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Simmons NURP 502 Exam 2 > 6: Rhythm Identification > Flashcards

6: Rhythm Identification Flashcards

1
Q

What distinguishes sinus node reentry from sinus tachycardia?

A

It is only the abrupt onset and offset that distinguishes sinus node reentry from sinus tachycardia.

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2
Q

What is the difference between Mobitz 1 and 2?

A

In both there are dropped QRS Complexes, but only in Mobitz 1 is there a lengthening of the PR Interval.

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3
Q

Looking at different leads helps make the diagnosis. Delayed and abnormal activation of the left ventricular myocardium and a diffuse slowing of conduction throughout the left ventricle lead to the following changes on the ECG: there is a tall monophasic and broadened R wave in leads I, aVL, and V6 instead of a septal Q wave; there is a QS complex which is abnormal and widened in V1, instead of a small initial R wave, due to septal activation; the QRS interval is prolonged >0.12 seconds; myocardial repolarization changes, including T-wave inversion and ST segment depression, are evident.

A

Complete LBBB

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4
Q

Every other beat is a PVC in a regular pattern.

A

Ventricular Bigeminy

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5
Q

Sinus rhythm with a rate between 60 and 100.

A

Normal Sinus Rhythm

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6
Q

Looking at different leads helps make the diagnosis. The initial myocardial activation is normal; thus, there is
a normal septal q wave in leads I and V6, followed by a
tall R wave. Similarly, there is a normal initial septal R
wave followed by a deep S wave in leads aVR and V1.
However, the subsequent abnormal right ventricular
activation occurs from left to right and goes through the ventricular myocardium instead of the His-Purkinje
system; thus, there will be a tall and broad secondary R
wave (R’) in leads aVR and V1 (a RSR’ complex), and
a deep and broad S wave in leads I and V6. The width
of the QRS complex is >0.12 seconds.

A

Complete RBBB

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7
Q

Impulses discharged in the SA node are either not conducted to the atria or are done so with a delay.

A

Sinoatrial Exit Block

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8
Q

Every 3rd beat is a PVC in a regular pattern.

A

Ventricular Trigeminy

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9
Q

What do you look for on an EKG in atrial flutter?

A

Flutter waves, which have a predictable, sawtooth appearance.

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10
Q

What causes PACs?

A

Different states of excitability promote occurrence.

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11
Q

Delay of conduction through the left bundle leads to slight prolongation of the QRS Complex (0.10-0.12 seconds). Initial septal activation is normal and the QRS Complexes resemble those associated with normal conduction.

A

Incomplete LBBB

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12
Q

What causes a sinus pause?

A

Intermittent failure of the sinus node impulse generation.

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13
Q

Complete loss of P Wave functioning. Narrow QRS. Slower rhythm.

A

Junctional Dysrhythmias

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14
Q

AV node gets excited and causes HR >100.

A

Junctional Tachycardia

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15
Q

Progressive lengthening of the PR Interval followed by a dropped QRS Complex.

A

Second-Degree Block 1 (Mobitz 1, Wenckebach)

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16
Q

Can occur when the backup pacemaker fails and now using the backup backup. Ventricles fire at a regular rate. QRS Complexes are wide and no P Waves.

A

Accelerated Idioventricular Rhythm

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17
Q

P Wave fires prematurely. A very early one can block the QRS Complex or cause it to be aberrantly conducted.

A

Atrial Premature Complexes (APCs or PACs)

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18
Q

Is second-degree Mobitz 1 or 2 more alarming?

A

Mobitz 2, b/c it often needs a pacemaker if the rhythm can’t be reversed.

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19
Q

A negative QRS complex in lead I and positive QRS complex in aVF is characteristic. The QRS duration is normal.

A

Left Posterior Hemiblock

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20
Q

Manifests as a long RR cycle length, which is longer than the RR interval of the underlying sinus rhythm.

A

Sinus Pause

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21
Q

Short PR Interval (<0.12 seconds) which represents a fusion beat. Delta Wave. Broad QRS Complex.

A

Wolff-Parkinson-White Syndrome

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22
Q

The AV junctional rate speeds up to 61-99 and takes over the pacemaking function.

A

Accelerated Junctional Rhythm

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23
Q

PR Interval is prolonged (>0.20). Delay in conduction.

A

First-Degree AV Heart Block

24
Q

P Waves and QRS Complexes dissociated. Both march along at their own rhythm. Usually requires pacemaker.

