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Y3 - CLASP Sudden Death > ECG interpretation and Cardiac Arrhythmias > Flashcards

ECG interpretation and Cardiac Arrhythmias Flashcards

1
Q

p wave

A

atrial depolarisation (contraction)

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2
Q

QRS complex

A

ventricular depolarisation, atrial repolarisation

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3
Q

T wave

A

ventricular repolarisation (resting phase)

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4
Q

U wave

A

usually not visible, may indicate hypokalaemia

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5
Q

when is bradycardia normal?

A

in athletes
during sleep
in response to a vagal manoeuvre

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6
Q

name some causes of brady

A 
Hypoglycaemia 
Hypothyroidism 
Previous cardiac history Medications 
Toxic exposure 
MI – inferior wall involving right coronary artery
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7
Q

signs and symptoms of brady

A 
Syncope 
Dizziness 
Chest pain 
SoB 
Exercise intolerance 
Cool, clammy skin
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8
Q

risk of brady

A

reduced CO

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9
Q

treatment of Brady

A

if patient is symptomatic - atropine

if patient is haemodynamically compromised - pacing

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10
Q

causes of tachy

A 
Damage to heart tissues  
Hypertension 
Fever 
Stress 
Excess alcohol, caffeine, nicotine or recreational drugs such as cocaine 
Side effect of medications 
Response to pain 
Imbalance of electrolytes 
Hyperthyroidism
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11
Q

signs and symptoms of tachy

A 
Dizziness 
SoB 
Light headedness 
Rapid pulse rate 
Heart palpitations 
Chest pain 
Syncope
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12
Q

risks of tachy

A

CO may fall due to inadequate ventricular filling time
Myocardial oxygen demand increases
Can cause myocardial ischaemia or infarct

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13
Q

treatment of tachy

A

aimed at finding cause and treating

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14
Q

what is sinus arrest or pause?

A

Transient absence of sinus P waves that lasts from 2 seconds to several mins

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15
Q

causes of sinus arrest or pause

A 
May occur in individuals with healthy hearts during sleep 
Myocarditis 
Cardiomyopathy 
MI 
digoxin toxicity 
Elderly 
Vagal stimulation
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16
Q

signs and symptoms of sinus arrest or pause

A

Syncope
Dizziness
LOC
Bradycardia

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17
Q

risks of sinus arrest or pause

A 
Sudden cardiac death 
Syncope 
Fall 
Thromboembolic events inc stroke 
CHF 
Atrial tachyarrhythmias such as atrial flutter or fibrillation
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18
Q

treatment of symptomatic sinus arrest or pause

A

atropine

pacemaker

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19
Q

causes of atrial flutter

A 
>60 years old 
Mitral valve disorder 
Thickening of the heart muscle 
Ischaemia 
Cardiomyopathy 
COPD
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20
Q

signs and symptoms of atrial flutter

A 
Palpitations 
SOB 
Anxiety 
Weakness 
Angina 
Syncope
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21
Q

risks of atrial flutter

A

Clot formation in atria as atria not completely emptying -> stroke, PE
Dramatic drop in cardiac output

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22
Q

treatment of atrial flutter

A

Cardioversion
Antiarrhythmics such as procainamide
Slow ventricular rate using diltiazem, verapamil, digitalis or B blocker
Heparin to reduce incidene of thrombus formation

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23
Q

causes of atrial fibrillation

A 
Hypoxia 
Hypertension
Congestive heart failure 
Coronary artery disease 
Dysfunction of the sinus node 
Mitral valve disorders 
Rheumatic heart disease 
Pericarditis 
Hyperthyroidism 
Excessive alcohol or caffeine consumption
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24
Q

signs and symptoms of atrial fibrillation

A 
Heart palpitations 
Irregular pulse which feels too rapid or too slow, racing, pounding or fluttering
Dizziness or light-headedness 
Fainting
Confusion
Fatigue 
Trouble breathing
Difficulty breathing when lying down 
Sensation of tightness in the chest
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25
Q

risks of atrial fibrillation

A

Clot formation in atria (atria not completely emptying) -> Stroke or PE
Dramatic drop in cardiac output

26
Q

treatment of atrial fibrillation

A

Rate control using digoxin, beta-adrenergic blockers, calcium channel blockers
Anti-thrombotic therapy
Chemical or electrical cardioversion

27
Q

describe ventricular tachy

A
  • All fast arrhythmias in which the HR is greater than 150 bpm
  • Usually not a discernible P wave
28
Q

causes of ventricular tachy

A
  • Stimulants
  • Hypoxia
  • Stress or over exertion
  • Hypokalaemia
  • Atherosclerotic disease
29
Q

signs and symptoms of ventricular tachy

A
  • Palpitations
  • Chest discomfort
  • Light-headedness or dizziness
  • Syncope
  • SoB
  • Pounding pulse
  • Sweating
  • Tightness or fullness in the throat
  • Tiredness
  • Excessive urine production
30
Q

risk of ventricular tachy

A

heart failure

31
Q

treatment of ventricular tachy

A
  • Stable patients = vagal manoeuvres
  • Adenosine
  • Cardioversion if unstable
32
Q

what are premature atrial contractions?

