Exam 1 Flashcards
1
Q
(2) Vagus Nerve Stimulation
A
- Carotid Massage
- Valsalva Maneuver
2
Q
12-lead EKG lead Placement
1 lead on each extremity ___, ____, ____, ____
A
RA, LA, RL, LL
3
Q
12-lead EKG lead Placement
V1?
A
Right 4th ICS at Sternal Margin
*ICS = Intercostal Space
4
Q
12-lead EKG lead Placement
V2
A
Left 4th ICS at Sternal Margin
5
Q
12-lead EKG lead Placement
V3
A
Midway between V2 and V4
6
Q
12-lead EKG lead Placement
V4?
A
5th ICS at L MCL
ICS - Intercostal Space
MCL - Mid-Clavicular Line
7
Q
12-lead EKG lead Placement
V5?
A
5th ICS at L AAL
ICS - Intercostal Pace
AAL - Anterior Axillary Line
8
Q
12-lead EKG lead Placement
V6?
A
5th ICS at L MAL
ICS = Intercostal Space
MAL = Midaxillary Line
9
Q
24-48 hours of continuous EKG recording
Used in conjunction with the patient diary for when they feel symptomatic.
A
Holter Monitor
10
Q
Gradually lengthening PR interval until a QRS complex is dropped.
A
2nd Degree AV Block: Mobtiz Type I
11
Q
A power source connected to electrodes, is inserted into the heart muscle
A
Pacemaker
12
Q
A rhythm is caused by an interruption of the electrical conduction from the SA node to the atria.
A
Sinus Node Block
13
Q
A rhythm originating paroxysmally (abruptly) at a re-entry circuit in the AV junction.
A
Paroxysmal Supraventricular Tachycardia (PSVT)
More commonly an Atrioventricular Node Re-entry Tachycardia (AVNRT) is the mechanism behind this.
14
Q
A run of more than 3 PVCs in a row where the R-R interval is regular and the rate is > 100 bpm. The beat originates in the ventricles.
A
Ventricular Tachycardia
15
Q
A supraventricular beat is conducted aberrantly through the ventricles.
Produces a wide, bizarre-looking QRS complex (like a PVC)
There is a visible P Wave
A
Aberrancy
16
Q
All PVCs come from the same irritable foci in the ventricle.
A
Unifocal PVC
17
Q
Any disturbance in the rate, regularity, site of origin, or conduction of the cardiac electrical impulse.
A
Arrhythmia
*Anything but normal sinus rhythm.
18
Q
Any obstruction or delay of the normal conduction between the SA node and the Purkinje fibers.
A
Conduction Block
19
Q
Application of a synchronized electrical current to a patient with the goal of depolarizing all cells to reset the excitable cells causing an arrhythmia.
Allows the SA node to regain control at a normal rate.
A
Cardioversion
*Delivery of the shock is time to avoid the T-Wave. It can induce ventricular fibrillation.
20
Q
Artificially induces electronic stimulus that paces the patient’s rhythm causing a blip or spike on the ECG waveform.
A
Singel Chamber Pacemaker
21
Q
Augmented Leads
A
aVR
aVL
aVF
22
Q
AV Block with no relationship between P and QRS complex.
More P waves than QRS complexes.
A
3rd Degree AV Block (Complete Heart Block)
23
Q
AV Node depolarization rate
A
40-60 beats/min
24
Q
Beat (of atrial origin) that arrives earlier than expected next beat.
Caused by irritable foci in the atria spontaneously depolarizing.
Associated with a different shape to P Wave.
This was followed by a compensatory pause.
A
Premature Atrial Contraction (PAC)
25
Beat originates in the ventricles and occurs when the ventricular myocytes depolarize at a faster rate than the SA and AV nodes, making the ventricular cells the pacemaker.
Idioventricular Rhythm (IVR)
26
Bipolar Leads
Lead III
Left Arm \> Left Leg
27
Bipolar Leads
Leads I, II, III
28
Bipolar Leads
Lead I
Right Arm \> Left Arm
29
Bipolar Leads
Lead II
Right Arm \> Left Leg
30
Cardiac cells become _______ during repolarization.
Negative
31
Cardiac cells become _________ charged during depolarization.
Postively
32
Cardiac cells carry a relatively _______ charge at rest.
