4 Flashcards
B. PR Interval - SHORT (<0.12 sec)
Pre-Excitation Syndromes
for which AV block do you have NSR
1st degree AV
why would you see an . AV block type 1
4
enhanced vagal tone
or congenital
acute MI or
electrolyte imabalances
what PRI do we see with 1st degree AV block
greater than .2 seconds
second degree AV block type I is usually due to
result of myocardial damage or atrial hypertrophy
sxs of av block 2 type 1
irregular heartbeat
Light-headedness, dizziness, or syncope (more common in type II)
Chest pain, if the heart block is related to myocarditis or ischemia
A regularly irregular heartbeat
Bradycardia may be present
Symptomatic patients may have signs of hypoperfusion, including hypotension
sxs of seocnd degree av block type 2
Light-headedness, dizziness, or syncope (more common than in type I)
Chest pain, if the heart block is related to myocarditis or ischemia
A regularly irregular heartbeat
Bradycardia may be present
Symptomatic patients may have signs of hypoperfusion, including hypotension
3 degree AV block is seen as what measurement
if the P to P interval is regular
R to R IS can also regular
for 3rd degree AV blocks the tx is a
pacemaker
when do you need a pacemaker for a block
second degree type two and third degree block
CCB and BB in AV blocks
use with caution because they can block further
Pre-Excitation Syndromes two major ones
wolf . parkinsons white and
lown ganong levine
In Pre-Excitation Syndromes two major ones we see Early activation of the ventricles due to
” Early activation of the ventricles due to impulses bypassing the AV node via an accessory pathway.
bundle of kent
pathophysiolog of WPW
James fibers
exist in the AV node and the issue with Lown Ganong Levine
Accessory pathways are formed during cardiac development and can exist in a variety of anatomical locations includin
anterograde =towards the ventricle
retrograde= away from the ventricle
but majority of the time= it goes in both direction
what is the major risk for a patient with pre excitation syndrome with accessory pathways in both direction
three impulses going on at the same time and therefore you risk the pt PSVT
paroxysmal supraventricular tachycardia
delta wave symbolizes
signal fomr bundle of kent
which pre excitation syndrome is more common?
how many of those are symptomatic
WPW
50-60% become symptomatic
first peak early childhood 2nd peak in young adulthood
syncope
palpations syncope in young adult?
need ECG work up for WPW
bundle of kent is located in what part of the heart
can be on either side of the atrium L or R
two types of WPW
” Type A (MC): Kent’s –> LV: tall R waves in V1 & V2)
“ Type B: Kent’s –> RV:
what is the difference in ECK finding with LGL and WPW
No Delta Wave)
TYPICAL FINDINGS with type B WPW
predominantly NEGATIVE R waves & Delta waves in V1 & V2, deep QS waves
in V1& V2 –> anteroseptal pseudoinfarct
Type A WPW is different than type b b/c
tall R wave in V1 and V2
what V1 and V2 findings do you see with Type B
RS QS waves are negative in v1 and V2
WPW if left untreated will cause
Can cause ventricular fibrillation & sudden death. Be suspicious of a healthy, young patient w/ syncopal episode.
need to cardiovert them and find out the underlying problem
TX of WPW
Stable/asymptomatic—> Cardiology referral.
Patient dying? D/C cardioversion or Unsynchronized
Radiofrequency catheter ablation - heats the tissue enough to destroy the accessory pathway.
QRS Interval - LONG (>0.12 sec) indicates
C. QRS Interval - LONG (>0.12 sec) —?>Bundle Branch Blocks (LBBB vs. RBBB)
Recall ventricular depolarization = 0.08-0.12 sec (2-3 small boxes
BBB on EKG in what lead as what
R- S-R prime in V1 or bunny ears
SLURRED s WAVE IN v6
RBB
left ventricle contracting first followed by the right ventricle
S wave in RBBB
goes down to the isoelectric line
can go below too
Left BBB in what lead as what
R knotch R seen in v6
what leads do you look at to diagnose BBB
V1 and V6
What is more common LBB or RBBB
RBBB
RBBB is usually caused by
usually caused by MI
LBBB usually indicated
possible MI
in V1 LBBB will be
QRS deeply negative
V5 V6
QRS wide
two types of fascicular blocks
Left anterior fascicular block
Left posterior fascicular block
Left anterior fascicular blocks are commonly seen with what other EKG finding
LAD
left posterior fascicular blocks are usually associated with
RAD
hemiblocks are also known as
fascicular blocks
V1 rabbit ears
V6 slurred S wave
with LAD
left anterior block with RBBB
also known as a bi-fascicular block
QRS intervals are long can be the result of these 4 situtations
> .12
bb BLOCKS
fascicular/hemiblockes
premature ventricular contraction
idioventircular rhythm
A long QT is interval can be the sign of what electrolyte imbalnces
hypokalemia
hypomagnesemia
hypocalcemia
second degree block type one is the result of
myocardial damage or atrial hypertrophy
which pre-excitation syndrome is intranodal
Lown Ganong Levine
exists around the AV node
paroxysmal supraventricular tachycardia (PSVT) usually arises through a ___________
paroxysmal supraventricular tachycardia (PSVT) usually arises through a reentrant mechanism.
ventricular escape would be seen as
20-40 bpm
junctional escape would be seen as
40-60 bpm
unifocal and bifocal as well as trigemeny and bigemeney refer to
PVC
seen with wide opposing T
first you’re cute and then you’re slurred
RBBB
first you hit the floor hard then you’re a couple of small bunny ears
LBBB
