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Clin Med, Path, Pharm > EKG, dysrrhythmias > Flashcards

EKG, dysrrhythmias Flashcards

1
Q

What are the four reasons someone would get an EKG?

A
  1. Chest pain
  2. Dyspnea
  3. Syncope
  4. Toxic ingestion
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2
Q

What are some limits to EKGs?

A

Can be completely normal in patient with ACS, AMI, PE

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3
Q

Do resting cells have a positive or negative charge?

A

negative

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4
Q

What is depolarization?

A

Influx of POSITIVE charge resulting in contraction

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5
Q

What are the lateral leads?

A

I and aVL

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6
Q

What are the inferior leads?

A

II, III, and aVF

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7
Q

Which chest leads (V1-V6) are positive?

A

all of them

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8
Q

What are the right sided leads?

A

V1 and V2

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9
Q

What are the septal leads?

A

V3 and V4

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10
Q

What are the left sided leads?

A

V5 and V6

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11
Q

J point

A

Junction of QRS and ST segment

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12
Q

Interval between the end of ventricular activation and beginning of ventricular recovery

A

ST segment

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13
Q

Ventricular repolarization

A

T wave

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14
Q

What can cause an abnormality in the T wave?

A

MI, electrolytes, drugs, conduction delays

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15
Q

Represents the complete cycle of ventricular systole

A

QT interval

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16
Q

How do you find QTc?

A

QT/square root of RR interval

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17
Q

What is QTc?

A

Estimated QT interval at HR of 60 bpm

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18
Q

What can cause a prolonged QT?

A

electrolytes, drugs, hypothermia

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19
Q

What is QTc > 500 associated with?

A

Torsades

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20
Q

Small positive deflection after T wave seen best in V2 and V3

A

U wave

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21
Q

What is a U wave caused by?

A

Caused by purkinje repolarization

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22
Q

What will allow you to see a U wave better?

A

decreased rate, more prominent with hypokalemia

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23
Q

What does it mean if you see an inverted U wave?

A

MI

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24
Q

What takes over if the SA node should fail?

A

Atrial foci take over (60-80 bpm)

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25
Q

What takes over if the atrial foci should fail?

A

AV junction foci (40-60 bpm)

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26
Q

What takes over if the AV junction should fail?

A

Ventricular foci (20-40 bpm)

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27
Q

How much time does 300 big boxes represent?

A

1 minute

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28
Q

How can you find rate?

A

300/number of big boxes

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29
Q

How do you find the rate on an EKG if it’s less than 50?

A

Use 3 second tick marks: Count cycles/beats in a 3 second run and multiply by 20

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30
Q

Where is the SA node?

A

Junction of RA and SVC

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31
Q

Where is the blood supply of the SA node from?

A

55% RCA, 45% LCA

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32
Q

What 3 things cause dysrrhythmias?

A
  1. Enhanced automaticity
  2. Triggered activity
  3. Reentry
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33
Q

What is the cause of dysrrhymia that is from a calcium overload?

A

Triggered Activity

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34
Q

What is the cause of dysrrhythmia that is from a current taking an abnormal path for conduction?

A

Reentry

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35
Q

What is the cause of dysrrhythmia from spontaneous depolarization of a non-pacemeaker cell?

A

Enhanced automaticity

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36
Q

What is the cause of dysrrhythmia from ischemia?

A

Enhanced automaticity

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37
Q

What is the cause of dysrrhythmia from having a lower threshold of depolarization in a normal pacemaker cell?

A

Enhanced automaticity

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38
Q

What type of antiarrhythmic drug moderately slows conduction through atria, AV node, and bundle of His?

A

1A sodium channel blockers

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39
Q

What is procainamide best used for?

A

Ventricular and Supraventricular dysrrhythmias (Class 1A sodium channel blocker)

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40
Q

SE of procainamide?

A

Hypotension, QRS widening

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41
Q

What class blocks sodium channels?

A

1

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42
Q

What class blocks calcium channels?

