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NSU AA Denver > 2025 ECG Midterm (Need Quizzes 1-3 to Complete Marterial) > Flashcards

2025 ECG Midterm (Need Quizzes 1-3 to Complete Marterial) Flashcards

Arrhythmias of Sinus Origin, Supraventricular & Ventricular Arrhythmias

1
Q

Detection: Event & Ambulatory Monitors

A

Event monitor:
* Records only 3 to 5 minutes
* Initiated by a cardiac event
* ECG recorded and stored internally

Ambulatory monitor:
* Portable ECG with memory
* Has multiple lead options
* 24-48 hours for Holter monitor
* Longer recording periods use patch
* Records and stores data for future analysis

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2
Q

Detection: New Technology

A

Apple watch
* Finger placed on crown creating a
closed circuit
* Assessment of rate and detection of
irregular heart rates such as atrial
fibrillation

Makes a Lead I

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3
Q

Detection: Arrhythmias

A

12 Lead ECG
* Standard 10 second time frame reading of all 12
leads in a single pages

ECG Rhythm Strips
* Long tracing printout of a single lead or multiple
select leads
* Easier to quickly identify irregularities or short
periods of sus electrical activity over long
timeframes

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4
Q

Determining Rate

A

Heart rate can be determined by
measuring length of a complete cardiac
cycle.. R-R

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5
Q

Determining Rate: 1500 vs 300 method

A

Memorize this slide

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6
Q

Determining Rate: 10 Second method

A
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7
Q

Practice: 300 Method

A

300/5 = 60 BPM

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8
Q

Practice: 1500 Method

A

1500/20 = 75 BPM

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9
Q

Practice: 10 Second

A

Lead II typically, look at R waves
Bottom row, this case Lead I

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10
Q

Practice

A

VTach
300/1.5 = 200 BPM

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11
Q

Practice

A

Because variable on Lead II (bottom row), going to use 10 seconds… count number of R Waves

13 BPM

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12
Q

What is an arrhythmia

A

Arrhythmia is a heartbeat that is
irregular, too fast, or too slow

Tachycardia = > 100 bpm
Bradycardia = < 60 bpm

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13
Q

Clinical Presentation of an Arrhythmia

A

Asymptomatic
Palpitations
Light-headedness
Syncopal episode
Angina
May lead to life threatening
conditions

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14
Q

Why Arrhythmias Happen: HIS DEBS

A

Hypoxia
Ischemia & irritability
Sympathetic stimulation
Drugs
Electrolyte disturbances
Bradycardia
Stretch

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15
Q

5 Basic Arrhythmias

A

Arrhythmias of sinus origin

Ectopic (impulse happening outside SA node)

Reentrant (Electrical activity is trapped in heart)

Conduction blocks (AV node, bundle of his)

Preexcitation syndromes (shortcuts or bypasses of normal pathway)

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16
Q

Normal Sinus Rhythm

A
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17
Q

Sinus Tachycardia

A
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18
Q

Sinus Bradycardia

A
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19
Q

Respiratory Sinus Arrhythmia (RSA)

A

Occurs with Greater than 10% of R-R activity

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20
Q

RSA x Anesthesia

A

RSA is reversed during positive
pressure ventilation

Decreased HR during PPV
inspiration

Increased HR during expiration

Can utilize to our advantage with
Valsalva maneuver

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21
Q

Sinus Arrest

A

Sinus node fails to send out electrical activity

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22
Q

Sinus Arrest vs Sinus Exit Block

A

Look into this More!!! Youtube

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23
Q

Asystole

A
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24
Q

Latent Pacemakers

A
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25
Q

Junctional Escape Rhythm

A

Key is the no P Wave

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26
Q

Pulseless Electrical Activity (PEA)

A
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27
Q

H’s of ACLS

A
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28
Q

T’s of ACLS

A
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29
Q

Practice

A

First Check R-R Intervals
Regular vs Irregular
Rate
300/5 = 60 BPM
P wave followed by QRS
Yes, looks good
T waves
Looks slightly abnormal

NSR

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30
Q

Practice

A

First Check R-R Intervals
Regular vs Irregular
Rate
115 BPM
P wave followed by QRS
Yes, looks good
T waves
Looks slightly abnormal

Sinus Tachycardia

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31
Q

Practice

A

First Check R-R Intervals
Regular vs Irregular
Rate
300/7.5 = 40 BPM
P wave followed by QRS
Yes, looks good
T waves
Looks slightly abnormal

Sinus Brady

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32
Q

Practice

A

Sinus Arrest to Asystole

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33
Q

Practice

A

Sinus Arrest/Sinus Exit Block followed by Junctional Escape Rhythm

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34
Q

4 Questions to Ask to Determine

A

Questions 1 & 2 help us make the distinction of whether the arrhythmia is atrial or
ventricular in origin

First question: Are normal P waves present?
* P wave is positive in lead II and negative in lead aVR = atrial in origin
* No P wave = origin is below the atria
* P wave with abnormal axis
* Origin from atrial foci other than SA node
* Retrograde activation from AV node or ventricles

Second Question: Are QRS complexes narrow (< 0.12 seconds) or wide (> 0.12 seconds)?
* Narrow means normal depolarization path
* Wide usually means ventricular origin, but not conduction system

Third Question: What is the relationship between the P waves and QRS complex?
* 1:1 ratio means sinus or atrial origin
* No correlation means atria and ventricles contracting independently of each other
* AV dissociation

Fourth Question
Regular or Irregular

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34
Q

Ectopic Rhythms

A
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34
Q

Physiology of Non-Sinus Arrhythmias

A
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35
Q

Reentrant Rhythms

A
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36
Q

Premature Atrial Contractions

A
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37
Q

Premature Junctional Contractions

A
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38
Q

PJC vs Junctional Escape Beat

A
39
Q

PJC vs PAC

A

This slide is wrong??? Ask for clarification

40
Q

Atrial or Junctional

A

Third beat is early
Lacks P-Wave

Premature Junctional Beat

41
Q

Atrial of Junctional

A

Third Beat comes after a pause
Lacks a P wave
Lacks subsequent wave?

