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medical physiology > cariophysiology EKG rhythms... not blocks > Flashcards

cariophysiology EKG rhythms... not blocks Flashcards

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USMLE® Step 1 flashcards
1
Q

sinus rhythm heart rate

A

60-100

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2
Q

sinus arrhythmia: cause

A

ANS changes pacing upon respiration.. its normal

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3
Q

three types of atrial irregular rhythms

A

wandering pacemaker
multifocal atrial tachycardia
atrial fibrillation

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4
Q

wandering pacemaker characteristics - 4

A

irregular rhythm cagegory

  • P wave shape changes
  • atrial rate is less than 100
  • irregular ventricular rhythm
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5
Q

multifocal atrial tachycardia characteristics - 4

A

irregular rhythm category

  • p wave shape changes
  • atrial rate is over 100
  • irregular ventricular rhythm
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6
Q

atrial fibrillation characteristics - 3

A

irregular rhythm categorm

  • continuous chaotic atrial spikes
  • irregular ventricular rhythm
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7
Q

escape rhythm =

A

automaticity focus escapes overdrive suppression and PACES at its intrinsic rate

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8
Q

escape beat

A

automaticity focus TRANSIENTLY escapes overdrive suppression to emit ONE BEAT

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9
Q

atrial escape rhythm characteristics - 3

A
  • normal sinus rhythm then sinus arrest
  • the escape rhythm has a different P shape
  • new pacing at 60-80 bpm
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10
Q

junctional escape rhythm characteristics - 4

A
  • normal sinus rhythm then sinus arrest
  • NO P wave, OR NEGATIVE P wave because this pacing is from AV node
  • aka idiojunctional rhythm
  • new pace is 40-60bpm
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11
Q

ventricular escape rhythm characteristics - 5

A
  • normal sinus rhythm then sinus arrest
  • regularly spaced P waves, but they don’t make QRS
  • wide QRS because
  • aka idioventricular rhythm
  • new pace is 20-40 bpm
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12
Q

atrial escape beat characteristics

A

same as atrial escape rhythm, but it only happens for one beat because the SA node misses a cycle

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13
Q

AV junctional escape beat

A

same as juncitonal escape rhytm but it only happens for one beat

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14
Q

ventricular escape beat

A

same idea as ventricular escape beat EXCEPT….
this happens when both the SA node and the AV node are suppressed (usually by parasympathetics)
when it escapes, the QRS is HUUUUGGGEEE

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15
Q

premature atrial beat characteristics - 4

A
  • premature P wave (because its irritable)
  • therefore, prematue QRS
  • the premature wave is from an ATRIAL focus, so the P wave looks different from normal
  • premature beat resets the system so the subsequent beats line up with the premature one
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16
Q

what sometimes happens with a premature atrial beat

A

sometimes, the ventricle isn’t totally REpolarized from the last beat so its wide. we call this “aberrant ventricular conduction”. the wide QRS is ONLY for the premature beat

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17
Q

nonconducted premature atrial beat - 3

A
  • the SA node paces, but the AV node decides its not ready yet, so you get NO QRS and T
  • the SA node paced, so its STILL the boss
  • this looks dangerous (like a block) but is not
18
Q

atrial bigeminy

A

when a premature atrial beat keeps tagging along on the end of a normal beat

19
Q

premature junctional beat

A
  • irritable AV junction fires prematuely
  • sometimes makes the P wave negative
  • can get a squggly QRST if one of the bundle branches is still trying repolarize
  • this is different from ventricular escape because its NOT WIDE
  • this usually resets the SA node via retrograde atrial depolarization
20
Q

AV (junctional) bigeminy

A

when one premature junctional beat keeps tagging along the end of a normal beat

21
Q

what causes a juncitonal focus irritable

A

low oxygen
low potassium
pathology
cocaine

22
Q

examples of low oxygen that causes junctional focus irritability

A

airway obstruction
air with poor O2
poor oxygenation in lungs (pneumothorax or embolus)
poor coronary blood supply

23
Q

example of pathology that causs junctional focus irritability

A

mitral valve prolapse, stretch, myocarditis

24
Q

what should you know about cocaine and hearts

A
  • it can make either ATRIAL OR JUNCTIONAL foci irritable
  • can cause a coronary spasm…. hypoxic heart in addition to irritable heart
  • thats not really a great combo.
25
Q

premature ventricular contraction

A

exactly what it sounds like. this has a wide QRS of opposite polarity from normal
(aka if QRS is normally going up, this one will be wide and down)

26
Q

ventricular parasystole - 3

A
  • ventricular focus has an entrace blook so it can’t be overdrive suppressed
  • pacing happens from two different locations at two different rates
  • distance between the vetricular complex is usually large
27
Q

ventricular tachycardia

A

a run of three or more PVCs

28
Q

if a PVC tries to on a T….

A

WATCH YOUR PATIENT CAREFULLY!!!
(did you like that rhyme)
this is a deadly arrhythmia

29
Q

heart rate of a paroxysmal tachycardia

A

150-250

30
Q

heart rate of flutter

A

250-350

31
Q

heart rate of fibrillation

A

350-450

32
Q

paroxysmal tachycardia characteristics -3

A
  • rapid firing of irritable atrial automaticity
  • P wave is different from normal
  • can be triggered beause of a premature stimulus from elsewhere
33
Q

PAT with (AV) block - 4

A
  • rapid rate,
  • spiked P’ wave
  • 2:1 ratio of P’ to QRS
  • suspect digitalis excess or toxicity
34
Q

paroxysmal junctional tachycardia characteristics

A
  • caused by irritable pacing of Av junction

- junctional focus may also cause retrograde depolarization of atrium causing weird P’ waves

35
Q

weird p’ waves in paraoxysmal junctional tachycardia look like (3 types)

A

inverted P’ immediately before each upright QRS
inverted P’ after each upright QRS
inverted P’ buried within each QRS

36
Q

supraventricular tachycardia - 3

A
  • produces both paroxysmal atrial tachycardia and paroxysmal junctional tachycardia
  • sometimes the P’ runs into the preceding T wave
  • this is an umbrella term for both tachycardia types, especially if the waves are too close to distinguish the origin of the tachycardia… it doesn’t really matter anyway since the treatment is the same
37
Q

paroxysmal ventricular tachycardia - 2

A
  • irritbalbe ventricular automatciity focus that paces quickly
  • to me this looks like upside-down “U” s
38
Q

torsades de pointes EKG - 2

A
  • upside-down U that gets taller and smaller and taller and smaller
  • rate is 250-350 bpm
39
Q

torsades de pointes cause

A

low potassium, potassium channel blockers or any other condition that will lengthen the QT setment

40
Q

atrial flutter EKG

A

“saw tooth” baseline. BE ABLE TO DISTINGUISH THIS FROM A PAT WITH AV BLOCK

41
Q

ventricular flutter - 2

A
  • this looks like a sine wave…. NOT upside down U

- rate is 250-350

42
Q

wolff-parkinson-white sydrome

A
  • P wave with a delta wave up to R
  • to me, its a P wave with a swoop up to the R
  • its from a “bundle of Kent” that lets the depolarization travel from the atrium to the ventricle…. its not supposed to do that

medical physiology (9 decks)

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