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Block 3 physiology > Cardiac Conduction Disorders: Other > Flashcards

Cardiac Conduction Disorders: Other Flashcards

1
Q

type of arrhythmia that begins at one or more irritable focus/foci pacing very rapidly

A

“tachy” arrhythmia

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2
Q

How are “tachy” arrhythmias defined?

A
  1. rate

2. site of origin

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3
Q

What are “tachy” arrhythmias associated with?

A

reduced cardiac output

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4
Q

What does paroxysmal mean?

A

suddenly occurring

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5
Q

sudden onset of rapid heart rate, between 150 and 250 BPM

A

paroxysmal tachycardia

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6
Q

originates from an irritable automaticity focus in the atria

A

paroxysmal atrial tachycardia

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7
Q

In PAT- P wave before each QRS, different origin therefore different ___ wave shape, and different __ interval

A

P wave before each QRS, different origin therefore different P wave shape, different PR interval

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8
Q

originates from an irritable automaticity focus at the AV junction

A

paroxysmal junctional tachycardia

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9
Q

EKG changes with paroxysmal junctional tachycardia

A

-May or may not have P waves, placement before, overlayed with, or after QRS
Possible QRS widening due to depolarization of one bundle branch before the other

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10
Q

originates above the ventricles, i.e., from the atria or the junction

A

supraventricular rhythm

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11
Q

encompasses both PAT and PJT

A

paroxysmal supra ventricular tachycardia (SVT)

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12
Q

when is paroxysmal supra ventricular tachycardia used?

A

used when P waves are not visible (high rates) and/or unable to differentiate (normal QRS width)

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13
Q

Causes of atrial and junctional focus irritability include:

A
  • Epinephrine
  • Sympathetic stimulation
  • B1 stimulants (caffeine, amphetamines, cocaine)
  • Drugs (excess digitalis, ethanol)
  • Hyperthyroidism
  • Cardiac stretch (heart failure)
  • Low oxygen
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14
Q

originates from an irritable automaticity focus below the AV junction

A

paroxysmal ventricular tachycardia

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15
Q

EKG changes with paroxysmal ventricular tachycardia

A
  • Very wide, PVC-like QRS complexes

- P waves are hidden in the QRS complexes (P waves are dissociated from QRS)

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16
Q

are defined as having a rate of 250-350 BPM

A

flutter rhythms

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17
Q

With flutter rhythms, _____ function of the affected part of the heart (atria, ventricles) is always _____

A

With flutter rhythms, pump function of the affected part of the heart (atria, ventricles) is always reduced

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18
Q

results from rapid atrial depolarization caused by an ectopic focus

A

atrial flutter

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19
Q

In atrial flutter, atria cannot ____ effectively and AV node cannot transmit all __________ to the ventricles

A

In atrial flutter, atria cannot pump effectively and AV node cannot transmit all depolarization to the ventricles

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20
Q

Characterized by number of P waves to each QRS (2:1 or 3:1 here)

A

atrial flutter

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21
Q

Sometimes difficult to detect, may be more recognizable if the ECG is flipped (top) or if a vagal maneuver is used (e.g., bear down)

A

atrial flutter

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22
Q 
Atrial flutter:
vagal maneuver (PNS stimulation) increases AV node delay (more “refractory”) and decreases SA node firing, thereby decreasing \_\_\_\_ \_\_\_\_ (separating QRS peaks), resulting in more flutter waves per QRS
A 
Atrial flutter:
Vagal maneuver (PNS stimulation) increases AV node delay (more “refractory”) and decreases SA node firing, thereby decreasing heart rate (separating QRS peaks), resulting in more flutter waves per QRS
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23
Q

results from rapid ventricular depolarization caused by an ectopic focus

A

ventricular flutter

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24
Q

What tachyarrhythmia usually degenerates to ventricular fibrillation?

A

ventricular flutter

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25
Q

Ventricular flutter:

Ventricular pumping markedly ______ (insufficient fill time) leading to ______

A

Ventricular flutter:

Ventricular pumping markedly inhibited (insufficient fill time) leading to hypoxia

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26
Q

As ventricular oxygenation falls, additional ventricular automaticity foci are recruited to produce ventricular ______.

