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Clin Med-Cardio pt 1 > EKG book...arrhythmias > Flashcards

EKG book...arrhythmias Flashcards

1
Q

Any disturbance in the rate, regularity, site of origin or conduction of the cardiac electrical impulse

A

Arrhythmia

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2
Q

HR as low as 35-40 bomb are common and quite normal in…

A

Well trained athletes

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3
Q
  • Palpitations
  • Light headedness/syncope
  • Sudden death
A

Clinical manifestations of arrhythmias

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4
Q

HIS DEBS mnemonic…arrhythmogenic factors that should be considered in patients w arrhythmias

A

Hypoxia
Ischemia/irritability
Sympathetic stimulation

Drugs
Electrolyte disturbances
Bradycardia
Stretch

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5
Q

In order to ID arrhythmias correctly, what must be examined?

A

Rhythm strip

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6
Q

Reentry loops represent a disorder of….

A

Impulse transmission

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7
Q

With junctional escape, depolarization originates near the AV node, and the usual pattern of atrial depolarization does not occur. As a result, a normal what is not seen?

A

P wave

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8
Q

What does an EKG of sinus arrest or sinus block look like?

A

Normal sinus rhythm followed by flat line

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9
Q

What does an EKG of junctional escape look like?

A

Normal sinus rhythm, followed by a longer than normal pause, then QRS complexes (further apart) with no p wave before

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10
Q

Ectopic rhythms and reetrant rhythms are the 2 major causes of

A

Nonsinus arrhythmias

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11
Q

These can be limited within a single anatomic site (i.e. the AV node), can occur through an entire chamber or they can even involve both an atrium and ventricle

A

Reentrant loops

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12
Q
  1. Are normal P waves present?
  2. Are the QRS complexes narrow (0.12 seconds)
  3. What is the relationship between the P waves and the QRS complexes
  4. Is the rhythm regular or irregular?
A

The 4 questions you must ask when looking at an arrhythmia EKG

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13
Q

If there are normal appearing P-waves with a normal axis, then the origin of the arrhythmia is most likely within the…

A

Atria

a normal P wave axis is a pretty good indication the rhythm originates above the AV node

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14
Q

A QRS complex of less than 0.12 seconds in duration…

A

Narrow

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15
Q

A QRS complex of greater than 0.12 seconds in duration…

A

Wide

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16
Q

A narrow QRS complex implies that ventricular depolarization is proceeding along which pathway?

A

The usual pathway! (AV node to Bundle of His to bundle branches to Purkinje cells)

*this is the most efficient means of conduction, which is why the QRS complex appears narrow

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17
Q

A narrow QRS complex indicates that the origin of the rhythm must be at or above the…

A

AV node

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18
Q

A wide QRS complex usually implies that the origin of depolarization is within…

A

The ventricles

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19
Q

What does the QRS complex look like when depolarization is initiated within the ventricular myocardium, not the conduction system

A

Wide QRS

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20
Q

If the P wave and QRS complexes correlate in a 1:1 fashion, with a single P wave preceding each QRS complex, then the rhythm almost certainly has a ______ origin

A

Sinus or other atrial

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21
Q

Single ectopic supra ventricular beats that originate in atria

A

Atrial premature beats

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22
Q

Single ectopic supra ventricular beats that originate in the vicinity of the AV node

A

Junctional premature beats

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23
Q

If the P wave contour of the premature beat differs from that of the normal sinus beat…

A

Atrial premature beat

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24
Q

If there is no P wave preceding the premature QRS complex..

A

Junctional premature beat

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25
Q

What is the difference between a junctional premature beat and a junctional escape beat?

A

Junctional premature occurs EARLY, prematurely interposing itself into the normal sinus rhythm

An escape beat occurs LATE, following a pause when the sinus node has failed to fire

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26
Q

A premature junctional beat has no..

A

P wave preceding the QRS complex

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27
Q

The QRS complex in both atrial and junctional premature beats..

A

Normal! …conduction occurs normally to the ventricles

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28
Q

Common arrhythmia with abrupt onset, initiated by a premature supra ventricular beat, with a quick termination. Rate is usually between 150-220 bpm

A

Paroxysmal supraventricular tachycardia (PSVT)

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29
Q

Regular, narrow QRS tachycardia

P waves usually not seen

A

Paroxysmal supraventricular tachycardia (PSVT)

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30
Q

Most common cause of Paroxysmal supra ventricular tachycardia (PSVT)

A

AV nodal reentry

31
Q

What can be done to help diagnose and terminate an episode of paroxysmal supra ventricular tachycardia (PSVT)

A

Carotid massage

vagal stimulation slows conduction through AV node

32
Q

Can interrupt the reentrant circuit and thereby terminate the PSVT arrhythmia OR can at least..
Slow the PSVT arrhythmia so that the presence or absence of P waves can be more easily determined and the arrhythmia diagnosed

A

Carotid Massage

33
Q

The carotid sinus contins baroreceptors that influence vagal input to the heart, primarily affecting the…

A

SA and AV nodes

34
Q

What must you check for before performing a carotid massage?

A

Carotid bruit

35
Q

With the pt lying flat, extend the neck and rotate the head away from you. Palpate the carotid artery at the angle of the jaw and apply pressure for….

