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SP: Cardiology Pearls (16%) > EKG > Flashcards

EKG Flashcards

1
Q

What arrhythmia is associated with the use of medications and sudden death?

A

Long QT syndrome

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2
Q

What do PVCs which increase in frequency with exertion represent?

A

Cardiac ischemia

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3
Q

What is the treatment for LBBB or RBBB?

A

No treatment - They are signs of an underlying condition

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4
Q

Chest pain plus a new LBBB (Left Bundle Branch Block) = ?

A

An acute heart attack until proven otherwise

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5
Q

First line treatment for ventricular fibrillation?

A

Unsynchronized cardioversion

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6
Q

First line treatment for ventricular tachycardia without a pulse?

A

Unsynchronized cardioversion

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7
Q

First line treatment for ventricular tachycardia with a pulse?

A

Synchronized cardioversion

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8
Q

For a patient with a stable SVT at 220 bpm what are the first and second line treatments?

A

Vagal maneuvers first then adenosine if vagal fails

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9
Q

Untreated ventricular tachycardia progresses into what rhythm?

A

Ventricular fibrillation

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10
Q

Three PVCs in a row =?

A

Ventricular tachycardia

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11
Q

Three PACs in a row =?

A

PSVT (AKA SVT or PAT)

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12
Q

Which of the two 2nd degree heart blocks almost always becomes 3rd degree heart block?

A

2nd degree type 2

Mobitz type II

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13
Q

What is treatment for 2nd degree type 1 heart block?

A

Observation (pacer only if symptomatic)

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14
Q

What is treatment for 3rd degree heart block?

A

Pacemaker

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15
Q

What heart block has no association of P waves and QRS complexes?

A

Third Degree

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16
Q

What heart block has a long PR interval and never drops a QRS?

A

First degree

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17
Q

What heart block gets longer and longer PR then drops a beat?

A

2nd degree type 1

Wenckebach

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18
Q

What valvular disorder when combined with atrial fibrillation has highest risk of embolization?

A

Mitral stenosis

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19
Q

What conditions does a patient with atrial fibrillation have an increase risk of?

A

Stroke - ischemic limb - ischemic bowel

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20
Q

What is the treatment for valvular heart disease + atrial fibrillation?

A

Warfarin

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21
Q

What is the treatment for a patient with atrial fibrillation and a CHADS 2 score of a 0?

A

Aspirin

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22
Q

What scoring system is used to determine anticoagulation in patients with atrial fibrillation?

A

CHA₂DS₂-VASc

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23
Q

What duration is a normal QRS?

A

Less than 0.12 seconds

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24
Q

What has a short less than 0.10 sec PR interval and delta wave?

A

WPW (Wolff-Parkinson-White Syndrome)

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25
Q

What is the PR interval over in first degree block?

A

Over 0.2 seconds (Normal is 0.12 to 0.2 seconds)

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26
Q

What is the rate for sinus tachycardia?

A

Over 100 bpm but less than 150

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27
Q

What is the rate for normal sinus rhythm?

A

60 - 100

28
Q

What is the rate for bradycardia?

A

Less than 60 bpm

29
Q

What electrolyte abnormality is associated with flattening of the T waves?

A

Hypokalemia

30
Q

What electrolyte abnormality is associated with a prolonged PR interval and a widened QRS complex?

A

Hypermagnesemia

31
Q

What electrolyte abnormality is associated with long QT?

A

Hypocalcemia

32
Q

A 69 year old male dialysis patient is found on 12 lead ECG to have peaked T waves in all leads. What is the most likely electrolyte abnormality?

A

Hyperkalemia

33
Q

How does the pharmacological management of ventricular fibrillation and ventricular tachycardia differ from that of Torsades do Pointes?

A

In Torsades, magnesium is used first line before amiodarone or lidocaine

34
Q

Which antiarrhythmic medications can be used for a patient in ventricular tachycardia or ventricular fibrillation?

A

Amiodarone or lidocaine

35
Q

A 54 year old in ventricular tachycardia, has a BP of 82/44 mmHg. What settings are appropriate for cardioversion of this patient?

A

Synchronized cardioversion

36
Q

What medication class may be used to prevent arrhythmic events in a patient who has non-acquired long QT syndrome?

A

Beta blockers

37
Q

What counseling must be given to a patient once they are diagnosed with non-acquired long QT syndrome?

