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ECG > ECG Rhythms And Disturbances > Flashcards

ECG Rhythms And Disturbances Flashcards

1
Q

What is a normal axis?

A

Positive lead I and AVF

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2
Q

What is a left axis deviation?

A

Positive lead I and negative AVF

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3
Q

What is a right axis deviation?

A

Negative lead I and positive aVF

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4
Q

What are the sx of arrhythmia?

A

Palpitations (skips, pounds, irregular)
Lightheadedness
Syncope (near syncope)
CP, dyspnea, sudden death

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5
Q

What are the etiologies for arrhythmias?

A

Stress, ischemia, MI, HF, hypoxia, PE, COPD, metabolic acidosis, infection (endocarditis, RF), inflammation (myocarditis, pericarditis), cardiomyopathy, alcohol, chemo, electrolyte imbalance, drugs, HTN

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6
Q

What can cause sinus tachycardia?

A

Emotion, anxiety, fear, drugs, hyperthyroidism, fever, pregnancy, anemia, CHF, hypovolemia

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7
Q

What medical conditions are associated with bradycardia?

A

Can be seen in normal individuals or healthy athletes
Physiologic component to sleep, fright, carotid sinus massage, carotid hypersensitivity, avoid tight collars, shave neck lightly, massage or ocular pressure (glaucoma), mental control
Obstructive jaundice
Sliding hiatal hernia
Valsalva maneuver (lifting heavy objects, straining bowels)
Drugs & electrolytes (digitalis, quinidine, hyperkalemia)
Beta blockers

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8
Q

What are some other medical conditions associated with bradycardia?

A 
Acute inferior MI (increased vagal tone, N/V)
Ischemia 
Decreased PO2 and pH 
Increased pCO2 and BP
Sick sinus syndrome
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9
Q

What is the treatment for sinus bradycardia?

A

Depends on clinical setting/Dx the cause (may not need to be treated)
Depends on hemodynamics/impaired
Atropine (AE include urinary renting, abd distention, transient)
Use cation in glaucoma (can increase IOP)

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10
Q

What is automaticity?

A

Property of a cardiac cell to depolarize spontaneously during phase 4 of AP/leads to generation of an impulse

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11
Q

Premature atrial contractions (PAC/APC) are usually associated with what?

A

Can be seen in an absence of heart disease

Associated with stress, alcohol, tobacco, coffee, COPD and CAD

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12
Q

What is the treatment for symptomatic PACs?

A

Reverse causes, beta adrenergic antagonist (BB), metoprolol 25-50mg BID/TID

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13
Q

What is paroxysmal atrial tachycardia?

A

Sudden HR greater than 100
Rate 150-250/min
ID irritable focus
Rapid rate, spiked P waves, 2:1 ratio of P:QRS

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14
Q

What is multifocal tachycardia (MAT)?

A 
3 or more different P waves 
PR interval varies 
Irregular ventricular rhythm 
Atrial rate >100 
Associated with lung disease (COPD, pneumonia, ventilators theophylline), beta agonists, electrolyte abnormalities, digitalis toxicity, sepsis
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15
Q

How is MAT treated?

A 
Focus on the underlying cause 
Ca channel blockers to control vent rate and dec ectopic atrial impulse 
Diltiazem 20mg IV then 5-15mg/hr drip
Verapamil 
MgSO4 then amiodarone/adenosine
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16
Q

What is atrial fibrillation?

A 
Atrial rate >350-600/min 
Undulating baseline 
No discernible P waves 
Irregular PR interval 
Irregularly irregular ventricular rhythm
17
Q

How is atrial flutter described on an EKG?

A

Saw tooth appearance

Leads II, III, AVF and V often best leads to view this

18
Q

What are junctional (nodal) rhythms?

A

Paroxysmal junctional tachycardia
150-250/min
P wave may be lost (buried), inverted before or after each QRS

19
Q

What is the etiology for premature ventricular contractions (PVCs)?

A

Normal heart
CAD, MI, HF, ischemia, hypoxia
Valvular heart disease, congenital heart disease
Cardiomyopathy, electrolyte abnormalities
Acid base imbalance
Hyperthyroid
Drugs

20
Q

What are the EKG characteristics for PVCs?

A

Premature, bizarre wide QRS
No preceding P wave; may produce a retrograde P wave in ST segment
ST-T wave moves in opposite direction of QRS
Usually full compensatory pause

21
Q

What is the treatment for PVCs?

A

If stable, no Rx
If symptomatic or in setting of ACS use metoprolol 2.5-10mg
If unstable use amiadarone, lidocaine, procainamide

22
Q

What is ventricular tachycardia?

A

3 or more consecutive bizarre QRS complexes
Ventricular rate 120-200
Usually regular, wide QRS (> 0.12 seconds)
P wave often lost; if seen, no relationship to QRS (AV dissociation)
Last longer than 30 seconds (sustained)

23
Q

What is torsades de pointes?

A 
Twisting of the points 
QRS swings from positive to negative direction 
May be inherited (prolonged QT) or acquired (class I, II anti-arrhythmias, alcohol, TCA, electrolyte imbalance—K, Ca, Mg)
24
Q

What is the treatment for torsades de pointes?

A

MgSO4 1-2g IV boys
Overdrive pacing
Isoproterenol

25
Q

What is ventricular fibrillation?

A

Disorganized depolarization
Not effective pump
Clinical setting — AMI, HF, IHD, K disturbance (low or high)

ECG (3 decks)

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