Arrhythmia

Question 1

Normal Sinus Rhythm

Answer 1

60-100bpm
All wave forms present
Normal Sinus Rhythm:
PR = 0.08-.20 QRS <50% of RR

Question 2

Atrial Rhythm

Answer 2

60-80 bpm

Question 3

Junctional Rhythm

Answer 3

40-60bpm; no p wave or retrograde P

at the AV node

Question 4

Ventricular Rhythm

Answer 4

20-40 bpm; no p wave; wide QRS >0.14

Question 5

Sinus bradycardia

Answer 5

<60 bpm

Question 6

Junctional bradycardia

Answer 6

<40 bpm

Question 7

Tachycardia

Answer 7

> 100bpm
accelerated ventricular= 40-100 bpm
accelerated junctional = 60-100bpm

Question 8

Supraventricular Tachycardia

Answer 8

HR >100bpm
All waves present
Regular R-R

Question 9

Multifocal Atrial Tachycardia

Answer 9

HR >100bpm 
Change in foci 
3 or more different looking p waves 
1:1 P:QRS 
Change in PR interval

Question 10

Wandering Atrial Pacemaker

Answer 10

HR < 100bpm
Change in foci
Different looking p waves
1:1 P:QRS
Change in PR interval

Question 11

Atrial Flutter

Answer 11

Single irritable foci
P:QRS = 2:1 3:1 4:1
P waves at regular intervals

Question 12

Atrial Fibrillation

Answer 12

Multiple foci
Irregular R-R
Non-discernable p waves
Bag of worms isoelectric line

Question 13

PAC, PJC, PVC

Answer 13

Uni-focal or multifocal
Three or more PVC’s in a row = non-sustained ventricular tachycardia
Usually due to
Prematurity occurs due to decreased O2 and increased SNS
Can be due to decreased K+ , decreased cardiac output

Question 14

Ventricular Tachycardia

Answer 14

HR > 100 bpm 
QRS >0.14 s
No p wave
T wave opposition 
V-flutter will demonstrate a more rounded QRS

Question 15

Torsades de Pointes (t de p)

Answer 15

Short bursts of deflection changes
No p wave wide QRS
T wave opposition

Question 16

Ventricular Fibrillation

Answer 16

No discernable wave forms

No coordination of activity

Question 17

Asystole

Answer 17

loss of electrical activity

Question 18

Agonal

Answer 18

<20 bpm

Question 19

Wolf Parkinson White

Answer 19

Bundle of kent
PR < 0.08 sec
Delta wave
R-R’
Diphasic P wave
Wide QRS 
At high rates can lead to PAT

Question 20

Lown Ganong Levine

Answer 20

Bundle of James
Normal QRS
PR <0.08
No delta wave
Can lead to PAT at high rates

Question 21

SA block

Answer 21

transient, no wave forms

Question 22

SA node arrest

Answer 22

No wave forms

usually leads to escape beat

Question 23

1st degree AV block

Answer 23

PR > 0.20

Regular R-R

Question 24

2nd degree AV Block Type I = Wenkebach (above AV node)

Answer 24

Progressive increase in PR interval until a dropped beat occurs
Normal QRS

Question 25

2nd degree AV Block Type II = Mobitz (below AV node)

Answer 25

Normal length PR interval Wide QRS Multiple P’s to QRS’s

Question 26

3rd degree AV Block

Answer 26

``` No PR interval No association between P and QRS Regular P-P and regular R-R Wide QRS T wave opposition ```

Question 27

Right Bundle Branch Block

Answer 27

QRS > 0.12 sec Not always global common in V1 and V2 results in an R-R’ T wave opposition

Question 28

Left Bundle Branch Block

Answer 28

QRS > 0.12 always global T wave opposition R-R’ in V5 and V6

Question 29

Anterior Hemiblock

Answer 29

Left Anterior Descending Q in LL I S in LL III Left Axis Deviation

Question 30

Posterior Hemiblock

Answer 30

Circumflex Q in LL III S in LL I Right Axis Deviation

Question 31

Right Atrial Enlargement

Answer 31

Large P wave | > 2.5 mm tall and/ or wide

Question 32

Left Atrial Enlargement

Answer 32

Diphasic P wave in V1 and V2

Question 33

Bi-atrial Enlargement

Answer 33

Double hump P (in lead of mean depolarization) | Large P waves > 2.5 mm tall and/ or wide

Question 34

Right Ventricular Hypertrophy

Answer 34

Large R wave in V1 Often Right Axis Deviated T wave strain in V1 and V2

Question 35

Left Ventricular Hypertrophy

Answer 35

S in V1 + R in V5 > 35mm S in V2 + R in V6 > 35mm Often Left Axis Deviated T wave strain V5 and V6

Question 36

Ischemia

Answer 36

Lack of blood flow | ST segment depression >1.5 mm, 80 ms from J point in > 50% of corresponding leads

Question 37

Injury

Answer 37

Acute (short term/ recent) damage | ST segment elevation > 1.5 mm 80 ms from J point in >50% of corresponding leads

Question 38

Infarction

Answer 38

``` Tissue death Acute coronary syndrome o Symmetrically inverted t waves o Sign of more server ischemia o Can be due to severe stress • Heart attack, clot, ventricular aneurysm • STEMI = transmural (across entire heart wall) • NSTEMI = subendocardial o Asymmetrical t wave inversion ```

Question 39

Anterior MI

Answer 39

reciprocal changes in inferior aspect = II, III, aVF

Question 40

Inferior MI

Answer 40

reciprocal changes in lateral aspect = I, aVL, and precordial leads

Question 41

Lateral MI

Answer 41

reciprocal change in inferior aspect = II, III, aVF

Question 42

Posterior MI

Answer 42

reciprocal change V1 and V2 (large R wave and upright T and ST depression) = mirror image of anterior MI

Question 43

Antero-septal

Answer 43

V1 and V2 = left anterior descending

Question 44

Anterior

Answer 44

V3 and V4 = left anterior descending

Question 45

Lateral

Answer 45

V5, V6, I ,and aVL = circumflex

Question 46

Inferior

Answer 46

II, III, and aVF = marginal

Question 47

Posterior

Answer 47

no indicative changes = right posterior descending