EKG pathology

Question 1

What if there is non discernable, non consistent p-wave and any heart rhythm outside of NormalSR?

Answer 1

Arrythmia

Question 2

What would the P wave look like if it came from many locations w/in atria?

Answer 2

Atria Rhythms
+P waves BUT Different shapes
P waves can be b4, within or after QRS

MC-Tachycardia ex. flutter, or fibrillation

Question 3

What is wandering Atrial pacemaker?

Answer 3

Normal atrial rate/rhythm 60-80bpm, <100
Gradual change in P-waves diff morphology
P-wave normal to small to inverted -to spiked
if inverted means atria firing close to AV node
Irregular rhythm

Question 4

What has rate of atrial 250-350, *saw tooth pattern, *multiple irregular psuedop-waves, *regular rhythm, clear consistent *ventricular regular response?

Answer 4

Atrial flutter- supraventricular
(4 p-wave b4 QRS, 4:1=75bpm, 3:1= 100, 2:1 =150, 1:1 300
IMpulse travels in circular course in atria

Question 5

What has rate of atrial 400-600, tremulous pattern, *no defined pwave, wavy t+p-wave, clear ventricular IRREGULAR response.

Answer 5

Atrial fibrillation- all irregular sinus rhythm are until otherwise
Impulse is chaotic in, random path in atria
Ventricular rate- >100BPM

Pathology- blood sits, risk clot. Ventricle still pump blood out, but inefficient

Question 6

What rhythm has *abnormal, *inverted or *absent P wave, Rate 40-60bpm, P wave + in AVR, P wave - in Lead II, w/ a normal *regular QRS?

Answer 6

Junctional rhythm
AV junction rate- 40-60bpm
>60 -AKA Accelerated junction rhythm
Pathology is regurgitation

Question 7

How to decipher if p wave vs. t, u etc?

Answer 7

P wave usually same direction has QRS complex, + or -
T wave Bigger and longer
U wave rare

Question 8

What are murmurs indicated w/ ECG and pumps?

Answer 8

Turbulent flow
atria and ventricle not in sync
Stenosis, regurgitation, CHF all cause a murmur

Question 9

Are people able to function with AFib?

Answer 9

Yes,

but if exercise, stress, caffeine, then at risk

Question 10

The strip show rate 20-40bpm, NON sinus, regular rhythm, *WIDE and strange QRS?

Answer 10

Idioventricular Rhythm
QRS may be biphasic, inverted, double peaked, double peaked and biphasic looking

Accelerated >40

Question 11

What is conduction that comes from ectopic (abnormal loc), or multiple areas?

Answer 11

Premature contraction

Occurs in Atria, AV junction, Ventricles

Question 12

This strip has some NSR, then a P-wave abnormally shaped, and abnormal PR break interval before next beat.

Answer 12

Premature Atrial contraction

Early atria contraction is from another spot outside SA node.

Question 13

This strip has NSR, then no p-wave and Wide QRS, rate 60-100. QRS is different shape than previous.

Answer 13

Premature Ventricular contractions

Question 14

A strip has a few normal PQRST, but then two no pwave, wide QRS but diff. shape?

Answer 14

Bifocal Premature Ventricular contractions
Stimulus coming from 2 diff locations,

Couplet, triplet

Question 15

A strip has grouped PVC. 1 PQRST NSR then PV *consistently. What is this PVC

Answer 15

Ventricular Bigeminy. Two ventricular contractions

N, AB, N, AB

Question 16

A strip has group PVC w a two NSR PQRST, then 1 PVC consistently. What is this PVC

Answer 16

Ventricular Trigeminy. Three group consistent ventricular contractions
N, N, AB, N, N, AB

Et for Quadrigeminy

Question 17

What is your system?

Answer 17

Lead II
Rate?- SA, AT, AV, Ven. Box vs 6sec
Rhythm? Reg. irreg
NSR?- p-wave or not, p-wave invert, shape
QRS? Narrow or wide, peak, biphasic
Axis
Confirm other leads-flutter, tachy, afib
See whole holistically

Question 18

What is consistent with SVT?

Answer 18

Any tachy-dysarrythmia that is coming from above bundle of HIS
QRS is narrow
A flutter and A fib

Question 19

A strip has rate 150, regular rhythm, no P-R interval, no wave b4 normal QRS. Big t-waveThis is?

Answer 19

Supraventricular Tachycardia
P-wave hidden with T-wave complex, bc. rate so fast

Patho- atria putting contracting putting blood in ventricle during relax
Caffeine, stress
TX- carotid massage

Question 20

What looks like A-fib but must has 3 different forms of a P wave?

Answer 20

Multifocal Atrial Tachycardia
NON sinus- P waves different sizes and morphology
Rate >100
Rhythm irregular

Not Junctional b/c beat is fast-absent or inverted
Not A-fib bc diff p-waves
Not Wandering bc no gradual change in P-wave

Question 21

Does the AV junction accept all stimulus?

Answer 21

NO its refractory, only accepts , a fraction of impulses to reach ventricular.
IF wasn’t refractory, then ventricles would be 600bpm

Question 22

A strip has a run of consecutive PVC, tachycardia >100, last longer then 30s with different shaped wide QRS?

Answer 22

Polymorphic Sustained Ventricle Tachycardia

Recall t-wave longer 2-4boxes

Question 23

A strip has a run of consecutive PVC, no -pwave tachycardia >100, less than 30s with same shaped wide QRS?

Answer 23

Monomorphic NON Sustained Ventricle Tachycardia

Question 24

What condition lead up to Ventricle fibrillation?

Answer 24

V-tach- urgent
Torsades de pointes- urgent
Main Defibrillator purpose- life threatening bc no cardiac output

Question 25

If stimulus in V-tach coming from ventricle which direction is the complex?

Answer 25

NEG down deflection

Question 26

Strip is *irregular, no p-wave, large t-wave, neg deflected QRS-wide polymorphic , rate- >100

Answer 26

VTACh

Pt unconscious, TX- epinephrine- to suppress ventricular abnormal ectopy location

Question 27

Is v-fib always wavy irregular line?

Answer 27

No can be almost flat with small wavy lines

Question 28

What is prior to Polymorphic VT Torsade de pointers, with DNA twisting lines?

Answer 28

Prolong QT interval or a U wave

Precursor to V-fib

Question 29

What are causes of prolonged QT?

Answer 29

ABx, hypokalemia, hypomagnesia

Tx- MgSO4