Conduction Disorders: Arrhythmias

Question 1

Rhythm starting from Sinus Node shows what on the multiple lead EKG

Answer 1

Upright P waves seen in I, II, III and aVF

Question 2

What is the PR interval like in 1st Degree Block?
What is the P wave and QRS relationship?
Treatment?

Answer 2

PR intervals are prolonged (>.2 sec, 1 large block) and constant.
P wave for every QRS.
Not a concern as age related normal variant

Question 3

PR intervals in 2nd Degree Block, Mobitz I or Wenkenbach?
P waves?
Treatment?

Answer 3

PR intervals gradually increase until QRS complex dropped.
P waves constant.
Most of the time do nothing as it doesn’t progress, can use atropine.

Question 4

Type 2 or Mobitz II AV Block
PR intervals?
P waves?
Treatment?

Answer 4

PR interval stays constant, then dropped QRS.
P waves constant
Sudden loss of P wave conduction, treat with pacer.

Question 5

3rd Degree AV Block,
PR intervals? P waves? QRS waves
Treatment?

Answer 5

PR intervals are random and change, some long some short.
P waves constant, QRS waves constant but don’t communicate with each other.
No conduction, pacer.

Question 6

When you see no P waves and a Wide QRS Regular Tachycardia think what?

Answer 6

VTach

Question 7

What has this pattern: atrial activity with sawtooth pattern

Answer 7

Atrial Flutter

Question 8

How long should the PR interval be?
What is the value of a large square?
What is the value of one small square?
How do you determine HR?

Answer 8

<0.2 sec.
0.2 sec.
.04 sec.
# of big squares between R waves/300

Question 9

How wide should the QRS be?

What is the value of one small box?

Answer 9

<0.12 sec or <3 small boxes

One small box = 0.04 sec

Question 10

Sinus Tachycardia
Rate typically? Narrow or wide QRS? Regular or irregular QRS? P wave?
Treatment?

Answer 10

<150 BPM
Narrow Regular QRS
P wave for every QRS
Treat underlying cause, never shock!

Question 11

Atrial Flutter is circuit movement in the atria
Rate?
Pattern?
Where to look?
QRS?

Answer 11

150 BPM
Saw tooth pattern
Narrow regular QRS
Look in all leads

Question 12

AFIB, atrium fires all over the place
Pattern?
P wave
QRS

Answer 12

Irregularly irregular, narrow irregular QRS: no distinct regular atrial activity–no P wave, but recognizable QRS

Question 13

Torsades de point has what EKG finding?
Causes?
Treatment?

Answer 13

Polymorphic Ventricular Tachycardia and QT prolongation.
(Rapid irregular QRS complex: Big,Big, Big, small, small, small.)
Causes: Hypokalemia, Hypomagnesium, hypocalcemia.

With prolonged QT than treat with Mg (Note Type 1 med makes this worse)

Question 14

Ventricular Fibrillation
Pattern?
Treatment?

Answer 14

Chaotic weird wavy baseline.
No pulse
Electricity fast, right now

Question 15

Multi focal Atrial Tachycardia (MAT)--what is this?
P wave pattern?
QRS?
Cause?
Treatment?

Answer 15

Multiple areas (ectopic Foci) in the atrium generate action potentials that are all conducted to the ventricles.
P waves present, but irregular and with >/= 3 morphological.
Narrow, but irregular QRS.
Usually COPD exacerbation; pneumonia, pulm Htn
Treat underlying cause, never shock

Question 16

What are the two Tachycardias that you never shock?

Answer 16

Sinus Tachycardia
Multi focal Atrial Tachycardia (MAT)

Treat the underlying cause.

Question 17

A Flutter and AFib
Causes?
Treatment?

Answer 17

HTN, CAD, CHF, COPD, Other chronic diseases: thyrotoxicosis, DM, CKD, metabolic syndrome, Etoh Use and withdrawal.
A flutter is easy to cardiovert, A fib is hard to cardiovert.
Anticoagulant, AV nodal blocker: Ca Ch Blocker or B Blocker, Type 1 meds–antiarrythmic agents: procainamide, lidocaine, amiodarone

Question 18

AFib with pre-excitation: Wolf-Parkinson-White
What is the ventricular rate approaching?
QRS morphology?
Treatment?

Answer 18

Rate approaching 300 BPM. This can kill if unstable.
QRS varies in morphology: width changes.
If unstable Shock patient. This can kill patient if treat like regular AFib.
Stable: Treat with procainamide and needs ablation.

Question 19

AFib with BBB
Rate?
QRS complex?
Treat?

Answer 19

Rarely >200 BPM
QRS complex has identical wide morphology.
Treat like AFIB.

Question 20

What is the QRS like in Right Bundle Branch Block?

What are the EKG findings?

Answer 20

QRS is wide.

-rsR’ pattern in V1 and V2

Question 21

What is the EKG pattern for LBBB?

Answer 21

Broad notched R wave in lateral leads: I, aVL, V5, V6

Question 22

What do inverted T waves on EKG mean?

Answer 22

Myocardial ischemia.

Question 23

Atrial Flutter is most often seen with what medical condition?

Answer 23

COPD

Question 24

What category are these medications: Verapmil or diltiazem?

Answer 24

Calcium Channel Blockers

Question 25

What is considered an unstable arrhythmia that needs to be treated with electricity?
What are stable arrhythmias treated with?

Answer 25

Signs of unstable arrhythmia: chest pain, dyspnea, altered mental status, hypotension.
Meds.

Question 26

What is the EKG finding for pericarditis?

Answer 26

Widespread concave ST elevation and PR depression throughout most of the leads.

Question 27

What is the EKG finding for pericardial effusion?

Answer 27

Low voltage, tachycardia, electrical alternans(when consecutive normally conducted QRS complexes alternate in height).

Question 28

How do you determine on the EKG if it is LVH?

Answer 28

One large box measuring vertically = 5mm.

Sum of the deepest S in V1, V2 + tallest R in V5, V6 >35

Question 29

What is Sick Sinus Syndrome?

Answer 29

Brady-Tachycardia Syndrome: intermittent paroxysms of SVT interspersed with periods of Bradycardia, commonly causes syncope seen in the elderly.