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Apex > Cardiac Rhythm and Monitors > Flashcards

Cardiac Rhythm and Monitors Flashcards

1
Q

What portion of the heart do leads II, III, and aVF monitor? What artery?

A

Inferior
RCA

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2
Q

What portion of the heart do leads I, aVL, V5 and V6 monitor? And what artery?

A

Lateral
Circumflex

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3
Q

What portion of the heart do leads V1 and V2 monitor? What artery?

A

Septum
LAD

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4
Q

What portion of the heart do leads V3 and V4 monitor? What artery?

A

Anterior heart
LAD

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5
Q

What are 3 bipolar leads?

A

I, II, III

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6
Q

What are 3 limb leads?

A

aVR
aVF
aVL

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7
Q

In extreme right axis deviation, what is the position of lead I and Lead aVF?

A

Both arrows pointing down 👇

(Just think…it’s the opposite of a normal axis, which is both leads pointing up ^^)

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8
Q

In left axis deviation, what is the position of lead I and lead aVF?

A

Leaving each other in Left axis deviation

Lead I ^
Lead aVF 👇

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9
Q

In right axis deviation, what is the position of lead I and lead aVF?

A

reaching each other in right axis deviation
(like a little puzzle piece)

(Lead I 👇 but lead aVF ^)

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10
Q

In normal axis, what is the position of lead I and lead aVF?

A

Both are upright ^^

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11
Q

What is normal axis in degrees?

A

-30 to +90

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12
Q

What is left axis deviation in degrees?

A

< - 30 degrees

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13
Q

What are some causes of right axis deviation?

A

COPD
Acute Bronchospasm
Cor Pulmonale
Pulmonary hypertension
Pulmonary Embolus

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14
Q

What are some causes of left axis deviation?

A

Chronic htn
LBBB
Aortic stenosis
Aortic insufficiency
Mitral regurge

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15
Q

What does the mean electrical vector point towards? The hat what does it shy away from?

A

Towards hypertrophy
Away MI

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16
Q

What is a useful medication in the setting of beta-blocker overdose or calcium channel overdose?

A

Glucagon

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17
Q

What are some treatment options for afib?

A

Beta-blockers, calcium channel blockers, and digoxin

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18
Q

What is acute onset afib treated with?

A

Cardioversion (100 joules)

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19
Q

What must be performed if the onset of afib is > 48 hours?

A

TEE to rule out thrombus

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20
Q

What is the most common postoperative tachydysrhythmia?

A

Afib

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21
Q

What should hemodynamically unstable atrial flutter treated with?

A

Cardioversion (start at 50 joules)

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22
Q

What are PVCs that arise from a single location?

A

Unifocal

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23
Q

What are PVCs that arise from multiple locations?

A

Multifocal

24
Q

What is the most common cause of sudden cardiac death?

A

Vfib

25
Q

what is brugada syndrome?

A

Sodium ion channelopathy in the heart.

Common cause of nocturnal death d/t vtach/vfib

26
Q

During Sinus arrhythmia, heart rate increases during what?

A

***Inhalation ~ decrease in intrathoracic pressure —> increase venous return —> increase heart rate

Exhalation ~ increase in intrathoracic pressure —> decrease venous return —> decrease heart rate

27
Q

What reflex initiates sinus arrhythmia?

A

Bain ridge reflex

28
Q

What is a 1st degree heart block?

A

PR interval > .20 sec
(AV node or bundle of his is affect)

Tx: nothing

29
Q

What is a second degree heart block (type 1)?

A

Longer, longer, longer, and drop

PR becomes progressively longer and then drops a QRS
(AV node affected)

Tx: asymptomatic ~ monitor
Symptomatic ~ atropine

30
Q

What is a 2nd degree heart block (Mobitz II)?

A

All the QRS have ps, but not all the ps go through resulting in a QRS.

(Affects bundle of his/BB)

Tx: pacemaker (atropine is NOT effective)

31
Q

What is a 3rd degree heart block?

