’s O2 IV/monitor/12 lead Sedation (midazolam 2-4 mg up to 10 mg) Synch cardio 100j Synch cardio 200j

129
Q

What is your treatment for pulse less vtach/vfib?

A

BSI CPR 02 IV/monitor Unwitnessed 2 min CPR/ witnessed 200j/360j Perform CPR as long as the patient is pulse less 1 mg EPI delivered every other cycle of CPR 200j/360j after 2 min CPR while in this rhythm 1.0-1.5 mg/kg lidocaine or 300 mg amiodarone IVP 2nd dose will be 0.5 mg/kg or 150 mg IVP *sequence is drug/shock/drug/shock

130
Q

What is the equation for converting with lidocaine?

A

2g in 500 mL/ 4 mg/mL, 1-4 mg/min

131
Q

What is the equation for an EPI drip?

A

2mg/500 mL

B SL ext. (3 decks)

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