Negative
33
Cause:
Idioventricular Rhythm (IVR)
34
Causes:
Hypoxia
Hyperkalemia
Sleep Apnea
Drugs such as Digoxin
Muscle Damage secondary to Myocardia Infarction
Sinus Node Block
35
Causes:
Electrolyte Imbalance (Commonly: K+, Ca+, Mg+)
Drugs that prolong the QT Interval
36
Causes:
Severe Bradycardia
Sinus Arrest, SA Exit Block
AV Block
Hyperkalemia
37
Chaotic, Irregular Rhythm, no true QRS.
No pulse on physical exam.
Ventricular Fibrillation.
38
Compare and Contrast PAC and PVC:
39
* Compromise the majority of the heart tissue.
* Responsible for the physical work of contraction and relaxation of the heart muscle.
* Depolarization results in calcium release within the cell causing contraction.
Cardiac Myocytes
40
Delivery of a high voltage shock to treat arrhythmias such as Ventricular Fibrillation and pulseless Ventricular Tachycardia.
Defibrillation
41
Depolarization is caused by (2):
* Spontaneous depolarization (Automaticity Property)
* Propagated current from an adjacent cell.
42
Depolarization is driven by the AV node, not the SA node.
Junctional Rhythm
43
Descriptors of Ventricular Tachycardia
Monomorphic Tachycardia
Polymorphic Tachycardia
44
Different QRS Complex Variations (5)
QRS, RSR', RS, QR, R
Lecture 2; Slide 24
45
Do EKGs tell you the structure of function of the heart?
No
46
Dominant pacemaker cells
The sinoatrial (SA) node.
47
Each PVC comes from different (or several) irritable foci in the ventricle.
Multifocal PVC
48
Early junctional beat (absent, inverted, or retrograde P Wave) followed by a compensatory pause.
Premature Junctional Contraction (PJC)
49
Electrical activity is measured by "views" produced y looking between two leads (from the positive lead perspective).
Bipolar Leads
50
Electrical conduction is the result of \_\_\_\_\_\_\_.
Depolarization
51
Enhanced automaticity of an ectopic atrial focus or from a reentrant circuit.
May be associated with digitalis toxicity, but often with a normal heart.
Paroxysmal Atrial Tachycardia (PAT)
52
Escape beat during Sinus Arrest comes from:
SA Node (Sinus Escape)
AV Node (Junctional Escape)
Ventricle (Ventricular Escape)
53
First negative (downward) deflection after the R Wave.
S Wave
\*A Q can never follow an R, even if it is the "the first downward deflection".
54
First negative (downward) deflection in the QRS complex
Q Wave
\*May not be present.
55
Following mapping of arrhythmia pathway, radio waves (other methods include cryo/freezing or thermal/heat) are applied to specific pathways to ablate aberrant electrical conduction.
Radiofrequency Ablation
56
Four varieties of the AV Block:
1st Degree AV Block
2nd Degree AV Block: Mobitz Type I
2nd Degree AV Block: Mobitz Type II
3rd Degree AV Block
The PR interval is key to distinguishing the type of block.
57
From the start of atrial depolarization to the start of ventricular depolarization.
PR Interval
58
High-energy shock
Used to treat Ventricular Fibrillation or Pulseless Ventricular Tachycardia
Not timed only use when the patient is pulseless.
Defibrillator
59
How to perform a Valsalva Maneuver?
Bear down like you are having a bowel movement.
Squat and stand with a closed mouth.
60
If the rate is \> ____ or \< \_\_\_\_\_\_, use the ________ estimation method.
300, 38, 6-Second Method
61
Precordial Leads
II, III, aVF
Inferior Heart
62
Impulses originate from three or more different foci in the atria, so we see at least 3 different p wave morphologies.
Wandering Pacemaker
63
In which direction does the mean electrical vector travel?
From the SA node down and to the left.
Right Atria to the Left Ventricle
64
In which populations are 1st Degree AV Blocks found:
Athletes.
May be seen in people with myocarditis or rheumatic fever.
65
In whom can we expect Sinus Bradycardia?
Well-trained athletes
Patients taking Beta-Blockers
Most common rhythm disturbance seen in early stages of Acute Myocardial Infarction.
66
In whom can we expect to see Sinus Tachycardia?
Exercise, Fever, Hyperthyroidism, Congestive Heart Failure (CHF), COPD
67
Isolated PVC
Single PVC
68
Key Features:
Junctional Rhythm
Absent, Retrograde, Inverted P Waves depending on the direction of the depolarization.
The rate usually 40-60 bpm.
