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RUSVM Small Animal Medicine I 2016 > Electrocardiography > Flashcards

Electrocardiography Flashcards

1
Q

ECG (EKG)

A

measures the electrical activity of the heart and is used to determine heart rate and conduction disturbances. It may also give information on the size of the heart chambers, myocardial hypoxia, and electrolyte imbalances.

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2
Q

What is the normal pacemaker of the heart?

A

Sinus node

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3
Q

What are the artifacts seen on an EKG?

A

60Hz electrical interference

Movement: Panting, trembling, respiration, or purring

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4
Q

If the P wave is too wide

A

Left Atrial Enlargment

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5
Q

IF the P wave is too high

A

Right Atrial Enlargement

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6
Q

If the P waves is too tall and too wide

A

Biatrial Enlargement

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7
Q

If the R wave is too tall and the P wave is too wide

A

Left Ventricular enlargement

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8
Q

Deep S wave

A

Right ventricular enlargement

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9
Q

Right Bundle Branch Block

A

a delay in conduction in the right bundle branch results in delayed activation of the right ventricle causing the QRS complex to widen the large wide S waves

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10
Q

What causes Right Bundle Branch Block?

A 
Cardiac Trauma
Infections 
Neoplasia
Infarction 
Fibrosis
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11
Q

Left Bundle Branch Block

A

the left ventricle is activated later than normal and the QRS complexes are prolonged

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12
Q

Wide QRS complex, Deep S wave, and normal R wave

A

Left Bundle Branch Block

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13
Q

What causes Low voltage QRS complexes?

A 
obesity
pleural or pericardial effusion
hypothyroidism
pneumothorax
diffuse myocardial disease
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14
Q

Electrical Alterans

A

if the heart is rotating in a sac of fluid due to pericardial effusion this causes the electrical current to change directions and the R wave changes heights

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15
Q

What can causes changes in the Q-T Interval?

A

Calcium
Potassium
Drugs (Digoxin, antiarrhythmic drugs, antibiotics, drugs used to modifiy behavior)

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16
Q

What causes the T wave to become tall and spiked?

A

Hyperkalemia

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17
Q

Arrhythmia

A

abnormality in the rate, rhythm or flow depolarization through the heart

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18
Q

Sinus rhythm

A

Normal cardiac rhythm

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19
Q

Sinus arrhythmia

A

normal P wave for every normal QRS complex but the R-R interval varies. Commonly associated with Respiration. the heart rate increased with inspiration and decreases with expiration

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20
Q

What breeds do sinus arrhythmias occur in?

A

brachycephalic breeds

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21
Q

What will exaggerate a sinus arrhythmia?

A

Ocular pressure or manipulation of the viscera during surgery

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22
Q

Wandering Atrial Pacemaker

A

P waves are not initiated by the SA node
The P-R interval is decreased and the amplitude/morphology of the P waves are variable. Conduction spreads from the left atria to the right atria

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23
Q

What is the treatment for a Wandering Atrial Pacemaker?

A

No treatment

Atropine needed for surgery

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24
Q

Sinus Bradycardia

A

ventricular rate is too slow

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25
Q

What is Sinus Bradycardia seen with?

A 
exaggerated parasympathetic (vagal) tone
conditions in the heart
drugs
electrolyte abnormalities
hypothyroidism
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26
Q

Treatment of Sinus Bradycardia

A

Stop or correct drug dosage
check electrolytes and thyroid
Atropine response test
Insert a pacemaker

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27
Q

Sinus Arrest

A

sinus rhythm is disrupted by occasional, prolonged failure of the SA node to initiate one or more impulses If the sinus arrest is prolonged the AV junctional or Purkinje or ventricular tissues may temporarily assume pacemaker function

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28
Q

Escape Beats

A

If the sinus arrest is prolonged the AV junctional or Purkinje or ventricular tissues may temporarily assume pacemaker function

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29
Q

Ventricular escape beats

A

originate from the ventricles

the QRS Complex is wide and bizzare

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30
Q

Diagnosis of Sinus Arrest

A

Holter monitoring/ cardiac event monitoring

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31
Q

Treatment of Sinus Arrest

A 
Terbutaline
isopropamide
isoproterenol
Probanthine
Insert a pacemaker
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32
Q

What causes Hyperkalemia?