A

4

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43
Q

What class blocks potassium channels?

A

3

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44
Q

What class is a beta adrenergic antagonist?

A

2

45
Q

What class of antiarrhythmics minimally slows conduction and shortens repolarization?

A

1B sodium channel blockers

46
Q

What is lidocaine best used for?

A

Ventricular tachycardia (Class 1B) Max dose is 3 mg/kg total

47
Q

What class of antiarrhythmics MARKEDLY slows conduction to the point you can develop new dysrrhythmias?

A

IC sodium channel blockers

48
Q

What is flecainide best used for?

A

SVTs

49
Q

What class of antiarrhythmics suppresses SA node automaticity and slows AV conduction?

A

Class II beta blockers

50
Q

What is Esmolol best used for?

A

AMI pt with A. Fib or A. Flutter. Controls ventricular rate in atrial dysrrhtymias

51
Q

What are SE of esmolol?

A

Bronchospasm, hypotension, heart failure. C/I in asthma, COPD patients

52
Q

Which antiarrhythmic is an alternative to class I agents for atrial and ventricular dysrrhythmias?

A

Class III potassium channel blockers

53
Q

Which antiarrhythmic prolongs repolarization and refractory period?

A

Class III potassium channel blockers

54
Q

What is amiodarone best used for?

A

Atrial and ventricular dysrrhythmias

55
Q

What is Sotalol best used for?

A

BB with K+ channel inhibition

SVT, ventricular tachycardia

56
Q

What are side effects of Sotalol?

A

Risk of QT prolongation

57
Q

Which antiarrhtymic is mostly used for SVTs and slows conduction within the AV node?

A

Class IV CCBs

58
Q

Who should avoid using Class IV CCBs?

A

Patients with heart block

59
Q

What is Diltiazem (Cardiazem) best used for?

A

A fib, A flutter (Class IV)

60
Q

What are SE of Diltiazem (Cardiazem)?

A

Hypotension, peripheral vasodilation

61
Q

What is Verapamil best used for?

A

A. Fib, A flutter (Class IV)

62
Q

What are SE of Verapamil?

A

Hypotension, less peripheral vasodilation than Cardiazem

63
Q

Na/K+ ATPase inhibitor that is not first line but used for A.fib and A. flutter because it leads to stronger, more forceful contractions (calcium influx)

A

Digoxin

toxicity = green halos

64
Q

Terminates narrow complex tachydysrrhythmias and SVTs

A

Adenosine

65
Q

Dose, Route, and Frequency of Adenosine

A

Dose/Route: 6 mg IV bolus

Frequency: ‘6, 12, 12’

66
Q

Palpitations, lightheadedness, dyspnea on exertion and anxiety

A

Stable

67
Q

Hypotension, chest pain

A

unstable

68
Q

altered LOC, syncope, respiratory distress

A

unstable

69
Q

Causes of sinus bradycardia

A

healthy young adults and athletes, increased parasympathetic stimulation, hypoxia and hypothermia

70
Q

How do you treat symptomatic bradycardia?

A

Atropine up to cumulative dose of 3 mg

71
Q

Normal P waves with varied RR interval. Ventricular rate is <60 bpm

A

sinus arrhythmia

72
Q

What do you do about sinus arrhythmia?

A

Nothing.. normal variant

73
Q

Failure of the SA node to generate an impulse

A

Sinus arrest

74
Q

Failure of the conduction out of the SA node

A

Sinoatrial Exit Block

75
Q

Absent P waves with an escape rhythm or dropped beats

A

Sinus arrest and sinus block

76
Q

Group of dysrrhythmias from a diseased sinus node. What are the 3 characteristics?

A

Sick sinus syndrome

Bradycardia, sinus arrest, sinoatrial exit block

77
Q

Who is sick sinus syndrome seen in?

A

Adults from fibrosis of the conduction system

78
Q

Impaired conductions through the atria, AV node, or the proximal His/Purkinje system

A

AV block

79
Q

Slowed conduction without the loss of any beats. PR interval >0.2 seconds

A

First degree AV block

80
Q

Some sinus impulses failing to reach the ventricles. Will have one or more dropped beats. P wave without a QRS wave.

