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Cardiology > 4) Atrial Rhythms > Flashcards

4) Atrial Rhythms Flashcards

1
Q

1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:

A

1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks

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2
Q

Which ECG component represents atrial depolarization?
Which ECG component represents ventricular depolarization?
Which ECG component represents ventricular repolarization?

A

= P wave
= QRS Complex
= T Wave

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3
Q

Vaughan-Williams Classification scale, Calcium channel blocker is a:
Vaughan-Williams Classification scale, Sodium channel blocker is a:
Vaughan-Williams Classification scale, Potassium channel blocker is a:
Vaughan-Williams Classification scale, a Beta-Blocker is a:

A

= Class IV Antiarrhythmic
= Class I Antiarrhythmic
= Class III Antiarrhythmic
= Class II Antiarrhythmic

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4
Q

In any limb lead, a normal P wave shape & maximum amplitude is:
In any chest lead, a normal P wave has maximum amplitude of:

A

= nice & round w/ maximum amplitude of: 0.25 mV
= maximum amplitude of: 0.15 mV

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5
Q

1st step when deciphering an ECG rhythm is:
2nd step when deciphering an ECG rhythm is:
3rd step when deciphering an ECG rhythm is:
4th step when deciphering an ECG rhythm is:
5th step when deciphering an ECG rhythm is:

A

= To calculate the heart rate
= Determine if the rhythm has a normal or abnormal cadence
= Evaluate the P Waves
= Measure the PR Interval
= Evaluate the QRS complexes

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6
Q

Normal T Wave in any limb lead should have a max amplitude of:
Normal T Wave in any chest lead should have a max amplitude of:

A

= 5 mm
= 10 mm

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7
Q

A normal PRI should be between
A normal QRS duration should be between:

A

= 0.12-0.20 seconds
= 0.04-0.12 seconds.

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8
Q

Class IV Antiarrhythmic of Vaughan-Williams Class is:
Class I Antiarrhythmic of Vaughan-Williams Class is:
Class III Antiarrhythmic of Vaughan-Williams Class is:
Class II Antiarrhythmic of Vaughan-Williams Class is:

A

= Calcium channel blocker
= Sodium channel blocker
= Potassium channel blocker
= Beta-Blocker

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9
Q

(ECG Paper) (Horizontal Boxes) small box duration:
5 small boxes makes:
Each large box duration:
(Vertical Boxes) Each small box volt & measurement:
5 small boxes makes:
Each large box voltage:
2 large boxes equivalent:

A

= 0.04 sec
= 1 large box
= 0.20 sec
= 0.1 mV & 1 mm
= 1 large box
= 0.5 mV
= 1 mV & 10mm

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10
Q

ST segment:
QT segment:
U wave:
P-T segment:
RR segment:

A

= Ventricle contraction
= Any action in ventricles
= “late bloomer”
= 1 cardiac cycle
= provides Rate & Rhythm

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11
Q

(P wave) morphology:
represents:
Limb Lead amplitude
Precordial “chest” Leads amplitude:

A

= + deflection in leads 1,2,&3 >Biphasic in V1
= Atrial depolarization
= <2.5
= <1.5

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12
Q

(Refractory periods) Absolute:
Relative:

A

= end of P to apex of T wave- cells absolute Beginning of repolarization
= “some really could happen” lot of cells repolar but not all so can throw out of rhythm Commodo cordis

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13
Q

(QRS complex) morphology Q,R,S waves:
Interval duration:
Represents:

A

= 1st neg deflection, 1st + deflection, neg deflection following R
= 0.04 - 0.12 secs (1-3 SB)
= Ventricles depolarization

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14
Q

(T wave) morphology:
Represents:
Duration:
Limb lead amplitude:
Precordial “chest” lead amplitude:

A

= + deflection, asymmetric w/ deeper downslope
= Ventricle repolarization
= QT variable calculation ()
= <5mm
= <10mm

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15
Q

Triplicate method:
6 sec method:
R to R small box method:
R to R big box method:

A

= for HR> Big box RR descends 300,150,100,75,50,50,43,38
= Count # of complexes in a 6-sec strip X 10
= Count small boxes between R waves then /1500 EX: 1500 / 22 = 68
= (only regular rhythm) Count big boxes between R waves then divide 300 by this number EX 300 / 4 = 75

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16
Q

(Arrhythmias) Mechanism of Impulse Formation Ectopic foci:

A

= Enhanced automaticity; automatically depolarize, producing ectopic (abnormal) beats.

