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IPAP > EKG Block 1 > Flashcards

EKG Block 1 Flashcards

1
Q

When is an EKG indicated?

A

Syncope
Episodic FADS: fatigue, angina, dizziness, Sob
Palpitations
Transient A-Fib/Flutter neuro events

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2
Q

What are the current speeds through the different areas of the heart?

A

SA/AV- 0.01-0.02m/s
Atria/Ventricles- 1m/s
PF- 2m/s

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3
Q

Define Automaticity

Define Excitability

A

Ability to discharge spontaneously w/out stimulus

Ability to depolarize by stimulus

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4
Q

Define Chronotrophy

Define Inotrophy

Define Dromotrophy

A

Affecting HR

Affecting myocardial contractility

Affecting conductivity

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5
Q

What does a small box on ECG paper mean?

What do the heavy black lines mean?

A

0.1mv in height, .04 seconds in width

5 squares= .5mv, .2 sec

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6
Q

What does the X and Y axis on ECG paper represent?

A 
X= time, 1mm=.04sec 5mm=0.20sec
Y= voltage, 10mm= 1mv (two large boxes)
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7
Q

Define ECG Amplitude

What factors causes it to inc and dec?

A

Height, measured from baseline in milivolts
Inc- hypertrophy
Dec- COPD

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8
Q

What are the parts of a 12 lead ECG?

Which one is typically used for the rhythm strip?

A

Six limb Bipolar- 1, 2, 3, AVR, AVL, AVF
Six Chest Percordial- V1-6

Lead 2

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9
Q

What do leads 1, 2 and 3 measure/record?

Where are leads V1-6 placed?

A

1= RA to LA 2= RA to LL 3= LA to LL

V1= R4IS  V2= L4IS  V3= Between V2 and V4
V4= 5ICSMCL V5= 5ICSAAL V6 5ISMAL
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10
Q

What underlying issues can cause an abnormal QRS complex?

A

HEV FACETIME

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11
Q

What can cause the T wave to be tall/peaked?

A 
Localized= MI
General= hyperkalemia
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12
Q

What can cause the T wave to be inverted?

A

General= pericarditis
Localized= MI
V5, V6, aVL= LVH/BBB
V1/V2= RVH/BBB

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13
Q

What can cause the T wave to be flat?

A

Ischemia
Evolving infarction
Hypokalemia

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14
Q

What can cause the T wave to be elongated/bizarre?

A

Acute cerebral disease

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15
Q

T wave indicates what occurrence?

What does the U wave indicate?

A

T= ventricle repolarization

U= Perkinje fiber repolarization

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16
Q

What is the normal distance of the U wave?

What can cause it to be abnormal?

A

Norm= >1mm best at V3

Over 1mm= abnormal due to Hypo K, Ca, Mg

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17
Q

What does a negative deflection on the U wave indicate?

A

LAD

L main disease

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18
Q

Norms and abnormals of PR segment

A

Normally isoelectric
Depressed- pericarditis
Elevated- atrial infarction

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19
Q

What does the J Point mean?

A

Point where QRS ends and ST segment begins

Describes ST abnormalities (elevated/depressed)

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20
Q

What is the use of the R-R interval?

A

Used to determine Rate and Rhythm

Necessary for determining normal QT

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21
Q

What is the PR Interval?

A

From P wave to beginning of QRS

Measures time taken to travel from SA node/ectopic origin to ventricular muscle fibers

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22
Q

What is the normal duration of the PR interval?

What does a prolonged or shortened interval mean?

A 
Norm= .12-.20 seconds
Pro= AV block, Meds (Adenosine, BBs, CCBs, Digitalis)
Short= low atrial/junctional foci, accelerated passage (WPW Syndrome, Lown-Ganong-Levine)
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23
Q

What does the QT interval include and what does it measure?

A

Beginning of Q to end of T

Measures total ventricular systole time

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24
Q

What factors can change the QT interval?

What is used to measure the corrected QT interval?

