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Clinical Medicine - Cards II Exam > EKG / Arrhythmia > Flashcards

EKG / Arrhythmia Flashcards

1
Q

EKGs are normal set at a speed of ___ mm/sec

A

25

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2
Q

A full EKG is __ seconds

A

12

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3
Q

Each little box on an EKG is _.__ seconds and __ mm tall

Each big box on an EKG is _.__ seconds and ___ mm tall

A

0.04 seconds
1 mm

0.20 seconds
5 mm

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4
Q

_______ standard EKGs are used when voltage is so high complexes run into each other.

A

Half Sandard

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5
Q

______ ___ is used when there is normal amplitude but the speed is set to 50 mm/sec.

A

Double box

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6
Q

When measuring rate and counting boxes the pattern is as follows…..

300-___-100-___-60-__-50-__-37

A

300-150-100-75-60-50-43-37

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7
Q

A rate greater than 100 bpm is considered ________

A rate less than 60 bpm is considered _______/

A

Tachycardic

Bradycardic

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8
Q

P waves on an EKG are indicative of ______ or supraventricular activity.

A

Atrial

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9
Q

If P waves are not the same (have varying morphological) then what is liking occurring?

A

Additional pacemaking cells are firing, liking in the atrium.

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10
Q

If each QRS complex does not have a P wave then it is likely an ___ nodal block.

A

AV

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11
Q

T/F: The PR interval should be constant throughout the EKG.

A

True

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12
Q

A QRS complex is considered wide when it is greater __.___ seconds.

A

0.12

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13
Q

If the QRS complexes are in groups of two, it is often described as being _________.

If they’re in groups of three, it is often described as ______.

A

Bigeminal

Trigeminal

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14
Q

T/F: The P wave in lead aVl is inverted in normal sinus rhythm

A

False

It is inverted in lead aVR in NSR

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15
Q

PR segment depression greater than 0.8mm is indicative of _______.

A

Pericarditis

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16
Q

A normal PR interval is __.___ - __.___ seconds.

A

0.12 - 0.20

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17
Q

A shortened PR interval with an inverted P wave indicates a ________ rhythm.

A

Junctional

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18
Q

T/F: WPW Syndrome will have a lengthen PR interval

A

False

It’ll be shortened

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19
Q

A prolonged PR interval is indicative of a _____ _____.

A

Heart Block

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20
Q

A normal QRZ complex should be less than __.___ seconds.

A

0.12 seconds

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21
Q

Higher amplitude in QRS complexes (a result of more vectors being present) is indicative of _______.

A

Hypertrophy

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22
Q

Unopposed waves occur when eletrical impulses can not pass through scar tissue likely indicated an ______ has occurred.

A

Infarct

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23
Q

Fluid or fat around the heart would likely lead to a ___ voltage EKG.

A

Low

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24
Q

What are common causes of a wide QRS complex?

Theres a lot! - EIGHT

A
  1. Hyperkalemia
  2. Medications (tricyclics)
  3. V Tach
  4. Idioventricular Rhythms
  5. WPW
  6. BBB
  7. PVC
  8. Pacemaker
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25
Q

T/F: Q waves can be benign or pathologic depending on size

A

True

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26
Q

A significant Q wave (>1/3 the total height of the QRS) is indicative of what?

A

An old infarct

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27
Q

The __ point is the point at which the QRS complex ends and the ST segment begins.

A

J-point

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28
Q

The J-point should be no less than __ mm away from the baseline.

A

1 mm

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29
Q

Hyperkalemia would result in ______ T waves.

A

peaked

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30
Q

A normal QT interval should be less than __.___ seconds

A

0.42 seconds

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31
Q

What are the two key leads in determining axis using “The Thumb Method”?

A

Lead 1

Lead aVf

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32
Q

if Lead I is negative but aVF is positive, then there is ______ ____ _______

if Lead I is positive but aVF is negative, then there is _____ ____ _________

If lead I is positive and lead aVF is positive, then the axis is ______.

if Lead I is negative and aVF is negative, then there is______ _____ ____ _________

A

Right Axis Deviation

Left Axis Deviation

Normal

Extreme Right Axis Deviation

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33
Q

What are the THREE RBBB criteria?

