Cardiac Rhythm Abnormalities - EKG Flashcards
what does atrial flutter appear as on an EKG
saw tooth appearance
- repeating P waves
how are atrial rhythm abnormalities treated
cardioversion
ablation
antiarrhythmic
antithrombotic
for those with atrial rhythm what does exercise tolerance depend upon
rate control due to loss of atrial kick
explain atrial fibrilliation
rate varies and is always irregular
= due to SA node not setting the pace
how to treat atrial fibrillation
rate control digoxin, beta blockers, or calcium channel blockers
if atrial fibrillation is found to be new, what needs to be done / why?
notify medical provider immediately
cardiac stroke
what medications are indicated for A-Fib? what can this affect in regard to PT
cardioversion / anticoagulants
CO and decrease exercise tolerance
if new, may be accompanied in BP drop with lightheadedness
if the rate is controlled during A-Fib, what is the implication of PT? what may the patient report?
low-moderate exercise with slow progression
- may report palpitations, angina, SOB and fatigue
explain HR associated with supraventricular tachycardia
<150 bpm but normal sinus rhyhtm
how is supraventricular tachycardia treated
self-limitations typically
what do patients typically report with supraventricular tachycardia
palpitations
dizziness
fatigue
SOB
chest discomfort
possible syncope
what is the treatment for premature ventricular contraction
none required if asymptomatic
- if >6-12 in one minute = underlying cardiac pathology may be indicated
if premature ventricular contractions occur in a run, what is the indication
may precede ventricular tachycardia
then V-fib
patterned preventricular contractions effect on SV
decreased –> then CO
for those with patterned PVCs, what is the PT indication?
low to moderate range
- monitor closely
what red flags are associated with PVCs
increased frequency of PVS
increased pattern changes
PVCs accompanied by symptoms
– maybe BP and/or syncope
what is the defining feature of ventricular tachycardia
three or more PVCs in a row
explain what ventricular tachycardia is
ventricles being in a constant state of contraction-relaxation
what to do if you notice ventricular tachycardia?
stop exercising
CPR/defibrillation
call a code
ventricular fibrillation is described as
chaotic and asynchronous electrical activity
– no CO
what do to if ventricular fibrillation is noticed
life threatening, stop call code and do CPR/defibrillation
asystole is described as ____? what is done in response?
cardiac standstill
CPR
first degree atrioventricular blocks are described as
PT interval is prolonged by >0.2 seconds
then normal conduction occurs
explain why 1st degree AV blocks occur
conduction through AV node is affected (slowed)
how do 1st degree AV blocks impair a pt
generally do not produce significant CO or exercise tolerance impairments
how are second degree AV blocks described
when not all P waves are followed by a QRS
PR Interval is progressively longer and longer until there is one without a QRS
for those with 2nd degree AV blocks, what is the PT indication?
submaximal testing with gradual progression to set exercise response baseline
- moderate intensity
- do what makes sense with symptoms (ie more symptomatic, less intervention)
what are second degree AV blocks also called?
Mobitz 1 and 2
how are second degree (mobitz 2) AV blocks described
P waves that appear normal
- end up being more P waves than QRS complexes
PT interval normal or prolonged, but consistent
comparing rate of ventricle and atria, what does a mobitz 2 AV block suggest
atrial rate > ventricle rate
explain QRS complexes in Mobitz 2 AV block
QRS is often wider than normal
explain CO in those with Mobitz 2
- what is often associated with Mobitz 2 AV blocks/what is done to treat this?
CO is significantly compromised, patient will be symptomatic
structural heart disease / higher risk of negative events
pacemaker placement
explain atria / ventricle relationship in 3rd degree AV block
completely disassociated
explain P wave and QRS complex relationship in 3rd degree AV block
if activated by P wave, QRS looks normal
if not, wide and bizarre QRS complex
what is atrial and ventricular rate
atria = 60-100 bpm
ventricle = 20-40 bpm
explain PT intervention for those with 3rd degree AV block
need pacemaker, do not do anything until then
what is a bundle branch block
block of conduction in the right or left bundle branch
explain the differnce between RBBB and LBBB
RBBB = typically benign
LBBB = structural heart disease
ST elevation is described as _____? this indicates _____?
ST segment higher than normal as assessed from J point
STEMI = requires immediate medical attention
ST depression is described as __? it indicates _____?
ST segment lower than normal
Ischemia
T wave changes indicate
ischemia
ventricular hypertrophy
non-coronary/cardiac conditions
are T wave changes ever normal
yea, in children
explain the evolution of STEMI in regard to EKG changes and times associated
hyperacute T wave = within minutes
ST elevation = minutes to hours
ST elevation & Q wave = 1-12 hrs
ST elevation & T wave inversion = days
T-wave recovery & Q-wave = weeks/months