A

HR, Age, Gender, Autonomic tone

QTc- based on gender and HR

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25
Q

What is the RoT for the QT interval

A

QT should be <1/2 of RR

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26
Q

What is a normal QT inteval for men and women?

A

M- <420 msec

F- <430

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27
Q

What does a prolonged QT interval mean and what can cause it?

A 
Delayed repolarization
Predisposes to ventricular dysarhythmias
Congenital/Rheumatic heart
Low K Mg Ca
Meds- Levafloxacin, Azithromycin, Zofran, Diflucan, Amiodarone
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28
Q

What would be considered a prolonged QT interval in men/women?

How is it treated?

A

M- >450
F- > 470

Tx w/ BB

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29
Q

What can cause a shortened QT interval?

A

Hyerkalemia
Hypercalcemia
Digitalis

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30
Q

What are the normal ranges for QRS Complexes, T Wave, PR Interval and QT Interval?

A

QRS- 1 to <3 boxes, .04-.11 sec
T- 2/3 height of R wave
PR- 3-5 boxes, .12-0.2 sec
QT- <1/2 R-R distance

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31
Q

What is the number sequence for determining rate on ECG paper?

A

300 150 100 75 60 50

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32
Q

When is the “6 Second Method” to determine the rate?

How is it done?

A

Useful with bradycardia or irregular rhythms

Two consecutive 3 second intervals
Count number of R waves
Multiply by 10

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33
Q

How is a normal Peds ECG different than an adult?

A 
\+100 bpm
Sinus aarythmia
Longer QTC
Dominant R V1-3
RSR V1 Pattern
T-wave inversion V1-3
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34
Q

What two events occur and create Tachycardia Cardiomyopathy

A

Incessant SVT

Uncontrolled ventricular rates

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35
Q

How can re-entry tachycardia be terminated?

A

Vagal maneuver

IV meds

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36
Q

How is SVT diagnosed?

A

12 lead EKG
Holter monitor x 24-48hrs
Continuous loop recorder x 1mon

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37
Q

When/why is Electrophysiologic testing done?

A

Distinguish between SVT or Ventricular Tachycardia

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38
Q

How are SVTs initiated?

A

Paced pre-mature beats

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39
Q

Define Stable Tachycardia

A

No hemodynamic compromise

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40
Q

Define Unstable Tachycardia

A

Evidence of hemodynamic compromise:

HOTN, Angina, AMS, HF

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41
Q

Sinus tachycardia is almost always a response due to ? and never exceeds ? BPM

A

Stress

180

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42
Q

Define Atrial Tachycardia and what are the two types?

A

SVTs originating from focal anatomic areas in atria and propogate in centrifugal pattern
AVNRT- nodal
AVRT- re-entrant

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43
Q

Define Paroxysmal Atrial Tachycardia

A

Rapid firing of irritable atrial focus between 150-220 bpm

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44
Q

Define Paroxysmal Junction Tachycardia

A

Focal tachycardia originating in AV junction at 150-250 bpm

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45
Q

Define Junctional Tachycardia

A

Tachycardia w/out P waves

Negative deflection @ end of leads 2, 3, and aVF= retrograde P wave

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46
Q

It is impossible to distinguish Junctional Tachycardia from what other rhythm on ECG?

A

AVN Re-Entry Tachycardia

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47
Q

What are the characteristics of AVNRT

A

Functional, unidirectional block in AV node leading to retrograde conduction and continuous re-entry circuit
120-220 bpm
P waves are inverted/buried
Narrow QRS complex unless BBB is present

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48
Q

What is the most common SVT and who is it seen in?

A

AVNRT
Young adults
Pregnancy/menstrual cycles

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49
Q

How is AVNRT treated?

A

Electrophsiology and catheter ablation

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50
Q

Characteristics of AVRT

A

Anatomic bypass bundle between atria and ventricles w/ no delay
Pathway stimulates atria leading to paroxysmal tachycardia

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51
Q

AVRT is seen in what cardiac syndromes?

