Dysrhythmia

Question 1

Atrial Fibrillation

Answer 1

Absent P-waves w/ random oscillation of the baseline; ventricular rhythm is irregularly irregular

***Look in leads VI, V2, II, III, and aVF

Question 2

Inferior leads

Answer 2

II, aVF, III

Question 3

High lateral leads

Answer 3

I, aVL

Question 4

Atrial Flutter

Answer 4

Rapid, regular atrial undulations; should be evenly spaced ventricular depolarizations

“Sawtooth appearance”

• INVERTED flutter w/o isoelectric baseline in inferior leads
• V1 should have small, positive deflections

Question 5

Multifocal Atrial Tachycardia

Answer 5

P-waves that have at least 3 different origins and will appear radically different on the EKG; will have isoelectric baseline

Causes: Cor Pulmonale, COPD, HF, Pulmonary Edema

Question 6

Unifocal Atrial Tachycardia

Answer 6

3 or more consecutive atopic atrial beats in which the P-wave may precede or be buried in the QRS; QRS is narrow indicating sinus rhythm

HOGH ASSOC. W/ DIGITALIS TOXICITY

-has a distinct isoelectric baseline b/w the p-waves unlike atrial flutter; but the QRS complexes should be regularly regular

Question 7

Premature Junctional Complex

Answer 7

Will see inverted p-waves in inferior leads; upright p-waves in left-lateral leads

QRS APPEARS WIDE AND BIZARRE; can progress to ventricular tachycardia

*P-waves seen due to AV nodal conduction activating the atria in the opposite direction (superiorly)

Question 8

Junctional Escape Complex

Answer 8

QRS occurring after a pause of atrial rhythm; may occur after cessation of atrial tachycardia, flutter, etc.

Question 9

Junctional Rhythm

Answer 9

Possible AV dissociation but R-R interval is typically normal; if retrograde atrial activation occurs (which would look like what?) constant QRS-P interval is present

***Digitalis toxicity possible if there is atrial flutter w/ typical R-R interval
=»indicative of complete heart block w/ junctional rhythm

-Could also be acute MI, myocarditis, following CABG

Question 10

PACs

Answer 10

Premature Atrial Complexes (is just what it sounds like)

P-waves will look abnormal; QRS is unchanged

Causes: Drugs, ethanol, stress, heart disease, smoking

Question 11

Lateral Leads

Answer 11

V2-V4

Question 12

Septal Leads

Answer 12

V1, V2

Question 13

If you suspect an aortic dissection, what should you order?

Answer 13

CT w/ contrast

Question 14

Possible EKG findings in acute dysrhythmia

Answer 14

ST elevation/depression

Pathological Q-wave

T-wave inversion