Arhythmias

Question 1

Sinus rhythm

Answer 1

SA node origination
Has P waves
Rate 60-99
Regular rhythm
P-R interval .12-.20 sec
QRS

Question 2

How to count rhythm quickly

Answer 2

6 second rule (bold 3 sec tabs) #in 6 sec x10

big box rule 300, 150, 100, 75, 60, 50

number of small boxes /1500

P wave, regular PR interval length .12-.20
QRS <=.12

Question 3

Questions to ask when evaluating ekg

Answer 3

1. Rhythm
2. rate
3. Are there P waves?
4. A QRS for every P wave?
5. How long is PR interval?
6. What is QRS interval

Question 4

Sinus tachycardia

Bradycardia

Answer 4

> 100

<60

Question 5

Escape rhythm

Answer 5

Impulse out of atrium

Junctional: Narrow QRS

Question 6

Premature atrial contraction

Answer 6

Rate 60-100
Rhythm looks irregularly irregular if multi PACs
Compensatory pause to keep rhythm the same regardless of premature beat, it has underlying regular rhythm.

Narrow QRS supraventricular origin

Question 7

Premature ventricular contraction

Answer 7

Wider QRS
R-R interval is same if compensatory pause
No P wave

Bigeminy pattern: normal , PVC, normal, PVC, normal
Multifocal: different focci look different shapes
Maintain rhythm

Question 8

Supraventicular tach

Answer 8

Originates above ventricle
Narrow QRS that all look alike
re-entry loop is self stimulating
      180-200
(Cardioversion vs defibrillation. Vtach has wide qrs >100)

Question 9

SupraV Tach differentiation

Answer 9

No pulse because electrical discharge can’t pulse heart.
like defibrillation which is pulseless, but don’t shock to stop, timed shock: cardioversion
Reg. rhythm
Wide QRS ft >100

Question 10

Torsades

Answer 10

Twisted ribbon v tach
No p wave.
Reg rhythm

Question 11

Atrial flutter

Answer 11

Look for P-P interval
Distinguish from Atrial fibrillation which has no P wave
Sawtooth with QRS

Can’t tell which is p or t wave, or a combo is represented
Constant rhythm

Question 12

Atrial Fibrillation

Answer 12

No p waves
Narrow QRS
Irregularly irregular

Question 13

Heart blocks

Answer 13

First degree (long PR)
Second degree: Type 1 (wenchebach), Type2 (same PR, dropped QRS randomly)
3rd degree (P-P, & R-R are consistant, but have nothing to do with each other)

Question 14

1st Degree Heart Block

Answer 14

PR is long (more than a big box)

but every P has a QRS

Question 15

2nd degree Heart Block

Answer 15

Type 1: PR is long, longer, then drops QRS
rhythm is irregularly regular
prolongation of PR
Type 2: Dropped QRS with out a pattern. Randomly “doesn’t come home” but PR is same every time.

Question 16

3rd degree Heart Block

Answer 16

most pathologic compared to 1st degree block
no communication or cooinsidance between P, QRS, and T’s. P is consistant with next P, and R with R, but not with each other.
Needs a pacemaker