Chapter 10 PowerPoint

Question 1

Where and what are premature beats generated by?

Answer 1

Generated by ectopic stimulation or irritable foci in either the Atria, AV junction, and Ventricle.

Question 2

What other terms for premature beats are used?

Answer 2

“Skipped beats” rather than early beats
“Palpitations”

Question 3

What are the three general causes of PVC?

Answer 3

-Absence of organic Heart disease
Idiopathic – caffeine, stress, exhaustion, smoking
Hypoxia – alcohol, cocaine, hypoxemia, hypercapnia
-Presence of Organic Heart Disease
Myocardial ischemia, myocardial infarction, mitral valve prolapse, cardiomyopathy
-Electrolyte Disturbance
Hypokalemia, hyperkalemia, hypomagnesemia, hypocalcemia

Question 4

What occurs in the absence of organic heart disease in premature beats?

Answer 4

Idiopathic – caffeine, stress, exhaustion, smoking
Hypoxia – alcohol, cocaine, hypoxemia, hypercapnia

Question 5

What occurs in the presence of organic heart disease in premature beats?

Answer 5

Myocardial ischemia, myocardial infarction, mitral valve prolapse, cardiomyopathy

Question 6

What occurs in electrolyte disturbances in premature beats?

Answer 6

Hypokalemia, hyperkalemia, hypomagnesemia, hypocalcemia

Question 7

What are four treatments for premature beats?

Answer 7

Benign – work on life style management
Pharmacologic management
Catheter ablation
Electrolyte replacement therapy

Question 8

Premature atrial contractions are very ____ and generally ____?

Answer 8

Premature atrial contractions are very common and generally benign

Question 9

What is the appearance of premature atrial contractions?

Answer 9

Appearance – looks similar to normal sinus beat
-Morphology of P wave is different
-P waves can hide in ST seg and T wave
-Most PAC’s conduct a beat some do not.. showing lone P wave
-Each PAC resets the SA node

Question 10

PAC patterns are the same as ____?

Answer 10

PVC

Question 11

Causes of PAC?

Answer 11

Causes – stress, caffeine, fatigue, electrolyte balance, oxygenation

Question 12

What are treatments for PAC?

Answer 12

Treatments – none at first, Meds, Catheter ablation

Question 13

Premature junctional contractions occur in the ____?

Answer 13

AV node “junction”

Question 14

How do premature junctional contractions appear on an ECG?

Answer 14

ECG Appearance – QRS usually narrow
P wave maybe absent, inverted or retrograde
Lack of atrial depol or atrial depol out of sequence
Also happens in couplets, bigeminy

Question 15

What are causes of PJC?

Answer 15

Causes – hypoxemia, electrolyte imbalances

Question 16

What are treatments for PJC?

Answer 16

Treatments – benign. Or medication

Question 17

In a PVC the ventricles depolarize out of sync with the ____ ____?

Answer 17

SA node

Question 18

PVC is associated with enhanced ____ of ventricles?

Answer 18

Automaticity

Question 19

During a PVC when does the atria contract?

Answer 19

No atrial depol or simultaneous or retrograde to PVC

Question 20

How does a PVC appear on an ECG?

Answer 20

ECG appearance
Large / obtuse
Wide QRS complex – slower ventricular depol than normal
T wave opposite of main QRS deflection
No visible p wave
Following PVC is a short no electrical activity

Question 21

What is a PVC couplet?

Answer 21

Couplets – 2 identical PVC’s in a row

Question 22

What is non-sustained ventricular tachycardia?

Answer 22

A run of PVC’s lasting < 30 sec
3 or more unifocal PVC’s in a row
A run of 3 PVC’s – burst

Question 23

What are multifocal PVCs?

Answer 23

Multifocal – PVC’s with different morphologies

Question 24

What is ventricular bigeminy?

Answer 24

Ventricular Bigeminy – alternating sinus beat and PVC

Question 25

What is ventricular trigeminy?

Answer 25

Ventricular Trigeminy – PVC beats every 3rd beat

Question 26

What is R on T premature ventricular contraction?

Answer 26

R wave of PVC falls on T wave Very unstable and can lead to Vtach

Question 27

What are three classifications of tachyarrhythmias?

Answer 27

Paroxysmal 200+/- 50 Flutter 300 +/- 50 Fibrillation 400 +/- 50

Question 28

What is Supraventricular Tachycardia (SVT) Rhythms?

Answer 28

HR above 100 coming from above the ventricles

Question 29

What can SA node dysfunction cause?

Answer 29

Sinus Tachycardia

Question 30

What can irritated atria cause?

Answer 30

Focal Atrial tachycardia Multifocal Atrial Tachycardia Atrial flutter Atrial fibrillation

Question 31

What can paroxysmal supraventricular tachycardia cause?

Answer 31

AV node reentrant tachycardia AV reentrant tachycardia

Question 32

S/S of typical supraventricular tacycardia?

Answer 32

Signs/Symptoms Palpitations Chest Pain Anxiety Shortness of Breath Dizziness (Rare Syncope)

Question 33

What are risk factors for typical supraventricular tachycardia?

Answer 33

Risk Factors Genetics Structural Abnormality CAD or Heart Disease COPD Pulmonary Embolism Hyperthyroidism Alcoholism Medication

Question 34

What are three different mechanisms for atrial tachycardia?

Answer 34

Automaticity Reentry Triggered

Question 35

What are causes for supraventricular tachycardia?

Answer 35

Causes Ischemia Cardiomyopathy Congestive heart failure Hypertension heart disease/ventricular hypertrophy Electrolyte imbalances Severe pulmonary disease

Question 36

What is atrial flutter?

Answer 36

250-350 BPM, non lethal

Question 37

How does atrial flutter appear?

Answer 37

Known for “Saw tooth” pattern Look at P waves carrying on pace with QRS at another pace Still see ventricular pattern 2:1 or 3:1