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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
What is Sinus Bradycardia seen with?
``` exaggerated parasympathetic (vagal) tone conditions in the heart drugs electrolyte abnormalities hypothyroidism ```
26
Treatment of Sinus Bradycardia
Stop or correct drug dosage check electrolytes and thyroid Atropine response test Insert a pacemaker
27
Sinus Arrest
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
28
Escape Beats
If the sinus arrest is prolonged the AV junctional or Purkinje or ventricular tissues may temporarily assume pacemaker function
29
Ventricular escape beats
originate from the ventricles | the QRS Complex is wide and bizzare
30
Diagnosis of Sinus Arrest
Holter monitoring/ cardiac event monitoring
31
Treatment of Sinus Arrest
``` Terbutaline isopropamide isoproterenol Probanthine Insert a pacemaker ```
32
What causes Hyperkalemia?
Renal Failure Muscle Damage hypoadrenocorticism Diabetic ketoacidosis
33
T waves become tall and spiked, P waves become smaller and then disappear, QRS complex are prolonged and sinusoidal
Hyperkalemia
34
Treatment for Hyperkalemia
Sodium bicarbonate glucose/insulin calcium gluconate
35
How does calcium gluconate treat hyperkalemia?
lowers the resting membrane potential away from the threshold potential and thereby prevents fibrillation/asystole
36
A-V Block
delay or failure in impulse transmission from the atria to the ventricles
37
What causes A-V block?
``` ischemia myocarditis neoplasia trauma hereditary ```
38
First degree A-V Block
prolonged conduction through the AV node
39
Normal QRS complex after each P wave but increased P-R Interval
First Degree A-V Block
40
Second Degree AV Block
only intermittent conduction of impulses from the atria to the ventricles
41
What are the three types of Second Degree AV Blocks?
Mobitz Type I Mobitz Type II High grade second degree
42
Mobitz type I Second Degree AV Block
the P-R Interval becomes progressively longer with each beat until eventually there is a P wave but no QRS Complex
43
Mobitz Type II Second Degree AV Block
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
High Grade second degree AV Block
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
What causes high grade second degree AV Block?
conduction system disease
46
Treatment of second degree AV Block?
Atropine/glycopyrrolate Beta-agonists or anticholinergics Insert a pacemaker
47
Third degree AV Block
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
Treatments of 3rd degree AV Block
Isoproterenol | Insert a pacemaker
49
Sinus Sick Syndrome
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
Clinical signs of Sinus Sick Syndrome
weakness and syncope during prolonged ventricular standstill
51
Treatment of Sinus Sick Syndrome
Insertion of a permanent pacemaker
52
Sinus Tachycardia
abnormally high heart rate with normal P wave and QRS-T Complexes
53
What is the cause of sinus Tachycardia?
Increased sympathetic tone Hyperthyroidism drugs
54
Treatment of sinus tachycardia
treat the underlying cause
55
Supraventricular premature depolarization
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
Clinical signs of Supraventricular premature depolarization
Syncope exercise intolerance cough dyspnea
57
Treatment of Supraventricular premature depolarization
correct the underlying disease Sotalol Diltiazem
58
Ventricular premature depolarization
arise from an ectopic focus in the ventricles.
59
What are Ventricular premature depolarization associated with?
``` ventricular hypertrophy myocarditis cardiac trauma hypoxemia use of drugs methyxanthine derivatives ```
60
Premature QRS complex that are wide and bizarre
Ventricular premature depolarization
61
What kind of deflection do Ventricular premature depolarizations arising from the right ventricle have?
positive deflection
62
What kind of deflection do Ventricular premature depolarizations arising from the left ventricle have?
negative depolarization
63
Bigeminy
every second beat is a Ventricular premature depolarization
64
Trigeminy
every third beat is a Ventricular premature depolarization
65
Quatrogeminy
every fourth beat is a Ventricular premature depolarization
66
Clinical signs of Ventricular premature depolarization
weakness | syncope
67
Fusion Beat
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
Treatment of Ventricular premature depolarization
``` Treat underlying disease Lidocaine procainamide Beta Blocker esmolol sotalol mexiletine and a beta blocker sotalol and a beta blocker ```
69
What disease is associated with Ventricular premature depolarization?
Cardiomyopathy | Dilated Cardiomyopathy
70
Ventricular tachycardia
runs (at >160-180bpm) of more than 3 Ventricular tachycardia
71
What are the types of Ventricular tachycardia?
sustained | non-sustained
72
Sustained Ventricular tachycardia
the runs are prolonged (>30s)
73
Nonsustained Ventricular tachycardia
the runs are short and terminated spontaneously
74
Capture beat
P wave activates the AV node and ventricles when they are not refractory and a normal QRS complex develops
75
Fusion beat
If the ventricles are activated by the normal QRS complex is fused with a VPC complex
76
Treatment of Ventricular tachycardia
``` Treat underlying disease Lidocaine procainamide Beta Blocker esmolol sotalol mexiletine and a beta blocker sotalol and a beta blocker ```
77
Accelerated idioventricular rhythm/ idioventricular tachycardia
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
Treatment of Accelerated idioventricular rhythm/ idioventricular tachycardia
Treatment is unnecessary | Closely monitor the arrhythmia
79
Ventricular fibrillation
life threatening and usually terminal arrhythmia with irregular and disorganized ventricular activity.
80
"R-on-T phenomenon"
a premature beat arriving during the vulnerable period of the cardiac cycle
81
Treatment of Ventricular fibrillation
electrical cardioversion
82
Electrical cardioversion
external countershock/defibrillation with DC current
83
Common disease associated with Atrial fibrillation
dilated cardiomyopathy
84
Atrial fibrillation
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
QRS complexes are normal but the R-R interval is variable
Atrial fibrillation
86
What does Atrial Fibrillation sound like?
a 5 year old playing the drums
87
How do you treat a dog with normal ventricular function and normal ventricular rate
do not require treatment | Monitor for regular development of dilated cardiomyopathy
88
How do you treat a dog with normal ventricular function and high ventricular rates
Diltiazem - calcium channel blocker | Beta Blocker
89
How do you treat a dog with decreased ventricular function and high ventricular response rate?
Diltiazem and Digoxin
90
What does an Atrial Flutter look like on EKG?
"saw tooth" pattern on EKG
91
Atrial Flutter
rapid rotary depolarization of the atria
92
Treatment of Atrial Flutter
Diltiazem | Beta Blockers

RUSVM Small Animal Medicine I 2016 (9 decks)

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