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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 * 6 =78 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

SA Node Arrhythmia

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18
Q

Sinus Bradycardia

A

SA Node Arrhythmia

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19
Q

Respiratory Sinus Arrhythmia (RSA)

A

SA Node Arrhythmia

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

SA Node Arrhythmia

Sinus node fails to send out electrical activity

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22
Q

Sinus Arrest vs Sinus Exit Block

A

SA Node Arrhythmia

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23
Q

Asystole

A

SA Node Arrhythmia… whole heart

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24
Q

Latent Pacemakers

A
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25
Q

Junctional Escape Rhythm

A

SA Node Arrhythmia… because SA node didn’t fire

Key is the no P Wave

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26
Q

Pulseless Electrical Activity (PEA)

A

SA Node Arrhythmia… whole heart issue

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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

MY SUMMATION:
Regular vs Irregular
Rate?
P- Wave
1:1 to QRS?
Absent?
Abnormal?
QRS Width

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

Ectopic arrhythmia
Supraventricular arrhythmia

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37
Q

Premature Junctional Contractions

A

Ectopic arrhythmia
Supraventricular arrhythmia

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38
Q

PJC vs Junctional Escape Beat

A
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39
Q

PJC vs PAC

40
Q

Atrial or Junctional

A

Third beat is early
Lacks P-Wave

Premature Junctional Beat

41
Q

Atrial or Junctional

A

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

Junctional Escapee followed by Junctional rhythm

42
Q

Atrial or Junctional

A

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

Premature Atrial Contraction

43
Q

Sustained Supraventricular Arrhythmias

44
Q

AV Nodal Reentrant Tachycardia (1)

A

Supraventricular arrhythmia

45
Q

AV Nodal Reentrant Tachycardia (2)

A

Supraventricular arrhythmia

46
Q

Carotid Sinus Massage

A

CSM can help terminate as well as diagnose AVNRT
CSM has no effect on Paroxysmal atrial tachycardia
CSM increase diagnosis of Atrial flutter but increasing number of Ps, but not treat
CSM has no effect on Multifocal atrial tachycardia

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

Ectopic arrhythmia
Supraventricular arrhythmia

49
Q

Atrial Flutter (1)

A

Reentrant arrhythmia
Supraventricular arrhythmia

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)

51
Q

Atrial Flutter (3)

52
Q

Atrial Flutter (4)

53
Q

Atrial Flutter x CSM

54
Q

Atrial Fibrillation (1)

A

Supraventricular arrhythmia

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)

56
Q

A-Fib (3)

57
Q

Multifocal Atrial Tachycardia

A

Ectopic arrhythmia
Supraventricular arrhythmia

58
Q

Wandering Atrial Pacemakers

A

Ectopic arrhythmia

59
Q

Atrial Arrythmias Review

60
Q

Premature Ventricular Contractions

A

Ventricular arrhythmia

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)

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)

66
Q

When to be Concerned about PVCs (2)

67
Q

Ventricular Tachycardia (1)

A

Ventricular arrhythmia

68
Q

Ventricular Tachycardia

69
Q

Uniform vs Polymorphic

70
Q

Uniform vs Polymorphic (2)

71
Q

Fusion Beats

72
Q

Clinical Significance of VT

A

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

Ventricular arrhythmia

74
Q

Ventricular Fibrillation (2)

75
Q

Course vs Fine V-Fib

76
Q

Course vs Fine V-Fib

77
Q

Course vs Fine V-Fib

78
Q

Clinical Significance of V-Fib

79
Q

V-fib to D-fib

80
Q

Implantable Defibrillators

81
Q

External Defibrillators

82
Q

Accelerated Idioventricular Rhythm (1)

A

Ventricular arrhythmia

83
Q

Accelerated Idioventricular Rhythm

84
Q

Torsade de Pointes (1)

85
Q

Torsade de Pointes

86
Q

Prolonged QTI x Torsade

87
Q

Torsade de Pointes (3)

88
Q

Medications that Prolong the QTI

89
Q

Aberrant Ventricular Contraction vs PVC

90
Q

Supraventricular vs Ventricular arrhythmias

91
Q

Clinical Clues for Aberrancy

92
Q

ECG Clues

93
Q

Quick Differential Diagnosis Tips

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

97
Q

Practice

98
Q

Highly Missed Question: Respiratory Sinus Arrythmia

A

Only difference is it positive or negative ventilation

Just because someone is asleep and intubated doesn’t mean they are breathing positive

99
Q

Highly Missed Question: ST Depression?

A

ST depression sharp one side, gradual other…
… find the slide it is referencing in this deck!!!

100
Q

Highly Missed Question: Exploring and Reference Electrodes

A

Can be asked this way for what way a wave will deflect

NSU AA Denver (42 decks)

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