Dubin first2 Flashcards
parasystolic
when an automaticity foci has an entrance block, and paces but cannot be overdrive suppressed
irregular rhythms
usually caused by multiple active automaticity sites
entrance block
blocks incoming depolarization in automaticity foci, cannot be overdrive suppresed
wandering pacemaker
an irregular rhythm produced by the pacemaker activity wandering from the SA Node to nearby atrial automaticity foci
wandering pacemaker
p’ wave shape varies, atrial rate less than 100, irregular ventricular rhythm
P’ wave
atrial depolarization by an automaticity focus, as opposed to normal sinus-paced p waves
multifocal atrial tachycardia (MAT)
irregular rhythm, p’ wave shape varies, atrial rate exceeds 100, irregular ventricular rhythm
multifocal atrial tachycardia (MAT)
a rhythm of patients with Chronic Obstructive Pulmonary Disease (COPD), with P’ waves of different shapes, since three or more atrial foci are involved
atrial fibrillation
irregular rhythm, continuous chaotic atrial spikes, irregular ventricular rhythm
atrial fibrillation
caused by the continuous rapid-firing of multiple atrial automaticity foci. no single impulse depolarizes the atria completely and only occasional ones reach AV node to be conducted to ventricles, no p waves
sinus arrhythmia
considered normal, varies with respiration, constant p waves
escape rhythm
an automaticity focus escapes overdrive suppression to pace at its inherent rate
escape beat
an automaticity focus transiently escapes overdrive suppression to emit one beat, due to sinus block
sinus arrest
when a sa node ceases pacemaking completely
junctional automaticity focus
pacing from av node, conducts to ventricles, may depolarize atria from below producing inverted p’ waves with an upright qrs
junctional automaticity focus
retrograde (inverted) p’ wave immediately before each qrs, after each qrs, or within each qrs
stoke’s adams syndrome
pacing from ventricular focus so slow that blood flow to the brain is reduced to the point of unconsciousness
ventricular escape beat
produces enormous QRS complex, caused by burst of parasympathetic activity that depresses SA node and atrial and junctional foci
premature beat
originates in an irritable automaticity focus that fires spontaneously, producing a beat earlier than expected in the rhythm
atrial, junctional
____ and ____ foci become irritable bc of adrenaline, increased sympathetic stimulation, caffeine, digitalis, hyperthyroidism, (adrenergic substances) stretch, low O2
premature atrial beat (PAB)
originates suddenly in an irritable focus, produces a P’ wave earlier than expected, or hides in T wave, making it taller than usual
resets
a center of automaticity ____ its rhythm when it is depolarized by a premature stimulus
aberrant ventricular conduction
if ventricular conduction system is depolarized by a Premature Atrial Beat but one Bundle Branch is not completely repolarized (still a little refractory), produces slightly widened QRS for one cycle
non-conducted
a ________ premature atrial beat is unable to depolarize a refractory AV node, no ventricular (QRS) response, does depolarize SA node to reset the pacemaking cycle
atrial bigeminy
an irritable automaticity focus fires a Premature Atrial Beat that couples to the end of a normal cycle, and repeats this process by coupling a PAB to the end of each successive normal cycle, resets cycle
couplet
the cycle containing the premature beat together with the cycle or cycles to which it couples
atrial trigeminy
when an irritable atrial focus prematurely fires after 2 normal cycles repeatedly
premature junctional beat
when an irritable focus in the av junction spontaneously fires a stimulus, widened qrs
junctional bigeminy
when an irritable junctional focus fires a premature stimulus coupled to the end of each normal cycle
junctional trigeminy
when an irritable junctional focus fires a stimulus after two consecutive normal cycles
ventricular
a _____ focus can be made irritable by low O2, Low K+, pathology (mitral valve prolapse)
Premature Ventricular Complex (PVC)
produced on EKG by irritable ventricular focus that suddenly fires, occur early in cycle, easily recognized by their great width and enormous amplitude, usually opposite polarity of normal QRS, weaker pulse bc ventricles aren’t filled yet
unifocal