A

Wolf Parkinson White

LGLS

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52
Q

Define Orthodromic AVRT

A

Most common
Impulse travels out of AV node but return to atria through Kent bundle
Presents as narrow complex tachycardia

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53
Q

Define Antidromic AVRT

A

Impulse travels from AV to kent bundle to AV node causing wide complex tachycardia

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54
Q

What are the characteristics of WPW Syndrome

A

PR interval <0.12
AV node is bypassed
D wave at beginning of QRS causing impulse delivered to myocardium instead of normal conduction route
Widened QRS complex
Inverted T wave
Atria reactivated by ventricles causing rapid, regular tachy in 50-80% of PTs

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55
Q

What is WPW Type A pattern and what does it mimic?

What is WPW Type B pattern and what does it mimic?

A

L sided accessory pathway with tall Rs in V1-3; RVH

R sided accessory pathways with tall R and inverted T in inferior leads; LVH

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56
Q

Orthodromic AVRT in PTs w/ WPW Syndrome looks like ?

Antidromic looks like ?

A

Ortho- SVT, treated as SVT

Anti- LVH, treated as LVH

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57
Q

What meds are not used in the treatment of Antidromic AVRT in PTs with WPW Syndrome?

A

ABCD meds- may block AV node and increase HR

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58
Q

Characteristics of LGLS

A

PR Interval <0.12 sec due to James fibres
Normal QRS width and normal ventricular conduction through pathway
No delta
Paroxysmal tachycardia

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59
Q

Characteristics of A-Fib

A

No P wave

Irregularly irregular

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60
Q

What is the etiology behind A-Fib

A 
PIRATES
Pulmonary- OSA, PE, Pneumonia, COPD
Rheumatic Dz/Mitral Regurg
Alcohol/Anemia
Thyrotoxicosis/Toxins
E+/endocarditis
Sepsis/Sick sinus syndrome
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61
Q

Define Paroxysmal, Persistent, Permanent and Recurrent A-Fib

A

Paroxysmal- resolves in 7 days
Persistent- Last longer than 7 days
Perm- always there and NEVER goes away
Recurrent- two or more episodes

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62
Q

All A-fib cases must be ?

A

Anticoagulated

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63
Q

How is A-Fib rhythm and rate controlled

A

Rhythm- cardioversion, antiarrhythmic

Rate- BBs, CCBs

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64
Q

A-Fib PTs without HOTN can be given what meds for rate control

A 
Esmolol
Metoprolol
Verapamil
Diltiazem
Digoxin
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65
Q

New onset A-Fib in PTs that are good candidates for cardioversion should be anticoagulated with which direct acting PO meds?

A

Dabigatran
Apixaban
Rivaroxaban
Edoxaban

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66
Q

Half of A-Fib cases revert to sinus in ? days

What is the fundamental component of management?

A

3-4days

Restore/maintain sinus or allow recurrence/progression to permanent A-Fib

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67
Q

All new A-Fib cases get ? procedure prior to conversion?

A

Transesophageal echo or

Anticoagulate 4wks prior and after procedure

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68
Q

What does a Cha2DS2VASc score of 0-1 or 2 mean?

A 
0-2= consider aspirin
\+2= anticoagulate
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69
Q

Characteristics of A-Flutter

A

Atrial rate regular, 250-300 bpm, variable ventricle rate

Characteristics saw tooth pattern

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70
Q

What is the etiology behind atrial flutters?

A

pericardial Dz
LAE/RAE
Hypoxia
Hyper/pothyroid

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71
Q

What are the S/Sx of Atrial Flutter

A

ASx - poor CO

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72
Q

How is Atrial Flutter treated?

A

Control ventricle rate w/ BB/CCB
Inc risk of recurrence= catheter ablation as definitive treatment
Tx w/ conversion, rate control and antiarrhythmias
If persistent, anticoagulate, but is rare

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73
Q

What medication can be used IV to attempt to treat atrial flutter?

A

Ibutilide

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74
Q

Atrial flutter should last less than 48hrs or ? needs to be performed?

A

Transesophageal echocardiogram to r/o clot in L atrial appendage

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75
Q

What is the INR limits for Atrial Flutter?

