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SF3 - Test 1 > 5 - EKG III: Clinical 2 > Flashcards

5 - EKG III: Clinical 2 Flashcards

1
Q

Clinical: Sinus Bradycardia

Is this always pathologic?

A

Slowing of normal heart rhythm, result of decreased firing at SA Node (pacemaker)

- - -

No, highly trained athletes have elevated vagal tone (parasympathetics)

Can be patholigic with aging, heart disease, medication (B blocker, calccium channel blocker) or metabolic diseas (hypothyroidism)

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2
Q

Diagnose:

A

Sinus Bradycardia

Normal P

Normal QRS Complex

Normal T

Just HR <60

What is the heart rate in this image?

(peaks x 6 = 24)

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3
Q

Diagnose Image

A

Ventricular Escape Rythm

No P Wave (no atrial depolarization)

Wide QRS (maybe double peak)

Normal T

Rate 15 - 40

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4
Q

Diagnose Image

Where is conduction originating?

A

Junctional Escape Rythm

No P Wave

Normal QRS

Normal T Wave

Conduction at AV Node

Rate 40-60

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5
Q

What is the EKG finding for escape rhythms?

How will you differentiate between Junction and Ventricular?

A

No P Waves Present (atrial depolarization)

Junction - No P, Normal QRS, Normal T

Rate ~ 40-60

Ventricular - No P, Wide QRS (maybe two peaks), Normal T

Rate ~ 15-40

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6
Q

Diagnose Image

A

First-degree AV Block

Prolonged PR Interval

Normal looking P, QRS, T

1/1 Ratio of P to QRS

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7
Q

Diagnose Image

A

Second-Degree AV Block: Möbitz Type 1 (Wenckebach)

Constant P Wave

PR Interval progressively lengthens, until QRS Blocked–will be missing a QRS in the String

Can be common in Distance runners

P/QRS no 1:1 ratio!

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8
Q

Diagnose Image

A

Second-Degree AV Block: Möbitz Type II

Consistent PR Interval

QRS Complex will be missing (random drop)

Medical treatment required, pacemaker, syncope

Found lower in His Bundle

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9
Q

Clinical: How do you differentiate AV Block types on ECG Strips?

First-Degree AV Block

Möbitz Type I (Wenckebach)

Möbitz Type II

A

First-Degree AV Block:

PR Interval > 0.2 Second

Möbitz Type I (Wenckebach)

Progressive Increase in PR Interval, until single QRS Absent

Möbitz Type II

Sudden loss of AV Conduction, Regular PR Intervals (absent QRS)

QRS can be widened in R/L branch block

Requires medical intervention (pacemaker)

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10
Q

Diagnose Image

A

Third-Degree AV Block “Complete Heart Block”

No relationship between P Waves and QRS Complexes (they will be on two different rhythms)

No progressive lengthening—will be random

Requires medical intervention

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11
Q

Clinical: Supraventricular Arrhythmias

Cause/Treatment

A

Sinus Tachycardia

SA Node discharge rate > 100 bpm (usually 100-180 bpm)

Cause: Most often Increased Sympathetics/Decreased Parasympathetics (vagal tone)

Treatment: Underlying cause!

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12
Q

Diagnose Image

A

Sinus Tachycardia

Normal P

Normal QRS

Normal T

HR > 100

What is the HR in the image?

~ 125

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13
Q

Diagnose Image:

A

Atrial Premature Beats (APB)

Originate from an atrial focus OUTSIDE SA Node

Earlier than expect P Wave, with abnormal shape

QRS Complex Usually Normal

Causes: Smoking, lack of sleep, coffee, alcohol

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14
Q

Clinical: Atrial Flutter

A

Rapid, Irregular Atrial Activity at rate 180-350 BPM

Will have several high amp P waves, followed by a single QRS complex

May cause palpitations,dyspnea, weakness

Atrial Rate ~ 300

QRS Conduction ~ 150

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15
Q

Diagnose Image

A

Atrial Flutter

AV Rate ~ 300

Conduction Rate ~ 150

“Sawtooth” Appearance

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16
Q

Clinical: Atrial Fibrillation

A

Chaotic rhythim with atrial rate 350-600

No P Waves, OR fine, high frequency LOW AMP wavy AV Conduction

Normal QRS-T complex, irregular timing ~ 140-160 bpm

17
Q

Clinical: Paroxysmal Supreventricular Tachycardias (PSVTs)

What form is most common in adults?