A

As ventricular oxygenation falls, additional ventricular automaticity foci are recruited to produce ventricular fibrillation.

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27
Q

What is a specific pattern of ventricular flutter?

A

Torsades de Pointes

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28
Q

What is characteristic of Torsades de Pointes?

A

undulating pattern of the flutter waves

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29
Q

What do conditions associated with Torsades de Pointes present with on EKG?

A

-prolonged QT segment, which can be due to hypokalemia, long QT syndrome`

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30
Q

Fibrillation rhythms are defined as having a rate of ___-___ BPM

A

350-450 bpm

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31
Q

Caused by multiple foci firing rapidly and simultaneously and NO pumping from affected chambers

A

fibrillation

32
Q

Characterized by rapid, erratic atrial rate (uneven baseline) and irregular ventricular rhythm caused by irregular conduction through the AV node

A

atrial fibrillation

33
Q

With afib, there is a _____ of ____ pumping action

A

With afib, there is a LOSS of atrial pumping action

34
Q

With fib, there is a ____ risk of atrial blood __________ (stroke risk)

A

With fib, there is a HIGH risk of atrial blood coagulation (stroke risk)

35
Q

Characterized by rapid, erratic ventricular rhythm caused by firing of multiple foci

A

ventricular fibrillation

36
Q

Vfib results in ________ motion of ventricular muscle and ______ of all pumping action

A

Vfib results in quivering motion of ventricular muscle and LOSS of all pumping action

37
Q

What EKG changes are seen with vfib?

A

Loss of identifiable wave patterns

38
Q

syndromes associated with tachyarrhythmia (2)

A
  • Wolfe-Parkinson-White (WPW) syndrome

- Lown-Ganong-Levine (LGL) syndrome

39
Q

occurs because of an accessory conduction pathway (bundle of Kent) between the atria and ventricles

A

WPW syndrome

40
Q

Results in ventricular pre-excitation, characterized by a “delta” wave on leading shoulder of QRS wave

A

WPW syndrome

41
Q

EKG changes with WPW syndrome

A
  • Apparent PR interval shortening

- QRS widening

42
Q

WPW can be associated with _____ and _______

A

WPW can be associated with SVT and AVNRT

43
Q

Very high ______ rates associated with supraventricular tachycardia when conduction bypassing ___ node approaches 1:1

A

Very high ventricular rates associated with supraventricular tachycardia when conduction bypassing AV node approaches 1:1

44
Q

Ventricular depolarization may conduct through bundle of ____, activating ___ node before SA node fires

A

Ventricular depolarization may conduct through bundle of Kent, activating AV node before SA node fires

45
Q

occurs because of an accessory conduction pathway (James bundle) between an atrial intranodal tract and the His bundle (bypassing AV node)

A

LGL syndrome

46
Q

EKG changes with LGL syndrome

A
  • short PR interval

- NO delta wave

47
Q

atrial tachycardia can be transmitted in a 1:1 pattern to ventricles, resulting in ventricular ______

A

Atrial tachycardia can be transmitted in a 1:1 pattern to ventricles, resulting in ventricular flutter

48
Q

occur when defects in the heart’s pacemaker nodes or conduction system retard or prevent achieving the depolarization threshold by the conductive cells

A

conduction blocks

49
Q

Occur in the SA or AV nodes, bundle of His, right or left bundle branches, or in the subdivisions of the left bundle branch (hemiblock)

A

conduction blocks

50
Q

Occurs when the unhealthy SA node fails to pace for at least one cycle, pacing recovers after skipping a beat, retaining its rate

A

sinus block

51
Q

Sinus block may induce an _____ ______ (atrial, junctional, or ventricular) from a focus other than the ___ node

A

Sinus block may induce an escape rhythm (atrial, junctional, or ventricular) from a focus other than the SA node

52
Q

EKG changes with sinus block

A

-P wave may be the same or different (SA or atrial escape), or absent (junctional or ventricular escape)

53
Q

3 types of AV blocks

A
  • first degree
  • second degree
  • third degree
54
Q

AV conduction intact but delayed

A

first degree AV block

55
Q

partial or variable conduction through the AV node or bundle of His or left bundle bra