A

The patient’s family must be screened for long QT as well

38
Q

A 76 year old who was recently started on levofloxacin, suffers a cardiac arrest. What may likely be found on further evaluation of her ECG?

A

Long QT

39
Q

What is the most common accessory pathway in Wolff-Parkinson- White syndrome (WPW)?

A

The bundle of Kent

40
Q

What medication is indicated for emergent treatment of tachyarrhythmia in a patient with diagnosed Wolff-Parkinson- White syndrome (WPW)?

A

Procainamide

41
Q

Direct thrombin inhibitors can not be used for anticoagulation of atrial fibrillation if the patient also has which disorder?

A

Valvular heart disease

42
Q

A 69 year old male with a history of mitral regurgitation has developed atrial fibrillation. Should he be placed on anticoagulation?

A

All patients with valvular heart disease + atrial fibrillation need to be anticoagulated

43
Q

Should a solitary episode of atrial fibrillation in a healthy 34 year old require anticoagulation?

A

CHADS2 score is 0 - Patient is to be sent home on aspirin only

44
Q

A stable 67 year old patient presents in atrial fibrillation but is unsure of any prior cardiac history. Should you cardiovert this patient?

A

No. 1) Medical treatment before cardioversion in stable patients 2) Unknown time of atrial fibrillation would anticoagulate prior

45
Q

What is the dosing protocol for adenosine and what must you ensure regarding the IV access prior to administering the adenosine?

A

Adenosine 6 mg, if no change then 12mg, if no change then second dose of 12mg - Give through a large bore IV followed by rapid saline bolus

46
Q

What is the first line treatment for a stable patient who is in a supraventricular tachycardia?

A

Vagal maneuvers (No carotid sinus massage in elderly)

47
Q

A 48 year old patient has chest pain. Comparison of his 12 lead ECG to past tracings finds a new left bundle branch block. What is this finding consistent with?

A

New myocardial infarction

48
Q

Although right bundle branch blocks are not pathological in and of themselves, what underlying pathology may they represent?

A

Pulmonary embolus - ASD - Heart attack

49
Q

A nurse notes that a patient is having frequent premature atrial contractions (PACs), but is asymptomatic. What is your next step?

A

Check O2 saturation and electrolytes

50
Q

Does second degree type I or type II more likely represent an significant underlying pathology?

A

Second degree type II

51
Q

What is the recommended treatment for a patient in a second degree type I heart block with a blood pressure of 74/40 mmHg and chest pain?

A

Pacing - Rule out acute underlying ischemic pathology

52
Q

Which of the following medications is the most likely to cause bradycardia?
Furosemide
Metoprolol
Amlodipine

A

Metoprolol (beta blocker)

53
Q

An 83 year old has a blood pressure of 90/58 mmHg and a heart rate of 132 bpm fever and a + UA. Should you use rate controlling medication?

A

No - The patient’s tachycardia is reactive from her urosepsis and fever

54
Q

What is the most common cause of sinus tachycardia?

A

Underlying non-cardiac pathology (sepsis, anemia, hyperthyroid state etc.)

55
Q

You count 12 QRS complexes across the entire length of a 12 lead ECG. What is the approximate heart rate?

A

72 bpm - 10 seconds X 6 = 60 seconds/1 minute - 12 beats X 6 = 72 beats per minute

56
Q

How many seconds are represented across the entire length of a 12 lead ECG?

A

10 seconds

57
Q

While undergoing a stress test a patient’s heart rate is 180 bpm and he is breathing heavily. What is the likely reason for his tachycardia?

A

Normal physiologic response to exercise

58
Q

A 45 year old marathon runner presents to the office with a resting heart rate of 42 bpm. He is stable. What is your recommendation?

A

No treatment

59
Q

Name leads which represent a lateral wall AMI?

A

V5 V6 I AvL

60
Q

Name leads which represent an anterior AMI?

A

V3 V4

61
Q

Name leads which represent a septal AMI?

A

V1 V2

62
Q

Name the leads which represent an inferior AMI?

A

II III AvF

63
Q

What does a finding of S1Q3T3 on a 12 lead EKG suggest?

A

Pulmonary embolism

64
Q

What do diffuse ST elevations on a 12 lead EKG suggest?

A

Pericarditis

65
Q

What is the first line medication for a patient with SVT from WPW?

A

Procainamide

66
Q

What is the first line medication used in the treatment of Torsades?

A

IV magnesium

SP: Cardiology Pearls (16%) (12 decks)

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