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RRCCPA Clinical Medicine I > EKG III and IV (Exam 3) > Flashcards

EKG III and IV (Exam 3) Flashcards

1
Q

Which kind of sinus dysrhythmia is this:

Rhythm: regular

Rate: <60 bpm

P wave: one for every QRS, nl in size/shape/direction

QRS complex: normal (<0.12sec)

A

Sinus bradycardia

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2
Q

Junctional rhythms originate in the

a. SA node
b. AV node
c. Bundle of Kent
d. Bundle of His

A

AV node! If you chose bundle of kent you owe me a crisp $20 bill.

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3
Q

You are looking at an EKG from left to right and it’s going normal, normal, normal, normal, wide QRS followed by a T wave in opposite direction of QRS, normal, normal, normal…

what the heck was that one weird thing in the middle?

A

Premature ventricular contraction (PVC). They can be unifocal or appear in groupings (bigeminy: every other complex, or trigeminy: every third complex)

Sorry, it’s hard to explain without seeing a picture! Hopefully not too confusing…. see slides 55-58

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4
Q

“Saw-tooth” pattern should make you think of……

A

Atrial flutter!

  • Single irritable atrial foci initiates beat rapidly (rate around 300bpm)
  • Results in “flutter waves” preceding QRS complex, hence the saw-tooth pattern
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5
Q

Define sinoatrial/sinus arrest

A

SA node fails to initiate a beat

  • Rhythm: irregular
  • Rate: changing
  • P waves: one for every QRS, however a pause (>2 sec) occurs and a new rhythm is then started
  • PR interval: nl (0.12-0.20 sec)
  • QRS complex: nl (<0.12 sec)

*Often concerning

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6
Q

What is the normal duration of the QRS complex?

A

0.12 sec or less

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7
Q

Define sinus arrhythmia

A

SA node initiates beat but at varying intervals:

  • Rhythm: irregular (R to R varies and P to P varies)
  • Rate: varies
  • P waves: one for every QRS, nl in size/shape/direction
  • PR interval: nl (0.12-0.20 sec)
  • QRS complex: nl (<0.12 sec)
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8
Q

What’s going on with multifocal atrial tachycardia and how do you identify it on an EKG?

A
  • Multiple foci within the atria are firing at a rate >100
    • Basically same thing as wandering atrial pacemaker but fast
  • Irregularly irregular
  • P waves vary
  • P-R interval varies
  • R-R interval varies
  • P:QRS is 1:1
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9
Q

What’s this rhythm?

A

Sinus arrythmia

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10
Q

What is going on with wandering atrial pacemaker and how do you identify it on an EKG?

A
  • Pacemaker changes “spots” within the atria
  • Rhythm is irregular
  • Shape of P waves vary
  • P-R interval varies
  • P:QRS is 1:1
  • At least 3 different P-waves within 1 lead are needed to make dx
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11
Q

Name that rhythm: Tachycardic, wide QRS complexes of varying amplitudes, “twisted ribbon”

A

Torsades de pointes

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12
Q

What is this rhythm?

A

Atrial Flutter

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13
Q

Supraventricular tachycardia (SVT) will show up on an EKG with regular atrial and ventricular rhythm, narrow QRS, and a HR between _____ and _____ bpm.

A

Supraventricular tachycardia (SVT) will show up on an EKG with regular atrial and ventricular rhythm, narrow QRS, and a HR between 160-250 bpm.

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14
Q

What’s this rhythm?

A

Sinus arrest

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15
Q

What’s this rhythm?

A

Idioventricular rhythm

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16
Q

What’s this rhythm?

A

Junctional tachycardia, rate >100

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17
Q

What’s going on with premature atrial contractions (PACs)? How do you identify them on an EKG?

A
  • Irritable site within the atria discharges before SA node
  • Identified by:
    • Early/premature P wave
    • Abnormal P wave differs in shape from a sinus P wave
    • QRS complex is nl
  • Not an entire rhythm - just a single beat!
18
Q

Atrial dysrhythmias are caused by abnormal electrical impulse formation and conduction in the atria secondary to decreased function of the ____________, or an ______________ becomes excited.