In what lead would you always expect to see positive complexes?

A
  1. R-S-R prime (Bunny Ears) in lead V1
  2. Prolonged QRS
  3. Slurred S wave in 1 and V6

V1

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34
Q

What are the THREE LBBB criteria?

A
  1. QRS prolongation of > 0.12 seconds
  2. Broad, monomorphic R waves in I and V6
  3. Broad, monomorphic S waves in V1; may have small R wave
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35
Q

T/F: A new onset LBBB is assumed to be a AMI until proven otherwise

A

True

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36
Q

A ____ _______ ______ occurs when the conduction through the left anterior fasicular fibers is blocked.

A

Left Anterior Hemiblock

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37
Q

T/F: LAD is seen in patients with a LAF

A

True

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38
Q

What are the THREE criteria for LAH?

A
  1. Left axis deviation with the axis at -30º to -90º
  2. Either a qR complex or an R wave in lead I
  3. An rS complex in lead III, and probably II & aVF
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39
Q

A ____ _______ ______ occurs when the conduction through the left posterior fasicular fibers is blocked.

A

Left Posterior Hemiblock

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40
Q

What are the THREE criteria for LPH?

A
  1. Right axis deviation of 90º to 180º
  2. An s wave in lead I and q in III
  3. Exclusion of RAE and/or RVH
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41
Q

In left atrial enlargement, the P wave in lead 2 is >0.12 second and is often has a ___-shape.

What is a common term for the shape of this P wave in lead 2?

A

M Shape (THINK: Camel Hump)

“P Mitale”

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42
Q

In left atrial enlargement, the P wave in lead V1 is often _________.

Is the negative of positive half taller?

A

Bipahsic

Negative half is taller

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43
Q

In right atrial enlargement, the P wave in lead 2 is >2.5 mm tall, and this peaked shape is often called “__-_______”.

A

P-Pulmonale

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44
Q

In right atrial enlargement, the P wave in lead V1 is often _________.

Is the negative of positive half taller?

A

Biphasic

Positive

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45
Q

Describe the criteria for LVH

A

Deepest S wave in V1 or V2

PLUS

Tallest R wave in V5 or V6

EQUAL

> 35 mm

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46
Q

LVH with the presence of ST depression and inverted T waves may indicate what?

A

Heart strain

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47
Q

T/F: EKG criteria to diagnose LVH may be used in the presence of a LBBB?

A

False

It CANNOT be used

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48
Q

Area of ischemia more negative than surrounding normal tissue causes ST _____ and T wave ______.

A

Depression

Inversion

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49
Q

A zone of injury that remains more positive than the surrounding tissue causes ST _______ while the T waves remain inverted

A

Elevation

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50
Q

T/F: Infarcted tissue doe not generate action potentials

A

True

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51
Q

How would you expect an EKG to progress in an acute MI?

A
  1. T-wave inversion begins early
  2. ST elevation (flat to “tombstoning” –> T wave disappears)
  3. Q waves appear
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52
Q

_______ changes occur when two electrodes view an AMI from opposite angles

(Think: Mirrored Images”)

A

Reciprocal Changes

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53
Q

In a lateral MI, what leads would you expect to see reciprocal changes?

In an anterior MI?

In an inferior MI?

A

Lateral: 3, aVf

Anterior: 2, 3, aVf

Inferior: aVl (+/- Lead 1)

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54
Q

ST Elevation in leads 1, aVL, V5, and V6 would be concerning for a _________ MI.

ST Elevation in leads 2, 3, aVf would be concerning for a _________ MI.

ST Elevation in leads V1 and V2 would be concerning for a _________ MI.

ST Elevation in leads V3 and V4 would be concerning for a _________ MI.

A

Lateral

Inferior

Septal

Anterior

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55
Q

What coronary artery is likely occlude in an anterior STEMI?

What coronary artery(s) is likely occlude in an Inferior STEMI?

What coronary artery is likely occlude in an anteroseptal-lateral STEMI?

What coronary artery is likely occlude in an anterolateral STEMI?

A

Anterior: LAD

Inferior: RCA, LCx

Anteroseptal-lateral: Proximal LAD

Anterolateral: LCx

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56
Q

S1Q3T3 seen on EKG is indicative of what?