A

INR of 2-3 w/ Warfarin or

DARE for 4wks prior to minimize stroke

76
Q

Define Ventricular Arrhythmias

A

Rhythms originating in ventricular myocardium or in His/Purkinje tissues between 150-250 bpm

77
Q

Ventricular arrhythmias includes which ones?

A

PVCs
Non/Sustained ventricular tachycardia
Life threatening V-tach

78
Q

Define Couplet

Define Non-Sustained VT

Define Sustained VT

A

Two consecutive PVCs

Three or more PVCs

+30 seconds

79
Q

What are the etiologies of Ventricular Tachycardia

A 
MI
Structural heart Dz
R on T
Irritability, myocardia 
Drugs
E+ disturbances
80
Q

How does Ventricular Tachycardia clinically present?

A

Pulselessness
ASx/palpitations
Dec CO
Syncope

81
Q

Define Paroxysmal V-Tach

A

Irritable ventricular focus

Consecutive PVC like complexes

82
Q

Define R on T Phenomenon and why it’s important

A

PVCs hit T-wave and causes V-Tach

This is why conversions are synchronized to avoid shocking on T-waves

83
Q

How is V-Tach managed in un/stable PTs

A

Unstable- synchronized conversion w/ 200J

Stable- Antiarrhythmia therapy w/ Procainamide, Amiodarone or Lidocaine

84
Q

Define Torsades de Pointes and what causes them

A

Genetic/medication induced long QT syndrome over 440/460

Hypo Mg, K, Ca

85
Q

How do you treat Torsades de Pointes

A

Unsynchronized conversion

Magnesium

86
Q

What are the characteristics of Ventricular Fibrillation

A

Variable wide complex rhythm over 300bpm w/ no P wave

87
Q

What is the etiology behind Ventricular Fibrillation

A 
Hypothermia
Acid base
VT/Torsades, untreated
Electrical shock
MI infarction/ischemia
88
Q

How does Ventricular Fibrillation present clinically

A

Pulseless

Non-functioning heart causing 50% of deaths w/ CAD

89
Q

Define PEA

A

Any supraventricular rhythm w/out an effective/detectable pulse caused by the 5 H’s and 5 T’s that presents as pulseless, non-functioning heart

90
Q

What are the 5 H’s of ACLS

A 
Hypovolemia
Hypoxia
H+ excess
Hypo/perkalemia
Hypothermia
91
Q

What are the 5 T’s of ACLS

A 
Tamponade
Toxins
Tension Pneumothorax
Thrombosis, pulmonary
Thrombosis, coronary
92
Q

What will a Sinus Block/Sinus arrest look like

A

Dropped P wave and QRS
Unhealthy SA node may temporarily fail to pace for one cycle
No P wave

93
Q

Define Sick Sinus Syndrome

A

Arrhythmic caused by SA node dysfunction w/ unresponsive supraventricular automaticity foci

94
Q

Sick Sinus Syndrome manifests as ? and presents w/ ?

A

Sinus brady without normal escape mechanisms

May present w/ Brady-Tachy Syndrome

95
Q

What is the etiology behind Sick Sinus Syndrome

How does it present in clinic?

A

CADz

Presents with palpitations, light headed and syncope

96
Q

Define Pseudo Sick Sinus Syndrome

A

Athletes w/ resting sinus brady

Holster/Pacemaker

97
Q

Define an AV Block

A

Impacted conduction from atria to ventricles

98
Q

Define First Degree AV Block

A

Regular rhythm with normal P waves and QRS

PR interval >0.20 sec

99
Q

What is the etiology behind First Degree AV blocks?

A

Athlete
Increases w/ age
Medications

100
Q

Define a Second Degree AV Block Mobitz Type 1

A

Irregular PR interval getting progressively longer until QRS is dropped
Normal P wave interval

101
Q

What is the etiology behind a Second Degree Block

A

Normally ASx

Possible Sx from bradycardia

102
Q

Define Second Degree Heart Block Mobitz Type 2

A

Prolonged PR interval w/ sudden dropped QRS complexes

Atrial depolarizations are totally blocked

103
Q

What is the etiology behind Second Degree Heart Block Mobitz Type 2

A

Large MIs
Damage to AV node (RCA)
Medications

104
Q

How does Second Degree Heart Block Mobitz Type 2 present in clinic and what is the treatment?

