EKG pathology Flashcards
What if there is non discernable, non consistent p-wave and any heart rhythm outside of NormalSR?
Arrythmia
What would the P wave look like if it came from many locations w/in atria?
Atria Rhythms
+P waves BUT Different shapes
P waves can be b4, within or after QRS
MC-Tachycardia ex. flutter, or fibrillation
What is wandering Atrial pacemaker?
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
What has rate of atrial 250-350, *saw tooth pattern, *multiple irregular psuedop-waves, *regular rhythm, clear consistent *ventricular regular response?
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
What has rate of atrial 400-600, tremulous pattern, *no defined pwave, wavy t+p-wave, clear ventricular IRREGULAR response.
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
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?
Junctional rhythm
AV junction rate- 40-60bpm
>60 -AKA Accelerated junction rhythm
Pathology is regurgitation
How to decipher if p wave vs. t, u etc?
P wave usually same direction has QRS complex, + or -
T wave Bigger and longer
U wave rare
What are murmurs indicated w/ ECG and pumps?
Turbulent flow
atria and ventricle not in sync
Stenosis, regurgitation, CHF all cause a murmur
Are people able to function with AFib?
Yes,
but if exercise, stress, caffeine, then at risk
The strip show rate 20-40bpm, NON sinus, regular rhythm, *WIDE and strange QRS?
Idioventricular Rhythm
QRS may be biphasic, inverted, double peaked, double peaked and biphasic looking
Accelerated >40
What is conduction that comes from ectopic (abnormal loc), or multiple areas?
Premature contraction
Occurs in Atria, AV junction, Ventricles
This strip has some NSR, then a P-wave abnormally shaped, and abnormal PR break interval before next beat.
Premature Atrial contraction
Early atria contraction is from another spot outside SA node.
This strip has NSR, then no p-wave and Wide QRS, rate 60-100. QRS is different shape than previous.
Premature Ventricular contractions
A strip has a few normal PQRST, but then two no pwave, wide QRS but diff. shape?
Bifocal Premature Ventricular contractions
Stimulus coming from 2 diff locations,
Couplet, triplet
A strip has grouped PVC. 1 PQRST NSR then PV *consistently. What is this PVC
Ventricular Bigeminy. Two ventricular contractions
N, AB, N, AB
A strip has group PVC w a two NSR PQRST, then 1 PVC consistently. What is this PVC
Ventricular Trigeminy. Three group consistent ventricular contractions
N, N, AB, N, N, AB
Et for Quadrigeminy
What is your system?
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
What is consistent with SVT?
Any tachy-dysarrythmia that is coming from above bundle of HIS
QRS is narrow
A flutter and A fib
A strip has rate 150, regular rhythm, no P-R interval, no wave b4 normal QRS. Big t-waveThis is?
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
What looks like A-fib but must has 3 different forms of a P wave?
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
Does the AV junction accept all stimulus?
NO its refractory, only accepts , a fraction of impulses to reach ventricular.
IF wasn’t refractory, then ventricles would be 600bpm
A strip has a run of consecutive PVC, tachycardia >100, last longer then 30s with different shaped wide QRS?
Polymorphic Sustained Ventricle Tachycardia
Recall t-wave longer 2-4boxes
A strip has a run of consecutive PVC, no -pwave tachycardia >100, less than 30s with same shaped wide QRS?
Monomorphic NON Sustained Ventricle Tachycardia
What condition lead up to Ventricle fibrillation?
V-tach- urgent
Torsades de pointes- urgent
Main Defibrillator purpose- life threatening bc no cardiac output
If stimulus in V-tach coming from ventricle which direction is the complex?
NEG down deflection
Strip is *irregular, no p-wave, large t-wave, neg deflected QRS-wide polymorphic , rate- >100
VTACh
Pt unconscious, TX- epinephrine- to suppress ventricular abnormal ectopy location
Is v-fib always wavy irregular line?
No can be almost flat with small wavy lines
What is prior to Polymorphic VT Torsade de pointers, with DNA twisting lines?
Prolong QT interval or a U wave
Precursor to V-fib
What are causes of prolonged QT?
ABx, hypokalemia, hypomagnesia
Tx- MgSO4