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17
Q

Hypothermia affect on heart:

A

= Osborn waves (J waves), <90 core usually, So irritable will/can throw to AFIB

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18
Q

Normal QRS duration:
Normal PRI duration:

A

= 0.04 - 0.12 seconds
= 0.12 - 0.20 secs

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19
Q

1st negative deflection following the R wave is the:
What wave on ECG represents repolarization of the ventricles:
The first negative deflection following the P wave is the:
What wave on ECG represents depolarization of ventricles:
1st positive deflection following the P wave is:
What wave on an ECG represents depolarization of the atriums:

A

= S wave
= T wave
= Q wave
= QRS wave
= R wave
= P wave

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20
Q

What is considered the normal max amplitude of a P wave in lead II?
What is considered the normal max amplitude of a P wave in lead V1?

A

= 2.5mm
= 1.5mm

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21
Q

When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?

A

= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular

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22
Q

What is considered the normal max amplitude of a T wave in lead I?
What is considered the normal max amplitude of a T wave in lead V1?

A

= 5mm
= 10mm

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23
Q

QT interval:
RR interval:

A

= any action in ventricles
= measuring HR

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24
Q

PRI measured by:
PRI “PR/PRI” interval rep/s:
A normal PRI interval range:
prolonged PRI indicates:

A

= distance from beginning of P wave to beginning of QRS complex.
= time impulse takes from atria-ventricles “Gatekeeper Gandolf”
= 0.12-0.20 sec / 3-5 SB
= a delay in the AV node & possible HB

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25
Q

QRS interval measured:
QRS interval represents
QRS interval range:
QRS interval Q,R,&S:

A

= distance from 1st deflection of complex to last deflection
= time needed for ventricle depolarization (bundle of his > ventricles)
= 0.04-0.12secs / 1-3SB
= 1st -deflection not >1SB, 1st +deflection, -deflection after R

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26
Q

Natural pacemaker of the heart is:
If SA Node failed to initiate a impulse, what is 1st back-up firing site?
If both SA & AV fails what is last firing site:

A

= SA node
= AV node
= Purjunkie

27
Q

Normal ECG paper speed is
On ECG paper, 1 Small horizontal box represents:
On ECG paper, 1 Large horizontal box represents

A

= 25mm/sec
= 0.04 secs
= 0.20 secs

28
Q

Eintovhens triangle (bipolar) camera always at
L1 + & - leads:
L2 + & - leads:
L3 + & - leads:

A

= positive > Bipolar - to +
= -RA to +LA
= -LL to + LL
= -LL to + LL

29
Q

Unipolar leads:
Unipolar lead camera:
aVR:
aVL:
aVF:

A

= 1 polarity(need 4 LL): AvR,LvR, (Wilson’s central terminal)
= Starts at middle point of lines look to center terminal
= augmented voltage right (right (looks at R-atrium)
= augmented voltage Left Positive Left arm +, L-wall
= augmented voltage Foot: Left Leg positive inferior

30
Q

(Limb leads) placement:
positive to negative makes wave:
positive to negative makes wave:

A

= mid forearm on M. & inside of calf (if amputee/ go less distally)
= positive wave
= negative wave

31
Q

(Einthoven’s triangle) Negitive & Positive lead 1 sites:
Negitive & Positive lead 2 sites:
Negitive & Positive lead 3 sites:

A

=negative @ RA & positive @ LA
= negative @ RA & positive @ LL
= negative @ LA & positive @ LL

32
Q

(leads veiws) I and aVL:
II, III, and aVF:
aVR:
V1 and V2:
V3 and V4:
V5 and V6:

A

= Left side of the heart in a vertical plane
= Inferior (diaphragmatic) side of the heart
= Right side of the heart in a vertical plane
= Right ventricle
= Interventricular septum and the anterior wall of the left ventricle
= Anterior and lateral walls of the left ventricle

33
Q

(Einthoven’s triangle(Bipolar/limb leads) leads 1 views:
Lead 1 Negative:
Lead 1 Positive:

A

= Left Lateral wall
= Right Arm
= Left Arm

34
Q

(Einthoven’s triangle(Bipolar/limb leads) leads 2 views:
Lead 2 Negative:
Lead 2 Positive:

A

= Inferior wall diagonally towards left foot
= Right Arm
= Left Leg

35
Q

Communication or the connecting of two or more vessels is known as:

A

= Anastomosis

36
Q

Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view

A

= Anterior
= Septal
= Inferior
= Lateral

37
Q

R-atrial enlargement:

Upside down P wave cause:

A

= changes P wave “P Pulmonele” b/c ventricle backing up or vasodialation, L-Pump failure P mitria “P wave double humps”,
= impulse comes from AV or below atrias

38
Q

Widowmaker :

A

clot in left coronary artery wiping out L side

39
Q

1Wandering Atrial Pacemaker WAP:
2Causes:
3Rules:
4Rhythm Etiology:
5 Symptomology:
6Treatment:

A

1= “pacing/firing comes from dif sites” May be precursor to AFib
2= atrial enlargement, L-Pump failure, getting old, metabolic disorder
3= irregular at least 3 dif P waves shapes, PRI varies, QRS WNL,
4= Transfer of pace sites from SA node to other sites in atria & AV
5= PT may c/o “palpitations” or a “skipping” feeling in their chest
6= Supportive care, Treat the underlying cause

40
Q

DIgoxin for

A

heart failure usually fools refractory Na K pumps

41
Q

1w/ PAC:
2Definer:
3PAC conduction:
4Causes:

5Symptoms:
6Treatmeant:

A

1= Premature Atrial Contractions “w/”
2= dif P wave shape w/ premature depolarization
3= Single impulse from the atria outside SA, premature depolarization
4= use of caffeine nicotine or alcohol, sympathomimetic, increased excitable “shout outs”, Ischemic heart disease, hypoxia, Digoxin,
5= PT may feel “palpitations” or “skipping” feeling in their chest
6= O2 supportive care

42
Q

Multifocal Atrial Tachycardia (MAT):
Rules:

A

1= multiple firing/pacemaker sites (is a rhythm) “WAP w/ RVR”
2= >100BPM, irregular, at least 3 dif/ P wave shapes

43
Q

1Paroxysmal Supraventricular Tachycardia (PSVT)
2Rules:
3Causes:
4 Can precipitate:

A

1= “ SVT sudden start & stop” not associated w/ underlying Cdisease
2= same as SVT but sudden onset, terminates abruptly
3= Stress, overexertion, smoking, ingestion of caffeine.
4=angina, hypotension, congestive heart failure.

44
Q

1Supraventricular Tachycardia (SVT)
2Rules:
3 Treat:

A

1= AV going NASCAR
2= No P waves, 150-250 BPM, regular rhythm
3= vagal maneuver, adenosine, unstable= cables (@50-100J) go to max)

45
Q

1Paroxysmal Supraventricular Tachycardia (PSVT)
2 Definer

A

1= “ SVT sudden start & stop” not associated w/ underlying Cdisease
2= same as SVT but sudden onset/ends abruptly

46
Q

Cardioversion or pharmacological intervention is only usually required for patients that present in A-Fib at what ventricular rate?

A

Above 150 beats per minute

47
Q

Ectopic

A

Not the normal

48
Q

The presence of a Delta Wave on an ECG is evidence of which of the following?

A

WPW

49
Q

Leads V1 and V2 look at what part of the heart?

A

Septal

50
Q

Leads V3 and V4 look at what part of the heart?

A

Anterior

51
Q

Leads II, III and aVF look at what part of the heart?

A

Inferior

52
Q

A patient presents with Atrial Fibrillation at a rate of 180-190 beats per minutes. How would you correctly describe this rhythm?