A

Atrial dysrhythmias are caused by abnormal electrical impulse formation and conduction in the atria secondary to decreased function of the SA node, or an ectopic atrial foci becomes excited.

*NOT conducted from the AV node!

19
Q

What is the normal duration of a PR interval?

A

0.12-0.20 sec

20
Q

If every other beat is a PAC, it’s called ___________. If every 3rd beat is a PAC, it’s called _________.

A

If every other beat is a PAC, it’s called bigeminy. If every 2rd beat is a PAC, it’s called trigeminy (shown).

21
Q

What’s this rhythm?

A

Wandering atrial pacemaker

22
Q

What’s this rhythm?

A

Junctional rhythm, rate ~60

23
Q

What’s this rhythm?

A

SVT

24
Q

Which kind of sinus dysrhythmia is this:

Rhythm: regular

Rate: >100 bpm

P wave: one for every QRS, nl in size/shape/direction

QRS complex: normal (<0.12sec)

A

Sinus tachycardia

25
Q

Describe ventricular tachycardia

A
  • Ventricular rhythm with rate >100 bpm
  • Wide QRS and no other discernible waves
  • May convert into v-fib or asystole
26
Q

What’s this rhythm?

A

V-tach

27
Q

What’s this rhythm?

A

Atrial bigeminy

28
Q

What’s this rhythm?

A

NSR w/ PVC

29
Q

T/F: atrial dysrhytmias are conducted from the AV node

A

False!

Abnormal electrical impulse formation and conduction in the atria - ectopic foci

30
Q

What’s going on here?

A

Premature atrial contration (PAC)

31
Q

What is the name of this rhythm:

  • Single foci in the ventricle acting as pacemaker with a rate of 20-40 bpm
  • P waves usually absent (buried)
  • QRS wide (>0.12 sec)
  • All QRS complexes look the same
A

Idioventricular rhythm

32
Q

Atrial flutter is almost always (regular/irregular) rhythm, whereas a-fib is always (regular/irregular)

A

Atrial flutter is almost always regular rhythm, whereas a-fib is always irregular

33
Q

What is this rhythm? What’s the rate?

A

Sinus tachycardia, Rate ~130 bpm

34
Q

What’s this rhythm?

A

Multifocal atrial tachycardia

35
Q

What’s the difference between atrial flutter and a-fib?

A
  • Atrial flutter: single irritable atrial foci initiates beat rapidly
    • Shows up as saw-tooth p-waves
  • A-fib: 300-600 atrial foci firing at once
    • Absence of discernible P waves
    • Pictured:
36
Q

_________ is the most common of all sustained atrial arrhythmias

A

A-fib! It’s present in 3-4% of the population >70 yrs old

37
Q

What’s this rhythm?

A

A-fib

38
Q

V-fib ain’t so bad, right?

A

*face palm*

  • Chaotic rhythm originating in the ventricles
  • Quivering heart = no contraction, no pulse, no cardiac output
  • EKG with chaotic deflections, no nl waveform present
  • Causes immediate syncope & death within minutes
  • Presenting rhythm in 70% of cardiac arrests
39
Q

An inverted, late, or missing p-wave is indicative of a _______ rhythm.

A

An inverted, late, or missing p-wave is indicative of a junctional rhythm.

  • Rate is usually slow: 40-60 bpm
    • But can be accelerated: 60-100 bpm
    • Can also be tachycardic: >100 bpm
  • P-wave sometimes inverted because of the retrograde impulse coming up from the AV node
40
Q

What’s this rhythm?

A

V-fib

41
Q

What is a premature junctional contraction?

A
  • An early beat generated from the AV node.
  • Just an event, not a rhythm!
  • Shows up as a single inverted P-wave

RRCCPA Clinical Medicine I (49 decks)

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