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Clinical Methods Test 1 > EKG II > Flashcards

EKG II Flashcards

1
Q

arrhythmia

A

disturbance of rate, regularity, site or origin, or conduction.

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2
Q

NSR

A

60-100 bpm

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3
Q

clinical manifestations

A

palpitations, syncope, angina, CHF, death

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4
Q

awarenes of own heartbeat

A

palpitations, (not syncope, syncope=sudden fainting spell)

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5
Q

angina

A

rapid arrhythmia pain, ^ O2 demands

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6
Q

HIS DEBS

A

hypoxia, ischemia, symp stim, drugs, electrolytes, bradycardia, stretch

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7
Q

most info from which lead

A

Lead II

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8
Q

first action when you see an arrythmia?

A

print a strip

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9
Q

Holter monitor

A

ambulatory, portable EKG, 1-2 days, 1 limb lead, 1 precordial

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10
Q

Event monitor

A

rhythm disturbances, infrequent, patient records

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11
Q

KNOW! Rhythm analysis (5 steps)

A

rate, regularity, P waves, PR interval, QRS duration

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12
Q

inefficient depolarization of ventricles

A

ectopy

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13
Q

how do you calculate rate?

A

divide 300 by the # large boxes seperating two R waves

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14
Q

5 large sqares

A

1 sec

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15
Q

If R-R distances have a pattern the rhythm is?

A

regular

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16
Q

What if there is no P wave?

A

originate below the atria

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17
Q

Inverted P waves?

A

current flowing backwards

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18
Q

Normal PR interval?

A

atrial depol to beginning of vent. depola. 0.12-0.20 sec

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19
Q

Prolonged PR interval>

A

AV block

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20
Q

QRS duration?

A

0.04-0.12s 1-3 small boxes

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21
Q

electrical activity normal but too fast, slow, or irregular

A

arrythmia of sinus origin

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22
Q

origin of electrical activity elsewhere

A

ectopic rhythm

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23
Q

electrical activity trapped in electrical racetrack

A

reentrant arrythmias

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24
Q

usual pathway with blocks or delays

A

conduction blocks

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25
Q

accessory conduction pathway (short cut)

A

pre-excitation syndromes

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26
Q

When can you see sinus tachycardia?

A

exercise, CHF, lung dx, hyperthyroidism

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27
Q

Sinus bradycardia?

A

< 60 bpm. athletes, enhances vagal tone, early MI

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28
Q

Is a sinus arrythmia normal?

A

yes, slightly irregular but normal. inspiration=^HR, expiration=vHR

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29
Q

This occurs when sinus node stops firing

A

sinus arrest

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30
Q

myocardial cells take over pacing

A

escape beats

31
Q

what occurs if escape beats do not occur after sinus arrest?

32
Q

Which myocardial cells can behave as pacemakers?

A

virtually all of them

33
Q

Prolonged electrical inactivity/

A

asystole, no CO or blood flow.

34
Q

Treatment for asystole

A

CPR and epinephrine

35
Q

Can you defibrillate asystole?

A

nope. only arrythmias

36
Q

what is the rate of nonsinus pacemakers?

A

atrial foci (60-75 bpm), junctional foci (40-60bpm). ventricular foci (30-40 bpm)

37
Q

what are atrial foci?

A

some point IN the atrium that acts as a pacemaker

38
Q

what are ventricular foci?

A

HIS bundle, bundle branches, purkinje system

39
Q

Most common escape mechanism

A

junctional escape. depol near AV node, NO P WAVE

40
Q

a P wave is ________ in aVR

41
Q

What is a sustained rhythm of escape beats?

A

ectopic rhythm

42
Q

what can cause ectopic rhythms?

A

enhanced automaticity, digitalis toxicity, reentrant loop

43
Q

Four questions to be answered?

A

normal P wave? QRS wide or narrow? relationship between P wave and QRS? rhythm regular of irregular?

44
Q

single ectopic supraventricular beat that originated in atria?

A

PAC, premature atrial cx

45
Q

single ectopic supraventricular beat that originated near the AV node?

A

junctional premature beats

46
Q

Sudden, narrow QRS tachycardia initiated by a premature supraventricular beat/

A

PSVT. paroxysmal supraventricular tachycardia. 150-250 bpm

47
Q

How do you slow or terminate?

A

carotid massage. 15 seconds.

48
Q

Common triggers of PSVT?

A

alcohol, coffee, stress (so all of us)

49
Q

Mechanism of carotid massage?

A

increases pressure that is sensed by baroreceptors, vagus nerve cause HR to slow

50
Q

Order of steps:

A

listen for carotid bruits, 1 carotid at a time, watch for rhythm changes on strip

51
Q

Regular saw toothed, 250-350 bpm

A

atrial flutter. variety of different ratios of atrial:ventricular rates.

52
Q

Does carotid massage help with atrial flutter/

A

NO! increases block

53
Q

What is treatment?

A

cardioversion/drugs

54
Q

Most common AV block?

A

2:1. for q 2 flutter waves= 1 QRS complex

55
Q

Atrial flutter is common in?

A

HTN, obese, DM, electrolye imbalances, alcohol intox, drug abuse (cocaine/amphetamines), COPD, CAD, CHF….

56
Q

AV node bombard with > 500 impulses/min

A

A-Fib, irregularly irregular. tx: cardioversion and drugs

57
Q

At least 3 different P wave shapes, rate 100-200 bpm

A

multifocal atrial tachycardia MAT. common in severe lung disease.

58
Q

Multifocal atrial tachycardia is AKA

A

wandering atrial pacemaker. when rate < 100bpm

59
Q

Results from enhanced automaticity of ectopic atrial focus or reentrant circle w/in atria?

A

paroxysmal atrial tachycardia PAT. most common cause? digitalis toxicity

60
Q

summary: ectopic rhythms

A

PSVT, A-flutter, A-fib. MAT, PAT

61
Q

Carotid massage?

A

PSVT, A-fib

62
Q

Most common ventricular arrythmia?

A

PVC. wide bizarre QRS. no tx. common. REPLACE Mg2+

63
Q

1 normal beat:1 PVC

64
Q

2 normal beats:1 PVC

65
Q

When are PVC’s a concern?

A

frequent, three consecutive, vary in size, fall on T wave of previous beat (R on T phenomenon)

66
Q

Three of more consecutive PVC’s?

A

V-tach. emergency. preceded cardiac arrest

67
Q

Polymorphic V-tachycardia?

A

Torsades De Pointes. (changes appearance beat to beat). “twisting of the points”. patient with prolonged QT intervals

68
Q

What electrolyte disturbances can cause prolonged QT/

A

decreased Ca, Mg, K

69
Q

Drugs that can cause it?

A

antiarrythmic, tricyclics, phenthiazines, erythromycin

70
Q

Pre-terminal event seen in dying hearts?

A

V-fib. tx: CPR/defibrillation

71
Q

Most frequently encountered arrhythmia with sudden death?

72
Q

Benign rhythm seen with acute MI?

A

accelerated idioventricular rhythm

73
Q

Treatment of arrythmias?

A

programmed electrical stimulation, defibrillators

Clinical Methods Test 1 (8 decks)

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