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Physical Assessment > 6 - EKG #2 > Flashcards

6 - EKG #2 Flashcards

1
Q

What are the learning objectives?

A

1) Recognize three different classes of tachyarrhythmias in both the atria and ventricles (paroxysmal tachycardia, flutter and fibrillation) on an EKG
2) Recognize first, second and third-degree AV blocks on an EKG
3) List medications (or other factors) that can potentiate the above arrhythmias
4) Develop a systematic approach to analyzing lead 2 of an EKG

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2
Q

At rest:

150 - 250 bpm indicates what?

A

paroxysmal tachycardia

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3
Q

At rest:

250-350 bpm indicates what?

A

tachycardia flutter

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4
Q

At rest:

350 - 450 bpm indicates what?

A

tachycardia fibrillation

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5
Q

For Age 20:

What is the target HR zone for tachycardias?

A

100-170 bpm (50-85%)

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6
Q

For Age 20:

What is the maximum HR (average)?

A

200 bpm

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7
Q

For Age 30:

What is the target HR zone for tachycardias?

A

95-162 bpm

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8
Q

For Age 30:

What is the maximum HR (average)?

A

190 bpm

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9
Q

For Age 40:

What is the target HR zone for tachycardias?

A

90-153 bpm

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10
Q

For Age 40:

What is the maximum HR (average)?

A

180 bpm

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11
Q

For Age 50:

What is the target HR zone for tachycardias?

A

85-145 bpm

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12
Q

For Age 50:

What is the maximum HR (average)?

A

170 bpm

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13
Q

What is PSVT?

A

Paroxysmal Supraventricular Tachycardia

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14
Q

Paroxysmal Supraventricular Tachycardia:

Rate?

A

Usually 140-250 ppm and “takes off” in a single beat

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15
Q

Paroxysmal Supraventricular Tachycardia:

Rhythm?

A

regular ventricular rate

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16
Q

Paroxysmal Supraventricular Tachycardia:

P waves?

A

often absent

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17
Q

Paroxysmal Supraventricular Tachycardia:

PR interval?

A

normal

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18
Q

Paroxysmal Supraventricular Tachycardia:

QRS ?

A

narrow

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19
Q

Atrial Flutter:

Atria Rate?

A

250-350 bpm

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20
Q

Atrial Flutter:

Ventricular Rate?

A

125-175 bpm

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21
Q

Atrial Flutter:

Rhythm?

A

usually regular

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22
Q

Atrial Flutter:

P waves ?

A

saw tooth pattern

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23
Q

Atrial Flutter:

PR interval?

A

variable

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24
Q

Atrial Flutter:

QRS ?

A

normal

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25
Q

Atrial Fibrillation:

Rate?

A

variable, but usually 350-450 bpm

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26
Q

Atrial Fibrillation:

Rhythm?

A

Irregularly irregular

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27
Q

Atrial Fibrillation:

P waves?

A

chaotic activity

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28
Q

Atrial Fibrillation:

PR interval?

A

none

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29
Q

Atrial Fibrillation:

QRS ?

A

normal

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30
Q

Ventricular Flutter:

Rate?

A

200-300 bpm

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31
Q

Ventricular Flutter:

Rhythm?

A

regular

32
Q

Ventricular Flutter:

P waves?

A

NONE

33
Q

Ventricular Flutter:

PR interval?

A

NONE

34
Q

Ventricular Flutter:

QRS?

A

wide, bizarre, sine-wave appearance

35
Q

__________ _________ = VERY BAD FOR THE PATIENT = DEATH

A

Ventricular Fibrillation

36
Q

Ventricular Fibrillation:

Rate?

A

very hard to determine

37
Q

Ventricular Fibrillation:

Rhythm?

A

chaotic

38
Q

Ventricular Fibrillation:

P waves?

A

None

39
Q

Ventricular Fibrillation:

PR interval?

A

None

40
Q

Ventricular Fibrillation:

QRS?

A

cannot determine

41
Q

______ __ _______ = also very bad for the patient

A

Torsade de Pointes

42
Q

Torsade de Pointes can cause ?

A

QT Prolongation

43
Q

Torsade de Pointes:

Rate?

A

200-250 bpm

44
Q

Torsade de Pointes:

Rhythm?

A

Irregular

45
Q

Torsade de Pointes:

P waves?

A

None

46
Q

Torsade de Pointes:

PR Interval?

A

None

47
Q

Torsade de Pointes:

QRS?

A

variable

48
Q

What are some QT prolonging drugs?

A
  • antipsychotics
  • antidepressants
  • antibiotics (fluoroquinolones)
  • azole antifungals
  • antiarrhythmics
49
Q

What are some stimulant drugs?

A
  • illicit drugs
  • caffeine
  • nicotine
  • OTC decongestants
  • ADHD treatments
50
Q

______ = holiday heart syndrome

A

alcohol

51
Q

1st degree heart block:

Rate?

A

variable (their example on page 3 is bradycardic)

52
Q

1st degree heart block:

Rhythm?

A

normal

53
Q

1st degree heart block:

P waves?

A

normal

54
Q

1st degree heart block:

P:QRS ratio?

A

1:1

55
Q

1st degree AV block:

PR interval?

A

prolonged > than 0.2 seconds (1 large square)

56
Q

1st degree AV block:

QRS ?

A

normal

57
Q

2nd degree AV block
Mobitz 1 (Wenchebach):
Rate?

A

variable (this one is ~65 bpm)

58
Q

2nd degree AV block
Mobitz 1 (Wenchebach):
Rhythm?

A

regularly irregular

59
Q

2nd degree AV block
Mobitz 1 (Wenchebach):
P waves?

A

normal

60
Q

2nd degree AV block
Mobitz 1 (Wenchebach):
P:QRS ratio?

A

variable (5:4)

61
Q 
2nd degree AV block
Mobitz 1 (Wenchebach):
PR interval?
A

increases until beat is dropped

62
Q

2nd degree AV block
Mobitz 1 (Wenchebach):
QRS ?

A

normal

63
Q

2nd degree AV block
Mobitz 2:
Rate?

A

variable (this one is 75-83 bpm)

64
Q

2nd degree AV block
Mobitz 2:
Rhythm?

A

regularly irregular

65
Q

2nd degree AV block
Mobitz 2:
P waves?

A

normal

66
Q

2nd degree AV block
Mobitz 2:
P:QRS ratio

A

P+1:QRS (ex. 3:2, 4:3, 5:4)

67
Q

2nd degree AV block
Mobitz 2:
PR interval?

A

normal (not the difference between Mobitz 1)

68
Q

2nd degree AV block
Mobitz 2:
QRS?

A

Normal

69
Q

3rd degree AV block = _____

A

complete

70
Q

3rd degree AV block:

Rate?

A

separate rates for atria and ventricles

ventricles = 38 bpm
atria = 115 bpm
71
Q

3rd degree AV block:

Rhythm?

A

normal

72
Q

3rd degree AV block:

P waves?

A

normal (there’s usually lots of them)

73
Q

3rd degree AV block:

P:QRS ratio ?

A

variable

74
Q

3rd degree AV block:

PR interval?

A

variable (no pattern)

75
Q

3rd degree AV block:

QRS ?

A

normal or wide

76
Q

What drugs can cause heart block?

A
  • beta blockers
  • digoxin
  • non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
  • some anti arrhythmic drugs (procainamide, amiodarone, quinidine, adenosine)
77
Q

What are other (non-drug) things can cause heart block?

A
  • heart disease and cardiac surgery
  • high vagal tone (athletes)
  • hyperkalemia (increased K+)

Physical Assessment (6 decks)

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