ECG Tutorial Part 1 - Dr. Johnston Flashcards
Treat sinus tachy
Find the cause and tx THAT
21yo otherwise healthy with 120bpm tachy most likely EKG finding
Supraventricular tachycardia
Normal sinus arrhythmia
Some beats are a little closer then others since you increase HR a little in inhalation and decrease a little in exhalation
Causes of sinus tachy 8
- Emotions (anxiety, fear)
- fever
- Preg
- Drugs
- Hyperthyroidism
- Anemia
- CHF
- Hypovolemia
Bradycardia causes 8
- Normal healthy people
- Athletes, yoga
- Sleep
- Fright
- Carotid sinus massage , carotid hypersensitivity = avoid tight collars
- Obstructive jaundice
- Sliding hiatal hernia
- Valsalva maneuver
9**. DRUGS : B-blocker, or hyperkalemia, HTN drugs
Biological conditions that can cause bradycardia
- acute Inferiror MI : you have more Vagal tone leading to N/V also
- Low pO2
- Low pH
- High BP
- High pCO2
- Sick Sinus Syndrome = going fast then going slow HR
- Ischemia
Tx bradycardia
** think of cause first** then ATROPINE
1. Atropine ——> repeat as needed, 2mg IV to 2mg IV
= can cause IOP (precipitate narrow angle) in glaucoma
= side effects : ABD distention, urinary retention
Automaticity
Cardiac cell that can spontaneously depolarize on its own during phase 4 of action potential ——> impulse
Premature Atrial Contraction causes
= normal heart pts
- Coffee
- Alcohol
- Stress
- Smoking
- COPD, CAD
Premature Atrial Contraction is what
Spontaneous fire in the SA node causing a smaller or different looking P wave and and the entire P, QRS,T complex to come sooner then expected, the next one takes longer then expected to come
Non-conductive Premature Atrial Contraction
P wave right after the T wave that is earlier then expected in the bpm, only with NO QRS following it , the next beat is farther then expected
Aberrant Premature Atrial Contraction
Premature p wave that causes the entire P,QRS,T to look different then normal
Premature Atrial Contraction TX
Nothing (reverse cause) unless symptomatic :
1. Small does B-blocker = Metoprolol
Paroxysmal Atrial Tachycardia (PAT)
= sudden unset HR greater then 100
- Rate 150- 250bpm
- From irritable foci someplace ——> P’ wave
Paroxysmal Atrial Tachycardia (PAT) causes
- Ischemia or hypoxia in atrium
Paroxysmal Atrial Tachycardia (PAT) looks like on ECG
Normal HR then premature P wave comes
- Then all beats after are that rhythm
- Only premature P wave is in place of the T normal wave and that happens every time in every beat
2:1 P’:QRS and you cant see T wave is what
2 spiked p waves for every QRS
= Paroxysmal Atrial Tachycardia (PAT) (you cant really see the T wave) + AV BLOCK
= suspect digitalis excess or toxicity
Multifocal Atrial Tachycardia (MAT)
- 3 or more P waves (meaning at least 3 p waves that look different)
- Irregular V rhythm
- Beats over 100bpm
Multifocal Atrial Tachycardia (MAT) associated with
- COPD ** = LUNG
- Pneumonia ** = LUNG
- Ventilator theophylline ** = LUNG
- B agonist
- Low K or low Mg
- digitalis toxicity ** which is drug for CHF or arrhythmia
- Sepsis
Multifocal Atrial Tachycardia (MAT) TX
- Ca Channel Blocker : CCB, be careful can make worse
- MgSO2 + Amiodarone / Adenosine
- Diliazem
- Verapamil
Multifocal Atrial Tachycardia (MAT) dont give
- B -Blocker
2. Digitalis
Atrial Fibrillation wha happens
- 350bpm - 600bpm, quivering P waves = undulation of baseline cant see what some P waves are
- Irregularly Irregular ** ventricular rhythm = QRS is not regular
- Causes blood to pool ——> clots form ——> travel to brain, kidney, foot other places
Atrial Flutter looks like what and seen in what leads
- “ Saw tooth appearance”
2. Leads 2,3,AVF, V
Atrial Flutter bpm
250-350bpm
Atrial Flutter with 2:1 AV Block
2 atrial saw tooth looking waves for each QRS
Proximal Junctional Tachycardia looks like
- Inverted P wave since ectopic impulse firing up is from junction above AV node
- Upright QRS wave
- P wave can come before QRS, after QRS, or after T wave
Proximal Junctional Tachycardia what happens no bpm
- Sudden ,Narrow QRS
- Cant see P wave is probably is buried ——> supraventricular tachycardia contraction (PSVT)
= 150-250bpm
Supraventricular tachycardia contraction (PSVT)
A type of Proximal Junctional tachy + proximal atrial tachy
= you cant see P wave or really know for sure you see T wave
Premature Ventricular Contraction (PVC, VPC) causes
- Normal heart
- CAD, MI, HF, myocardial ischemia, hypoxia
- Cardiomyopathy
- Acid base problem, electrolyte problem
- Hyperthyroidism
- Drugs
Things to order for abnormal EKG
- Toxicity panel
- CBC : ischemia or bleeding, hypoxia can be seen in vitals
- Electrolytes CMP
- ABG acid base
- Thyroid hormones hyperthyroidism
Premature Ventricular Contraction (PVC, VPC) looks like what on EKG
- Premature not normal looking QRS
- No P wave or small inverse P wave in ST segment
- ST-T wave opposite of QRS
More then 3 Premature Ventricular contractions
For longer then 30 sec = V tach with hemodynamics significance
Multifocal Premature Ventricular Contraction
More then 2 foci = more then 2 different looking QRS waves from different places in V
= they are hemodynamicaly unstable
Ventricular Premature contraction with R on T phenomenon
Means premature beat happens during repolarization of normal beat
= notch in the bottom part of QRS ( S wave)
Accelerated idioventricular rhythm
Looks like very bad V tach = huge upward wide R and narrow S
= you dont see P or T
= this is GOOD
= after thrombolysis is done ( clot buster is working)
Premature Ventricular Contraction (PVC, VPC) TX
- Stable = nothing
- Symptomatic or acute coronary syndrome = give B-blocker small dose ( Metoprolol)
- Unstable : Amiodarone, Lidocaine , Procainamide
Monomorphic Ventricular tachycardia
All the same looking V Tach
Sustained V Tach
Goes on and on until something is done
Torsades de Pointes what is it
“ twisting of the points”
- QRS goes from + to - direction
- Looks like a party streamer like a twisting flat streamer
Causes of Torsades de Pointes
- Anti-psychotic , anti- arrhythmia
- Alcohol
- TCA
- Inherited prolonged QT
- Electrolytes imbalanced
Torsades de Pointes TX
- Pacemaker put in
- MgSO4 IV
- Isoproterenol
- Remove the drug and reverse it if they were taking something
When will you most likely be asked to do CPR
Ventricular Fibrillation
Ventricular Fibrillation is what
No pumping, quivering
Disorganized depolarization of V
= usually no pulse and not conscious
Ventricular Fibrillation causes
- AMI
- HF
- IHD (ischemic heart disease)
- K+ low or high
Asystole
No rhythm , goes away downward line
