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EKG > Ch. 9 Notes: Ventricular Dysrhythmias > Flashcards

Ch. 9 Notes: Ventricular Dysrhythmias Flashcards

1
Q

Where are the ventricular pacemaker cells?

A

In the Purkinje fibers

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2
Q

The Purkinje fibers are the ______ ___________ pacemaker cells in the heart

A

last inherent

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3
Q

What is the rate of automaticity of the Purkinje fibers?

A

20-40 bpm

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4
Q

Why does the current travel through the ventricles through cell-by-cell conduction?

A

Because there are no conductive pathways beyond the Purkinje fibers

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5
Q

What occurs as a result of the current traveling through cell-by-cell conduction?

A

The ventricles take longer to depolarize so there is a wide QRS complex

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6
Q

What are the reasons for ventricular rhythms?

A
  1. Higher pacemaker sites in the heart fail
  2. Increased automaticity
  3. Third degree block prevents supraventricular impulses from reaching the ventricles
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7
Q

Why does increased automaticity lead to a ventricular rhythm?

A

Purkinje fibers is faster than other pacemakers so it takes over as the primary pacemaker

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8
Q

What causes the Purkinje fibers to become the primary pacemaker?

A
  1. Ischemia (most common)
  2. Electrolyte disturbances (involving potassium or magnesium)
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9
Q

What are characteristics of all ventricular rhythms?

A
  1. Missing P waves
  2. Wide and bizarre QRS complex (>120 ms)
  3. Inverted T waves
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10
Q

Why are P waves missing from ventricular rhythms?

A

The impulse is coming from the ventricular fibers, not the SA node

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11
Q

What are premature ventricular complexes (PVCs)?

A

Ectopic impulses that occur early in the cycle and originate from the ventricles

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12
Q

What causes PVCs?

A

Ischemic region in the ventricles which increased irritability of ventricular myocardium

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13
Q

What are unifocal PVCs?

A

PVCs coming from one ectopic focus; all have same shape since they all take the same path

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14
Q

What are multifocal PVCs?

A

PVCs coming from more than one ectopic impulse; all have different shapes

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15
Q

What can multifocal PVCs indicate?

A

More than one area of ischemia

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16
Q

Why is there a “pause” on the ECG strip containing unifocal or multifocal PVCs?

A

The PVC interrupts the rhythm, so it has to wait for next normal impulse to come

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17
Q

What are interpolated PVCs?

A

PVC comes right between normal impulses without interrupting rhythm; not common

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18
Q

What are occasional PVCs?

A

Less than 6 PVCs per minute on the ECG strip

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19
Q

What are frequent PVCs?

A

6 or more PVCs per minute on the ECG strip

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20
Q

What are bigeminal PVCs?

A

Every other impulse is a PVC

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21
Q

What are trigeminal PVCs?

A

Every third impulse is a PVC

22
Q

What are quadrigeminal PVCs?

A

Every fourth impulse is a PVC

23
Q

What are R-on-T PVCs?

A

When the PVCs begin on the downslope of the T wave; stimulating heart on T wave could lead to cardiac arrest/ventricular fibrillation

24
Q

What are coupling PVCs?

A

Back-to-back PVCs

25
Q

What is run of ventricular tachycardia aka Salvo of PVCs?

A

3 or more PVCs in a row

26
Q

What is paroxysmal event?

A

Sudden change in cardiac rhythm; cardiac arrest occurs, needs defib

27
Q

What is the characteristic of the atrial and ventricular rhythms of an ECG strip with PVCs?

A

Regular for underlying rhythm; PVCs interrupts underlying rhythm w/ early QRS complexes and causes a pause until underlying rhythm returns (irregular)

28
Q

How do you find the atrial and ventricular rate of an ECG strip with PVCs?

A

Same as underlying rhythm; PVCs make ventricular rhythm faster than atrial rate

29
Q

What is the characteristic of P waves in an ECG strip with PVCs?

A

U+R in underlying rhythm; absent in PVCs

30
Q

What is the characteristic of the PR interval in an ECG strip with PVCs?

A

Follows underlying rhythm; not measurable in PVCs

31
Q

What is the characteristic of the QRS complex in an ECG strip with PVCs?

A

Underlying is usually 60-100 ms; complex in PVC is wide and bizarre (120 ms or more)

32
Q

How does the patient tolerate PVCs?

A

Can be normal depending on PVC frequency; frequent or grouped PVCs can cause dizziness or other s/s of low CO

33
Q

When does agonal rhythm occur?

A

All of the pacemakers in the heart have failed; aka dying heart rhythm

34
Q

What are the characteristics of the atrial rhythm and rate of agonal rhythm?

A

Cannot be determined

35
Q

What is the characteristic of the ventricular rhythm and rate of agonal rhythm?

A

May or may not be regular and rate is less than 20 bpm

36
Q

What is the P wave morphology for agonal rhythm?

A

Absent

37
Q

What is the characteristic of the PR interval for agonal rhythm?

A

Cannot be determined

38
Q

What is the characteristic of the QRS complex for agonal rhythm?

A

Greater than 120 ms, wide, bizarre

39
Q

How does the patient tolerate agonal rhythm?

A

Profound loss of CO, unconscious

40
Q

What occurs during an idioventricular rhythm?

A

Impulse is created by the ventricular pacemaker

41
Q

What is idioventricular rhythm also referred to as?

A

The ventricular version of escape rhythm

42
Q

What is the characteristic of the atrial rhythm and rate for idioventricular rhythm?

A

P-P interval and atrial rate cannot be determined

43
Q

What is the characteristic of the ventricular rhythm and rate for idioventricular rhythm?

A

R-R interval is regular and 20-40 bpm

44
Q

What is the P wave morphology for idioventricular rhythm?

A

Absent

45
Q

What is the characteristic of the PR interval for idioventricular rhythm?

A

Cannot be measured

46
Q

What is the characteristic of the QRS complex for idioventricular rhythm?

A

Greater than 120 ms, wide, bizarre

47
Q

How does the patient tolerate idioventricular rhythm?

A

Profound loss of CO, unconscious

48
Q

Why is there a profound loss of CO in idioventricular rhythm?

A

Because of the low rate of 20-40 bpm

49
Q

What extra measures should be taken if a patient has agonal or idioventricular rhythm?

A
  1. BLS and ACLS interventions if patient is unconscious
  2. Medication and/or pacing as treatment (for idiovent.)
50
Q

What is the main identifier for accelerated idioventricular rhythm?

A

Faster HR than idiovent.

51
Q

What is the characteristic for the atrial rhythm and rate for accelerated idioventricular rhythm?

A

P-P interval rhythm and rate cannot be determined

52
Q

What is the characteristic of the ventricular rhythm and rate

A

EKG (19 decks)

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