69
Lead ___ mimics the mean electrical vector the best.
II
70
Limitation of EKG
The ectopic beat must be occurring during the time the EKG is done.
Only captures 6 seconds!
71
* Long, thin cells that carry current to distant regions of the heart.
* Divided into atrial and ventricular conducting systems.
Electrical Conduction Cells
72
* Look at the electrical activity of the heart.
* Allow you to infer certain conditions
Electrocardiograms (EKG)
73
Low Energy Shock
Timed or Synchronized to be delivered at a specific point in the QRS complex. (The goal is to prevent inducing Ventricular Fibrillation by shocking during the T-Wave (Ventricular Repolarization))
Used to treat conditions such as Atrial Fibrillation, Atrial Flutter, Sinus Tachycardia, AVNRT, Ventricular Tachycardia with a Pulse
Cardioversion
74
Method of temporarily taking over the rate at which the heart depolarizes.
Cardiac Pacing (Transcutaneous)
75
Most common cause of Atrial Fibrillation
Long-Standing Hypertension
76
The most common cause of Sudden Cardiac Death.
Ventricular Fibriallation
77
Most common location of the delay for an AV block is:
Between the AV node and the Bundle of His.
78
Most common rhythm after a return of circulation after cardiac arrest in the immediate recovery phase.
Accelerated IVR
79
Most common ventricular arrhythmia.
Premature Ventricular Contraction (PVC)
80
Most frequent cause of Pulseless Electrical Activity (PEA)?
Hypoxia
81
No electrical activity. (Isoelectric Baseline)
TP Interval
82
No electrical activity.
Not able to defibrillate.
Look for cause and treat specific abnormalities.
Asystole
83
Normal Cycle of Electrical Activity
1. The Sinoatrial (SA) node fires.
2. The signal travels across atria through the internodal pathway to the Atrioventricular (AV) node.
1. Simultaneously signal travels via Bachman's Bundle to the right atrium.
3. A slight pause, then signal travels down Bundle of His.
4. His Bundle branches into Right and Left bundles.
5. Ending at the Purkinje fibers.
6. Slight pause, then repolarization occurs.
84
Normal 12-lead EKG lead Layoout
I AVR. V1. V4
II AVL V2 V5
III AVF V3 V6
Six-second rhythm strips at bottom of 12-lead (usually lead II, but V1, V5, but any can be used)
85
Often associated with long QT intervals.
Polymorphic Ventricular Tachycardis
86
One spike followed by an abnormal P (Atrial capture) followed by a second spike producing a wide QRS (ventricular capture)
Dual-Chamber Pacing
87
One spike producing an abnormal P wave (atrial capture) followed by a normal QRS.
Atrial Pacing
88
Pacemaker Error
No pacer spikes/activity when needed.
Pacemaker failure
89
Pacemaker Error
Pacer firers, but heart does not respond.
Failure to capture.
90
Patient exercises (treadmill/bike) and EKG is obtained.
If ectopic beats resolve with exercise, they are okay.
Exercise Stress Test
91
Patients push a button when they feel symptomatic and recording starts.
Backdates ~30 Seconds
Event Recorder
92
PR interval remains constant, but the intermittent dropping of QRS
2nd Degree AV Block: Mobitz Type II
Usually associated with heart disease.
93
Precordial Leads
aVR, V1
Right Ventricle
94
Precordial Leads
V2, V3, V4
Anterior Heart
95
Precordial Leads
I, aVL, V5, V6
Lateral Heart
96
Presence of EKG recording/tracing without actual physical contraction of the heart muscle.
There is no pulse.
Pulseless Electrical Activity (PEA)
97
PVC Morphology (2):
Unifocal - All PVCs look the same.
Multifocal - PVCs do not look the same.
98
R wave of the PVC occurs during the T wave of the preceding beat.
R-on-T Phenomenon
99
* Recurrent, spontaneous depolarization at a set rate (eg. SA node at 60-100 bpm)
* Depolarization results in an action potential
Pacemaker Cells
100
Represents repolarization of the ventricles.
T Wave
101
Represents the depolarization of the atrium.
P Wave
102
Represents the depolarization of the ventricles and the repolarization of the atrium.
QRS Complex
103
Rhythms that have a consistent R-R interval throughout the rhythm strip
Regular Rhythms
104
Rhythms that have an inconsistent\* R-R interval throughout the rhythm strip.
Irregular Rhythms
\*R-R intervals that are off by 2 little boxes (0.08s) or less are considered regular.