A

10-15 seconds

36
Q

Which side should you try first when doing a carotid massage because the rate of success is higher

A

Right!

37
Q

Regular and rapid arrhythmia
P waves appear at a rate of 250-350 bpm
Usually generated by a reentrant circuit that runs largely around the annulus of the TRICUSPID valve

A

Atrial flutter

38
Q

Atrial depolarization occurs at such a rapid rate that discrete P waves separated by a flat baseline are not seen. Instead, the baseline continually rises and falls

A

Atrial flutter

39
Q

In some leads, especially leads II and III, may see a “saw toothed pattern”

A

Atrial flutter

40
Q

The AV node cannot handle all of the atrial impulses in atrial flutter, so not all of the atrial impulses pass through the AV node to generate QRS complexes..some just bump into a refractory node. This is known as…

A

AV block

41
Q

Which type of AV block is most common?

A

2:1

42
Q

For every 2 visible flutter waves, one passes through the AV node to generate a QRS complex and one does not

A

2:1 AV block

43
Q

What can increase the degree of a block (i.e. changing a 2:1 block to a 4:1 block), making it easier to identify the saw toothed pattern

A

Carotid massage

44
Q

Will carotid massage stop atrial flutter?

A

No! Because atrial flutter originates above the AV node

45
Q

Will the saw tooth pattern be negative or positive if the reentrant circuit of atrial flutter is rotating COUNTERCLOCKWISE

A

Negative

46
Q

Will the saw tooth patter be negative or positive if the reentrant circuit of atrial flutter is CLOCKWISE around the tricuspid valve

A

Positive

47
Q
  1. at least 2 conduction pathways

2. variable block in one of the pathways

A

Criteria for reentry

48
Q

Although atrial flutter is rarely life threatening, the rapid ventricular response may cause…

A

SOB
Angina
Precipitate or worsen CHF

49
Q

In those that are hemodynamically stable, what is the first method of choice to return patients from atrial flutter back to normal sinus rhythm

A

Pharmacologic cardioversion

50
Q

During this type of arrhythmia, the AV node may be bombarded with more than 500 impulses per minute!!

A

Atrial Fibrillation

51
Q

Multiple reentrant circuits whirl around in unpredictable fashion. No true P wave seen
*baseline appears flat or undulates slightly

A

Atrial Fibrillation

52
Q

The AV node, faced with a blitz of atrial impulses, allows only occasional impulses to pass through at variable intervals, generating an IRREGULARLY IRREGULAR VENTRICULAR RATE usually between 120-180 bpm

A

Atrial fibrillation

53
Q

The irregularly irregular appearance of QRS complexes in the absence of discrete P waves is the key** to identifying…

A

Atrial fibrillation

54
Q

Irregularly irregular supra ventricular (narrow QRS) rhythm

A

Atrial fibrillation

55
Q

Multiple re-entrant circuits in the atria..chaotic atrial activity generates 400-600 atrial depolarizations per minute, most of which are blocked because AV node in refractory period

A

Atrial fibrillation

56
Q

Ventricular rate is usually 120-180 bp
No reproducible P waves; undulating baseline

*initial goal=slow rate with meds!!!

A

Atrial fibrillation

57
Q

Patients with atrial fibrillation are at risk of…

A

Clot/stroke

lots of stagnant blood

58
Q

Most common sustained arrhythmia in the general popular

A

A fib

59
Q
  1. Slow down HR
  2. fully anticoagulate

Tx for…

A

A fib

60
Q

Palpitations, chest pain, SOB, dizziness may occur in..

A

A fib

61
Q

How do you determine ratio in atrial flutter?

A

Count downward deflections!

62
Q

Which lead will have positive/upward flutter waves?

A

V1

63
Q

When a reentry loops causes regular, narrow QRS with VERY fast rate!!! No P waves

A

PSVT

64
Q

Very abrupt start, very abrupt termination. Can tell to the second the beginning and end of.

A

PSVT

65
Q

Reentrant supraventricular tachycardia with regular fast QRS complexes, 150-220 bpm

A

PSVT

66
Q

Escape rhythm as a result of sinus slowing or sinus arrest. May occur normally in sleep due to increased vagal tone.
Narrow QRS
P waves usually not seen
Typical rate is 40-60 bpm.

A

Junctional escape rhythm

minimally symptomatic

67
Q

DOC for PSVT?

A

Adenosine

68
Q

If the QRS is wide, where did the arrhythmia originate?

A

Ventricles

69
Q

An early beat with a wide QRS complex..

A

Premature ventricular contraction (PVC)

70
Q

Every third beat is a PVC

A

Ventricular trigeminy

71
Q

2 PVCs back to back

A

Ventricular couplet

72
Q

3 PVCs in a row and a rate GREATER than 100

A

Ventricular tachycardia

73
Q

“Twisting of the points” or “Fringe of pointed/twisting tips”
Polymorphic VT, very fast and dangerous.
Associated with prolongation of QT interval.
Difficult to treat and often deteriorates into ventricular fibrillation (VF).

A

Torsade de Points

74
Q

Fairly common (1/200 incidence) during invasive cardiac procedures including coronary angiography.

A

Ventricular fibrillation

Clin Med-Cardio pt 1 (10 decks)

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