EKG

Question 1

pactmaker synd sx

Answer 1

Orthostatic hotn, near syncope, fatigue, malaise, exercise intolerance, chest fullness, awareness of heartbeat, HA, chest pain

Question 2

pacemaker synd complications

Answer 2

Infection
Lead fracture
Diaphragmatic stimulation
Perforation- tamponade

Question 3

1st degree av block

cause

Answer 3

Increased vagal tone, Digitalis, Beta blockers, Hypokalemia, TV stenosis, CHD

Question 4

1st degree av block

sx

Answer 4

Incidental finding

Question 5

1st degree av block

trmt

Answer 5

none

Question 6

MC form of 2nd degree av block

Answer 6

2nd degree AV block: Mobitz 1- Wenckebach

Question 7

2nd degree AV block: Mobitz 1- Wenckebach?

Answer 7

Consecutive increasing PR intervals until an impulse is blocked and there is no QRS after a P wave

Question 8

2nd degree AV block: Mobitz 1- Wenckebach

sx

Answer 8

Asymptomatic

Question 9

2nd degree AV block: Mobitz 1- Wenckebach

trmt

Answer 9

none

Question 10

2nd degree AV block: Mobitz 2

?

Answer 10

“Grouped beating”
Prolonged PR or fixed duration and there is no QRS after a P wave
HIS purkinje system disease

Question 11

2nd degree AV block: Mobitz 2

cause

Answer 11

Almost always Organic heart disease

Question 12

2nd degree AV block: Mobitz 2

sx

Answer 12

Syncope, angina, CHF

Question 13

trmt 2nd degree AV block: Mobitz 2

Answer 13

Permanent pacemaker if sx

Question 14

complications 2nd degree AV block: Mobitz 2

Answer 14

Can progress to complete heart block if untreated

Question 15

sinus tach ?

Answer 15

Normal P waves at a rate between 100 bpm and 180 bpm

If HR 150 + think of supraventricular arrhythmia

Question 16

sinus tach cause

Answer 16

Emotional, physical, pharmacologic, ETOH, caffeine, nicotine, PE (MC clinical sign of PE is sinus tach)

Question 17

Premature atrial beats/APC/ PAC

Answer 17

Impulses in ectopic atrial focus that are extra beats
PR interval normal or prolonged
Usually in normal ppl

Question 18

Paroxysmal supraventricular tachycardia (PSVT)?

Answer 18

All tachyarrhythmias above bundle of HIS
Atrial rate over 100 bpm
Narrow QRS
Short (AVNRT) or long RP

Question 19

Paroxysmal supraventricular tachycardia (PSVT)

sx

Answer 19

Dizziness, dyspnea, CP, anxiousness, sweating

Question 20

Paroxysmal supraventricular tachycardia (PSVT)

classification

Answer 20

Paroxysmal- sec to hrs
Persistent- hrs to days
Permanent or chronic- lays to yrs

Question 21

MC mechanism of SVT

Answer 21

PSVT Atrioventricular nodal reentry tachycardia/AVNRT

Question 22

2 different paths near the av node

for PSVT Atrioventricular nodal reentry tachycardia/AVNRT

Answer 22

Anterograde- slow
Retrograde- fast
P waves may be buried in QRS

Question 23

PSVT Atrioventricular nodal reentry tachycardia/AVNRT

trmt

Answer 23

Vagal maneuvers
IV adenosine
IV cardizem, digoxin, beta blockers
Long term with pharmacologic methods or ablation

Question 24

2nd MC form of SVT

Answer 24

Wolff parkinson white (WPW)

Question 25

Wolff parkinson white (WPW)

dx

Answer 25

Narrow or wide QRS
160-240 bpm
PR less than 0.12msec
Delta wave- slurred QRS
Accessory pathway

Question 26

Wolff parkinson white (WPW)

trmt

Answer 26

Catheter based intervention is best
Class 1C agents- flecainide, propafenone
NO cardizem

Question 27

Wolff parkinson white (WPW)

sx

Answer 27

Palpitations, syncope, dizziness, SCD, arrest, dyspnea

Question 28

Junctional rhythm

Answer 28

Abnormal heart rhythm from impulses in the AV node
Escape mechanism
Rate 40-60 bpm
Narrow QRS bc above ventricles
May have retrograde P wave

Question 29

Junctional rhythm

dx

Answer 29

Athletes from inc vagal tone
Meds- beta blockers, BBC, antiarrhythmic agents, digoxin toxicity
After cardiac surgery
SSS

Question 30

Junctional rhythm

trmt

Answer 30

Remove offending agent
Give Digibind for digoxin toxicity
Permanent pacemaker
No trmt for healthy ppl with inc vagal tone