105
SA Node depolarization rate:
60-100 beats/min
106
Sinus Node ceases to fire for at least 2 seconds (10 big boxes).
Sinus Arrest
107
Sites of Origin of Arrhythmias:
* Sinus Origin
* Atrial Origin
* Junctional Origin
* Ventricular Origin
108
How to detect PVC and other Ectopic Beats
EKG
Holter Monitor
Event Recorder
Stress Test
109
Sources of Arrhythmias are mapped in EP lab; then appropriate therapy is determined.
Electrophysiologic studies
110
A special pattern of PACs where they occur every other beat.
Atrial Bigeminy
111
T/F?
The mean vector changes depending on which lead you are looking at?
True
112
The change in ______ \_\_\_\_\_\_ from depolarization to repolarization is what is recorded by the EKG.
Electrical Charge
113
The first positive (upward) deflection of the QRS complex.
R Wave
114
The left side of the P Wave represents ____ Atrial depolarization.
Right
115
The mean direction (average direction) of all electrical activity of the heart can be summarized by the yellow arrow.
Mean Electrical Vector
116
The pacing lead is inserted into the atrium to cause atrial depolarization.
Atrial Pacing
117
The pacing lead is inserted into the ventricle to cause ventricular depolarization.
Ventricular Pacing
118
The pacing leads are inserted both into the Atria and the Ventricle stimulating at set intervals.
A-V Sequential Pacing
119
The purpose of this device is to "wall-off" the opening to the left atrial appendage and keep any clots from traveling via the circulation to the brain.
Watchman Device
120
The right side of the P Wave represents the ____ Atrial depolarization.
Left
121
The time elapsed between two successive R waves (two successive ventricular depolarizations).
R-R Inteval
122
Three cells that can spontaneously depolarize:
SA Node
AV Node
Ventricles
123
Three Major Classifications of Blocks
Sinus Node Block
Atrioventricular (AV) Block
Bundle Branch Block
124
Time from the beginning of ventricular depolarization to the end of ventricular repolarization.
QT Interval
125
Time from the end of atrial depolarization to the start of ventricular depolarization.
PR Segment
126
Time from the end of ventricular depolarization to the start of ventricular repolarization.
ST Segment
127
Two types of cardiac cell types:
* Conducting Cells
* Pacemaker cells
* Bundles
* Myocytes
128
Unipolar measurement
aVL, aVR, aVF, V1-V6
129
Utilizing an EKG machine you can measure and interpret three things:
Amplitude (mV)
Duration (time)
Configuration of a Cardiac Cell
130
Valid for both regular and irregular rhythms.
6-Second Estimation Method
131
Valid for regular rhythms only.
300 estimation method
132
Ventricle depolarization rate
20-40 beats/min
133
Ventricular Fibrillation is associated with greater success with defibrillation.
Fine Ventricular Fibrillation
134
Ventricular Fibrillation is associated with more recent onset.
Coarse Ventricular Fibrillation
135
Ventricular Fibrillation
Amplitude \> 3mm
Coarse Ventricular Fibrillation
136
Ventricular Fibrillation Amplitude \< 3mm
Fine Ventricular Fibrillation
137
Ventricular Tachycardia with multiple QRS shapes.
Polymorphic Ventricular Tachycardia
138
Ventricular Tachycardia with one QRS shape.
Monomorphic Ventricular Tachycardia
139
What are the two descriptors for describing a PVC?
Morphology (What does it look like?)
Frequency
140
What causes an arrhythmia?
* Hypoxia
* Ischemia
* Sympathetic Stimulation
* Drugs
* Electrolytes
* Bradycardia
* Stretch (Enlargement/Hypertrophy)
141
What is the danger of a R-on-T phenomenon?
Creates a prolonged PVC, which may initiate Ventricular Tachycardia or Ventricular Fibrillation.
142
What is the main danger of Atrial Fibrillation?
Potential for blood to coagulate in LA, which will send a clot to the brain and result in a CVA/stroke!
Transesophageal echo required before electrical interventions
143
What is the most common conduction block?
Atrioventricular Block
144
What is the order for the 300 estimation method?
300, 150, 100, 75, 60, 50, 43, 38, 33
145
What is the purpose of Carotid Massage?
Parasympathetic Nervous System innervation, which slows the heart rate down.
146
Which is the more accurate 300 estimation method or the 6-second estimation method?
300 estimation method
