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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
accessory conduction pathway (short cut)
pre-excitation syndromes
26
When can you see sinus tachycardia?
exercise, CHF, lung dx, hyperthyroidism
27
Sinus bradycardia?
< 60 bpm. athletes, enhances vagal tone, early MI
28
Is a sinus arrythmia normal?
yes, slightly irregular but normal. inspiration=^HR, expiration=vHR
29
This occurs when sinus node stops firing
sinus arrest
30
myocardial cells take over pacing
escape beats
31
what occurs if escape beats do not occur after sinus arrest?
asystole
32
Which myocardial cells can behave as pacemakers?
virtually all of them
33
Prolonged electrical inactivity/
asystole, no CO or blood flow.
34
Treatment for asystole
CPR and epinephrine
35
Can you defibrillate asystole?
nope. only arrythmias
36
what is the rate of nonsinus pacemakers?
atrial foci (60-75 bpm), junctional foci (40-60bpm). ventricular foci (30-40 bpm)
37
what are atrial foci?
some point IN the atrium that acts as a pacemaker
38
what are ventricular foci?
HIS bundle, bundle branches, purkinje system
39
Most common escape mechanism
junctional escape. depol near AV node, NO P WAVE
40
a P wave is ________ in aVR
inverted
41
What is a sustained rhythm of escape beats?
ectopic rhythm
42
what can cause ectopic rhythms?
enhanced automaticity, digitalis toxicity, reentrant loop
43
Four questions to be answered?
normal P wave? QRS wide or narrow? relationship between P wave and QRS? rhythm regular of irregular?
44
single ectopic supraventricular beat that originated in atria?
PAC, premature atrial cx
45
single ectopic supraventricular beat that originated near the AV node?
junctional premature beats
46
Sudden, narrow QRS tachycardia initiated by a premature supraventricular beat/
PSVT. paroxysmal supraventricular tachycardia. 150-250 bpm
47
How do you slow or terminate?
carotid massage. 15 seconds.
48
Common triggers of PSVT?
alcohol, coffee, stress (so all of us)
49
Mechanism of carotid massage?
increases pressure that is sensed by baroreceptors, vagus nerve cause HR to slow
50
Order of steps:
listen for carotid bruits, 1 carotid at a time, watch for rhythm changes on strip
51
Regular saw toothed, 250-350 bpm
atrial flutter. variety of different ratios of atrial:ventricular rates.
52
Does carotid massage help with atrial flutter/
NO! increases block
53
What is treatment?
cardioversion/drugs
54
Most common AV block?
2:1. for q 2 flutter waves= 1 QRS complex
55
Atrial flutter is common in?
HTN, obese, DM, electrolye imbalances, alcohol intox, drug abuse (cocaine/amphetamines), COPD, CAD, CHF....
56
AV node bombard with > 500 impulses/min
A-Fib, irregularly irregular. tx: cardioversion and drugs
57
At least 3 different P wave shapes, rate 100-200 bpm
multifocal atrial tachycardia MAT. common in severe lung disease.
58
Multifocal atrial tachycardia is AKA
wandering atrial pacemaker. when rate < 100bpm
59
Results from enhanced automaticity of ectopic atrial focus or reentrant circle w/in atria?
paroxysmal atrial tachycardia PAT. most common cause? digitalis toxicity
60
summary: ectopic rhythms
PSVT, A-flutter, A-fib. MAT, PAT
61
Carotid massage?
PSVT, A-fib
62
Most common ventricular arrythmia?
PVC. wide bizarre QRS. no tx. common. REPLACE Mg2+
63
1 normal beat:1 PVC
bigeminy
64
2 normal beats:1 PVC
trigeminy
65
When are PVC's a concern?
frequent, three consecutive, vary in size, fall on T wave of previous beat (R on T phenomenon)
66
Three of more consecutive PVC's?
V-tach. emergency. preceded cardiac arrest
67
Polymorphic V-tachycardia?
Torsades De Pointes. (changes appearance beat to beat). "twisting of the points". patient with prolonged QT intervals
68
What electrolyte disturbances can cause prolonged QT/
decreased Ca, Mg, K
69
Drugs that can cause it?
antiarrythmic, tricyclics, phenthiazines, erythromycin
70
Pre-terminal event seen in dying hearts?
V-fib. tx: CPR/defibrillation
71
Most frequently encountered arrhythmia with sudden death?
V-fib
72
Benign rhythm seen with acute MI?
accelerated idioventricular rhythm
73
Treatment of arrythmias?
programmed electrical stimulation, defibrillators

Clinical Methods Test 1 (8 decks)

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