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Cardiovascular 2 > Cardiac Rhythm Disturbances - Johnston > Flashcards

Cardiac Rhythm Disturbances - Johnston Flashcards

1
Q

Sinus arrhythmia

A

Rate changes based on respiration

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2
Q

Wandering pacemaker

A

Multiple atrial foci, different P wave morphologies

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3
Q

Atrial escape beat

A

Pause of unhealthy SA node –> ectopic focus fires (different shape P wave)

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4
Q

Junctional escape beat

A

Pause of unhealthy SA node –> ectopic AV junction focus fires (giant QRS, no P wave)

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5
Q

Atrial escape rhythm

A

Sinus arrest –> 60-80 beats/min, different P wave morphology than normal

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6
Q

Junctional escape rhythm

A

Sinus arrest –> 40-60 beats/min, no P waves or inverted P waves AFTER QRS

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7
Q

Ventricular escape rhythm

A

Sinus arrest –> 20-40 beats/min, no P waves

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8
Q

A ventricular pacemaker focus may ultimately cause what phenomenon?

A

Stokes-Adams syndrome (transient syncope via insufficient cerebral perfusion)

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9
Q

Premature atrial beat

Treatment?

A

EARLY, unique P wave –> normal, aberrant, or no QRS (depends on how early)

  • IF symptomatic – Beta blocker (Metoprolol)
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10
Q

How does the heart respond to a single premature atrial beat?

A

The SA node is depolarized, then starts again at the same rate as before (RE-SETS)

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11
Q

Explain possible QRS’s after a premature atrial beat (3)

A
  • TOO early = refractory ventricles = no QRS
  • EARLY = 1 bundle branch refractory = ABERRANT QRS
  • OK = normal QRS
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12
Q

Ventricular beats appearing in groups of 2 or 3, with the last one early and a different P wave

A

Atrial Bigeminy or Trigeminy (ectopic focus tied to SA rhythm somehow)

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13
Q

EKG sign of significant myocardial hypoxia/ischemia

A

Premature/Ectopic ventricular beats

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14
Q

Premature ventricular contraction

Treatment?

A

WIDE QRS w/o a P wave, inverted T wave, pause afterward

IF symptomatic…Metoprolol (Amiodarone/Lidocaine if really unstable)

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15
Q

Why is an ectopic ventricular QRS wider than a normal one?

A

Conduction in myocardium is slower than in the conduction system

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16
Q

What to avoid administering w/ ectopic ventricular beats/rhythms?

A

SNS stimulants or K+ wasting drugs

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17
Q

Ventricular beats appearing in groups of 2 or 3, with the last one wide, early, and without a P wave

A

Ventricular Bigeminy or Trigeminy

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18
Q

Ventricular Parasystole

A

Dual QRS rhythms at once via 2 independent pacemakers (SA and ectopic)

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19
Q

PVC falling immediately after a normal QRS (where T wave would be)

Significance?

A

“R on T” - HIGH RISK for ventricular tachy-arrhythmia

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20
Q

Multiple different QRSs of different morphologies and varying rates

Risk?

A

Multifocal PVCs

RISK of V. FIB.

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21
Q

Barlow Syndrome

A

Multifocal PVCs caused by MITRAL VALVE PROLAPSE

22
Q

Tachycardia, rate 150-250, same PQRS every time

Treatment?

A

Paroxysmal Atrial Tachycardia (PAT) - ectopic focus overrides SA node

  • Magnesium sulfate + CCB (Verapamil), then Amiodarone/Adenosine instead of Magnesium
23
Q

Tachycardia (150-250), 2 P’s for every 1 QRS

A

PAT w/ AV Block - DIGITALIS TOXICITY + HYPO-K+

24
Q

Tachycardia (150-250), inverted Ps (or none), normal QRSs

A

Paroxysmal Junctional Tachycardia (PJT) - ectopic focus overrides SA node

25
Q

Tachycardia (150-250), no Ps, abnormal QRSs

A

Ventricular tachycardia

26
Q

What can often be seen occasionally w/ V. tach?

A

Capture (normal QRS btwn VT) or Fusion beats (1/2 and 1/2)

27
Q

What is Supraventricular Tachycardia?

Treatment?

A

Any tachycardia arrhythmia (not normal) that originates above the ventricular tissue (PAT or PJT or AVNRT)

– Tx = Adenosine

28
Q

When suspecting VT, what MUST you rule out?

A

SVT + BBB/aberrant conduction –> wide QRS’s like VT

- NOT TREATED THE SAME AS VT

29
Q

How to distinguish VT from Wide QRS SVT?

A

Wide SVT = no RAD or coronary disease

VT = coronary disease, captures and fusions, EXTREME RAD

30
Q

Cause of Torsades de Pointes

A
  • Low K+, K+ blockers, and/or long QT (syndrome or drug)
31
Q

Good Dx tool for atrial flutter

Best leads to see it?

A

Vagal Maneuver (help slow AV node to show more flutter waves)

2, 3, AVF

32
Q

Ventricular flutter

A

Smooth, sine-wave appearance (as opposed to wide QRSs), same size every time

33
Q

Problem with V. flutter if not treated

A

PROGRESS to V. FIB due to coronary blood insufficiency

34
Q

Flutter rate

A

250-350 beats/min

35
Q

Fibrillation appearance

A

Random, super-fast, jagged beats w/ changing amplitudes and no recognizable pattern

36
Q

What will be seen on long-term EKG w/ untreated V. FIB?

A

Diminished amplitude over time as heart dies

37
Q

Immediate treatment for V. FIB

A

Defibrillation + CPR

38
Q

Upward-curving R waves (“delta waves”)

A

Wolff-Parkinson-White Syndrome (via Bundle of Kent)

39
Q

V1-V3…RBBB (RSR’) w/ ST elevation

Treatment?

A

Brugada Syndrome (congenital)

ICD placement

40
Q

T wave inversion in V2 and V3 (upward)

Cause? Treatment

A

Wellens Syndrome (congenital)

LAD stenosis (stent or bypass)

41
Q

QT interval greater than 1/2 the length of the cycle

A

Long QT syndrome (congenital)

42
Q

COPD - EKG findings

A
  • Low voltage
  • RAD
  • MAT (multiple p wave morphologies, abnormal rates)
43
Q

Pulmonary embolus - EKG findings

A 
S1 Q3 T3
   - Large S in lead 1
   - Large Q in lead 3
   - Inverted T in lead 3
RAD
ST depression in lead 2
T wave inversion in leads V1 - V4
44
Q

Flatter, wider P wave
Wide QRS
Peaked T waves

A

Hyperkalemia

45
Q 
Flat or inverted T waves
U waves (if severe)
A

Hypokalemia

46
Q

Hypercalcemia

A

Short QT

47
Q

Hypocalcemia

A

Long QT

48
Q

Sinus tachycardia

Causes?

Treatment?

A

Elevated HR, normal PQRST

  • Emotion, anxiety, fear, drugs, hyperthyroid, pregnancy, anemia, CHF, hypovolemia
  • Treat underlying cause
49
Q

Sinus bradycardia

A

Slow HR, normal PQRST (

50
Q

Tachycardia, followed by bradycardia (cycle)

A

Sick Sinus Syndrome

51
Q

When to treat sinus bradycardia?

How to treat? (preferred)

A

HR

52
Q

SVT vs. VT

A

SVT - normal narrow QRSs

VT - wide QRSs

Cardiovascular 2 (20 decks)

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