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Diagnostic Medicine > Bradycardia > Flashcards

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
Q

Medications that affect the cardiac conduction system

A

Antiarrhythmic drugs, Beta blockers, Calcium channel blockers and Digoxin.

26
Q

Sinus Bradycardia

A

P wave before every QRS.
P-P intervals are consistent.
R-R intervals are consistent.
Heart rate under 60.

27
Q

If a patient with sinus bradycardia is symptomatic, what is the treatment

A

Permanent pacemaker.

28
Q

Sinus Node Dysfunction includes what?

A

Sinus node exit block
Symptomatic sinus bradycardia
Sinus arrest
Tachybrady syndrome.

29
Q

What happens in a sinus node exit block?

A

Depolarizations in the sinus node are not conducted through the atria.

30
Q

Sinus node exit block

A

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
Q

Treatment for sinus node exit block

A

Generally do not treat because generally asymptomatic

32
Q

What happens in sinus arrest?

A

Failure of the sinus node to initiate impulse, leading to a pause of greater than 2 seconds.

33
Q

When is treatment necessary for sinus arrest?

A

Symptoms and/or pause greater than 6 seconds

34
Q

Treatment for sinus arrest

A

Permanent pacemake

35
Q

What happens in a junctional rhythm?

A

No atrial activity.
AV junction has taken over as primary pacemaker.
Heart rate of 40-60 bpm.

36
Q

Treatment for junctional rhythm

A

Removal of any offending agents, implant pacemaker.

37
Q

Junctional Rhythm

A

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
Q

What happens during tacky-brady syndrome?

A

Intermittent episodes of slow and fast rates from the SA node or atria

39
Q

Complete heart block can also be called

A

Third degree heart block

40
Q

What is the most common reason for pacemakers?

A

Tachy-brady syndrome

41
Q

What happens in first degree AV block?

A

Problem located within the AV node, slowing conduction

42
Q

First degree AV block

A

PR interval over 200 milliseconds

43
Q

Treatment for first degree AV block

A

Usually asymptomatic, no treatment necessary

44
Q

What happens in second degree AV block, Mobitz I

A

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
Q

Another name for second degree AVB, Mobitz I

A

Wenkebach Block

46
Q

Treatment for second degree AV block, Mobitz I

A

Not dangerous in most cases and usually not symptomatic. No treatment.

47
Q

Second degree AV block, Mobitz II

A

Fixed PR interval.

Dropped QRS complexes (nonconductive beats), Sometimes 2:1.

48
Q

Second degree AVB, Mobitz II (high grade AV block) can progress to what?

A

Complete heart block

49
Q

Where is the site of the block in second degree AV block, Mobitz II

A

In the HIS (below the AV node), malignant form of heart block.

50
Q

Treatment for second degree AVB, Mobitz II

A

This is an emergency! Permanent pacemaker.

51
Q

What are the two most dangerous bradycardia rhythms?

A

Second degree AV block, Mobitz II

Complete heart block

52
Q

What happens during complete heart block?

A

No conduction from the atria to the ventricles. Atrias fire independently from the ventricles.

53
Q

Complete Heart Block

A

P waves are independent from QRS complexes.
Atria rate is faster than ventricle rate.
Very long QRS complexes.
Ventricular escape rhythm

54
Q

Treatment for complete heart block

A

Medical emergency!

Permanent pacemaker.

55
Q

Symptoms of complete heart block

A

SOB and syncope.

Diagnostic Medicine (4 decks)

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