A

Renal Failure
Muscle Damage
hypoadrenocorticism
Diabetic ketoacidosis

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33
Q

T waves become tall and spiked, P waves become smaller and then disappear, QRS complex are prolonged and sinusoidal

A

Hyperkalemia

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34
Q

Treatment for Hyperkalemia

A

Sodium bicarbonate
glucose/insulin
calcium gluconate

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35
Q

How does calcium gluconate treat hyperkalemia?

A

lowers the resting membrane potential away from the threshold potential and thereby prevents fibrillation/asystole

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36
Q

A-V Block

A

delay or failure in impulse transmission from the atria to the ventricles

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37
Q

What causes A-V block?

A 
ischemia 
myocarditis
neoplasia 
trauma 
hereditary
38
Q

First degree A-V Block

A

prolonged conduction through the AV node

39
Q

Normal QRS complex after each P wave but increased P-R Interval

A

First Degree A-V Block

40
Q

Second Degree AV Block

A

only intermittent conduction of impulses from the atria to the ventricles

41
Q

What are the three types of Second Degree AV Blocks?

A

Mobitz Type I
Mobitz Type II
High grade second degree

42
Q

Mobitz type I Second Degree AV Block

A

the P-R Interval becomes progressively longer with each beat until eventually there is a P wave but no QRS Complex

43
Q

Mobitz Type II Second Degree AV Block

A

Dropped beat without any progressive changes in P-R Interval.
There may be one or multiple P waves that are not followed by QRS complexes

44
Q

High Grade second degree AV Block

A

block occurs with 2:1, 3:1 blocks where it is not possible to determine if there is progressive lengthening of the P-R Interval

45
Q

What causes high grade second degree AV Block?

A

conduction system disease

46
Q

Treatment of second degree AV Block?

A

Atropine/glycopyrrolate
Beta-agonists or anticholinergics
Insert a pacemaker

47
Q

Third degree AV Block

A

no conduction from the atria to the ventricles and each beat independently.
QRS Complex occur as escape beats originating from the AV junctional or ventricular pacemakers

48
Q

Treatments of 3rd degree AV Block

A

Isoproterenol

Insert a pacemaker

49
Q

Sinus Sick Syndrome

A

impaired function of the SA node and AV conduction system. There is usually sinus bradycardia, intermittent period of sinus arrest or AV block, long periods of asystole and escape beats. Between the periods of bradycardia and asystole there may be paraoxysms of tachycardia.

50
Q

Clinical signs of Sinus Sick Syndrome

A

weakness and syncope during prolonged ventricular standstill

51
Q

Treatment of Sinus Sick Syndrome

A

Insertion of a permanent pacemaker

52
Q

Sinus Tachycardia

A

abnormally high heart rate with normal P wave and QRS-T Complexes

53
Q

What is the cause of sinus Tachycardia?

A

Increased sympathetic tone
Hyperthyroidism
drugs

54
Q

Treatment of sinus tachycardia

A

treat the underlying cause

55
Q

Supraventricular premature depolarization

A

beats that occur earlier than expected (premature) and arise from outside the SA node. There is a P’ wave and QRS complexes are normal. Sometimes the P’ waves are buried in the proceeding QRS-T complex

56
Q

Clinical signs of Supraventricular premature depolarization

A

Syncope
exercise intolerance
cough
dyspnea

57
Q

Treatment of Supraventricular premature depolarization

A

correct the underlying disease
Sotalol
Diltiazem

58
Q

Ventricular premature depolarization

A

arise from an ectopic focus in the ventricles.

59
Q

What are Ventricular premature depolarization associated with?

