EXAM #1: VENTRICULAR PRE-EXCITATION & ARRHYTHMIA

Question 1

What is the definition of ventricular pre-excitation?

Answer 1

Early stimulation of the ventricles via an accessory pathway

Question 2

What is the eponym for an accessory pathway in the heart?

Answer 2

Bundle of Kent

Question 3

What is the clinical consequence ventricular pre-excitation?

Answer 3

Predisposes to re-entrant supraventricular tachyarrhythmias

Question 4

What are the ECG manifestations of pre-excitation?

Answer 4

1) Short PR-interval (less than 0.12sec or three small boxes)
2) Delta wave

Question 5

What is the classic triad for the WPW pattern?

Answer 5

1) Widened QRS
2) Short PR interval
3) Delta wave

Question 6

What is the difference between WPW pattern and WPW Syndrome?

Answer 6

Syndrome= development of tachyarrhythmias

Question 7

What will WPW mimic?

Answer 7

1) Bundle branch block

2) MI

Question 8

When WPW converts into PSVT, what happens to the delta wave?

Answer 8

Delta wave will disappear

Question 9

What four things will cause a tall r-wave in V1?

Answer 9

1) RVH
2) RBBB
3) WPW
4) Dextrocardia

Question 10

What are the requirements for re-entry?

Answer 10

1) Bifurcated pathway
2) Different refractory periods in the two pathways
3) Unilateral slow conduction

Question 11

What is “disturbed automaticity?”

Answer 11

Alterations in sympathetic and parasympathetic activity that change heart rate

Question 12

What are three general characteristics of premature beats?

Answer 12

1) Occur early in the cycle
2) Prevent occurrence of next normal beat
3) Generate a pause of varying length

Question 13

What are the ECG features of atrial premature beats?

Answer 13

1) Abnormally shaped p-wave
2) Normal QRS
3) NO COMPENSATORY PAUSE

Question 14

What is the most common cause of a pause on an ECG?

Answer 14

Nonconducted atrial premature complex

Question 15

What are the ECG features of a Junctional Premature complex?

Answer 15

1) No p-wave

2) Normal QRS

Question 16

What does bigeminy mean?

Answer 16

Groups of two

Question 17

How can you tell atrial premature complexes from 2nd degree AV block?

Answer 17

1) 2nd degree block will have a p-wave with a dropped QRS complex
2) P-p interval will be constant for 2nd degree AV block

Question 18

What are the ECG characteristics of PVCs?

Answer 18

1) Wide QRS
2) No p-wave
3) T-wave opposite of QRS
4) Compensatory pause is usual

Question 19

What does the “R on T” phenomenon refer to?

Answer 19

R-wave that occurs during the T-wave

This is BAD–leads to VT and VF

Question 20

What is a Grade 0 classification of PVCs?

Answer 20

None

Question 21

What is a Grade 1 classification of PVCs?

Answer 21

Less than 30/hour

Question 22

What is a Grade 2 classification of PVCs?

Answer 22

30+ an hour

Question 23

What is a Grade 3 classification of PVCs?

Answer 23

Multiform

Question 24

What is a Grade 4A classification of PVCs?

Answer 24

2x consecutive

Question 25

What is a Grade 4B classification of PVCs?

Answer 25

3x consecutive

Question 26

What is a Grade 5 classification of PVCs?

Answer 26

R-on-T

Question 27

What are the characteristics of LVP?

Answer 27

Upright in V1

Question 28

What are the characteristics of a RVP?

Answer 28

Down in V1

Question 29

What are the clinical consequences of a LVP?

Answer 29

More clinically concerning:

• IHD
• More likely to cause V-fib in MI