A

A Fib w/ RVR

53
Q

1A-Fib rate problem:
2Rules:
3Types:
4conduction:
5S/S:
6Treat:

A

1= most common (only treated when rate problem=150BPM
2=NEVER P waves, rhythm totally irregular,
3= controlled <150 AV node can control, >150 or <60 uncontrolled
4= Different sites all shouting, atrium “quivering
5= loose / reduces atrial kick CO<20-25%, looses preload < starling
6= Ca blocker, sym unstable BPM>150 cable (120-200J) more sites to control)

54
Q

1Atrial Flutter:
2Rules:
3Conduction:

4Treat:

A

1= “3 to 1 block” R-atrium impulse stuck to I/vena-cava valve pathway
2= multiple sawtooth P waves
3= autorhythmic cells loco “saw tooth flutter waves” R-atrium impulse stuck to I/vena-cava valve triangular(cabo trismis ismis)pace site in atria
4= Ca channel blocker, 1st line med diltiazem (or beta blocker), symp unstable & BPM150> cables

55
Q

Lown-Ganong

A

Bundle of James connects posterior internodal pathway to bundle of his (short PRI)

56
Q

Mahaim

A

Accessory connects to Below bundle of his (wide QRS) looks like VTach

57
Q

Preexcitation Disorders of Conduction)Most Common:
2nd:
3rd

A

= – 1st Wolff Parkinson White (WPW) syndrome
= 2nd Lown-Ganong Levine Syndrome
= 3rd Mahaim Fiber Tachycardia

58
Q
  1. (Preexcitation Syndromes SVT (AVRT)) Know:
  2. Most common PS & Etiology:
  3. 2nd Accessory Pathway:
  4. 3rd APS:
  5. Orthodromic Re-entry loop:
  6. Antidromic Re-entry loop
  7. Treat:
A

1= needs accessory pathway & “Ventricles’ back-door w/o passing AV”
2= WPW most common Wolff-Parkinson bundle of Kent (allows SA fired impulse use accessory path to pass AV to prefire) usually R-side dif/ wave morph ) delta wave “2nd P wave slides/slurs to QRS” to pre excite
3= 2nd lown ganong Levine
4= 3rd Mahaim Fiber Tcardia
5= Clockwise rentry narrow complex
6= counterclockwise- QRS wide
7 =procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion 50-100J

59
Q

Orthodromic Re-entry loop:
Antidromic Re-entry loop

A

= Clockwise rentry conduction loop >narrow QRS
= counterclockwise reentry conduction loop > wide QRS

60
Q
  1. (Atrial Flutter) Know:
  2. Definer:
  3. Etiology:
  4. Rules:
  5. Causes:
  6. S/S:
  7. Treat:
A

1= “saw tooth Ps”, count bottom of points of flutters “3 to 1 block”
2= Sawtooth Ps w/ regular rhythm
3= R-atrium impulse stuck to Ivena-cava valve triangular pathway (cabo trismis ismis) b/c jacked up autorhythmic cells & 150BPM usually when AV goes to fast
4= Atrium Rate 250-350, Reg Rhythm, Flutter P Waves, PRI Usually constant but may vary, Pace-Site Atria outside SA, QRS Usually norm
5= Occurs w/ old age, CHF, rarely from a MI
6= depends on rate,
7= Ca channel blocker, 1st line med diltiazem (or beta blocker), symp unstable & BPM>150 cables 50-100Js

61
Q
  1. (Atrial Flutter) Know:
  2. Definer:
A

1= “saw tooth Ps”, count bottom of points of flutters “3 to 1 block”
2= Sawtooth Ps w/ regular rhythm

62
Q
  1. (A-Fib) know:
  2. Definer:
  3. Rules:
  4. Etiology:
  5. S/S:
  6. Treat:
  7. Types of AFib:
A

1= most common, only treated when >150BPM, more Js b/c more sites
2= No definite P waves, Totally Irregular
3= NEVER P waves, Pacing-sites 350-750BPM in atriums, rhythm is always totally irregular, PRI: None, QRS: Usually normal
4= AV randomly lets a impulse down after blocking shower of impulses
5= < Atrial kick CO<20-25% & preload thus <Starling then ect, AMS,
6= Ca blocker, sym unstable BPM>150 cable (120-200J) more sites to control),
7= Controlled <150 AV can control, >150 = w/ RVR, w/ 3rd degree AV block (reg rhythm(Atriums & Ventricles on own)

63
Q
  1. (A-Fib) know:
  2. Definer:
A

1= most common, only treated when >150BPM, more Js b/c more sites
2= No definite P waves, Totally Irregular

Cardiology (20 decks)

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