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Monitoring > Cardiac monitors and rhythm > Flashcards

Cardiac monitors and rhythm Flashcards

1
Q

What pathway depolarizes the left atrium?

A

Bachmann bundle

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2
Q

What is the electrical pathway through the heart?

A

SA node
Internodal Tracts
AV node
Bundle of His
Bundle Branches
Purkinje fibers

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3
Q

What has the slowest conduction through the heart?

A

SA and AV nodes .02-.1

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4
Q

What has intermediate conduction through the heart?

A

Myocardial muscle cells

.3-1

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5
Q

What has the fastest conduction through the heart?

A

Bundle of His, Bundle branches, Purkinje fibers

1-4

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6
Q

What is conduction velocity a function of?

A
  1. RMP
  2. Amplitude of action potential
  3. Rate of change in membrane potential during phase 0
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7
Q

What affects conduction velocity?

A

ANS tone
Hyperkalemia
Ischemia
Acidosis
Antiarrhythmic drugs

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8
Q

What are accessory pathways?

A

Connective tissue that isolates the atria

Prevents atria from prematurely exciting ventricular tissue

***AV node plays big real

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9
Q

What does the James fiber connect?

A

Atrium to AV node

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10
Q

What does Atrio-hisian fiber connect?

A

Atrium to Bundle of His

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11
Q

What does Kents bundle connect?

A

Atrium to ventricle

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12
Q

What does Mahaims bundle connect?

A

Av node to ventricle

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13
Q

When does the atria repolarize?

A

During the QRS

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14
Q

When does ventricular depolarization begin? end?

A

Beings during QRS

Ends - ST segment

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15
Q

When does ventricular repolarization begin? end?

A

Beings- T wave

Ends - After T wave

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16
Q

Can a stimulus depolarize the myocyte during absolute refractory period?

A

No

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17
Q

Can a stimulus depolarize the myocyte during relative refractory period?

A

Yes but need a larger stimulus

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18
Q

What ion is leaking out to start the depolarization of the myocyte? What phase?

A

Phase 4

Potassium (K funny channels)

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19
Q

What phase does depolarization occur in? What is the ion movement?

A

Phase 0

-Na in

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20
Q

What phase does initial repolarization occur in? What is the ion movement?

A

Phase 1

Cl In

K out

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21
Q

What phase does plateau occur in? What is the ion movement?

A

Phase 2

Ca In

K out

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22
Q

What phase does final repolarization occur in? What is the ion movement?

A

3

K out

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23
Q

What ion moves out of the cell in 4 out of 5 phases of the ventricular action potential?

A

Potassium

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24
Q

What disease causes PR interval depression?

A

Pericarditis

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25
Q

What disease causes a U wave?

A

Hypokalemia

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26
Q

What disease causes a peaked T wave?

A

Intracranial hemorrhage

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27
Q

What disease causes a Delta wave?

A

Wolff-Parkinson White

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28
Q

Where is ST elevation or depression measured?

A

The J point

looking for a change of at least 1.0

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29
Q

What segment of the ECG is considered isoelectric?

A

PR interval

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30
Q

What do leads 2, 3, and aVF monitor?

A

Inferior wall - RCA

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31
Q

What do leads 1, aVL, V5, and V6 monitor?

A

Lateral

Circumflex

32
Q

What do leads V1 and V2 monitor?

A

Septum

LAD

33
Q

What do leads V3 and V4 monitor?

A

Anterior wall

LAD

34
Q

What is the mean electrical vector?

A

The average current flow of all action potentials at one time

35
Q

What are the three bipolar leads?

A

I
II
III

36
Q

What are the three limb leads?

A

aVR
aVL
aVF

37
Q

Where does the mean electrical current tend to point to?

A

Away from ischemia
Toward Hypertrophy

38
Q

What is the deflection for a normal axis?

A

+ Lead 1
+ Lead aVF

Both hands up (YAY)

39
Q

What is the deflection for a left axis deviation?

A

+ Lead 1
- Lead aVF

Left hand up, right down (shake left hand)

40
Q

What is the deflection for a right axis deviation?

