EKG V Lecture Powerpoint

Question 1

Healthy P wave should be upright in these 4 leads, upright or downward in this lead, and biphasic sometimes
or upright or inverse in these 2 leads

Answer 1

• I, II, AVL, AVF
• III
• V1, V2

Question 2

P pulmonale

Answer 2

Right atrial enlargement manifesting on an EKG as a P wave taller than 25mm

Question 3

Most common cause of left atrial enlargement

Answer 3

Left ventricular hypertrophy

Question 4

Common causes of sinus bradycardia (4)

Answer 4

• athlete
• B blockers, Ca2+ channel blockers
• hypothyroidism
• electrolyte imbalances

Question 5

How to determine if sinus bradycardia requires treatment

Answer 5

Ask if the organs are being perfused (if yes leave it alone or take time to think about pacemaker, if no identify underlying cause and correct)

Question 6

DOC to improve sinus bradycardia

Answer 6

atropine IV repeated every 5 min

Question 7

Sick sinus syndrome and 3 subtypes

Answer 7

Dysfunctional SA node due to ischemia, fibrous, or fatty infiltration decreasing the cells and the conduction system, can be slow, fast or both (tachy-brady syndrome)

Question 8

Sick sinus syndrome treatment

Answer 8

-dual chamber pacemaker (pace SA node and right ventricle)

Question 9

Premature atrial complex and some common causes (5)

Answer 9

Irritable atrial foci that fires early and spontaneously occurs when the PR interval is less then .20 sec

very common due to things such as stress, anxiety, drug use, hypoxia, thyroid dysfunction

Question 10

3 fates of a premature atrial complex

Answer 10

• Nonconduction: no conduction because PAC finds AV node refractory
• Conducted with aberrancy: PAC makes it to ventricle but finds fascicle or bundle branch refractory taking a longer alterante path and has a wider QRS complex
• Normal conduction: normally when PAC occurs later in cycle

Question 11

Sinus tachycardia and common causes (4)

Answer 11

HR higher than 100 bpm

caused by fever/infection, dehydration, anxiety, hypoxia

Question 12

Sinus arrhythmia

Answer 12

Normal physiologic response to changes in preload with inspiration due to fluctuations in parasympathetic vagal tone with inspiration increasing rate and expiration decreasing, regularly irregular variation common in young individuals

Question 13

Any arrhythmia that occurs above the bundle of His is a…

Answer 13

…supraventricular

Question 14

Paroxysmal supraventricular tachycardia (PSVT)

Answer 14

Common episodic tachycardia that has narrow complex except in the setting of bundle branch block

Question 15

Every time someone has ischemia or an MI, this sequence of 3 events is the same

Answer 15

• tachycardia
• fibrillation
• asystole

Question 16

4 conditions required for re-entry phenomena

Answer 16

• electrophysiologic inhomogeneity (diff between conduction and refractory period) in 2 or more areas of the heart that are connected by a potentially closed loop
• unidirectional block in one pathway
• slow conduction over an alternative pathway allowing for preveiously blocked path to recover excitability
• reexcitation of the initially blocked pathway to complete the loop

Question 17

AV nodal re-entry tachycardia and how does it present on EKG

Answer 17

Most common PSVT that has abrupt onset, narrow complexes usually initiated by PAC, reentrant mechanism, tolerated well by young and heart disease free but not tolerated well in patients with cardiac disease, rate typically >150 bpm, QRS

Question 18

AV nodal re-entry tachycardia treatment (3)

Answer 18

• mammalian diving reflex, vagal maneuvers of carotid, valsalva
• adenosine 6mg rapid IV bolus (stops heart with a chemically short half life drug to allow for full refractory period to return)
• Electrophysiologist (EP) lab referral***

Question 19

Mammalian diving reflex

Answer 19

When water fills the nostrils, the autonomic nervous system redirects blood flow thru peripheral vasoconstriction from the limbs and viscera to the heart and brain to conserve oxygen, causes slowing of the heart rate

Question 20

AV reentrant tachycardia (AVRT) nick name

Answer 20

Wolf parkinson white syndrome

Question 21

Atrial fib can sequelae into…

Answer 21

…ventricular fib

Question 22

Atrial flutter

Answer 22

Involves circus movement (conduction around same loop in atrium) generally 250-350 bpm, saw tooth pattern, often with picket fence P waves seen in leads 2, 3, and AVF

Question 23

Atrial flutter causes (5)

Answer 23

• rheumatic heart disease
• congenital heart disease
• left ventricular dysfunction
• COPD
• obesity

Question 24

atrial flutter treatment (4)

Answer 24

• Digoxin
• B blockers or Ca2+ blockers
• pacemaker
• ablation

Question 25

Atrial fibrillation

Answer 25

Occurs when atrial rate is 350-700 bpm, ventricular rate may be normal or rapid, involves a complete lack of P waves, irregularly irregular rhythm, at risk for stroke and hypotension

Question 26

Faster ventricular rate, more important ___ is

Answer 26

atrial kick

Question 27

Common causes of atrial fib (4)

Answer 27

- thyroid abnormalities - alcohol - COPD - underlying heart disease

Question 28

Why is paroxysmal Afib more dangerous than constant?

Answer 28

Clot builds then is ejected upon atrial kick and embolus occurs

Question 29

Afib treatment (3)

Answer 29

- rate control (B blockers, Ca2+ channel blockers, digoxin - anticoagulation before and after cardioversion - rhythm control

Question 30

PAC's have a ____ pause while PVC's have a ___ pause

Answer 30

Noncompensatory, compensatory

Question 31

Defibrillation will not work on a heart that has reached what stage of arrest?

Answer 31

Asystole

Question 32

S1Q3 is a strong indicator of what pathology?

Answer 32

Pulmonary embolism

Question 33

Multifocal atrial tachycardia

Answer 33

irregular rate >100bpm with 3 morphological distinct p waves***, >100bpm, associated strongly with copd

Question 34

Graves disease can cause what atrial pathology

Answer 34

Atrial fibrillation