6 or more PVCs per minute is pathological, if they are identical, they are _____ (from the same focus)
ventricular bigeminy
when a PVC becomes coupled with a normal cycle with every cycle
ventricular trigeminy
when a PVC couples with every two normal cycles
ventricular parasystole
produced by a ventricular automaticity focus that suffers from an entrance block that is not irritable. not vulnerable to overdrive suppression
ventricular tachycardia
a run of three or more PVC’s in rapid succession, if lasts longer than 30 seconds it is sustained
mitral valve prolapse (MVP)
causes PVC’s, including runs of VT and multifocal PVC’s, yet it is considered a benign condition, the mitral valve is floppy and billows into left atrium during ventricular systole
R on T phenomenon
if a PVC falls on a T wave, particularly in situations of hypoxia or low serum potassium, dangerous arrhythmias may result
tachyarrhythmias
rapid rhythms originating in very irritable automaticity foci
paroxysmal tachycardia
tachyarrhythmia from 150 to 250 bpm
flutter
tachyarrhythmia from 250 to 350 bpm
fibrillation
tachyarrhythmia from 350 to 450 bpm
paroxysmal tachycardia
a very irritable automaticity focus suddenly paces rapidly (atrial, junctional, ventricular)
paroxysmal atrial tachycardia (PAT)
rate range from 150 to 250 bpm, P’ waves that do not look like sinus generated P waves, normall appearing cycles
PAT with AV block
more than one P’ wave spike for every QRS complex, suspect digitalis excess or toxicity, atrial foci are very sensitive to digitalis
paroxysmal junctional tachycardia (PJT)
rate range from 150 to 250, may depolarize atria from below in retrograde fashion with inverted P’ wave before, after, or buried within each QRS complex, may be widened QRS
AV nodal reentry tachycardia (AVNRT)
type of junctional tachycardia, a continuous reentry circuit develops and rapidly paces the atria and ventricles
paryoxysmal supraventricular tachycardia (SVT)
includes PAT and PJT, all foci above ventricles
paryoxysmal ventricular tachycardia (PVT)
rate range from 150 to 250, characteristic pattern of enormous, consecutive PVC-like complexes, SA node still paces the atria,
fusion beat
a blending on the EKG of a normal QRS with a PVC-like complex, confirms the diagnosis of VT
torsades de pointes
peculiar form of very rapid ventricular rhythm caused by low potassium, medications that block potassium, or congenital abnormalities, lengthen the QT segment, rate between 250 and 350 bmp, usually in brief episodes, outline looks like a twisted ribbon
atrial flutter
extremely irritable atrial automaticity focus fires at 250 to 350 bpm, producing a rapid series of atrial depolarizations,identified by inverting tracing or vagal maneuvers
ventricular flutter
rate range of 250 to 350 bpm, produced by a single ventricular automaticity focus, produces a rapid series of smooth sine-waves of similar amplitude, ventricles dont have time to fill, rapidly becomes deadly
Atrial fibrillation (AF)
rate range of 350 to 450 bpm, caused by many irritable parasystolic atrial foci, rapid erratic atrial rhythm with irregular ventricular response, may just look like irregular baseline with irregular QRS complexes
ventricular fibrillation
rate range of 350 to 450 bpm, caused by rapid-rate discharges from many irritable, parasystolic ventricular automaticity foci, erratic, rapid twitching of ventricles, no effective cardiac output
cardiac standstill (asystole)
occurs when there is no detectable cardiac activity on EKG, rare, the SA node and the escape mechanisms of all the foci at all levels are unable to assume pacing responsibility
pulseless electrical activity (PEA)
present when a dying heart produces weak signs of electrical activity on EKG but the heart cannot respond mechanically (no detectable pulse)
automated external defibrillator (AED)
small portable unit for defibrillation
implantable cardioverter defibrillator (ICD)
implanted under skin delivers shock if needed automatically
WPW (wolff-parkinson-white) syndrome
an abnormal accessory Bundle of Kent short-circuits usual delay of AV node and causes ventricular pre-excitation, produces delta wave on EKG just before normal ventricular depolarization begins
(lown-ganong-levine) LGL syndrome