A
  • Ectopic beat that originates from the atria
33
Q

causes of PACs

A
  • Occurs in healthy patients
  • Stress
  • Stimulants
  • Hypertension
  • Valvular condition
  • Infectious disease
  • Hypoxia
34
Q

signs and symptoms of PACs

A

palpitations

skipped beat

35
Q

risks of PACs

A
  • Benign

* May be a sign of underlying heart condition

36
Q

treatment of PACs

A

if symptomatic, treat the cause

BBs or CCBs

37
Q

describe premature ventricular contractions

A
  • Ectopic beat that arises from an irritable site in the ventricles
  • Always wide and bizarre compared to a normal beat
38
Q

causes of PVCs

A
  • Exercise
  • Stress
  • Caffeine
  • Heart disease
  • Electrolyte imbalances
  • Hypoxia
  • Tricyclic antidepressants
  • Digitalis toxicity
39
Q

signs and symptoms of PVCs

A
  • Palpitations
  • Weakness
  • Dizziness
  • Hypotension
40
Q

risks of PVCs

A
  • Reduced CO
  • HF
  • May convert to V tach or V fib
41
Q

treatment of PVCs

A
  • Oxygen
  • Treat the cause
  • Lidocaine
42
Q

describe idioventricular rhythm

A
  • Ventricular escape rhythm
  • Last attempt by ventricles to prevent cardiac standstill
  • Rhythm is slow, no P wave, wide and bizarre QRS
43
Q

causes of idioventricular rhythm

A
  • Drugs – digitalis
  • MI
  • Metabolic imbalances
  • Hyperkalaemia
  • Cardiomyopathy
44
Q

signs and symptoms of idioventricular rhythm

A
  • Pale
  • Cool with mottled skin
  • Weakness
  • Dizziness
  • Hypotension
  • Alteration in mental status
45
Q

risks of idioventircular rhythm

A
  • Usually a terminal event occurring before ventricular standstill
  • Death – cardiac arrest
46
Q

treatment of idioventricular rhythm

A
  • Atropine
  • Pacing
  • Dopamine when hypotensive
  • CPR
47
Q

what is accelerated idioventricular rhythm?

A

exactly the same except the rate is 41-100bpm

48
Q

describe agonal rhythm

A
  • Idioventricular rhythm is 20 beats or less per minute
  • Last ordered semblance of a heart rhythm when resus efforts are unsuccessful
  • no P waves
49
Q

causes of an agonal rhythm

A
  • Trauma
  • Acute MI
  • Natural progression to death
50
Q

describe ventricular fibrillation

A
  • Coarse and fine

- No coordinated atrial or ventricular contraction

51
Q

why does ventricular fibrillation occur?

A

can be deterioration from ventricular tachy

as a result of multiple weak ectopic foci in the ventricles

52
Q

causes of ventricular fibrillation

A
  • AMI
  • Untreated VT
  • Electrolyte imbalance
  • Hypothermia
  • Myocardial ischaemia
  • Drug toxicity or overdose
  • Trauma
53
Q

signs and symptoms of ventricular tachy

A
  • Loss of consciousness

* Absent pulse

54
Q

causes of torsades de pointes

A
  • Assoc with prolonged QT interval
  • Often caused by drugs recommended for VT
  • Phenothiazine or tricyclic antidepressant overdose
  • Electrolyte disturbances, especially hypokalaemia and hypomagnesemia
55
Q

signs and symptoms of torsades de pointes

A
  • Chest pain
  • Loss of consciousness
  • Dizziness
  • Nausea
  • SoB
56
Q

treatment of torsades de pointes

A
  • CPR
  • Eliminate predisposing factors
  • Magnesium sulfate bolus
  • Synchronised cardioversion when the patient is unstable if possible or defibrillate
57
Q

causes of asystole

A
  • Extensive myocardial damage, secondary to MI
  • Failure of pacemakers
  • Cardiac tamponade
  • Prolonged V fib
  • PE
58
Q

signs and symptoms of asystole

A
  • No palpable pulse
  • No measurable BP
  • Loss of consciousness
59
Q

causes of pulseless electrical activity

A

Hs and Ts

60
Q

signs and symptoms of PEA

A
  • Pulselessness
  • Loss of consciousness
  • No palpable BP

Y3 - CLASP Sudden Death (7 decks)

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