Junctional Escapee followed by Junctional ryhtm

42
Q

Atrial of Junctional

A

R-R appears to be early
A P wave is abnormal

Premature Atrial Contraction

43
Q

Sustained Supraventricular Arrhythmias

A
44
Q

AV Nodal Reentrant Tachycardia (1)

A
45
Q

AV Nodal Reentrant Tachycardia (2)

A
46
Q

Carotid Sinus Massage

A

Can help terminate as well as diagnose AVNRT

Interrupts reentrant circuits

May slow arrhythmia, aiding in diagnosis

Application of gentle pressure to the carotid area

Mimics rise in blood pressure

Stimulates vagal input to heart, slowing sinus node firing and conduction through AV node

47
Q

How to Perform CSM

A

Know what rhythms CSM works on

48
Q

Paroxysmal Atrial Tachycardia

A
49
Q

Atrial Flutter (1)

A

Risk factors include HTN, DM, obesity, polysubstance abuse

Clinical significance
* Probability of converting to NSR is low
* Rarely lethal, but may result in or exacerbate CHF
* Conscious patients may experience SOB, angina, weakness, dizziness

Treatment
* Consult cardiology for asymptomatic or mildly symptomatic presentation
* Definitive treatment is radiofrequency ablation
* Synchronized cardioversion if unstable

50
Q

Atrial Flutter (2)

A
51
Q

Atrial Flutter (3)

A
52
Q

Atrial Flutter (4)

A
53
Q

Atrial Flutter x CSM

A
54
Q

Atrial Fibrillation (1)

A

Characterized by chaotic atrial activity

AV node is flooded with impulses up to 500+ per minute, atrial rate cant be determined

Multiple tiny reentrant circuits, creating fibrillation waves

Rhythm is irregularly irregular

Ventricular rate may vary, but usually between 120-180bpm

Normal QRS

No P waves

Flat or undulating baseline

55
Q

A-Fib (2)

A
56
Q

A-Fib (3)

A
57
Q

Multifocal Atrial Tachycardia

A
58
Q

Wandering Atrial Pacemakers

A
59
Q

Atrial Arrythmias Review

A
60
Q

Premature Ventricular Contractions

A
61
Q

Classification of PVCs (1)

A

Unifocal PVCs arise from a single firing ectopic foci, and display a constant timing and
morphology

Polymorphic PVCs arise from a single ectopic foci, and display constant timing and varied
morphology

Multifocal PVCs arise from two or more foci, and display varied timing and varied
morphology

62
Q

Classification of PVCs (2)

A

Unifocal

63
Q

Classification of PVCs (3)

A

Polymorphic

64
Q

Classification of PVCs (4)

A

Multifocal

65
Q

When to be Concerned about PVCs (1)

A
66
Q

When to be Concerned about PVCs (2)

A
67
Q

Ventricular Tachycardia (1)

A
68
Q

Ventricular Tachycardia

A
69
Q

Uniform vs Polymorphic

A
70
Q

Uniform vs Polymorphic (2)

A
71
Q

Fusion Beats

A
72
Q

Clinical Significance of VT

A

Clinical significance of VT
* Sustained VT severely compromises CO and coronary artery perfusion

  • Medical emergency indicating imminent cardiac arrest, requires immediate interventions
  • VT may be a perfusing (pulsatile) or non perfusing (pulseless)
  • Treatment
    Pulseless – Defibrillate/ACLS
    VT with a pulse
    Stable-procainamide or amiodarone
    Unstable- synchronized cardioversion
73
Q

Ventricular Fibrillation (1)

A
74
Q

Ventricular Fibrillation (2)

A
75
Q

Course vs Fine V-Fib

A
76
Q

Course vs Fine V-Fib

A
77
Q

Course vs Fine V-Fib

A
78
Q

Clinical Significance of V-Fib

A
79
Q

V-fib to D-fib

A
80
Q

Implantable Defibrillators

A
81
Q

External Defibrillators

A
82
Q

Accelerated Idioventricular Rhythm (1)

A
83
Q

Accelerated Idioventricular Rhythm

A
84
Q

Torsade de Pointes (1)

A
85
Q

Torsade de Pointes

A
86
Q

Prolonged QTI x Torsade

A
87
Q

Torsade de Pointes (3)

A
88
Q

Medications that Prolong the QTI

A
89
Q

Aberrant Ventricular Contraction vs PVC

A
90
Q

Supraventricular vs Ventricular arrhythmias

A
91
Q

Clinical Clues for Aberrancy

A
92
Q

ECG Clues

A
93
Q

Quick Differential Diagnosis Tips

A
94
Q

Remember the 4 Questions

A

Are normal P waves present?

Are the QRS complexes narrow or wide?

What is the relationship between the P waves and QRS complexes?

Is the rhythm regular or irregular?

95
Q

Practice

A

Normal Sinus Rhythm
Brady (poor strip demarcation to determine)

96
Q

Practice

A

A Fib

97
Q

Practice

A

V Tach

NSU AA Denver (15 decks)

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