EKG - Exam 2 Flashcards
What anatomic site does first degree AV block occur?
in the AV node of His bundle
AV dissociation occurs most often with what kind of block?
3rd degree AV
What will an incomplete right BBB look like on EKG? What leads should you look at?
RSR’ pattern but the QRS will NOT be wide like it is in a normal RBBB
leads V1 and V2
What arrhythmia are commonly seen with increased frequency in WPW?
atrial fib AND paroxysmal SVT (both wide and narrow complext)
What arrhythmia are commonly seen with increased frequency in LGL?
atrial fib AND paroxysmal SVT (both wide and narrow complext)
What is the delta wave of WPW syndrome a result of?
premature ventricular depolarization
What are some characteristics of the atrial fib that is associated with WPW?
It can induce ventricular fibrillation
Ventricular rates can rise as high as 300 bpm
It can cause syncope or sudden death
______ is likely to be present in torsades before the patient starts to have s/s?
long QT interval due to a prolonged ventricular repolarization
What are some EKG characteristics of a patient with hypothermia?
Prolongation of the PR interval
Prolongation of the QT interval
sinus bradycardia
prolongation of the QRS complex
What is the unusually shaped QRS complexes shown reveal what abormality? What lead should you look at?
the osborne wave of hypothermia?
can see rsr’ in V5
EKG changes associated with therapeutic levels of digitalis include?
ST segment depression
T/F: The length of the QT interval varies with the heart rate?
True
What are 4 things Brugada syndrome is characterized by?
Inherited as an autosomal dominant trait
A pattern resembling right bundle branch block
ST segment elevation in leads V1, V2, and V3
It is a cause of sudden cardiac death in persons with seemingly normal hearts.
a pt taking a TCA, what abnormality may present on an EKG?
prolonged QT interval
What are the 4 questions you need to ask yourself at the start?
normal P waves?
QRS narrow/wide?
what is the relationship between P and QRS complex?
is the rhythm regular or irregular?
What are reentrant rhythms due to?
due to accessory pathways, reenter the cycle of condition
What is recentrant impulse formation?
new impluses are formed elsewhere other than the sinus node
What is reentrant impulse transmission?
reentrant reentry
What is the reentrant reentry loop?
electric impulse that spins in a loop and send out wave of depolarization in all directions (can over ride sinus mechanism)
What rate is sinus tachycardia? what does a deep breath do to your heart rate? How many boxes?
101-149
deep breath in= increases HR
less than 3 big boxes
What rate is considered sinus bradycardia? What happens when you exhale? By how many boxes?
less than 60
exhale out = decrease HR
greater than 5 big boxes
What is the MC escape node?
junctional escape (AV node)
what rate is associated with atrial pacemaker?
60-75 bpm
What rate is associated with a junctional pacemaker?
40-60 bpm
What rate is associated with ventricular pacemaker?
30-45 bpm
What is the rate associated with mulitfocal atrial rhythm?
100-200 bpm and need at least 3 different P waves
What is the rate associated with atrial flutter?
250-350 bpm
What are PAC characterized by?
abnormal P wave followed by narrow QRS, some P wave can be embedded in the T wave
What is the difference between junctional escape and premature junctional?
junctional escape occurs late following a pause and premature happens early
What is accelerated idioventricular rhythm characterized by?
sustained VT but slower between 50-100 bpm
less than 50, loss the accelerated
T/F: Any rhythm can become regularly irregular`
TRUE
What is the normal length of PR interval?
0.12- 0.2
If you have a RBBB, what leads should QRS be positive?
V1, V2, aVR, III
If you have a LBBB, what leads should have positive QRS?
V5, V6, I, aVF
What is a bifascular block?
RBBB with combo of either left anterior or left posterior hemiblock
What is the criteria for nonspecific intraventricular conduction delay?
QRS wider than 0.1 but no other criteria are met
What is the criteria for incomplete RBBB?
rsr’ pattern but normal width QRS
What is the accessory pathway for WPW? LGL?
bundle of kent - WPW
james fibers = LGL
How wide is QRS in WPW? in LGL?
WPW= QRS is wider than 2.5 boxes (greater than 0.1 seconds)
LGL= QRS is normal
What is an orthodromic tachycardia? What will the QRS look like?
a rapid, NARROW complex tachycardia that occurs when electrical signal loop through the AV node and accessory pathway
What is antidromic tachycardia? What will the QRS look like?
activates ventricles through accessory pathways
will have WIDE QRS
What is characteristic EKG finding for a pt with hypothermia?
everything slows down!! sinus brady!!
can see rsr’ in V5 on EKG
abrupt rise at J point and then sudden depression back = J wave/Osborn wave
ST elevation with J point elevation
What is characteristic to find for digoxin effect on EKG?
ST segment depression with flattening/inverted T waves DIFFUSE across all leads
What can the digoxin effect lead to? What is it commonly seen with?
can result in bradyarrythmias/tacharrythmias
commonly seen with AV blocks
How many boxes is 1 second?
5 big boxes = 1 second
What leads are digitalis effect more prominent in? What AV blocks are they associated iwth?
leads with tall R waves
Digitalis slows conduction through the AV node and can therefore cause first-, second-, and even third-degree AV block.
What is the most characteristic rhythm disturbances of digitalis intoxication?
PAT with second-degree AV block
What are causes of a prolonged QTc interval?
What does Brugada syndrome resember? MC in men or women? What is the underlying cause?
long QT syndromes
men
genetic
mutation affecting voltage-dependent sodium channels during repolarization.
How do you identify the Brugada pattern?
(1) a pattern resembling right bundle branch block with a slow,
prolonged downslope of the R′ component of the QRS complex
(2) T-wave
inversion in leads V1 and/or V2
(3) ST-segment elevation in leads V1,
V2, and V3.
in Brugada pattern, describe the ST-segment elevation pattern?
The ST-segment elevation is often concave and descends into an inverted T wave, a pattern referred to as coving.
What is this?
brugada pattern in lead V1