A

Third-Degree (Complete) Heart Block

25
Q

Can be normal in athletes or when sleeping.

A

Sinus Bradycardia

26
Q

Why is a left anterior hemiblock more common that a left posterior hemiblock?

A

This is because the left posterior hemifascicle is much thicker than the anterior hemifascicle. It also has a dual blood supply (from the left and right coronary arteries), whereas the anterior hemifascicle does not.

27
Q

Sinus rhythm with a rate greater than 100, but less than approximately 160-180.

A

Sinus Tachycardia

28
Q

The junctional rate in an adult is 40-60. The rhythm rises because the SA node is either delayed or fails in its pacemaking function.

A

AV Node Escape Rhythm

29
Q

Normal in young children and elderly adults.

A

Sinus Arrhythmia

30
Q

What drug toxicity might you suspect if the AV nodal escape rhythm is faster than the normal 40-60?

A

Digoxin (digitalis) toxicity

31
Q

P Wave circling around through the atria. There may be regular QRS Complexes that follow (but not always). More of a regularly irregular pattern.

A

Atrial Flutter

32
Q

Twisting pattern of V-Tach.

A

Torsades de Pointes

33
Q

The only heart block where the P Waves can be buried.

A

Third Degree Heart Block

34
Q

When is SVT paroxysmal (PSVT)?

A

When it starts and stops on its own (independent, abrupt starting and stopping).

35
Q

Complete chaos with the rhythm. Distorted QRS Complexes. No pattern to it.

A

V-Fib

36
Q

A run of 3 or more PVCs in a row.

A

Ventricular Tachycardia

37
Q

How do you tell the difference in PAC and PVC?

A

A narrow QRS complex indicates the conduction starts at the AV node (not below it), indicating a PAC.

38
Q

Accelerated heart rate (150-250) originating above the ventricles.

A

Supraventricular Tachycardia (SVT)

39
Q

AV node fires independently, without stimulation from above. Leads to absence of P Wave (or inverted P Wave).

A

Premature Junctional Contraction

40
Q

This arrhythmia has a sudden onset and offset with a rate that is usually 100 to 160 beats per minute. A P wave precedes each QRS complex and has a morphology identical to the sinus P wave. The PR interval is also similar to that of sinus rhythm. Looks like a skipping pattern.

A

Sinus Node Reentry

41
Q

Variability in HR based on breathing pattern. Seen as variability between successive P Waves.

A

Sinus Arrhythmia

42
Q

How do you differential V-Tach from A-Flutter, since they both have a sawtooth pattern?

A

V-Tach has no QRS in between the flutters, b/c this F Wave is the QRS Complex, unlike in A-Flutter where there is a QRS Complex b/c the F Wave replaces the P Wave.

43
Q

Caused d/t vagal inhibition.

A

Sinus Tachycardia

44
Q

How do you differentiate V-Tach and V-Fib?

A

V-Tach may have a pulse with a chaotic rhythm, but V-Fib will never have a pulse.

45
Q

Complete stopping of P Wave firing.

A

Sinus Arrest

46
Q

Which node acts as the backup pacemaker and is programmed at a slower baseline rate?

A

AV Node (SA Node is the natural pacemaker)

47
Q

What is a high risk PVC that can set you up for Torsades?

A

R-on-T

48
Q

Affected bilaterally. Wide QRS Complexes.

A

Bilateral BBB (has characteristics of both RBBB and LBBB)

49
Q

How does a sinoatrial exit block look on EKG?

A

Loss of P Waves (loss of atrial activation) and consequently loss of QRS Complexes (loss of ventricular depolarization).

50
Q

Sinus rhythm with a rate less than 60.

A

Sinus Bradycardia

51
Q

Blocked P Waves of varying degrees, without progressive lengthening of PR Interval (as indicated by a dropped QRS Complex).

A

Second-Degree Block 2 (Mobitz 2)

52
Q

What often causes Torsades?

A

Magnesium deficiency, so often associated with alcoholism.

53
Q

This is d/t continuous activity or reentry within the sinus node or the sinoatrial junction.

A

Sinus Node Reentry

54
Q

In sinus arrhythmia, the heart rate _____ with inspiration and _____ with expiration.

A

In sinus arrhythmia, the heart rate increases with inspiration and decreases with expiration.

55
Q

Results in a long pause and a complete skipped beat.

A

Sinus Arrest

Simmons NURP 502 Exam 2 (27 decks)

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