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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
Q

Normal axis deviation

A

+ 1
+ avf

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25
Q

Alterations to axis deviation

A

Side to wherever positive is
(-/+)= R axis deviation
(+/-)= L axis deviation
(-/-)= extreme R axis deviation

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26
Q

R axis deviation causes

A

Things that affect the R heart
COPD
Cor pulmonale
Pulmonary embolus
Bronchospasm

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27
Q

L axis deviation causes

A

Things that effect L heart
HTN
LBBB
A stenosis
A insufficiency
Mitral regurgitation

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28
Q

When looking at the heart, axis deviations

A

view of LV- normal axis
view of RV- r axis deviation
view of RA- extreme r axis deviation
view of LA- left axis deviation

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29
Q

Normal axis degrees

A

-30 (3pm)- +90 (6pm_)

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30
Q

How does glucagon work for BB OD?

A

stimulates cAMP= CONTRACTION

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30
Q

Sinus arrhythmia

A

Inhalation causes increase heart rate
Exhalation causes exit of heart rate (slows)

31
Q

What reflex causes sinus arrhythmia?

A

Bainbridge- alot of preload will stimulate the SA node

32
Q

Glucagon dose for bradycardia

A

50-70mcg/kg q3
then infuse at 2-10 mg/hr

33
Q

Voltage to cardiovert A fib
When to cardiovert

A

100J
New onset- within 48 hours

34
Q

Voltage for a flutter cardiovert

A

50j

35
Q

Atropine dose for junctional rhythm

A

0.5mg iv
Underdosing can cause bradycardia

36
Q

Lidocaine dose for pvc

A

1mg/kg

37
Q

Brugada syndrom

A

STEMI
firemans hat
grave

38
Q

Second degreee heart block

A

1- longer longer longer drop (the one everyone knows)
2- doesn’t always cause ventricle contraction

39
Q

Affected region of 2nd degree heart block

A

His bundle
Bundle branches

40
Q

Treatment for 2nd degree HB

A

Atropine doesnt work bc it fires for atria and not conudction pathway
Pacer

41
Q

Treatment for 3rd degree hb

A

isoproterinol
Packer

42
Q

Lenegres disease

A

3rd degree hb cause
Fibrotic degeneration of atrial conduction system

43
Q

Class 1 antiarrhythmics

A

Sodium channel blockers (slowers)
Lidocaine
Procainamide
Phenytoin

44
Q

Class 2 antiarrhythmics

A

Beta blockers- slows sa node depolarization
esmolol
metoprolol
propanolol
atenolol

45
Q

Class 3 antiarrhytmics

A

K channel blockers, prolong phase 3 ventricle AP
Amiodarone

46
Q

Class 4 antiarrhythmics

A

CA channel blockers
Negative dromotropy
Verapamil
Diltiazem

47
Q

How does adenosine work?

A

Allows hyper efflux of K
6,12,12
Unless centrally given
3,6,6
Can cause broncho spasm

48
Q

Causes of re entry

A

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
Q

How to break re entry?

A

Slow the conduction
Increase rest period

50
Q

Most common cause of atrial tachycardia

A

Reentry pathway

51
Q

WPW syndrome on ekg

A

Delta wave- early slope of up qrs

52
Q

Most common pre excitation syndrome?

A

WPW

53
Q

How to treat WPW (common orthodromic) but less dangerous

A

Increase rest period of AV node
cardiovert
Vagal
Adenosine
BB
Verapamil
Amio

54
Q

How to treat WPW less common antidromic more dangerous

A

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
Q

Why is antidromic WPW more dangerous?

A

Since the AV node is bypassed, ventricle cotraction can reach 300

56
Q

WPW is associated with what accessory conduction pathway?

A

Kents

57
Q

Increases risk of death in patient with long QT?

A

Lasix - hypomagnesemia and hypoK
Methadone- increases qt interval
Hyperventilation- cause hypoK (like hypoM)

58
Q

Treatment for long qt

A

magnesium
Atropine
BB are safe and effective

59
Q

QTC intervals that are dangerous

A

men- >.45
women- >0.47

60
Q

Can electrical stimulus initiate torsades?

A

Yes
R on T
Poorly timed PVC or pacer

61
Q

Electrolytes causing torsades

A

LOW k, ca, and mag

62
Q

Positions of pacemakers

A

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
Q

Options for all position

A

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
Q

Common pacing modes

A

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
Q

What can cause pacer to not work in surgery?

A

Hypocarbia, which blew off all acid and K, which made RMP too low
Hypothermia causes bradycardia

65
Q

Treatment for pace maker failure

A

Isoproterinol
Epinepherine
Atropine

66
Q

What does a magnet do to pacer, icd, and combo?

A

Converts to asynchronous mode
Suspends icd and prevents shock delivery
Suspends icd and shock delivery, no effect on pacemaker function

67
Q

Failure to sense

A

Pacer sends too many impulses bc it doesnt sense rhythm, asynchronous

68
Q

Failure to capture, causes

A

Heart doesnt beat after pacer spike
Hypocarbia, hypokalemia, hypothermia, MI, antiarrhythmics

69
Q

Failure to output, causes

A

When shock isnt given in asystole
Oversensing, pulse generator failure, lead failure

70
Q

Cx for pacer patients, not cx

A

MRI
Not Cx- electroconvulsive therapy, lithotripsy

71
Q

What is atria doing during QRS?

A

repolarization

72
Q

When to cancel surgery for a fib?

A

New onset, undiagnosed

73
Q

When to give adenosine for what diagnosis

A

WPW

74
Q

Adenosine MOA

A

Potassium efflux, hyperpolarization

75
Q
A

AP + Phys (38 decks)

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