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Bradycardia Flashcards

1
Q

What is the automaticity rate of the SA Node (upper)

A

60-100 bpm

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2
Q

What is the automaticity rate of the AV junction (middle)

A

40-60 bpm

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3
Q

What is the automaticity rate of the Purkinjie Network. (Lower)

A

20-40 bpm

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4
Q

What is Automaticity

A

The ability of cardiac cells to contract or depolarize spontaneously without external influence.

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5
Q

P wave

A

Depolarization of atria in response to SA node triggering

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6
Q

PR

A

Delay of AV node to allow filling the ventricles.

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7
Q

QRS complex

A

depolarization of ventricles, triggers main pumping contraction.

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8
Q

ST Segment

A

beginning of depolarization, should be flat

Absolute refractory period.

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9
Q

T wave

A

Ventricular repolarization

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10
Q

How big should a PQ segment be

A

Not more than one big box.

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11
Q

How big should the QRS duration be

A

80 to 120 ms
Normal is 0.08.
0.1 has some conduction delay.
0.12 has definite conduction delay.

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12
Q

In the QRS complex, what is each wave

A

Q: first negative deflection
R: the positive deflection
S: first negative deflection after R wave.

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13
Q

Steps to read rhythm strips

A
  1. ) fast or slow heart rate?
  2. ) regular or irregular?
  3. ) wide QRS vs narrow QRS?
  4. ) Relationship of P waves to QRS complexes
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14
Q

What are the numbers for the big box method to calculate the heart rate

A

1: 300
2: 150
3: 100
4: 75
5: 60
6: 50
7: 43
8: 37

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15
Q

What classifies a heart rate as bradycardia?

A

Heart rate under 60.

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16
Q

What classifies a heart rate as tachycardia?

A

Heart rate over 100

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17
Q

The automaticity rate of the SA node can also be called

A

Sinus rate

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18
Q

The automaticity rate of the AV node can also be called

A

The junction rate

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19
Q

The automaticity rate of the Purkinji network can also be called

A

Ventricular escape rate

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20
Q

Bradycardia is due to either

A

a defect in the impulse formation (sinus node) or impulse conduction (AV node): fibrosis, MI, side effects of medications, or a combination

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21
Q

Normal Sinus Rhythm

A

Rate of 60-100, a P wave for every QRS complex, QRS following every P, P waves all the same morphology, and QRS complexes also have the same morphology?

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22
Q

Sinus Arrhythmia

A

Variation in the heart rate based on the respiratory cycle. Related to vagal tone. Inspiration increases heart rate. P waves all have the same morphology.

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23
Q

Symptoms of bradycardia

A

Generalized fatigue, dyspnea, dizzy spells, near syncope, and syncope.

24
Q

In general, if a patient has no reversible cause of bradycardia and is symptomatic, what treatment is necessary

A

Permanent pacing

25
Medications that affect the cardiac conduction system
Antiarrhythmic drugs, Beta blockers, Calcium channel blockers and Digoxin.
26
Sinus Bradycardia
P wave before every QRS. P-P intervals are consistent. R-R intervals are consistent. Heart rate under 60.
27
If a patient with sinus bradycardia is symptomatic, what is the treatment
Permanent pacemaker.
28
Sinus Node Dysfunction includes what?
Sinus node exit block Symptomatic sinus bradycardia Sinus arrest Tachybrady syndrome.
29
What happens in a sinus node exit block?
Depolarizations in the sinus node are not conducted through the atria.
30
Sinus node exit block
No P wave present (or after QRS due to retrofire of the SA node from the AV node) Represented as a pause on the rhythm strip. May be a precursor of early sinus node disease.
31
Treatment for sinus node exit block
Generally do not treat because generally asymptomatic
32
What happens in sinus arrest?
Failure of the sinus node to initiate impulse, leading to a pause of greater than 2 seconds.
33
When is treatment necessary for sinus arrest?
Symptoms and/or pause greater than 6 seconds
34
Treatment for sinus arrest
Permanent pacemake
35
What happens in a junctional rhythm?
No atrial activity. AV junction has taken over as primary pacemaker. Heart rate of 40-60 bpm.
36
Treatment for junctional rhythm
Removal of any offending agents, implant pacemaker.
37
Junctional Rhythm
No P wave (no atrial activity) Rate 40-60 bpm Wide QRS complex (the lower the impulse generates, the wider and slower) and T.
38
What happens during tacky-brady syndrome?
Intermittent episodes of slow and fast rates from the SA node or atria
39
Complete heart block can also be called
Third degree heart block
40
What is the most common reason for pacemakers?
Tachy-brady syndrome
41
What happens in first degree AV block?
Problem located within the AV node, slowing conduction
42
First degree AV block
PR interval over 200 milliseconds
43
Treatment for first degree AV block
Usually asymptomatic, no treatment necessary
44
What happens in second degree AV block, Mobitz I
Progressive prolongation of the PR interval until there is a failure to conduct and a ventricular beat is dropped. The site of the block is located within the AV node.
45
Another name for second degree AVB, Mobitz I
Wenkebach Block
46
Treatment for second degree AV block, Mobitz I
Not dangerous in most cases and usually not symptomatic. No treatment.
47
Second degree AV block, Mobitz II
Fixed PR interval. | Dropped QRS complexes (nonconductive beats), Sometimes 2:1.
48
Second degree AVB, Mobitz II (high grade AV block) can progress to what?
Complete heart block
49
Where is the site of the block in second degree AV block, Mobitz II
In the HIS (below the AV node), malignant form of heart block.
50
Treatment for second degree AVB, Mobitz II
This is an emergency! Permanent pacemaker.
51
What are the two most dangerous bradycardia rhythms?
Second degree AV block, Mobitz II | Complete heart block
52
What happens during complete heart block?
No conduction from the atria to the ventricles. Atrias fire independently from the ventricles.
53
Complete Heart Block
P waves are independent from QRS complexes. Atria rate is faster than ventricle rate. Very long QRS complexes. Ventricular escape rhythm
54
Treatment for complete heart block
Medical emergency! | Permanent pacemaker.
55
Symptoms of complete heart block
SOB and syncope.

Diagnostic Medicine (4 decks)

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