EKG

Question 1

What are the four types of irregular rhythms?

Answer 1

1. Sinus Arrhythmia
2. Wandering Pacemaker
3. Multifocal Atrial Tachycardia
4. Atrial Fibrillation

Question 2

What are the characteristics of a sinus arrhythmia? (3)

Answer 2

1. Irregular rhythm that varies w/ respiration
2. All P-waves are IDENTICAL
3. These trends are considered normal.

Question 3

What are the characteristics of a Wandering Pacemaker? (3)

Answer 3

1. Irregular rhythm
2. P-waves CHANGE SHAPE as the pacemaker locations varies
3. Rate = Less than 100/minute

Question 4

What are the characteristics of a Multifocal Pacemaker? (How is is it different from a Wandering Pacemaker)

Answer 4

It is essentially the same as a Wandering Pacemaker, except for the rate.

Rate = Greater than 100/minute

Question 5

What are the characteristics of Atrial Fibrillation? (2)

Answer 5

1. Irregular ventricular rhythm

2. Erratic atrial spikes (w/ NO P-waves) from multiple atrial automaticity foci.

Question 6

What are the two types of escapes?

Answer 6

Escape Beat

Escape Rhythm

Question 7

Explain an escape beat.

Answer 7

Where an unhealthy sinus node may fail to emit a pacing stimulus (“sinus block”).

This pause may evoke an escape beat from an automaticity foci.

After the escape beat (via either the atrial, junctional, or ventricle), the SA Node RESUMES its pacing.

Question 8

Explain an escape rhythm.

Answer 8

Where a sick SA Node may cease pacing (“sinus arrest”), causing an automaticity focus to “escape
to assume pacemaker status.

An automaticity of a lower level will take control as the dominant pacemaker if sinus arrest were to occur.

Question 9

For atrial, junction, and ventricular escape rhythm; what are their rates?

Answer 9

Atrial -> 60-80/minute
Junctional -> 40-60/minute
Ventricular -> 20-40/minute

Question 10

What is a premature beat?

Answer 10

Where an irritable automaticity focus may suddenly discharge, producing a depolarization before it is supposed to.

Question 11

What are the three categories of tachyarrhythmias?

Answer 11

Paroxysmal -> Flutter -> Fibrillation

Question 12

What are the rate ranges for the three categories of tachyarrhythmias?

Answer 12

Paroxysmal -> 150-250/minute
Flutter -> 250-350/minute
Fibrillation -> 350-450/minute

Question 13

What is a characteristic of paroxysmal atrial tachycardia (PAT)? (2)

Answer 13

Discharging @ 150-250/minute.

Produces a normal wave sequence if P’ waves are visible.

Question 14

What is a characteristic of a paroxysmal atrial tachycardia w/ a Block?

Answer 14

It is the same as PAT, except that every second (or more) P’ wave produces a QRS.

Question 15

What is a characteristic of junctional tachycardia? (2)

Answer 15

Produces a rapid sequence of QRS-T cycles @ 150-250/minute.

QRS may be slightly widened.

Question 16

What is a characteristic of ventricular tachycardia? (1)

Answer 16

Ventricular focus produces a rapid sequence of PVC-like wide ventricular complexes.

Question 17

What are the characteristic of atrial flutter? (2)

Answer 17

1. Continuous “saw-tooth” rapid sequence

2. Many fluttering p-waves are needed to produce a ventricular response.

Question 18

What are the characteristics of ventricular flutter? (2)

Answer 18

1. Series of smooth, sine-waves form a single rapidly firing ventricular focus
2. Usually in a short burst leading to VF

Question 19

What the characteristics of atrial fibrillation? (2)

Answer 19

1. Multiple atrial foci rapidly discharging producing a jagged baseline of fine spikes.
2. Ventricular (QRS) response is irregular.

Question 20

What are the characteristics of ventricular fibrillation?

Answer 20

1. Foci rapidly discharging producing a totally erratic ventricular rhythm w/o identifiable waves.

Question 21

What will you see in a first degree AV block? (1)

Answer 21

1. Prolonged PR-intervals ( > 0.2 seconds or one large square)

Question 22

What are the two types of second-degree heart blocks?

Answer 22

1. Wenckebach
2. Mobitz

In a second degree heart block you may see some p-waves w/o a QRS response

Question 23

What is the characteristic of a Wenckebach second-degree AV block?

Answer 23

PR gradually lengthens w/ each cycle until the last p-wave in the series does NOT produce a QRS.

Question 24

What characteristic makes up a Mobitz second degree AV block?

Answer 24

Some P-waves don’t produce a QRS response.

May have a 2:1, 3:1, etc. ratio of p-wave to QRS

Question 25

What is a characteristic of a third degree AV block?

Answer 25

There will be only p-waves, but NO QRS response.

Question 26

In a third degree block, how do you know if the junctional focus is active? (2)

Answer 26

1. If the QRS is narrow

2. If the ventricular rate of 40-60/minute

Question 27

In a third degree block, how do ou know if the ventricular focus is active?

Answer 27

1. If the QRS is PVC-like

2. If the ventricular rate is 20-40/minute

Question 28

What is a landmark of a BBB?

Answer 28

R, R’ in the chest leads

Question 29

What do you always check besides the R,R’ for a BBB?

Answer 29

You check to see if the QRS is within 3 tiny squares.

Question 30

For a RBBB, what will you see?

Answer 30

1. A QRS in V1 and V2 w/ their R,R’

Question 31

For a LBBB, what will you see?

Answer 31

1. A QRS in V5 and V6 w/ their R/R;

Question 32

When checking for a hemiblock, what do you always check?

Answer 32

1. To see if the axis shifted outside of the normal range.

Question 33

What happens in an anterior hemiblock and what do you want to look for?

Answer 33

1. You will have an axis shift leftward (LAD)

2. Look for Q1/S3

Question 34

What happens in an posterior hemiblock and what do you want to look for?

Answer 34

1. You will have an axis shift rightward (RAD)

2. Look for S1/Q3

Question 35

What do you look for in atrial hypertrophy for both left and right sides?

Answer 35

You look for a diphasic p-wave. If the initial is larger, then it’s right atrial hypertrophy; if the terminal is larger, then its left atrial hypertrophy.