4) Atrial Rhythms Flashcards
1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:
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
Which ECG component represents atrial depolarization?
Which ECG component represents ventricular depolarization?
Which ECG component represents ventricular repolarization?
= P wave
= QRS Complex
= T Wave
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:
= Class IV Antiarrhythmic
= Class I Antiarrhythmic
= Class III Antiarrhythmic
= Class II Antiarrhythmic
In any limb lead, a normal P wave shape & maximum amplitude is:
In any chest lead, a normal P wave has maximum amplitude of:
= nice & round w/ maximum amplitude of: 0.25 mV
= maximum amplitude of: 0.15 mV
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:
= 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
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:
= 5 mm
= 10 mm
A normal PRI should be between
A normal QRS duration should be between:
= 0.12-0.20 seconds
= 0.04-0.12 seconds.
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:
= Calcium channel blocker
= Sodium channel blocker
= Potassium channel blocker
= Beta-Blocker
(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:
= 0.04 sec
= 1 large box
= 0.20 sec
= 0.1 mV & 1 mm
= 1 large box
= 0.5 mV
= 1 mV & 10mm
ST segment:
QT segment:
U wave:
P-T segment:
RR segment:
= Ventricle contraction
= Any action in ventricles
= “late bloomer”
= 1 cardiac cycle
= provides Rate & Rhythm
(P wave) morphology:
represents:
Limb Lead amplitude
Precordial “chest” Leads amplitude:
= + deflection in leads 1,2,&3 >Biphasic in V1
= Atrial depolarization
= <2.5
= <1.5
(Refractory periods) Absolute:
Relative:
= 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
(QRS complex) morphology Q,R,S waves:
Interval duration:
Represents:
= 1st neg deflection, 1st + deflection, neg deflection following R
= 0.04 - 0.12 secs (1-3 SB)
= Ventricles depolarization
(T wave) morphology:
Represents:
Duration:
Limb lead amplitude:
Precordial “chest” lead amplitude:
= + deflection, asymmetric w/ deeper downslope
= Ventricle repolarization
= QT variable calculation ()
= <5mm
= <10mm
Triplicate method:
6 sec method:
R to R small box method:
R to R big box method:
= 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
(Arrhythmias) Mechanism of Impulse Formation Ectopic foci:
= Enhanced automaticity; automatically depolarize, producing ectopic (abnormal) beats.
Hypothermia affect on heart:
= Osborn waves (J waves), <90 core usually, So irritable will/can throw to AFIB
Normal QRS duration:
Normal PRI duration:
= 0.04 - 0.12 seconds
= 0.12 - 0.20 secs
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:
= S wave
= T wave
= Q wave
= QRS wave
= R wave
= P wave
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?
= 2.5mm
= 1.5mm
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?
= 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
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?
= 5mm
= 10mm
QT interval:
RR interval:
= any action in ventricles
= measuring HR
PRI measured by:
PRI “PR/PRI” interval rep/s:
A normal PRI interval range:
prolonged PRI indicates:
= 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
QRS interval measured:
QRS interval represents
QRS interval range:
QRS interval Q,R,&S:
= 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
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:
= SA node
= AV node
= Purjunkie
Normal ECG paper speed is
On ECG paper, 1 Small horizontal box represents:
On ECG paper, 1 Large horizontal box represents
= 25mm/sec
= 0.04 secs
= 0.20 secs
Eintovhens triangle (bipolar) camera always at
L1 + & - leads:
L2 + & - leads:
L3 + & - leads:
= positive > Bipolar - to +
= -RA to +LA
= -LL to + LL
= -LL to + LL
Unipolar leads:
Unipolar lead camera:
aVR:
aVL:
aVF:
= 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
(Limb leads) placement:
positive to negative makes wave:
positive to negative makes wave:
= mid forearm on M. & inside of calf (if amputee/ go less distally)
= positive wave