A

Second degree AV block

81
Q

“Longer and longer until you drop” Disturbance within the AV node itself.

A

Type 1 Second degree AV block

Wenkebach or Mobitz 1 Block

82
Q

What makes Wenkebach better and worse?

A

Better with Atropine

Worse with Vagal

83
Q

Block just below the AV node. Seen in AMI setting. Consistent PR intervals

A

Mobitz II Block

Second degree AV block

84
Q

What makes Second degree AV block better? Worse?

A

Better with Vagal
Worse with Atropine
(opposite of type 1)

85
Q

What’s the difference between type 1 and type 2 AV block?

A 
Type 1:  Normal variant
Type 2:  Never a normal variant
Type 1:  Inconsistent PR intervals
Type 2:  consistent PR intervals
Type 1:  Worse with vagal, better with atropine
Type 2:  Reversed
86
Q

Complete AV block or complete heart block. No conduction gets through the ventricles. PP and RR intervals are consistent, just not paired.

A

Third Degree AV Block

87
Q

QRS 100 BPM

A

Narrow Complex Tachycardias

Supraventricular tachycardia

88
Q

Normal P waves before each QRS. Rates rarely above 170 BPM

A

Sinus tachycardia

89
Q

Abnormal P waves (P prime). Atrial rhythm over 100 BPM. Pacer originates from a site other than the SA node

A

Atrial tachycardia

90
Q

What’s seen in kids and young adults with structural heart disease?

A

Atrial tachycardia

91
Q

Atrial tachycardia with 3 or more different P waves

A

Multifocal atrial tachycardia.

Usually seen in COPD patients

92
Q

“Everything is happening”
“Irregularly irregular”
No identifiable P waves

A

Atrial fibrillation
A. Fib with RVR (rapid ventricular response)
V. rates can be 150-170 bpm

93
Q

Atrial depolarization at a rate of 250-350 BPM. Due to re-entry mechanism.

A

Atrial Flutter

94
Q

Saw tooth pattern at Lead II

A

Atrial flutter

95
Q

Regular narrow complex tachycardia with a ventricular rate >160 BPM. Results from reentry circuit within the AV node. Travels through HIS with retrograde back to the atria

A

AVNRT

AV nodal reentry tachycardia

96
Q

Acute onset and acute termination of rhythm. Triggered by emotional stress or exercise. Usually without underlying disease. No risk of CV collapse.

A

AVNRT

97
Q

What’s best for treating A.fib and a. flutter?

A

Beta blockers and CCBs

98
Q

What’s good prophylactic treatment of AVNRT?

A

Beta blockers and CCBs

99
Q

What’s acute treatment given to AVNRT?

A

Adenosine

100
Q

On EKG: Short PR 0.10 seconds, slurred QRS (delta wave)

A

Wolf Parkinson White

101
Q

Any tachycardia with a QRS >0.12 seconds. Source is pacer from within the ventricle or above the AV node

A

Wide Complex Tachycardia

102
Q

Ventricular tachycardia that lasts <30 seconds

A

Nonsustained

103
Q

Ventricular tachycardia that has consistent QRS appearances

A

Monomorphic

104
Q

Ventricular tachycardia with varied QRS appearance

A

Polymorphic

105
Q

How do you treat stable ventricular tachycardia?

A

Amiodarone

Lidocaine

106
Q

How do you treat unstable ventricular tachycardia?

A

Synchronized Cardioversion (Defibrillator)

107
Q

Ventricular tachycardia with rate >200 BPM, undulating QRS, and paroxysms less than 90 seconds. Seen in QT prolongation.

A

Torsades de Points

108
Q

What are causes of torsades de points?

A

Hypokalemia, hypomagnesium, drug induced, starvation, hypothyroidism, MI

Clin Med, Path, Pharm (12 decks)

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