EKG-LVH and Pacemaker

Question 1

What causes INC signaling on EKG during depolarizations?

Answer 1

HYPERtrophy- atria or ventricle.

LVH MC

Question 2

This EKG has a tall P-wave that is peaked. What is this and what leads?

Answer 2

Right atrial hypertrophy. LEADs I-II,

1. Peak >2.5mm Lead 2, 3, AVF.
2. Right shift of p-wave
3. • deflection of p-wave in V1 OR V2 >1.5mm

Question 3

This EKG has a wide, notched P-wave that is peaked. What is this and what else my be seen in each lead?

Answer 3

Left atrial hypertrophy-Lead II.

Other V1-biphasic P wave

Question 4

What are cause of RAE?

Answer 4

Pulmonary HTN, COPD, Tricupsid stenosi, Tetraology,

Question 5

What are cause of LAE?

Answer 5

Mitral stenosis, LVH+ AS, HCM, HTN

Question 6

What is required in LAE?

Answer 6

1. V1 negative biphasic deflection is 1 box.
2. L shift of p-wave
3. Notched and wide Pwave Lead 1 or 2

Question 7

What is natural progression of R wave for LV?

Answer 7

V1-2- biphasic, large neg S wave.

V3-V6 tall R wave

Question 8

What should be considered if RVH is suspected?

Answer 8

Right AXis Deviation. V1- Pos. Large S wave. Lead I neg deflection

Question 9

This EKG has abnormal deep S wave in V1-2 and Tall R wave in V5-6?

Answer 9

LVH. R wave >11-13mm AVL

Question 10

What else is seen on EKG for LVH?

Answer 10

LAD and/or LBBB- wide QRS, notched

Question 11

For RVH what are other waves showing?

Answer 11

ST depression, upward convex and

V1-V2-T wave inversion

Question 12

Which leads are needed to add in order to determine if LVH?

Answer 12

DEEpest V1 or V2 - S wave + V5 or V6 taller R wave

Must= >35mm

Question 13

Used to treat d/t slow HR post MI. Other cardia surgery, MED OD, emergent. Complications are common and include infection, local trauma, pneumothorax, arrhythmias and cardiac perforation. Carry pulses from the generator to atrium and both ventricles. The pulses help coordinate electrical signaling between the two ventricles.

Answer 13

Temporary pacemaker- each lead placed in chambers

Question 14

Pt has a slow HR from MI w/ recent cardiac surgery. PMH of drug overdose? What pacemake is needed?

Answer 14

Temporary pacemaker- emergency while waiting for implant

Question 15

If a patient has sick sinus syndrome, Brady arrythmias, Heart Block, Afib,flutter?

Answer 15

Permanent Pacemaker

Question 16

Speed up a slow heart rhythm.
control an abnormal or fast heart rhythm.
ventricles contract normally if the atria are quivering
Coordinate signaling btwn the upper and lower chambers of the heart.
Coordinate signaling btwn the ventricles. Prevent dangerous arrhythmias caused by a disorder called long QT syndrome, and CHF

Answer 16

cardiac resynchronization therapy (CRT)

Question 17

A disease characterised by abnormal sinus node functioning with bradycardia to tacycardia<50bpm and cardiac insufficiency.

Answer 17

Sick sinus syndrome

Question 18

What blocks are seen in sick sinus syndrome?

Answer 18

Sinus arrest/sinoatrial block (via Holter recording), brady-tachy syndrome atrial tachyarrhythmias, probable coexistence with AV block

Question 19

pacemaker monitors your heart rhythm. It only sends electrical pulses to your heart if your heart is beating too slow or if it misses a beat. Or if falls below preset value.

Answer 19

Demand pacemaker- sensing + pacing mech.

Question 20

pacemaker will speed up or slow down your heart rate depending on how active you are. To do this, the device monitors your sinus node rate, breathing, blood temperature, and other factors to determine your activity level.

Answer 20

Rate Responsive

Question 21

WHich system paces the R ventricle?

Answer 21

Single chamber

Question 22

WHich systmem paces RA and RV?

Answer 22

Dual chamber pacemaker

Question 23

What do pacemaker do?

Answer 23

They act synchronously when a slow naturalheart rateis detected to mimic the sequential physiological contraction of theatriaandventricles.

Question 24

Which are much more commonly used in practice, are appropriate where conduction between the atria and ventricles is impaired.

Answer 24

Single-chamber ventricular pacemakers

Question 25

Fires at a specific preset rate regardless of patient’s own heart rate
Only pacing mechanism

Answer 25

Fixed Pacemaker

Question 26

On ECG, what is seen with Atrial sensing Ventricular pacing?

Answer 26

pacemaker conduction spike at Q wave. Means detected a ventricular depolarization. Sensing will only spike if sense somethin wrong at the complex

Question 27

On ECG, what is seen with Atrial PACEING Ventricular pacing?

Answer 27

pacemaker conduction spike at BEG of p-wave and Q-wave. Both chambers were dysf

Question 28

On ECG, what is seen with Atrial PACE Ventricular SENSE?

Answer 28

pacemaker conduction at P-wave. Atrial need help

Question 29

On ECG, what is seen with Atrial and Ventricular SENSE

Answer 29

no sharp condutcions spike. NSR- Neither need spike

Question 30

What occures when a pacing stimulus is gerated but fails to trigger depoloriazion?

Answer 30

Failur to capture aka trigger. PURPOSE- starte depolarization.

Question 31

Oversensing, lead problem, batter, interference all cause of what

Answer 31

Failure to caputure

Question 32

WHat will EKG heart look like if failued caputre?

Answer 32

Spikes then multiple dropped QRS

Question 33

What cause P and T waves with spikes in middle of complex?

Answer 33

Oversensing, bc failed to capture. Inapproatiet sensing of extra activity

Question 34

What is cause of oversensing?

Answer 34

signal are picked up, pacemake doens fire

Question 35

What is used for fast HR?

Answer 35

Automatic implantable cardioverter defibrilater- Patho- Tachy arrhythmia, Vtach, Vfib