A

Pulmonary Embolus

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57
Q

Global ST elevation is indicative of what?

A

Pericarditis

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58
Q

Low voltage in the limb leads and alternating QRS amplitudes is indicative of what?

A

Pericardial Effusions

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59
Q

A rounded “Osborn Wave” at the J-point is indicative of what?

A

Hypothermia

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60
Q

Prominent “U-Waves” leading to flattens T waves, ST depression, and a prolonged QT are indicative of what?

A

Hypokalemia

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61
Q

Hypocalcemia can lead to a prolonged ___ interval?

Hypercalcemia can lead to a shortened ___ interval?

A

QT Interval

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62
Q

A prolonged QT interval can progress to what arrhythmia?

A

Torsades

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63
Q

A “spike” prior to the P wave is indicative of a ______ paced rhythm.

A “spike” prior to the QRS complex is indicative of a _______ paced rhythm.

A

Atrial

Ventricular

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64
Q

This arrhythmia occurs as a normal variant during inspiration

A

Sinus Arrhythmia

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65
Q

T/F: Sinus Arrhythmia is considered a regular rhythm

A

False

Regularly Irregular

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66
Q

This is a normal sinus rhythm that is less than 60 bpm.

Common causes include….

Beta-blockers
Disease of the SA node
Ischemia
Increase vagal influence

A

Sinus Bradycardia

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67
Q

What are symptoms of sinus bradycardia?

What is important to rule out in patients who are bradycardic?

Should HR increase with exercise?

How can sinus bradycardia be treated?

A

Sx:

  1. Weakness
  2. Pre-syncope / syncope
  3. SOB

R/O:

  1. Electrolyte imbalance
  2. Toxicitiy
  3. Hypothyroidism

HR should increase with exercise

Tx:

  1. Remove toxin/medications
  2. Replace electrolytes
  3. Epinephrine, Atropine, Dopamine
  4. Pacemaker
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68
Q

This is a variant of normal sinus rhythm in which the rate is greater than 100 bpm.

A

Sinus Tachycardia

69
Q

T/F: Sinus tachycardia is almost always do to an underlying cause.

A

True

These include…..

Exercise
Hyperthyroidism
Fever
Hypovalemia
Anxiety
Sepsis 
Hypotension
PE
70
Q

What are the symptoms of sinus tachycardia?

How can this be treated?

A

Sx:

  1. Palpitations
  2. Dizziness
  3. SOB
  4. Angina

Tx:

  1. Vagal maneuvers
  2. Removal/Decrease of stimulants
  3. Nodal Blocking agents
71
Q

This is described as a variable time period during which there is no sinus pacemaker working.

Sx include:

Dizziness
Pre-syncope / syncope
Rarely Death

A

Sinus pause/arrest

72
Q

Is sinus pause considered a regular or irregular rhythm?

Are there “dropped beats” present?

A

Irregular

Yes

73
Q

Impulses that originate from tissues outside the SA node are considered to be ________.

74
Q

Another pacemaker cell fires at rate faster than SA node is considered a ________ beat

Slowing of SA node rate allowing faster foci to take control is considered an _______ beat

A

Premature

Escape

75
Q

What are three types of ectopic beats?

Where is the pacemaker located in each of the above?

A
  1. Premature Atrial Contraction (PAC): pacemaker site is in atria
  2. Premature Junctional Contraction (PJC): pacemaker site is in AV Junction
  3. Premature Ventricular Contraction (PVC): pacemaker site in the ventricles
76
Q

T/F: Typically PACs are not treated pharmacologically.

A

True

But beta-blockers can be used

77
Q

Are PACs considered a regular or irregular rhythm?

78
Q

T/F: The PR interval is constant throughout the EKG in a patient with PACs

A

False

It is variable

79
Q

This arrhythmia is a run of PACs that can be as high as 180 bpm.

A

Ectopic atrial tachycardia

80
Q

Is ectopic atrial tachycardia considered a regular or irregular rhythm?

81
Q

What three arrhythmias are considered ‘irregularly irregular’?

A
  1. Atrial Fibrillation
  2. Wandering Atrial Pacemaker
  3. Multifocal Atrial Tachycardia
82
Q

This irregularly irregular arrhythmia is created by multiple atrial pacemakers firing at their own pace.