A

Low CO

Possible pacemaker

105
Q

Define Third Degree Block

A

Total block of conduction to ventricles
Regular rhythm-
40-60 if junctional
20-40 if ventricular

106
Q

What is the etiology behind 3* Blocks?

A

Damage to AV node
IMI
MI at infra-nodal level
UNLIKELY from meds

107
Q

How do 3* AV Blocks present

A

ASx to dec CO

Cannon A waves from valaves closing when chambers are firing

108
Q

How are 3* blocks treated?

A

Pharmacotherapy

Pacing

109
Q

When do PR intervals increase?

A

First degree AV block
Wenckebach cycles
Mobitz w/ QRS drops

110
Q

When do PR intervals decrease?

When are PR intervals variable?

A

WPW Syndrome

3* Block

111
Q

When are there P waves without WRS complexes?

A

Wenckebach
Mobitz
3* block

112
Q

How is unstable bradycardia treated?

A

1mg Atropine or,
Isoproterenol infusion
Temporary pacemaker

113
Q

How is stable bradycardia treated?

A

Remove any medications

Implant pacemaker- especially if Mobitz II and 3* AVB

114
Q

Define BBB

A

QRS greater than 0.12sec

Recognized by R,R’ in specific leads of ECG

115
Q

Define Intraventricular Conduction Delay

A

QRS between 0.10 - 0.12sec

116
Q

Where do you look on the ECG to find a R BBB and a L BBB?

A

R- V1, 2

L- V5, 6

117
Q

What etiologies cause R BBB?

A 
Atrial Septal Defects
Senile Degeneration
Ischemic Heart Disease
Cardiomyopathy
Massive PE
RVH
Normal Variant
118
Q

What characteristics will be seen in ECG paper with a R BBB?

A

QRS > 0.12
RSR’ in V1 or V2
Wide S in V4-6
V1 and V2- ST depression and Inverted T

119
Q

What are the etiological causes of L BBB?

A 
Idiopathic degeneration conduction system Dz
Ischemic Heart Dz
MI
New L BBB c/w STEMI
Cardiomyopathy
Aortic Stenosis
HTN/LVH
Hyperkalemia
Normal Variant (unusual)
120
Q

What will be seen on ECG paper during a L BBB?

A

QRS > 0.12
High voltage S wave V1-2
Tall R wave V5-6, 1 and aVL
Slurred notch in any of above

V5, V6, 1 and aVL- ST depression and Inverted T

121
Q

Left BBB confounds ECG interpretation for what three things?

A

Ischemia/infarction
Ventricular hypertrophy
ST/T wave changes

122
Q

What does the R Coronary Artery supply?

What does the L Coronary Artery supply?

A

Posterior division of L BB and AV node

R BB and Anterior division of L BB

123
Q

What are the 4 Fascicular Blocks

A

Acute MI (LAD)
HTN
Aortic stenosis
Dilated cardiomyopathy

124
Q

Where will an Anterior Fascicular Block be seen on ECG paper?

A

Q1, S3, 2, and aVF

Normal/slightly wide QRS

125
Q

Where will a Posterior Fascicular Block be seen on ECG paper?

A

S1Q3- S in L1, Q in L3
Right axis deviation
Normal/slightly widened QRS

126
Q

Why are posterior fascicular blocks rare?

A

Usually dual blood supply

127
Q

Define Axis

A

Direction of movement of depolarization that spreads through heart to stimulate the myocradium

128
Q

What part of the heart beat identifies contraction of the myocardium?

A

QRS

129
Q

Which way does the QRS point on ECG paper?

A

Down and L due to L ventricle wall thickness

130
Q

Which two leads are the key ones for determining the axis?

A

1 and aVF

131
Q

Which wax does the axis point during hypertrophy and MIs?

