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AP + Phys > APEX Cardiac Rhythm Monitors/ Equipment > Flashcards

APEX Cardiac Rhythm Monitors/ Equipment Flashcards

1
Q

Which pathway depolarizes the LA?

A

Bachmann bundle

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2
Q

Internodal tracts

A

Anterior internodal (goes to bachmann bundle)
Middle internodal (wenckebach, goes to AV)
Posterior internodal (thorel goes to AV)

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3
Q

Conduction velocity of the heart

A

SA/AV nodes- 0.02-0.1m/s (slow)
Myocardial muscle cells- 0.3-1m/s (intermediate)
His, bundle branches, purkinje fibers- 1-4-m/s (fast)

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4
Q

What controls conduction velocity?

A

ANS tone
Potassium
Ischemia
Acidosis
Antiarrhythmic drugs

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5
Q

Accessory pathways

A

Electrical pathways that bypass the AV node and go straight to ventricles
James fiber
Atrio hisian fiber
Kents bundle (WPW)
Mahaims bundle

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6
Q

RMP / THP ventricle AP

A

Phases 0,1,2,3,4
-90mv
-70mv

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7
Q

Phases of Ventricle AP

A

0 Na in
1 Cl in (k out too)
2 CA in (k out too)
3 K out
4 Restore ions, K leaks out (hypokalemia lowers RMP)

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8
Q

Absolute vs refractory period

A

Absolute- 0,1,2 (all of AP except downslope)
Refractory- 3 (downslope)

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9
Q

Q wave

A

Before QRS
If Q wave is at least 1/3 height of R wave, suggests previous MI

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10
Q

Pericarditis EKG changes

A

Depressed PR

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10
Q

Peaked t wave causes

A

Hyperkalemia
ischemia
LV Hypertrophy
Intracranial bleeding

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11
Q

J wave threshold

A

After QRS
+1 or -1

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12
Q

Hyperkalemia EKG changes

A

Peaked T wave/ low P wave
PR prolongation
QRS prolongation
SINE wave
V fib

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13
Q

Hypokalemia EKG

A

U wave
Depressed T wave
Increased PR

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14
Q

Hypercalcemia EKG

A

Short QT (when RMP reaches this high level from hypercalcemia, the rest of the AP is shortened)

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15
Q

Hypocalcemiaekg changes

A

Prolonged QT
(Makes AP/THP closer to RMP, which starts it sooner, causing long QT)

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16
Q

Hypermagnesemia will cause _____

A

Heart block/ cardiac arrest (me if i kept taking mag glyc!)

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17
Q

Hypomagnesemia

A

Torsades! Long QT

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18
Q

EKG leads/ Artery

A

2,3,avf= RCA
v1-v4= LCA
I,avl,v5,v6= CXA

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19
Q

Bipolar, limb, and precordial leads

A

B- 1,2,3
L-avr,avl,avf
Precordial, v1,v2,v3,v4,v5,v6

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20
Q

EKg lead/ correlation with heart it monitors

A

3 up /down x 4 right/left
Bottom left 3 “L tetris thing”= inferior
Rotate up in next line 4= anterior/septum
top left, diagonal down, and right bottom 2- lateral

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21
Q

ventricle depolarization

A

From base to apex
From endo to epi
Negative to positive
Positive R wave

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22
Q

Ventricle repolarizationin regards to ekg -/+ heart mean AP pathways

A

Apex to base
epi to endo
Negative to positive-BUT
SINCE DOUBLE NEGATIVE (DOWNWARDS AND NEGATIVE DEFLECTION) it produces a positive t wave

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23
Q

Where does Mean vector point towards?