P waves in this case would have varying morphologies (How many varying morphologies would need to be present?)

The rate would be 100 bpm or less.

A

Wandering Atrial Pacemaker

3 different P wave morphologies would need to be present

83
Q

This irregularly irregular arrhythmia is similar to WAP however is tachycardic (>100 bpm)

A

Multifocal Atrial Tachycardia

84
Q

MAT is predominately related to what pulmonary disease?

85
Q

How would MAT be treated?

A
  1. Improve underlying disease
  2. Manage Mg2+ and K+
  3. Verapamil or Beta-blockers
  4. Ablation
86
Q

This is a regular rhythm with a rate of 150 - 250 bpm.

Sx include (typical abrupt)….

Palpitation
Angina
SOB

A

Paroxysmal Supraventrivular Tachycardia

87
Q

Where are the P waves in PSVT?

A

Buried in the preceding T wave

88
Q

How is PSVT treated mechanically?

Pharmacologically?

Additional treatment options?

A

Mechanically:

Valsalva Maneuver
Coughing
Head between knees
Carotid Massage

Pharmacologically:

Adenosine (avoid in reactive airway disease)
Cardizem
Verapamil

Cardioversion
Catheter ablation

89
Q

Should cardioversion in a patient with PSVT be synchronized?

90
Q

This is a regularly irregular rhythm with an atrial rate of 250-350 and a ventricular rate of 125-175

Sx present similar to atrial fibrillation

A

Atrial Flutter

91
Q

Atrial Flutter is said to have a “____-______” appearance on EKG.

What gives it this appearance?

A

Saw-tooth

A variable P to QRS ratio, most commonly 2:1

92
Q

What P-QRS ratio is most dangerous in atrial flutter?

What can this lead to?

A

1:1

Can lead to ventricular fibrillation

93
Q

How is atrial flutter treated?

A
  1. Control rate with CCB/Beta blocker, diogixin in HF patients, or amiodarone
  2. Convert to NSR (Ablation, Synchronized cardioversion)
  3. Prevent systemic embolism
94
Q

This irregularly irregular arrhythmia is the choatic firing of multiple pacemaker cells in the atria and is the most common cardiac arrhythmia.

A

Atrial Fibrillation

95
Q

Is there atrial contraction in atrial fibrillation?

Is there a P wave?

96
Q

What are three concerning complications of atrial fibrillation?

A
  1. CVA (increased risk of stroke 5% a year)
  2. CHF
  3. MI
97
Q

_________ atrial fibrillaion that terminates spontaneously or with intervention within seven days of onset.

A

Paroxysmal

98
Q

___________ atrial fibrillation that fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm

A

Persistent

99
Q

__________ atrial fibrillation that has lasted for more than 12 months.

A

Long-standing persistent

100
Q

_________ atrial fibrillation occurs following a joint decision by the patient and clinician has been made to no longer pursue a rhythm control strategy.

101
Q

___________ atrial fibrillation AF in the absence of rheumatic mitral stenosis, a mechanical or biprosthetic heart valve, or mitral valve repair.

A

Non-valvular

102
Q

What are the Sx of atrial fibrillation?

Can be asymptomatic

A
  1. Palpitation
  2. Tachycardia
  3. Fatigue
  4. Weakness
  5. Dizziness
  6. SOB
  7. Angina
  8. Pre-syncope / Syncope
103
Q

A stress test should be ordered in a patient in whom you suspect ____.

104
Q

In what three circumstances should urgent cardioversion be considered in a patient with Afib with RVR?

A
  1. Active ischemia
  2. Evidence of of organ hypoperfusion
  3. Severe HF manifestation
105
Q

Afib for longer than 48 hours or of unknown duration increases the risk of stroke.

What should be done prior to cardioversion (TWO OPTIONS)?

A

A TEE because you are at risk for dislodging a clot

OR

Anticoagulants for at least three weeks

106
Q

How should new STABLE new onset atrial fibrillation be treated?

A
  1. Rate control (GOAL: <85bpm with symptoms, <100 asymptomatic) with Beta-blockers, CCB, or amiodarone
  2. Restoration of NSR (Everyone should have one attempt at cardioversion)
107
Q

What is the name of the “scoring system” used to determine anticoagulant use in patients with Afib?

