EKG Class 3 Flashcards
causes of sinus tachycardia
response to exercise, fever, hypovolemic shock/dehydration, thyroid dz, anxiety, drugs (caffeine, epi, isoproternerol)
causes of sinus bradycardia:
hypothermia, drugs (BB), intracranial HTN, vagus nerve stimulation
location of dz in sick sinus syndrome:
SA node “forgets to fire”
EKG findings of sick sinus:
P waves are present, varying rate (PPintervals)
intermittent normal SR and sinus brady
Treadmill test with sick sinus will show:
sinus rate will NOT increase w/ exercise
Difference between sick sinus and sinus arrythmia:
sinus arrhythmia does not have long pauses like sick sinus
sinus arrhythmia often has cyclical variation a/w:
respiration
EKG findings with premature atrial contractions (PACs)
wonky P waves (tall/skinny/variable)
pause after T wave (SA node reset)
EKG findings of A fib
fibrillation
no P waves (loss of atrial kick)
irregularly irregular rhythm
Clinical advise for pts with PACs
avoid caffeine/stimulants
types of Afib:
paroxysmal: <7days
persistent: >7days
permanent: >1 year
causes of A fib:
HTN idiopathic valvular heart dz thyroid dysfunction heart surgery heart failure obstructive sleep apnea
Tx for Afib if unstable:
cardioversion synchronous biphasic shock
Tx for Afib if stable: 2 goals
anticoagulation: protect against stroke, CHADS2VASC >2, NOAC or coumadin (INR2-3)
rate/rhythm control: rate 1st, then consider anti-arrythmic drug or procedure to achieve sinus rhythm
CHADS2VASC variables:
CHF HTN Age (>65,>75) diabetes female sex stroke/TIA/embolism vascular hx
anatomical region of heart a/w Afib:
posterior left atrium
near pulmonary veins
left atrial appendage
Atrial flutter rate
atria: 300-320
ventricular: 150-100
(2: 1 or 3:1)
HR difference between A fib and A flutter:
Afib: bounces around (62-97-110-83)
Aflutter: stuck at 150
A flutter is what type of pathway?
MACRO re-entrant pathway
EKG findings w/ A flutter:
saw tooth waves
anatomical region of heart a/w A flutter:
tricuspid annulus
near IVC
first line treatment for stable A flutter
radiofrequency ablation (higher success than Afib, disrupt the electrical circuit)
duration of paroxysmal SVT
abrupt onset/offset
sxs of paroxysmal SVT:
lightheadedness, palpitations, chest pain, anxiety, sweating, SOB (mostly symptomatic)
triggers of paroxysmal SVT:
idiopathic anxiety stimulants overactive thyroid onset of menstruation
EKG findings of SVT:
narrow complex tachycardia
no p waves (1:1 Q and T waves)
regular rhythm
HR 160-200
Tx for stable SVT:
valsalva maneuver
place face in cold water
carotid sinus massage
Tx for unstable SVT:
adenosine or verapamil
electrical (DC) cardioversion
long term treatment of SVT:
BB
radiofrequency ablation
Macro re-entrant pathways:
a flutter
AVRT
Micro re-entrant pathways:
AVNRT
EKG findings AVNRT:
p wave hidden in QRS
1:1 ratio atrial and ventricular contraction
Wolf Parkinson White is a type of:
AVRT
EKG findings WPW
delta wave (slurred upstroke with wide QRS) “pre-excitation”
MOA atrial tachycardia:
focal source of tachycardia outside of SA node
NOT re-entrant circuit
EKG findings Multifocal atrial tachycardia:
at least 3 p wave morphologies
rate 100-180
irregular
causes of MAT
COPD, hypoxia, pulm HTN
Tx MAT
supplement O2
tx underlying condition
Difference between MAT and wandering atrial pacemaker:
wandering HR<100
MAT HR >100
Difference between atrial and sinus tachycardia:
atrial tachycardia does NOT resolve at rest (sinus does)
EKG findings for junctional/nodal rhythms
can be brady or tachy
absence of P wave or retrograde Ps
QRS nl
short PR interval
