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SMP - Cardiopulmonary Exam 1 > CC 1 - Arrhythmia > Flashcards

CC 1 - Arrhythmia Flashcards

1
Q

What 4 questions should we ask ourselves to identify arrhythmias?

A
  1. Are the P waves normal?
  2. In the QRS wide or narrow?
  3. What is the relationship between the P wave and the QRS complex?
  4. Is the rhythm regular or irregular?
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2
Q

Sinus tachychardia pattern?

A
  1. Are the P waves normal?
    YES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR

=> all normal except elevated HR (above 100 bpm)

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3
Q

PAC pattern?

A
  1. Are the P waves normal?
    NO, DIFFERENT SHAPE (more spiky)
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR
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4
Q

What does PAC stand for?

A

Premature Atrial Contraction

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5
Q

Junctional rhythm pattern?

A
  1. Are the P waves normal?
    NONE OR NEGATIVE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    REGULAR AND NORMAL RATE
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6
Q

What are we talking about when we talk about anything that is junctional?

A

AV node

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7
Q

Would atrial depolarization be possible during junctional rhythm? If so, what would that look like on an EKG?

A

YES!

Would be a negative P wave right after the QRS because could go back up to the SA node after ventricular depolarization

May also be buried in the QRS and be completely absent

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8
Q

What is sinus arrhythmia? What is it due to?

A

Irregular beat generated by the SA node

Due to different vagal stimulation happening on a respiratory pattern

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9
Q

Sinus arrhythmia pattern?

A

LOOK AT RYTHM STRIP:

  1. Are the P waves normal?
    YES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    IRREGULAR
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10
Q

What is atrial flutter?

A

Re-entry counter-clockwise circuit in the RA going 300 bpm causing RA and LA depolarization

AV node protects the ventricles from this very fast bpm by only conducting a certain ratio of the depolarization cycles in a regular or irregular pattern (2:1 in young healthy people)

Overall there is a dissociation of rates between the atria and the ventricles

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11
Q

Atrial flutter EKG pattern?

A
  1. Are the P waves normal?
    NO: FAST, NEGATIVE = SAW-TOOTH PATTERN P WAVES (SOME MISSING BECAUSE BURIED IN QRS COMPLEXES)
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    REGULAR OR IRREGULAR BUT LESS QRS COMPLEXES THAN P WAVES
  4. Is the rhythm regular or irregular?
    REGULAR OR IRREGULAR
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12
Q

What would happen if the 300 bpm in the atria was conducted to the ventricles during atrial flutter?

A

Ventricles would not fill with blood = death

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13
Q

What are the best leads to look at P waves?

A

Inferior leads

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14
Q

What is atrial fibrillation?

A
  1. Atrial depolarization patterns are abnormal: electrical circuits = disorganized wavelets which do not communicate and have no pattern => NO ATRIAL CONTRACTIONS
  2. In pulmonary veins there are triggers that start firing (might be the ones getting the wavelets going) – disorganized electrical activity
  3. AV node protects the ventricles from this very fast bpm by only conducting a certain ratio of the depolarization cycles in an irregular pattern because it’s receiving irregular signals
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15
Q

Atrial fibrillation pattern?

A
  1. Are the P waves normal?
    CLOSE TO NONE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    IRREGULARLY IRREGULAR
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16
Q

Difference between HR and heart rhythm?

A

The heart rate is the number of times the heart beats in a minute.

The heart rhythm is the pattern of the heart beat.

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17
Q

What is the classic irregular heart rhythm?

A

A-fib

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18
Q

What is multifocal atrial tachychardia?

A

At least 3 foci in the atria are signaling at a fast rate to the other atrial cells

19
Q

Multifocal atrial tachychardia EKG pattern?

A
  1. Are the P waves normal?
    NOPE, DIFFERENT KINDS OF P WAVES WITH DIFFERENT SHAPE/POLARITY (AT LEAST 3) = 3 MORPHOLOGIES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    IRREGULAR
20
Q

What does SVT stand for?

