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DMS EKG > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Palpitations are

A

Awareness of ones own heart beats

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2
Q

Angina

how is this a common manifestation?

A

increased demands for oxygen cause chest pain

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3
Q

What mnemonic is used for causes of Arrhythmias?

What does it stand for?

A

H-hypoxia (COPD)
I- ischemia & irritability ( MI can cause)
S- Sympathetic stimulation (CHF, anxiety, exercise, caffeine, cocaine)
D- drugs
E- electrolyte disturbances (hypokalemia, etc)
B- bradycardia (sick sinus syndrome)
S- stretch (CHF & valvular diseases)

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4
Q

What is helpful when a suspected arrhythmia is infrequent and not likely to be captured on a 12 lead EKG?

A

Holter Monitor

Worn 24-48 hrs

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5
Q

What if so infrequent even a Holter Monitor won’t pick up?

A

Event monitor

Multiple recordings can be made over several months

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6
Q

Determining Rate:
1 large square=
2 large squares=

A

300 beats/min

150 beats/min

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7
Q

Determining Rate:
3 large squares =
4 large squares=

A

100 beats/ min

75 beats/min

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8
Q

Determining Rate:
5 large squares =
6 large squares=

A

60 beats/min

50 beats/min

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9
Q

Arrhythmias of Sinus origin can be classified as having….

A

electrical activity follows usual conduction pathways but is either too fast, too slow, or irregular

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10
Q

Ectopic rhythms can be classified as having…

A

electrical activity originates from a focus other than the sinus node

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11
Q

Reentrant arrhythmias can be classified as having…

A

electrical activity trapped within an electrical racetrack

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12
Q

Conduction block arrhythmias can be classified as having…

A

electrical activity that originates in the sinus node and follows the original pathways but encounters unexpected blocks and delays

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13
Q

Sinus rhythm over 100 beats/min=

Normal or pathological?

A

Sinus tachycardia

Can be normal or pathological

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14
Q

Causes of sinus tachycardia include:

A 
strenuous exercise
CHF
severe lung disease
hyperthyroidism
drugs
fever
intravascular volume loss
pain
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15
Q

Tachycardia in elderly is…

A

Rare, often can’t get over 140-150

If over this it is probably nonsinus

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16
Q

Sinus rhythm less than 60 beats/min

A

Sinus Bradycardia

Normal and pathological

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17
Q

Causes of sinus bradycardia include:

A 
early in acute MI
enhanced vagal tone
drugs
hypothyroidism
hyperkalemia
sick sinus syndrome
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18
Q

Sinus arrhythmia looks like:

most like from:

A

NSR but slightly irregular

Usually increases in inspiration and decreases in exhalation

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19
Q

Prolonged electrical inactivity

A

asystole

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20
Q

occurs when the sinus node stops firing or from a sinus node exit block

A

sinus arrest

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21
Q

what are escape beats?

A

rescue beats originating outside the sinus node

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22
Q

Sinus node fires between

A

60-100 times/min

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23
Q

Atrial pacemakers fire between

A

60-75 times/min

24
Q

Junctional pacemaker fire between

-where are they located?

A

46-60 time/min

-located near the AV node

25
Q

Ventricular pacemakers fire between

A

30-45 times/min

26
Q

What pacemaker cells will produce a normal QRS complex?

A

Atrial and junctional

27
Q

What pacemaker cells will produce an abnormal or wider QRS complex?

A

Ventricular pacemakers

28
Q

What is the most common escape beat?

A

Junctional

29
Q

In junctional escape beats a _______ p wave is seen

A 
Usually no p wave
sometimes retrograde (atrial depol)
30
Q

In junctional escape beats the mean electrical axis of the retrograde P wave is ________

A

reversed 180 degrees from normal p wave

31
Q

A normal P wave is upright in what leads?

Inverted in what leads?

A

lead I

aVR

32
Q

What is a prolonged sinus pause due to failure of the sinus depolarization to be transmitted out of the node into the atria?

A

Sinus exit block

33
Q

What causes ectopic rhythms?

A

Enhanced automaticity of a nonsinus node site

  • digitalis toxicity
  • beta adrenergic stimulation
34
Q

Four questions to identify nonsinus arrhythmias:

A
  1. Are normal P waves present?
  2. Are the QRS complexes narrow (.12s)
  3. What is the relationship between the P waves and QRS complex
  4. Is the rhythm regular or irregular
35
Q

Normal P waves with normal p wave axis are indicative of arrhythmias from _____

A

within the atria

36
Q

No P waves present are indicative of arrhythmias from_____

A

AV node or ventricles

37
Q

Abnormal P wave axis is indicative of arrhythmias from_____

A

AV node or ventricles

38
Q

Narrow QRS axis indicates origin or rhythm must be_____

A

at or above the AV node

39
Q

A wide QRS complex indicates rhythm must be____

A

within the ventricles

40
Q

A single P wave preceding each QRS complex means the rhythm has ______ origin

A

sinus or other atrial origin

41
Q

AV dissociation is

A

Atrial and ventricles are depolarizing/contracting independent of one another

42
Q

Abnormal P wave that comes too early
otherwise regular
not generally sustained

A

premature atrial contraction

43
Q 
A small blip (pseudo R') in V1
Regular rhythm
P Wave often buried
Rate ~150-250
Sudden Onset
A

Paroxysmal Supraventricular Tachycardia (PSVT)

44
Q

When is carotid massage contraindicated?

A

If there is evidence of carotid disease

45
Q

The flutter waves of atrial flutter are best seen in

A

Leads II and III

46
Q

Atrial flutter is generated by a reentrant circuit that runs around_____

A

annulus of tricuspid valve

47
Q

Can carotid massage terminate atrial flutter?

A

No, but it may increase the block

example: 3:1 block to 5:1 block

48
Q

irregularly irregular ventricle rate between 120-180 bpms, with an absence of p waves is

A

Atrial fibrillation

49
Q

What is needed to diagnose multifocal atrial tachycardia (MAT)?

A

At least 3 different p wave morphologies

50
Q

What is needed to diagnose wandering atrial pacemakers?

A

3 different p wave morphologies seen, but there will be two or three beats of each

51
Q

What is paroxysmal atrial tachycardia?

A

regular rhythm with rate of 100-200bpm

  • initiated by a premature beat
  • hard to differentiate from SVT unless you see the start
52
Q

Differences between PAT and PSVT

A

PAT has warm up or cool down period

Carotid massage doesn’t affect PAT while it terminates or slows PSVT

53
Q

A wide and bizarre QRS lasting at least .12seconds and is premature with discordant t wave is a

A

premature ventricular contraction

-usually followed by prolonged compensatory pause

54
Q

A run of three or more consecutive PVCs is

A

ventricular tachycardia (VT)

55
Q

An EKG showing tracing spasmodic jerks (or an undulating line) with no true QRS complexes is____
Most often seen in_______
Requires_______

A

Ventricular Fibrillation (VF)
Seen most often in dying hearts
Requires CPR & Defib at once

56
Q

Prolonged QT intervals can lead to ________

which has QRS complexes that spiral around the baseline

A

Torsade de Pointes

DMS EKG (9 decks)

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