= negative wave
(Einthoven’s triangle) Negitive & Positive lead 1 sites:
Negitive & Positive lead 2 sites:
Negitive & Positive lead 3 sites:
=negative @ RA & positive @ LA
= negative @ RA & positive @ LL
= negative @ LA & positive @ LL
(leads veiws) I and aVL:
II, III, and aVF:
aVR:
V1 and V2:
V3 and V4:
V5 and V6:
= 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
(Einthoven’s triangle(Bipolar/limb leads) leads 1 views:
Lead 1 Negative:
Lead 1 Positive:
= Left Lateral wall
= Right Arm
= Left Arm
(Einthoven’s triangle(Bipolar/limb leads) leads 2 views:
Lead 2 Negative:
Lead 2 Positive:
= Inferior wall diagonally towards left foot
= Right Arm
= Left Leg
Communication or the connecting of two or more vessels is known as:
= Anastomosis
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
R-atrial enlargement:
Upside down P wave cause:
= 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
Widowmaker :
clot in left coronary artery wiping out L side
1Wandering Atrial Pacemaker WAP:
2Causes:
3Rules:
4Rhythm Etiology:
5 Symptomology:
6Treatment:
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
DIgoxin for
heart failure usually fools refractory Na K pumps
1w/ PAC:
2Definer:
3PAC conduction:
4Causes:
5Symptoms:
6Treatmeant:
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
Multifocal Atrial Tachycardia (MAT):
Rules:
1= multiple firing/pacemaker sites (is a rhythm) “WAP w/ RVR”
2= >100BPM, irregular, at least 3 dif/ P wave shapes
1Paroxysmal Supraventricular Tachycardia (PSVT)
2Rules:
3Causes:
4 Can precipitate:
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.
1Supraventricular Tachycardia (SVT)
2Rules:
3 Treat:
1= AV going NASCAR
2= No P waves, 150-250 BPM, regular rhythm
3= vagal maneuver, adenosine, unstable= cables (@50-100J) go to max)
1Paroxysmal Supraventricular Tachycardia (PSVT)
2 Definer
1= “ SVT sudden start & stop” not associated w/ underlying Cdisease
2= same as SVT but sudden onset/ends abruptly
Cardioversion or pharmacological intervention is only usually required for patients that present in A-Fib at what ventricular rate?
Above 150 beats per minute
Ectopic
Not the normal
The presence of a Delta Wave on an ECG is evidence of which of the following?
WPW
Leads V1 and V2 look at what part of the heart?
Septal
Leads V3 and V4 look at what part of the heart?
Anterior
Leads II, III and aVF look at what part of the heart?
Inferior
A patient presents with Atrial Fibrillation at a rate of 180-190 beats per minutes. How would you correctly describe this rhythm?
A Fib w/ RVR
1A-Fib rate problem:
2Rules:
3Types:
4conduction:
5S/S:
6Treat:
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)
1Atrial Flutter:
2Rules:
3Conduction:
4Treat:
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
Lown-Ganong
Bundle of James connects posterior internodal pathway to bundle of his (short PRI)
Mahaim
Accessory connects to Below bundle of his (wide QRS) looks like VTach
Preexcitation Disorders of Conduction)Most Common:
2nd:
3rd
= – 1st Wolff Parkinson White (WPW) syndrome
= 2nd Lown-Ganong Levine Syndrome
= 3rd Mahaim Fiber Tachycardia
- (Preexcitation Syndromes SVT (AVRT)) Know:
- Most common PS & Etiology:
- 2nd Accessory Pathway:
- 3rd APS:
- Orthodromic Re-entry loop:
- Antidromic Re-entry loop
- Treat:
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
Orthodromic Re-entry loop:
Antidromic Re-entry loop
= Clockwise rentry conduction loop >narrow QRS
= counterclockwise reentry conduction loop > wide QRS
- (Atrial Flutter) Know:
- Definer:
- Etiology:
- Rules:
- Causes:
- S/S:
- Treat:
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
- (Atrial Flutter) Know:
- Definer:
1= “saw tooth Ps”, count bottom of points of flutters “3 to 1 block”
2= Sawtooth Ps w/ regular rhythm
- (A-Fib) know:
- Definer:
- Rules:
- Etiology:
- S/S:
- Treat:
- Types of AFib:
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)
- (A-Fib) know:
- Definer:
1= most common, only treated when >150BPM, more Js b/c more sites
2= No definite P waves, Totally Irregular