A

Ps and Qs don’t agree ~ no connection

(Degeneration of atrial conduction system)

Tx: pacemaker or isoproterenol

32
Q

What do class 1 antiarrhythmic drugs inhibit?

A

Inhibit fast sodium channels (think lidocaine)

33
Q

What do class 2 antiarrhythmic drugs inhibit?

A

Decrease the rate of depolarization (beta blockers)

34
Q

What are class 3 antiarrhythmic agents?

A

Inhibit potassium ion channels (amiodarone)

35
Q

What are class 4 antiarrhythmic drugs?

A

Inhibit slow calcium channels (CCB)

36
Q

What are the common EKG characteristics in WPW?

A

DELTA wave
Short PR (bypass the AV)
Wide QRS complex
Possible T wave inversion

37
Q

What is Orthodromic AVNRT?

A

(Type of WPW) Orthodromic AV nodal recently Tachycardia

More common ~ atrium —> AV node —> ventricle —> accessory pathway —> atrium

Block conduction at the AV node (vagal, cardioversion, adenosine, BB, verapamil, amiodarone)

38
Q

What is antidromic AVNRT?

A

Antidromic AV node reentry tachy (WPW)

Atrium —> accessory pathway —> ventricle —> AV node —> atrium

Tx: cardioversion or procainamide

(AVOID: ADENOSINE, LIDO, CCBS, BBS, and DIGOXIN)

39
Q

What is the definite treatment of WPW?

A

Ablation.

40
Q

What are some conditions that prolong the QTc?

A

Hypokalemia
Hypomagnesemia
Hypocalcemia

41
Q

What are some drugs that increase the QTc?

A

Methadone
Droperidol
Haloperidol
Ondansetron
Amiodarone
Quinidine

42
Q

What are some cardiac conditions that increase the QTc?

A

Hypertrophic cardiomyopathy
Subarachnoid hemorrhage
Bradycardia

43
Q

What is position 1 of n the pacemaker?

A

This is the chamber being paced

O: none
A: atrium
V: ventricular
D: Dual

44
Q

What is position 2 of the pacemaker?

A

This is the chamber that is sensed

O: none
A: atrium
V: ventricle
D: Dual

45
Q

What is position 3 of the pacemaker?

A

This is the response to the sensed native cardiac activity

T: tells the pacemaker to fire
I: tells pacemaker NOT to fire
D: if native activity is sensed ~ pacing is inhibited; if native activity is not sense ~ pacemaker fires

46
Q

What is position 4 of the pacemaker?

A

Indicated the programmability of the pacemaker

O: none
R: rate modulation

47
Q

What are examples of asynchronous pacing?

A

AOO, VOO, DOO

Pacemaker delivers at a constant rate
No sense/inhibition
Can result in R on T

48
Q

What are examples of single-chamber demand pacing?

A

AAI or VVI

Back-up mode
Only fires when the native heart rates falls below a predetermined rate

49
Q

What are examples of dual-chamber AV Sequential demand Pacing?

A

DDD

Mode is very flexible and is the most common mode of pacing.
Makes sure the atrium contracts first followed by the ventricle
Improves AV synchrony

50
Q

What does placing a magnet over a pacemaker do to the pacemaker portion?

A

Usually converts it to an asynchronous mode

51
Q

What does placing a magnet of a device due to the ICD?

A

Suspends the ICD and prevents shock delivery

52
Q

What does placing a magnet do for a pacemaker + ICD?

A

Suspends the ICD and prevents shock.
Has no effect on pacemaker function

53
Q

What is the only contraindication for a pacemaker or ICD?

A

MRI?

54
Q

What are not contraindications for a Pacemaker or ICD?

A

Lithotripsy
Electroconvulsive therapy

55
Q

Which setting of electrocautery causes more EMI?

A

The coagulation setting is the worst.

56
Q

Which cautery causes more EMI (think bipolar vs monopolar)

A

Monopolar cautery

Apex (47 decks)

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