arrhythmia 3

Question 1

junctional rhythm:

Answer 1

1. They may be either slow or fast.
2. They are a regular rhythm usually with narrow QRSs.
3. P waves are often not seen because they are buried within the QRS complex or they may occur very shortly before or after the QRS.
4. P waves are often inverted because they are conducted upward from the AV node rather than downward from the sinus node.

Question 2

The region surrounding the atrioventricular node is often termed

Answer 2

“the junction” and rhythms originating there are called “junctional rhythms”.

Question 3

PVC results in

Answer 3

1. Wide-abnormal QRS
2. No P-Wave
3. Ectopic Ventricular Focus - Conducted by Slow Myocardium (not Purkinje)
4. Short Path Length Blocks Re-entry

Question 4

Premature atrial complexes are preceded by

Answer 4

P waves usually of different shape than those of the regular complexes and the QRS is normal

Question 5

Premature ventricular complexes have

Answer 5

no P waves and the QRS is widened and of abnormal shape

Question 6

ventricular tachycardia (VT) EKG appearance

Answer 6

1. Repetitive Wide-abnormal QRS
2. No P-Wave
3. Ectopic Ventricular Focus - Conducted by Slow Myocardium (not Purkinje)
4. Long Path Length Permits Re- entry

Question 7

VT heart results

Answer 7

1. fibrosis
2. infiltrate
3. dilation

Question 8

Rapid ventricular tachycardia or VF require _____.

Answer 8

emergency defibrillation

Question 9

There is _____ contraction in VT and there is _____ contraction in VF.

Answer 9

typically abnormal ventricular

no

Question 10

In asystole ECG:

Answer 10

only a straight line is seen on the ECG

prognosis is dismal.

Question 11

how to identify common cardiac arrythmia steps:

Answer 11

1. look for P wave
2. does each P wave preced a QRS?
3. Is the atrioventricular block present?
4. are occasional early QRS complexes present?
5. are very fast, abnormal P waves present?
6. No P waves but QRS complexes present
7. No P wave and no QRS?

Question 12

Look for the P wave.

Answer 12

A normal P wave is inverted in lead aVR and upright in aVF

Question 13

Does each P wave precede a QRS?

Answer 13

1. Normal sinus rhythm
   (rate 60-100 b/min)
2. Sinus bradycardia
   (rate 100 b/min)

Question 14

Is atrioventricular heart block present?

Answer 14

1. 1st degree block
2. 2nd degree block
3. 3rd degree block

Question 15

1st degree block

Answer 15

1. sinus rhythm

2. with PR interval longer than 0.2 secs

Question 16

2nd degree block

Answer 16

1. sinus rhythm

2. but QRS rate slower than P rate because some P waves do not conduct to the QRS

Question 17

3rd degree block

Answer 17

1. sinus rhythm but

2. QRS slower than P rate because none of the P waves conduct to the QRS.

Question 18

Are occasional early QRS complexes present?

Answer 18

1. Atrial premature beats

2. Ventricular premature beats

Question 19

Atrial premature beats

Answer 19

QRS is usually narrow and preceded by an abnormal P wave

Question 20

Ventricular premature beats

Answer 20

QRS is wide without a preceding P wave

Question 21

Are very fast, abnormal P waves present?

Answer 21

1. Atrial flutter

2. Atrial tachycardia

Question 22

Atrial flutter

Answer 22

1. P waves extremely fast 240-320/min

2. typically P:QRS ratio 2:1 or 3:1 or 4:1

Question 23

Atrial tachycardia

Answer 23

1. abnormal P waves
2. fast 160-220/min
3. abnormal P wave before each QRS

Question 24

No P waves but QRS complexes present.

Answer 24

1. Atrial fibrillation
2. Junctional rhythm
3. Ventricular tachycardia

Question 25

Atrial fibrillation

Answer 25

1. irregularly irregular QRS beats
2. often with an undulating baseline.
3. QRS may be narrow or wide

Question 26

Junctional rhythm

Answer 26

regular rhythm with flat baseline

Question 27

Ventricular tachycardia

Answer 27

Wide, regular, usually fast QRS

Question 28

No P wave and no QRS?

Answer 28

1. ventricular fibrillation
   (wavy baseline)
2. Asystole
   (flat baseline)

Question 29

second degree AV block

Answer 29

1. may reflect conduction system disease, high vagal tone or excessive effects of drugs.
2. Some P waves conduct normally to the ventricles but others do not.
3. Patterns vary.

Question 30

second degree AV block can result in

Answer 30

If the rate is too slow to support cardiac output adequately, syncope or confusion may occur requiring a pacemaker.

Question 31

In Mobitz 1 type

Answer 31

the PR lengthens until a P does not conduct.

Question 32

In Mobitz 2 type

Answer 32

there is no change in PR as in this example.