A
  • Lead 1
    + Lead aVF

Right hand up, left down (shake right hand)

41
Q

What two leads are monitored for axis deviations?

A

Lead 1
Lead aVF

42
Q

What is the deflection for extreme right deviation ?

A
  • Lead 1
  • Lead aVF

Left hand down, right down (both down, boo)

43
Q

What is a normal axis degree?

A

-30 to +90

44
Q

What degree is left axis?

A

< -30

45
Q

What degree is right axis

A

> +90 degrees

46
Q

What causes L axis deviation?

A

Problems with the L heart

HTN
LBBB
aortic stenosis and regurg
Mitral regurg

47
Q

What causes R axis deviation?

A

Problems with the R heart (lungs)

Pulmonary HTN
PE
Cor pulmonale
Bronchospasm
COPD

48
Q

Can adenosine be used for an effective treatment of afib?

A

NO

49
Q

How to determine 1st degree heart block?

A

> .20 PR

AV node or Bundle of His issue

50
Q

How to determine 2nd degree type 1 heart block?

A

Longer Longer Longer - Drop
Wenckebach

Av node issue

symptomatic - give atropine

51
Q

How to determine 2nd degree type 2 heart block?

A

Random dropped qrs - mobitz 2

Problem with bundle branches

Treatment - Pacemaker

*****High risk for type 3

52
Q

How to determine 3rd degree heart block?

A

Ps and Qs don’t agree

Degeneration of atrial conduction system (Lenegre’s disease)

Can lead to CHF

53
Q

What drugs are class 1? How do they work?

A

Na channel blockers

1A - Prolong phase 3

1B - Shorten phase 3

1C- Strong depression of phase 0

54
Q

What drugs are class 2? How do they work?

A

Beta Blockers

Slows phase 4

55
Q

What drugs are class 3? How do they work?

A

K channel blockers

Prolongs phase 3

56
Q

What drugs are class 4? How do they work?

A

Ca channel blockers

Slows conduction velocity

57
Q

How does adenosine work?

A

Endogenous nucleoside that slows AV node conduction through adenosine 1 receptor

Can cause bronchospasm

58
Q

What class is quinidine, procainamide, and disopyramide?

A

1A Na channel blockers

Prolong phase 3

59
Q

What class is lidocaine, phenytoin?

A

1B Na channel blockers

Shorten phase 3

60
Q

What class is flecainide, propafenone ?

A

1C Na channel blocker

Shorten phase 0

61
Q

What class are beta blockers?

A

2

Slows phase 4

62
Q

What class is amiodarone, bretyium?

A

K channel blockers

Class 3

Prolongs phase 3

63
Q

What class is verapamil, diltiazem

A

Ca channel blockers

Class 4

Slows conduction through AV node

64
Q

What disease is associated with atrial-ventricular reentry?

A

Wolff Parkinson white

Through the Kents Bundle

65
Q

What EKG findings are consistent with Wolff Parkison white?

A

Delta wave
Short PR
Wide QRS
Possible t wave inversion

66
Q

What is a Delta wave?

A

Slowed, curve upstroke of QRS

67
Q

What are the two ways to disrupt the reentry circuit?

A

1, Slow the conduction velocity
2. Increase the refractory period

68
Q

What is the most common cause of tachyarrhythmias?

A

The reentry pathway

69
Q

How can mitral stenosis cause a reentry pathway?

A

Conduction must occur a longer distance

70
Q

How can ischemia cause a reentry pathway?

A

Conduction velocity through the damaged tissue is slowed

71
Q

How can epi cause a reentry pathway?

A

Shortens the duration of the refractory period

72
Q

What is the definitive treatment for WPW?

A

Ablation

**Risk is thermal injury so monitor esophageal temperatures

73
Q

What are other treatments for WPW?

A

Procainamide

Cardioversion

74
Q

What is the most common tachydysrhythmias associated with WPW?

A

Orthodromic AV nodal reentry

90%

75
Q

Is orthodromic or antidromic more dangerous?

A

Antidromic

ANTI - Av node is bypassed

Leads to CHF and Vfib

Monitoring (10 decks)

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