A

Sudden onset/termination

Atrial rates ~ 140 - 250

Most Common: Atrioventricular Nodal Reentrant Tachycardia (AVNRT)

P Waves not apparent (hidden/retrograde)

Normal QRS Complex

18
Q

Diagnose Image

A

Paroxysmal Supraventicular Tachycardia (PSVT)

Atrioventricular Nodal Reentrant Tachcardia (AVNRT)

19
Q

Clinical: Ventricular Pre-Excitation Syndrome (Wolff-Parkinson-White Syndrome, WPW)

A

Ventricles stimulated earlier than normal by conduction over AV Node

Atrial impulses can pass in antergrade direction through AV nose and accessory pathway

Short PR Interval (<0.12 sec)

QRS has slurred upstroke (Delta Wave)

Widened QRS complex

20
Q

Diagnose Image

A

Ventricular Pre-excitation Syndrome (Wolf Parkinson White, WPW)

Short PR Interval (<0.12)

Slurred QRS (Delta)

Widened QRS

21
Q

Clinical: What are patients with WPW Syndrom predisposed to?

Why?

A

PSVT

Accessory Pathway provides a potential limb of reentrant loop

22
Q

Clinical:

Orthodromic AVRT (most common)

Antidromic AVRT

Concealed Accessory Pathway

A

Orthodromic AVRT - most common

Impulse travels anterograde down AV node to ventricles, then retrograde up accessory tract back to atria

No Delta Wave, ventricles depolarize via normal conduction

Antidromic AVRT

Impuls tavels anterograde down accessory pathway, an retrograde up AV Node

Wide QRS, ventricles actived from anterograde conduction via accessory pathways

Concealed Accessory Pathway

Can result in Orthodromic AVRT

ECGs do not result in ventricular pre-excitation

23
Q

Clinical: Antidromic Atrioventricular Reentrant Tachycardia

What can you not give these patients?

A

Impulses are conducted anterogradely down accessory tract, and retrogradely up AV Node

RETROGRADE/REVERSED P Waves

WIDE, IRREGULAR QRS Complex

- - -

AV Nodal agens will kill patient!

  1. Adenosine
  2. Calcium Channel Blockers
  3. Beta Blockers
  4. Digitalis
24
Q

Diagnose Image:

What should you NOT prescribe these patients?

A

Antidromic Atrioventricular Reentrant Tachycardia

AV Nodal Agents will kill patient!

  1. Adenosine
  2. Calcium Channel Blockers
  3. Beta Blockers
  4. Digitalis
25
Q

Clinical: Ventricular Arrhythmias

Ventricular Premature Beats (VPB)

A

Ectopic ventricular focus fires action potential

P Wave Generated, not linked to every QRS

Widened QRS, impulse travels cell-to-cell Not His-Purkinje System

T Wave reversed

**Extra beats fired from ventricle**

26
Q

Diagnose Image

A

Ventricular Premature Beats (VPB)

Widened QRS

Inverted T

Ectopic beat not related to P Wave

27
Q

Clinical: Ventricular Tachycardia

A

Series of three or more VPBs

Wiiiiide QRS Complexes (>0.12)

100 - 200 bpm

If QRS complex are monomorphic, indicates structural abnormality that supports reentry circuit

If QRS complex are polymorphic, (Torsades de Pointes) acute myocardial ischemia / infarction most common causes; abnormalities of ion channels or calcium handling (long-QT syndromes)

28
Q

Diagnose Image

A

Polymorphic Ventricular Tachycardia

29
Q

Clinical: Ventricular Fibrillation (VF)

A

Life threatening arrhythmia

No coordinated contractions

No discrete QRS waveforms

30
Q

Diagnose Image

Treatment?

A

Ventricular Fibrillation

SHOCK!

31
Q
A

SF3 - Test 1 (28 decks)

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