A

second degree AV block

56
Q

2 subtypes of second degree AV block

A
  • Wenckebach (Type 1)

- Mobitz (Type 2)

57
Q

complete block of atrial impulses, resulting in atrial and ventricular dissociation

A

third degree AV block

58
Q

occur because an incorrectly functioning AV node may conduct depolarizations in a delayed fashion

A

first degree AV block

59
Q

EKG changes with first degree AV block

A
  • P waves look the same (from SA node)

- PR interval is increased, i.e., > 0.2 sec (> 1 large block or 5 mm) and consistent in length

60
Q

occur because atrial depolarizations are delayed or stopped as they pass through the AV node or distal fibers (bundle of His or left bundle branch)

A

second degree AV block

61
Q

occurs in the AV node, when the AV delay becomes progressively longer until an escape rhythm occurs, then the process repeats

A

second degree AV block, type 1

62
Q

occurs in the distal fibers, when one or several atrial depolarizations (P waves) fail to conduct to the ventricles

A

second degree AV block, type 2

63
Q

EKG changes with second degree AV block, type 1 (Wenckebach)

A

progressively longer PR intervals until the last P wave of the series fails to conduct (absence of a QRS complex following the P wave)

64
Q

second degree AV block, type 1 (Wenckebach) can look like ______ or trigeminy except for ______ PR interval, final P wave without _____

A

second degree AV block, type 1 (Wenckebach) can look like bigeminy or trigeminy except for increasing PR interval, final P wave without QRS

65
Q

EKG changes with second degree AV block, type 2 (Mobitz)

A

normal P wave/PR interval and QRS, followed by one or more P waves without QRS complexes

66
Q

Second degree AV block, type 2 is characterized by the number of __ waves associated with each normal ____, e.g., 2:1, 3:1, 4:1, 5:1;
Higher ratios associated with _____ severity

A

Second degree AV block, type 2 is characterized by the number of P waves associated with each normal QRS, e.g., 2:1, 3:1, 4:1, 5:1;
Higher ratios associated with increased severity

67
Q

occur because atrial depolarizations do not conduct through the AV node, therefore atrial contractions (P waves) are disassociated from QRS waves

A

third degree AV block

68
Q

EKG changes with third degree AV block

A
  • P-P distance uniform, QRS-QRS distance uniform
  • QRS may be narrow (junctional automaticity focus) or wide (ventricular automaticity focus)
  • Junctional or ventricular foci have different QRS complex shapes and inherent rates
69
Q

Third degree AV block with junctional focus has ____ QRS complexes with a rate between __-__ BPM

A

Third degree AV block with junctional focus has narrow QRS complexes with a rate between 40-60 BPM

70
Q

Third degree AV block with ventricular focus has ___, ___-like QRS complexes with a rate between __-__ BPM

A

Third degree AV block with ventricular focus has wide, PVC-like QRS complexes with a rate between 20-40 BPM

71
Q

Block in the conduction through one bundle branch (a BBB) delays conduction to the affected chamber (conduction via muscle), resulting in __________ of the chambers at different times

A

Block in the conduction through one bundle branch (a BBB) delays conduction to the affected chamber (conduction via muscle), resulting in depolarization of the chambers at different times

72
Q

EKG changes with BBB

A

-wide and deformed QRS wave ≥ 0.12 sec (3 mm)

73
Q

what leads is an abnormal RBBB wave form best seen?

A

V1 and V2 since the right ventricle is under these leads

74
Q

what leads is an abnormal LBBB wave form best seen?

A

V5 and V6 since the left ventricle is under these leads

75
Q

With RBBB, R=___ ventricle and R’=____ ventricle

A

With RBBB, R=left ventricle and R’=right ventricle

76
Q

With LBBB, R=___ ventricle and R’=___ ventricle

A

With LBBB, R=right ventricle and R’=left ventricle

77
Q

If an R, R’ pattern is noted but QRS interval is not prolonged this is called an __________ ___

A

If an R, R’ pattern is noted but QRS interval is not prolonged this is called an incomplete BBB

Block 3 physiology (6 decks)

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