A

Hypertrophy, away from MI
Just like me at the gym! towards hypertophy, no MI

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24
Normal axis deviation
+ 1 + avf
25
Alterations to axis deviation
Side to wherever positive is (-/+)= R axis deviation (+/-)= L axis deviation (-/-)= extreme R axis deviation
26
R axis deviation causes
Things that affect the R heart COPD Cor pulmonale Pulmonary embolus Bronchospasm
27
L axis deviation causes
Things that effect L heart HTN LBBB A stenosis A insufficiency Mitral regurgitation
28
When looking at the heart, axis deviations
view of LV- normal axis view of RV- r axis deviation view of RA- extreme r axis deviation view of LA- left axis deviation
29
Normal axis degrees
-30 (3pm)- +90 (6pm_)
30
How does glucagon work for BB OD?
stimulates cAMP= CONTRACTION
30
Sinus arrhythmia
Inhalation causes increase heart rate Exhalation causes exit of heart rate (slows)
31
What reflex causes sinus arrhythmia?
Bainbridge- alot of preload will stimulate the SA node
32
Glucagon dose for bradycardia
50-70mcg/kg q3 then infuse at 2-10 mg/hr
33
Voltage to cardiovert A fib When to cardiovert
100J New onset- within 48 hours
34
Voltage for a flutter cardiovert
50j
35
Atropine dose for junctional rhythm
0.5mg iv Underdosing can cause bradycardia
36
Lidocaine dose for pvc
1mg/kg
37
Brugada syndrom
STEMI firemans hat grave
38
Second degreee heart block
1- longer longer longer drop (the one everyone knows) 2- doesn't always cause ventricle contraction
39
Affected region of 2nd degree heart block
His bundle Bundle branches
40
Treatment for 2nd degree HB
Atropine doesnt work bc it fires for atria and not conudction pathway Pacer
41
Treatment for 3rd degree hb
isoproterinol Packer
42
Lenegres disease
3rd degree hb cause Fibrotic degeneration of atrial conduction system
43
Class 1 antiarrhythmics
Sodium channel blockers (slowers) Lidocaine Procainamide Phenytoin
44
Class 2 antiarrhythmics
Beta blockers- slows sa node depolarization esmolol metoprolol propanolol atenolol
45
Class 3 antiarrhytmics
K channel blockers, prolong phase 3 ventricle AP Amiodarone
46
Class 4 antiarrhythmics
CA channel blockers Negative dromotropy Verapamil Diltiazem
47
How does adenosine work?
Allows hyper efflux of K 6,12,12 Unless centrally given 3,6,6 Can cause broncho spasm
48
Causes of re entry
Long distance of conduction- Mitral stenosis causes LA dilation Low conduction velocity- ischemia, hyperkalemia (hasnt picked up speed) short rest period (epinepherine, electric shock)
49
How to break re entry?
Slow the conduction Increase rest period
50
Most common cause of atrial tachycardia
Reentry pathway
51
WPW syndrome on ekg
Delta wave- early slope of up qrs
52
Most common pre excitation syndrome?
WPW
53
How to treat WPW (common orthodromic) but less dangerous
Increase rest period of AV node cardiovert Vagal Adenosine BB Verapamil Amio
54
How to treat WPW less common antidromic more dangerous
Block at accessory pathway (bottom R of RA) not AV node bc otherwise conduction will just go thru accessory pathway and not AV Cardiovert Procainamide
55
Why is antidromic WPW more dangerous?
Since the AV node is bypassed, ventricle cotraction can reach 300
56
WPW is associated with what accessory conduction pathway?
Kents
57
Increases risk of death in patient with long QT?
Lasix - hypomagnesemia and hypoK Methadone- increases qt interval Hyperventilation- cause hypoK (like hypoM)
58
Treatment for long qt
magnesium Atropine BB are safe and effective
59
QTC intervals that are dangerous
men- >.45 women- >0.47
60
Can electrical stimulus initiate torsades?
Yes R on T Poorly timed PVC or pacer
61
Electrolytes causing torsades
LOW k, ca, and mag
62
Positions of pacemakers
1 - chamber that is paced 2 - chamber that is sensed 3 - response to sensed native activity 4 - programmability 5 - if pacemaker can pace multiple sites
63
Options for all position
O-none A-atrium V-ventricle D-dual (both a and v) I- inhibited T-triggered R-rate modulation 1 OAVD 2 OAVD 3 OTID 4 OR 5 OAVD
64
Common pacing modes
AOO, VOO, DOO- Delivers at a constant rate regardless of anything, can cause r on t AAI, VVI- back up plan, only fires when no hr sensed (atria sensed, paced, and inhibited when natural heart rate falls low) DDD- most common, both sensed, paced, and both inhibited and triggered. triggered when hr is low, and inhibits when there is a natural pacemaker
65
What can cause pacer to not work in surgery?
Hypocarbia, which blew off all acid and K, which made RMP too low Hypothermia causes bradycardia
65
Treatment for pace maker failure
Isoproterinol Epinepherine Atropine
66
What does a magnet do to pacer, icd, and combo?
Converts to asynchronous mode Suspends icd and prevents shock delivery Suspends icd and shock delivery, no effect on pacemaker function
67
Failure to sense
Pacer sends too many impulses bc it doesnt sense rhythm, asynchronous
68
Failure to capture, causes
Heart doesnt beat after pacer spike Hypocarbia, hypokalemia, hypothermia, MI, antiarrhythmics
69
Failure to output, causes
When shock isnt given in asystole Oversensing, pulse generator failure, lead failure
70
Cx for pacer patients, not cx
MRI Not Cx- electroconvulsive therapy, lithotripsy
71
What is atria doing during QRS?
repolarization
72
When to cancel surgery for a fib?
New onset, undiagnosed
73
When to give adenosine for what diagnosis
WPW
74
Adenosine MOA
Potassium efflux, hyperpolarization
75

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