A

Hypertrophy- towards trophied side

MI- away from side w/ infarct

132
Q

What are the causes of L Axis Deviation

A 
LVH
Inf MI
L Ant Fasc. Block
L BBB
Paced Rhythm
WPW Syndrome
133
Q

What are the causes of R Axis Deviation?

A 
RVH
Lateral MI
L Post Fasc Block
Acute Lung Dz (PE)
COPD
134
Q

What are the causes of Extreme R Axis Deviation?

A

V-Tach

Hyperkalemia

135
Q

What is the next step after identifying an axis deviation for better localization?

A

Find next best isoelectric lead
Vector is 90* from lead
Known quadrant allows axis vector determination

136
Q

Define Horizontal Axis

A

R Wave Progression

Determined w/ precordial leads

137
Q

Define Horizontal Zone of Transition

A

How deflection moves across precordial leads

138
Q

What are the normals seen in Horizontal Zone of Transistion?

A

Norm= negative in V1
Transition= + in V6
Normal zone= V2-4

139
Q

What are the causes of poor R Wave progression?

What needs to be checked here for operator error?

A

Anterior Infarction
RVH
Chronic Lung Dz
Obesity

*Check for lead reversal

140
Q

Define Acute Coronary Syndrome

A

Spectrum from unstable angina to NSTEMI

141
Q

Define Angina

A

Chest pain from ischemia

142
Q

Define Ischemia

A

Lack of O2 to myocardial muscle

143
Q

Define Unstable Angina

A

Partial clot that can occur without case and last 15-20min
Poor response to Nitro
Dx on 1st episode

144
Q

Define Stable Angina

A

Predictable, usually w/ activity or stress

Dx only after work up for angina

145
Q

Define Variant/Printzmetal Angina

A

Chest pain from a coronary artery spasm that can occur at rest/night in a non-atherosclerotic vessel
Thought to be caused by an endothelial dysfunction

146
Q

Define Infarct

A

Cellular death and necrosis leading to permanent loss of myocardium and function

147
Q

Define NSTEMI

A

AKA Non-Q wave MI
Difficult to distinguish from unstable MI w/out assessing markers
Markers= NSTEMI
No Markers= Unstable angina

148
Q

Acute Coronary Syndrome has a 50% or higher prevalence in what three areas?

A

NSTEMI
65y/o
Men

149
Q

What T wave changes will be seen with ischemia/infarction?

A

Peaked w/ hyperacute

Inverted w/ ischemia, infarct or injury

150
Q

What ST changes will be seen with ischemia/infarction?

A

Depressed w/ ischemia

Elevated w/ injury/infarct

151
Q

What Q wave changes will be seen with ischemia/infarction?

A

Start appearing w/ ischemia, injury, or infarct

Remain permanent if infarct occurs

152
Q

What U wave changes will be seen with ischemia/infarction?

A

Seen on leads w/ pathological Q Waves

Exercise stress test can cause inversions

153
Q

How do you measure for ST Segment Deviations?

A

Locate J point
Move 1.5 small boxes to R
Measure from baseline to isoelectric point

154
Q

Define ST Depression

A

Represents sub-endothelial myocardial ischemia
Can be reversible and not necessarily associated w/ injury but can be a dire warning sign
Associated w/ T wave inversion

155
Q

Define ST Elevation

A 
Represents acute transmural myocardial injury and appears in areas of necrosis
M= >2mm
W= >1.5mm 
Or >1mm in 2 or more contigous leads
Occurs w/out necrosis in variant angina
156
Q

What are the four types of ST morphologies?

A

Concave- less concerning
Up Slope
Horizontal
Convex

157
Q

What are the 3 evolving phases of change on an ECG during a MI?

A

Hyper/Early Acute
Evolved Acute
Chronic/Stabilized

158
Q

What events occur during the Hyper/Early Acute phase of changes of a MI?

A

T waves increase and widen over area of injury
ST goes from concave to straight to convex up
Proceeds clinical Sxs

159
Q

What events occur during the Evolved Acute phase of changes of a MI?