the AV node is bypassed by an extension of the anterior internodal tract. without the AV node conduction delay, this “James bundle” conducts atrial depolarizations directly to the His Bundle without delay,
blocks
retard or prevent the conduction of depolarization, may occur in SA node, AV node, His bundle, Bundle Branches, Left Bundle Branch
sinus block
an unhealthy sa node stops pacing for at least one complete cycle, may induce an escape beat from an automaticity focus
SSS (sick sinus syndrome)
a wastebasket of arrhythmias caused by SA node dysfunction associated with unresponsive supraventricular automaticity foci, which are also dysfunctinoal and can’t employ their normal escape mechanism to assume pacing responsibility, marked bradycardia
Bradycardia-Tachycardia Syndrome
when patients with SSS develope intermittent episodes of SVT mingled with sinus bradycardia
first degree AV block
retards AV node conduction, prolongs PR interval more than one large square, PR interval is consistently prolonged the same amount every cycle and following sequence is normal
second degree AV block
allows some atrial depolarizations to conduct to the ventricles, while some atrial depolarizations are blocked, leaving lone P waves, 2 types
Wenckebach blocks
second degree blocks of AV node, produce a series of cycles with progressive blocking of AV node conduction until the final P wave is totally blocked in the AV Node, eliminating the QRS complex, consistent P:QRS ratio like 3:2, 4:3, etc, innocuous
Mobitz blocks
second degree blocks of Purkinje fiber bundles, produce a series of cycles consisting of one normal P-QRS-T cycle preceded by a series of paced P waves that fail to conduct through the AV node. ratios like 3:1, 4:1, 5:1, pathological, widened QRS
mobitz
if there is a 2:1 av block and parasympathetic stimulation has no effect of eliminates block, it was a _______ block
wenckebach
if there is a 2:1 av block and parasympathetic stimulation increases the number of cycles/series, it was a _______ block
third degree AV block
completely blocks AV conduction, automaticity focus below the block escapes to pace the ventricles at its inherent rate
downward displacement of the pacemaker
the failure of all automaticity centers above the ventricles-bad prognosis
bundle branch block (BBB)
caused by a block in the right or left bundle branch, the blocked branch delays depolarization to the ventricle that it supplies, causes two joined QRS’s on the EKG, QRS is 3 small squares (.12s) or greater, and there are 2 R waves
intermittent mobitz
occasional dropped qrs due to permanent BBB (one side) with intermittent BBB of the other side
hemiblock
a block of one of the two subdivisions (fasicles) of the left bundle branch, commonly occurs with infarction
reverse
when an automaticity foci has an entrance block, and paces but cannot be overdrive suppressed
parasystolic
reverse
usually caused by multiple active automaticity sites
irregular rhythms
reverse
blocks incoming depolarization in automaticity foci, cannot be overdrive suppresed
entrance block
reverse
an irregular rhythm produced by the pacemaker activity wandering from the SA Node to nearby atrial automaticity foci
wandering pacemaker
reverse
p’ wave shape varies, atrial rate less than 100, irregular ventricular rhythm
wandering pacemaker
reverse
atrial depolarization by an automaticity focus, as opposed to normal sinus-paced p waves
P’ wave
reverse
irregular rhythm, p’ wave shape varies, atrial rate exceeds 100, irregular ventricular rhythm
multifocal atrial tachycardia (MAT)
reverse
a rhythm of patients with Chronic Obstructive Pulmonary Disease (COPD), with P’ waves of different shapes, since three or more atrial foci are involved
multifocal atrial tachycardia (MAT)
reverse
irregular rhythm, continuous chaotic atrial spikes, irregular ventricular rhythm
atrial fibrillation
reverse
caused by the continuous rapid-firing of multiple atrial automaticity foci. no single impulse depolarizes the atria completely and only occasional ones reach AV node to be conducted to ventricles, no p waves
atrial fibrillation
reverse
considered normal, varies with respiration, constant p waves
sinus arrhythmia
reverse
an automaticity focus escapes overdrive suppression to pace at its inherent rate
escape rhythm
reverse
an automaticity focus transiently escapes overdrive suppression to emit one beat, due to sinus block
escape beat