A

CHADS-VASc

108
Q

In a patient with Afib longer than 48 hours, what three steps should be taken regarding treatment in terms of anticoagulant use prior to cardioversion, after cardioversion, and long-term?

A
  1. 3 weeks prior to cardioversion
  2. 4 weeks following cardioversion
  3. CHADS-VASc to determine long term use
109
Q

This syndrome occurs due to an accessory pathway in the electrical conduction pathway (Bundle of Kent) causing the ventricles to prematurely contract.

A

WPW Syndrome

110
Q

What is the unique EKG finding in a patient with WPW?

What would this cause in terms of PR interval and a QRS complex?

A

Delta Wave

Shorten PR
Wide QRS

111
Q

T/F: WPW is present at birth

112
Q

Is WPW a regular or irregular rhythm?

113
Q

This arrhythmia occurs when the normal pacemaking function of the atria and SA node is absent and another pacemaker takes over (usually AV node)

A

Junctional Rhythm

114
Q

What happens to the P waves in a junctional rhythm?

A

P waves are either inverted or absent prior to the QRS complexes in a junctional rhythm

115
Q

What is the typical rate of a junctional rhythm?

116
Q

This arrhythmia is similar to a junctional rhythm, however, the rate is 60-100 bpm.

A

Accelerated junctional rhythm

117
Q

A junctional rhythm greater than 100 bpm is referred to as ________ ________.

A

Junctional Tachycardia

118
Q

This arrhythmia results because of a premature firing of a ventricular cell usually from the Purkinje fibers.

A

Premature Ventricular Contraction (PVCs)

119
Q

T/F: The underlying pacing schedule is not altered so the next beat will arrive on time.

If true…. what is this referred to as?

A

True

Compensatory pause

120
Q

Are PVCs considered a regular or irregular rhythm.

121
Q

Are P waves present in PVCs?

122
Q

Is bigeminy or trigeminy possible with PVCs?

123
Q

2 PVC complexes is referred to a _______.

124
Q

Greater than 3 PVCs or PVCs lasting less than 30 seconds is considered _____________ _____________ ___________

A

Unsustained ventricular tachycardia

125
Q

This arrhythmia occurs when SA node fails to fire and next available pacemaker cell is in the ventricle.

A

Ventricular Escape Beat

126
Q

In a ventricular escape beat the original pacemaker ____ ____ fire so the next beat will not arrive on time.

What is this called?

A

does not

Non-compensatory pause

127
Q

When would a pacemaker be indicated as treatment in a patient with ventricular escape beats?

A

If it becomes the primary rhythm

128
Q

Is a ventricular escape beat considered a regular or irregular rhythm?

129
Q

This arrhythmia occurs when ventricular foci act as primary pacemaker for the heart (everything above has failed).

A

Idioventricular rhythm

130
Q

What is the rate in an indioventricular rhythm?

In an accelerated idioventricular rhythm?

A

20-40 bpm

40-100 bpm

131
Q

Are P waves present in an idioventricular rhythm?

Why?

A

No

There is no atrial activity

132
Q

_____________ ventricular tachycardia occurs when there are runs three or more ventricular beats lasting less 30 seconds and terminating spontaneously

A

Non-sustained

133
Q

_________ ventricular tachycardia occurs when there are ventricular beats lasting longer than 30 seconds and require intervention to terminate.

134
Q

____________ ventricular tachycardia occurs when the appearance of all beats match each other in each lead.

What can this rapidly deteriorate into?

A

Monomorphic

Ventricular Fibrillation

135
Q

____________ ventricular tachycardia occurs when the morphology of the ventricular beats varies.

The above in the context of a prolonged QT interval can result in what arrhythmia?

A

Polymorphic

Torsades

136
Q

What medication should be avoided in V Tach in the setting of CAD?

What medication should be avoided in V Tach following an MI?

A

Lidocaine

Amiodarone

137
Q

Is ventricular tachycardia typically a regular or irregular rhythm?

138
Q

Are the QRS complexes narrow or wide in ventricular tachycardia?