A

Supraventricular tachycardia

21
Q

What is SVT? Mechanism? What arrhythmias does this include? What to note?

A

An umbrella term used to describe atrial and/or ventricular tachycardias with rates in excess of 100 bpm at rest: very narrow, rapid, and regular rhythm

Mechanism: increased rate generated by tissue from the His bundle or above.

Includes:

  1. Sinus tachycardia
  2. Atrial tachycardias (focal and multifocal)
  3. Atrial flutter
  4. Junctional tachycardia
  5. AV nodal re-entry tachychardia (AVRT)

Note: while atrial fibrillation is technically an SVT, the term does not generally include Atrial Fibrillation

22
Q

What is a subtype of AVRT? Explain it.

A

Wolff–Parkinson–White syndrome (WPW syndrome): accessory pathway is on the lateral wall of the heart between the LV and the LA

23
Q

Describe AVRT.

A

Re-entry circuit: AV node => His-Purkinje system => ventricular myocytes => accessory pathway of abnormal tissue connecting the atria and ventricles (developed in utero) => atria

24
Q

AVRT EKG pattern?

A
  1. Are the P waves normal?
    NONE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    REGULAR AND FAST
25
Q

Other name for delta wave?

A

Pre-excitation wave

26
Q

What is the pattern on the EKG when you have abnormal tissue connecting the atria and ventricles?

A

Delta waves: up-slur of the QRS complex because as the atria contract the signal goes down through 2 different pathways => combination of the 2 is the delta wave

27
Q

What does PVC stand for?

A

Premature ventricular contraction

28
Q

What is PVC?

A

An area or more of the ventricle fires outside of the conduction system and depolarizes the ventricles

29
Q

PVC EKG pattern?

A
  1. Are the P waves normal?
    NORMAL
  2. In the QRS wide or narrow?
    WIDE AND PREMATURE
  3. What is the relationship between the P wave and the QRS complex?
    IRREGULAR
  4. Is the rhythm regular or irregular?
    IRREGULAR
30
Q

Ventricular tachycardia (VT) EKG pattern?

A
  1. Are the P waves normal?
    NONE
  2. In the QRS wide or narrow?
    WIDE
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    REGULAR BUT FAST RATE
31
Q

What is always true on an EKG if the signal is coming from someplace in the ventricles?

A

WIDE QRS complex

32
Q

What arrhythmia do people die from during heart attacks?

A

Ventricular fibrillation causing ischemia

33
Q

What is ventricular fibrillation?

A

Disorganized rhythm with ventricular foci firing all over the place and very fast=> No pulse and heart cannot fill with blood

34
Q

Ventricular fibrillation EKG pattern?

A
  1. Are the P waves normal?
    NONE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    NA
  4. Is the rhythm regular or irregular?
    IRREGULAR and FAST
35
Q

Sinus bradycardia EKG pattern?

A
  1. Are the P waves normal?YES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR BUT SLOWER
36
Q

What is bradycardia by definition?

A

HR < 60 bpm

37
Q

What is a first degree AV block?

A
  1. Are the P waves normal?
    YES
  2. In the QRS wide or narrow?
    NARROW BUT LONGER PR INTERVAL (>200 ms)
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR
38
Q

Is the irregular P wave seen in PAC generated by the SA node?

A

NOPE

39
Q

What does intermittent jugular venous pulse mean?

A

Complete heart block because the atria are sometimes contracting against mitral valves

40
Q

When there is a disconnect between the atria and ventricles contracting, which do you pick for HR?

A

Ventricular rate of contraction = HR

41
Q

What would an “occasionally” explosive S1 mean?

A

Complete heart block because the AV valve closes on a different amount of blood each time

42
Q

What often causes syncope?

A

Heart blocks

43
Q

What type of second degree AV block is bad?

A

Type II

44
Q

How is SV affected by AV block?

A

Increased because ventricles do not fire as frequently as atria

SMP - Cardiopulmonary Exam 1 (28 decks)

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