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EKG Certification > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

Atrioventricular Block

A

Depolarization and repolarization are slow in the AV node, which makes this area vulnerable to blocks in conduction

AV block is a delay or interruption in impulse conduction from the atria to the ventricles which occurs as a result of a temporary or permanent anatomical or functional impairment

Anatomic - structure
Functional - internal “software”

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2
Q

PR interval in AV block

A

Assess PR intervals to detect conduction disturbances

Normal PR interval measures 0.12 to 0.20

PRI will be longer in AV block

ALWAYS measure PRI

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3
Q

What are the classifications of AV blocks?

A

First degree AV block - will look like NSR with long PRI

Second degree AV block
-Type I (Mobitz I or wenchebach phenomenon)
-Type II (Mobitz II)
-2:1
-Advanced second degree AV block (high grade)

Third degree AV block

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4
Q

First degree AV block

A

Will have normal sinus rhythm characteristics, but a more than normal (over 0.20 PRI)

PRI will be constant

Causes: Acute myocardial infraction, acute myocarditis or endocarditis, cardiomyopathy, degenerative fibrosis and sclerosis of the conduction system, drug effects, etc

What to do about it: monitor patient

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5
Q

Second degree AV block type I

A

Type I, Mobitz I, wenchebach phenomenon

PRI will progressively get longer over time, followed by a “drop” (P wave with no QRS) and a reset of the rhythm.

Gradual shortening of R-R intervals

Causes: blockage of the right coronary artery (inferior myocardial infraction, right ventricular infraction), can also occur in healthy individuals during sleep or in athletes. Other possible causes - aortic valve disease, atrial septal defect, medications, etc.

What to do about it: monitor and normal pulse oximeter, oxygen, 12 lead ECG, IV access, etc

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6
Q

Second degree AV block type II

A

At least 2 beats in a row
Constant PRI
Fewer QRS
More P waves (P waves occur on time)
Atrial rate regular
Ventricular rate irregular

Causes: left coronary artery disease, anterior MI, acute myocarditis, aortic valve disease, cardiomyopathy, etc.

What to do about it: same as others monitor

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7
Q

Second degree AV block 2:1

A

One conducted P wave followed by a block P wave; thus 2 P waves for every QRS (2:1). P-P ratio will be higher than R-R ratio

Need at least TWO beats in a row to classify as a type I or type II. If there is only one beat, it’ll be most likely a 2:1

normal beat, “drop”, normal beat, “drop”, normal beat, “drop”

Always look at PRI and measure

Can be indications of pacemaker

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8
Q

Advanced second degree AV block

A

AV block high grade

Three or more consecutive P waves that are not conducted (multiple consecutive blocks “drops”)

Regular rhythm then “drops” (heart stops)

P waves are constant (sinus P waves)

PRI constant

P-P regular / R-R irregular

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9
Q

Third degree AV block

A

Complete heart block (CHB) - complete block in impulse conduction between the atria and ventricles (neither side knows what the other is doing)

P waves and QRS are completely dissociated - atria and ventricles are not communicating). P waves are constant

PRI inconsistent (long, short)

SA node creating atrial depolarization while ventricular depolarization happening, but neither is connected or working together

Causes: acute MI, acute myocarditis, drug effect, fibrosis of the conduction systems

What to do about it: same as others, monitor. IV access, pulse oximeter, medications, etc.

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10
Q

Which of the following dysthymias may be a normal finding in individuals with no history of cardiac disease?
A. Atrial fibrillation
B. First degree AV block
C. Third degree AV block
D. Ventricular tachycardia

A

B

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11
Q

Which of the following ECG components is used to detect AV conduction disturbances?
A. P wave
B. PR interval
C. QT interval
D. ST segment

A

B

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12
Q

The term second degree AV block type I is synonymous with:
A. Mobitz I
B. Mobitz II
C. Wenchebach
D. AV dissociation
E. High grade AV block
F. Wolf parkinson white pattern

A

A, C

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13
Q

Identify the ECG characteristics of 2:1 AV block:
A. The ventricular rate is twice the atrial rate
B. Atrial and ventricular rhythms are regular
C. Every other P wave is not followed by a QRS complex
D. PR intervals progressively lengthen until a P wave appears without a QRS after it

A

B, C

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14
Q

A key difference between second degree type I and type II AV block is that with:
A. Type I the P wave occurs irregularly
B. Type I the ventricular rhythm is regular
C. Type II the QRS duration is consistently more than 0.12sec in duration
D. Type II the PR intervals before and after a blocked P wave are constant

A

D

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15
Q

With third degree AV block, the PR interval:
A. shortens
B. Is absent
C. Lengthens
D. Remains constant

A

B

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16
Q

Which of the following dysthymias is more commonly seen with an inferior wall myocardial infraction?
A. Sinus arrhythmia
B. Second degree AV block type I
C. Second degree AV block type II
D. Third degree AV block with wide QRS

A

B

17
Q

An ECG rhythm strip reveals an irregular ventricular rhythm at a rate of 46 to 54bpm, more P waves than QRS complexes with regular P-P intervals, PR intervals after nonconducted P waves are shorter than the interval preceding the nonconducted beats, and a QRS duration of 0.08sec. This rhythm is:
A. 2:1 AV block
B. Third degree AV block
C. Second degree AV block type I
D. Second degree AV block type II

A

C

18
Q

An ECG rhythm strip reveals an irregular ventricular rhythm at a rate of 28 to 40bpm, more P waves than QRS complexes, regular P-P intervals, a constant PR interval of 0.16sec, and a QRS duration of 0.14sec. This rhythm is:
A. 2:1 AV block
B. Third degree AV block
C. Second degree AV block type I
D. Second degree AV block type II

A

D

19
Q

A 67 year old man presents with a blood pressure of 64/42mm HG, a heart rate of 38bpm, and an oxygen saturation on room air of 90%. The cardiac monitor reveals a type II AV block. Interventions to consider in the management of this patient include:
A. Administer oxygen
B. Administering atropine
C. Establishing IV access
D. Obtaining a 12 lead ECG
E. Obtaining a cardiology consult
F. Preparing for temporary pacing

A

A, C, D, E, F

20
Q

ECG characteristics of third degree AV block include:
A. Regular atrial and ventricular rhythm
B. A QRS that may appear narrow or wide
C. An atrial rate is greater than the ventricular rate
D. PR intervals that are constant before each QRS

A

A, B, C

21
Q

An ECG rhythm strip shows a regular ventricular rhythm at a rate of 128bpm, one upright P wave before each QRS, a regular atrial rate, a constant PR interval of 0.24sec and a QRS duration of 0.08sec. This rhythm is:
A. Third degree AV block
B. Second degree AV block type I
C. Sinus tachycardia with first degree AV block
D. Junctional tachycardia with first degree AV block

A

C

EKG Certification (9 decks)

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