139
Q

This arrhythmia occurs from a polymorphic ventricular tachycardia with an underlying prolonged QT interval

A

Torsades de Pointes

140
Q

What classes of drugs have Torsades as an ADR?

A

Anti-arrhythmics

Antibiotics

141
Q

Tosades can lead to ventricular _________ or ________

A

Ventricular fibrillation

Death

142
Q

How is Torsades treated?

A

IV Magnesium/Potassium

Defibrillation

143
Q

This arrhythmia is a very fast tachycardia in which you can no longer determine QRS complexes, T waves, or ST segments.

A

Ventricular Flutter

144
Q

Ventricular Fibrillation is often referred to as “_____ ____”.

A

Cardiac Chaos

145
Q

What is the main cause of sudden cardiac death?

A

Ventricular fibrillation

146
Q

What are three common causes of ventricular fibrillation?

A
  1. MI
  2. Hypokalemia
  3. Drug Toxicity
147
Q

How is V Fib treated?

A
  1. Non-synchronized defibrillation (120-200 joules)
  2. Amiodarone for 24-48 hours
  3. Revascularization
  4. ICD
148
Q

This is also referred to as “flatline”.

149
Q

This is electrical activity seen on the monitor however the patient does not have a pulse.

A

Pulseless Electrical Activity (PEA)

150
Q

This is a delay or interruption in the transmission of an impulse from the atria to the ventricles?

151
Q

AV blocks typically occur at the _____ __ ______ and below.

A

Bundle of His

152
Q

A _____-______ heart block occurs when there is a prolonged block in the AV Node.

A

First-Degree Heart Block

153
Q

What would you expect the PR interval to be in a patient with a first-degree heart block?

A

> 0.20 seconds

154
Q

Are pacemakers commonly used in the treatment of a First-Degree Heart Block?

155
Q

A ______ _ ______ _____ block is caused by a diseased AV node with a long refractory period that results in a lengthening PR interval with the eventual failure of a QRS complex (dropped beat).

What is another name this is referred to as?

A

Mobitz 1 Second Degree Block

Wenkenbach

156
Q

T/F: Lyme Disease is a common cause of a Mobitz 1 second degree block

157
Q

Is it common to see a Mobitz 1 second degree block in young athletes?

158
Q

How is a Mobitz 1 second degree block treated in unstable patients?

Stable patients

A

Usstable:

  1. Atropine
  2. Cardiac Pacing

Stable:

  1. Place pacing pads
  2. Revascularization
  3. Remove Toxins
159
Q

What is the rhythm described as in a Mobitz 1 second degree block?

P-QRS ratio?

PR Interval?

A

Regularly Irregular Rhythm

Variable P-QRS ratio

Widening (Then dropped beat)

160
Q

A ______ __ _____ _____ block typically occurs in the bundle of His and has the presence of a non-conducted beat without progressive PR interval lengthening.

A

Mobitz II Second-Degree Block

161
Q

A Mobitz II Second-Degree Block may ultimately lead to a ______ _____ ____.

A

Complete Heart Block

162
Q

T/F: A Mobitz II Second-Degree Block is a regularly irregular rhythm

163
Q

Describe the P-QRS ratio/relationship in a Mobitz II Second-Degree Block

A

Group (P with QRS)

Dropped (P w/o QRS)

Group (P with QRS)

Dropped (P w/o QRS)

164
Q

A _____ _______ heart block is a complete block of the AV node in which the atria and ventricle are firing at their own rates.

A

Third-degree heart block

165
Q

T/F: A third degree heart block is not a medical emergency

A

False

It is

166
Q

What is REQUIRED in terms of treatment for a third degree heart block?

167
Q

Describe the rate in a Third-Degree heart block?

Rhythm?

P-QRS ratio?

PR Interval?

A

Separate rates between the atria (60-100 bpm) and the Ventricle (30-50 bpm)

Rhythm is regular however, the P and QRS rates are different

P-QRS ratio is variable

PR Interval is variable without a pattern

168
Q

________ syndrome involves T wave inversion throughout the precordium (Leads V1 - V4) and is typically a sign of ____ stenosis.

T/F: These T-waves can often be somewhat biphasic

A

Wellen’s Syndrome

True

Clinical Medicine - Cards II Exam (3 decks)

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