A

ST segments regress
T waves invert
Q waves develop after 1-2hrs

160
Q

What events occur during the Chronic/Stable phase of changes of a MI?

A

ST returns to base line or slightly elevated after 2wks
Early perfusion therapy helps accelerate changes
Obtain new baseline ECG

161
Q

What medications are considered in a sinus bradycardia DDx?

A 
BB
CCB
Antiarryhythmics
Digoxin
Lithium
162
Q

S/Sxs of sinud bradycardia?

A 
If PT can compensate/ASx= athlete
AMS
Blurred vision
Angina
Cool/clammy skin
Adeventitious lungs
Dizz
HOTN
S3 heart sound
Syncope
163
Q

Define a Wandering Atrial Pacemaker

A

Site shifts between SA, atria and AV nodes
3 different p-wave morphologies
HR below 100bpm

164
Q

What is the etiology of Wandering Atrial Pacemaker?

A 
Idiopathic
Vagal tone
Dig toxicity
Inflammed atrium
VHD
165
Q

Define Multifocal Atrial Tachycardia

A

Sped up version of WAP

Common in PTs w/ COPD

166
Q

What characteristics about MAT are different that WAP?

A

SA node doesn’t pace
3 or more different shaped P-waves
+100bpm
Irregular P-r, R-R and P-P intervals

167
Q

What is the etiology behind MAT?

A

Sever pulmonary Dz (COPD/Pneumonia)
Hypoxia
CHF

168
Q

How does MAT manifest?

A

Palpitations
SOB
Chest pain
Lightheaded/syncope

169
Q

What are the etiological causes of escape beats/rhythms

A

Dec automaticity- sinus node suppression, AMI, rheumatic disease, respiratory failure

Automaticity focus transiently escapes overdrive suppression- caffeine, adrenaline, digitalis, hyper thyroid, stretch

170
Q

How do frequent pauses/escape beats clincially manifest?

A

Normally ASx
HOTN
Light headed/syncope

171
Q

How does an atrial escape beat look on ECG?

A

Upright P wave

Occurs in healthy people related to sinus node suppression by meds, MI or respiratory failure

172
Q

How does a ventricular escape beat look on ECG?

A

Widened QRS

173
Q

How does a junctional escape beat look on ECG?

A

Inverted/absent P wave

174
Q

What causes junctional escape beats?

A 
Caffeine
Nicotine
ETOH/withdrawl
Digitalis
Hypoxia
Sinus node ischemia
Heart valve Dz
Myocarditis
175
Q

What causes ventricular escape beats?

A

Failed SA and AV pacing

Heart failure

176
Q

Define Bigeminy

What is it associated with?

A

Irritable focus (atria/venticle) that couple to the end of a normal cycle

Hypoxia

177
Q

What causes a run of PVCs

A

Irritable venticular focus fires spontaneous impulses

178
Q

What criteria makes non-sustained V-Tach?

A

3 or more PVCs

179
Q

Define R on T phenomenon

What does this definition justify in medical treatments?

A

PVC falls on a T wave and can cause deadly arrhythmia

Non-emergent conversions are synchronized to avoid T waves

180
Q

What factors make the heart vulnerable to R on T Phenomenons?

A

Hypoxia

Hypokalemia

181
Q

A normal P wave is seen inverted on which lead?

A

aVR

182
Q

What heart issues is AKA the “Holiday Heart”

A

A-Fib

183
Q

What are the intrinsic conduction rates?

A 
SA Node 60
Atrial cells- 55
AV node- 45
His bundle- 40
Bundle branch- 40
Purkinje- 35
Myocardial- 30
184
Q

The hearts BPMs are altered by ? and the m/s of conduction are altered by ?

A

Autonomic stimulus

Meds

185
Q

How fast does ECG paper move?

What does that mean calibrated?

A

22mm/sec

10mm=1mv

186
Q

How is HCM manageed?

A

ECG and holter monitor
No vigorous activities
Verapamil or BBs
Consider implant pacemaker

IPAP (212 decks)

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