A 
ventricular hypertrophy
myocarditis
cardiac trauma
hypoxemia 
use of drugs 
methyxanthine derivatives
60
Q

Premature QRS complex that are wide and bizarre

A

Ventricular premature depolarization

61
Q

What kind of deflection do Ventricular premature depolarizations arising from the right ventricle have?

A

positive deflection

62
Q

What kind of deflection do Ventricular premature depolarizations arising from the left ventricle have?

A

negative depolarization

63
Q

Bigeminy

A

every second beat is a Ventricular premature depolarization

64
Q

Trigeminy

A

every third beat is a Ventricular premature depolarization

65
Q

Quatrogeminy

A

every fourth beat is a Ventricular premature depolarization

66
Q

Clinical signs of Ventricular premature depolarization

A

weakness

syncope

67
Q

Fusion Beat

A

P wave has happened but no time for the AV node to be activated so the ectopic focus generates a beat at the same time of the AV node causing a fusion of beats

68
Q

Treatment of Ventricular premature depolarization

A 
Treat underlying disease
Lidocaine
procainamide 
Beta Blocker 
esmolol
sotalol 
mexiletine and a beta blocker
sotalol and a beta blocker
69
Q

What disease is associated with Ventricular premature depolarization?

A

Cardiomyopathy

Dilated Cardiomyopathy

70
Q

Ventricular tachycardia

A

runs (at >160-180bpm) of more than 3 Ventricular tachycardia

71
Q

What are the types of Ventricular tachycardia?

A

sustained

non-sustained

72
Q

Sustained Ventricular tachycardia

A

the runs are prolonged (>30s)

73
Q

Nonsustained Ventricular tachycardia

A

the runs are short and terminated spontaneously

74
Q

Capture beat

A

P wave activates the AV node and ventricles when they are not refractory and a normal QRS complex develops

75
Q

Fusion beat

A

If the ventricles are activated by the normal QRS complex is fused with a VPC complex

76
Q

Treatment of Ventricular tachycardia

A 
Treat underlying disease
Lidocaine
procainamide 
Beta Blocker 
esmolol
sotalol 
mexiletine and a beta blocker
sotalol and a beta blocker
77
Q

Accelerated idioventricular rhythm/ idioventricular tachycardia

A

Rate = 70-100bpm
P waves are seen before or superimposed on the QRS complex which maybe normal or wide or bizarre. P waves occur early to cause a capture beat or fusion beat.

78
Q

Treatment of Accelerated idioventricular rhythm/ idioventricular tachycardia

A

Treatment is unnecessary

Closely monitor the arrhythmia

79
Q

Ventricular fibrillation

A

life threatening and usually terminal arrhythmia with irregular and disorganized ventricular activity.

80
Q

“R-on-T phenomenon”

A

a premature beat arriving during the vulnerable period of the cardiac cycle

81
Q

Treatment of Ventricular fibrillation

A

electrical cardioversion

82
Q

Electrical cardioversion

A

external countershock/defibrillation with DC current

83
Q

Common disease associated with Atrial fibrillation

A

dilated cardiomyopathy

84
Q

Atrial fibrillation

A

many foci in the atria which all fire independently. There is rapid and chaotic electrical activity in the atria with an absence of P waves

85
Q

QRS complexes are normal but the R-R interval is variable

A

Atrial fibrillation

86
Q

What does Atrial Fibrillation sound like?

A

a 5 year old playing the drums

87
Q

How do you treat a dog with normal ventricular function and normal ventricular rate

A

do not require treatment

Monitor for regular development of dilated cardiomyopathy

88
Q

How do you treat a dog with normal ventricular function and high ventricular rates

A

Diltiazem - calcium channel blocker

Beta Blocker

89
Q

How do you treat a dog with decreased ventricular function and high ventricular response rate?

A

Diltiazem and Digoxin

90
Q

What does an Atrial Flutter look like on EKG?

A

“saw tooth” pattern on EKG

91
Q

Atrial Flutter

A

rapid rotary depolarization of the atria

92
Q

Treatment of Atrial Flutter

A

Diltiazem

Beta Blockers

RUSVM Small Animal Medicine I 2016 (9 decks)

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