Exam 2 review Flashcards
1
Q
Determine axis?
A
Lead 1 and Lead aVF. Normal=+,+ Left deviation=+,- Right deviation=-,+ Extreme right deviation=-,-
2
Q
Normal QRS duration? Wide?
A
Normal=0.06-0.1sec
Wide= >0.1sec
3
Q
RVH criteria?
A
Right axis deviation.
Poor R-wave progression=R-wave larger than S-wave in V1 and S-wave larger than R-wave in V6
4
Q
R waves tallest in which two leads?
A
V4 and V5
5
Q
LVH criteria?
A
Left axis deviation
R-wave amp in V5 or V6 plus S-wave amp in V1 or V2 exceeds 35mm (7 boxes)
6
Q
Causes of Sinus Arrythmia?
A
Hypoxia, ischemia, irritability, sympathetic stimulants, drugs, lyte imbalance, enlargement/hypertrophy
7
Q
What does the term “Sinus Arrythmia” imply?
A
A benign slight irregularly which is a variant of normal
8
Q
Sinus tach rate?
A
> 100bpm
9
Q
Sinus Brady rate?
A
<60bpm
10
Q
What stops firing in a Sinus Arrest?
A
SA node stops firing
11
Q
What does a rescue beat do?
A
Restarts sinus node.
12
Q
Inhalation and sinus rate?
A
Increases
13
Q
Exhalation and sinus rate?
A
Decreases
14
Q
Where does a rescue beat originate from?
A
AV-node (most common)
15
Q
When rescue beat originates from the AV node what’s it called?
A
Junctional Pacemaker
16
Q
Which wave does the junctional rhythm lack?
A
P-waves
17
Q
Sick Sinus Syndrome is a dysfunction of which node?
A
SA- node
18
Q
Sick Sinus Syndrome is the inability of the heart to do what?
A
Inability to generate heart rate to meet physiologic needs
19
Q
Sick Sinus Syndrome can cause what rates?
A
Profound bradycardia, sinus pause, sinus arrest, paroxysmal SVT
20
Q
Most common ventricular arrythmia?
A
Premature Ventricular Contraction (PVC)
21
Q
The QRS-complex of a PVC looks like?
A
Wide and bizarre. ≥0.12sec
22
Q
When to PVCs become dangerous?
A
Run of >3, variable morphology, during MI
23
Q
Premature Atrial Contraction (PAC) due to what?
A
Ectopic focus which fires at random
24
Q
What do the P-waves of PACs look like compared to other beats?
A
Different from other beats
25
PAC aka
Atrial Premature Beat
26
Where do Supraventricular Arrythmias originate from?
Above ventricles in AV-node or atria
27
How long can Supraventricular Arrythmias last for?
Single beats or sustained rhythms lasting for seconds to years
28
Supraventricular Tachycardia rate?
150-250bom
29
Does Supraventricular Tachycardia have P-waves?
NO!
30
Supraventricular Tachycardia QRS-complex wide or narrow?
Narrow
31
Supraventricular Tachycardia initiatedby?
Premature supraventricular beat atrial or junctional
32
Supraventricular Tachycardia driven by?
Reentrant circuit looping within the AV-node (AVNRT)
33
Causes of Supraventricular Tachycardia?
Alcohol, coffee, exitement
34
First tx for Supraventricular Tachycardia?
Valsalva
35
Second tx for Supraventricular Tachycardia?
Adenosine
36
MC type of Supraventricular Tachycardia?
Atrioventricular Nodal Reciporcating Tachycardia
37
Supraventricular Tachycardia is what type of rhythm?
Reentrant rhythm
38
Supraventricular Tachycardia is a disorder of what?
Disorder of impulse transmission
39
Supraventricular Tachycardia on-set and cessation time?
Sudden on-set, sudden cessation
40
Does Supraventricular Tachycardia have P-waves?
No P-waves!
41
Why doesn’t Supraventricular Tachycardia have P-waves? (Hint: where originates)
Originates below atria in AV-node or ventricules
42
Which MC- Afib or AFlutter?
Afib
43
HTN, mitral valve dz, thyrotoxicosis, pericarditis can all cause which rhythm abnormality?
Afib
44
Afib rhythm regular or irregular?
irregular
45
Afib rate?
120-180
46
P-waves in Afib?
No true P-waves due to completely chaotic atria
47
Which rhythm is irregularly irregular, narrow complex, with no discernable P-waves at a rate of 120-180?
Afib
48
Does A-Flutter have P-waves?
Yes, in saw tooth pattern
49
How many P-waves to ventricular beats in A-flutter?
2:1
| “2:1 AV block”
50
A-flutter rate regular? Rapid?
Regular rate but very rapid
51
What is a random firing of several different ectopic atrial foci?
Multifocal Atrial Tachycardia
52
Multifocal Atrial Tachycardia rhythm regular or irregular?
Irregular rhythm 100-200bpm
53
If Multifocal Atrial Tachycardia <100 bpm called what?
Wandering Atrial Pacemaker
54
Wandering Atrial Pacemaker seen in normal hearts?
Yes
55
Multifocal Atrial Tachycardia common in PTs with what severe disease?
Lung dz
56
Multifocal Atrial Tachycardia P-waves?
Vary in morphology ≥3
57
If P-wave morphology is ≥3 then what called?
Multifocal Atrial Tachycardia
58
QTc normal duration?
<440ms
59
QTc dangerous for ventricular arrythmias?
>500ms
60
QTc >500ms danger for what rhythm?
Torsades
61
VTach rate?
≥120BPM
62
2 types of VTach?
1. Non-sustained
| 2. Sustained
63
Non-sustained VTach lasts for how long?
≤30 seconds “short runs:
64
Non-sustained VTach benign?
Yes usually benign if no structural heart dz
65
Sustained VTach duration?
≥30 seconds “long runs”
66
Does Sustained VTach have a pulse? Conscious?
+/- pulse
| +/- conscious
67
What does Sustained VTach lead to?
Vfib and death
68
QRS in Sustained VTach?
Wide. Only wide QRS in Sustained VTach.
69
Torsades is a unique form of which rhythm?
VTach
70
Normal or prolonged QT intervals in Torsades?
Prolonged QT intervals
71
QRS comples does what in Torsades?
Spirals around baseline, changes axis and amplitude
72
Torsades likened to what fun thing?
Party streamer
73
VTach can degenerate into which rhythm?
VFib
74
Is there a QRS in VFib?
No discernable QRS
75
Cardiac output in VFib
None
76
What does VFib require?
CPR and defibrillation
77
First-degree AV block is a conduction block between where?
SA-node and purkinje fibers (including AV-node and His bundle)
78
First-Degree AV block common in what kind of hearts?
Normal hearts
79
First-Degree AV block is a prolonged conduction delay where?
At AV-node
80
Do impulses from Atria make it through the AV-node?
Yes, but slowed
81
Every QRS-complex in First-Degree AV block preceeded by what?
Single P-wave
82
Do atrial impulses in Second-Degree AV block make it through?
Not all pass through AV-node
83
2 types of Second-Degree AV block?
1. Type 1 “Wencheback”
| 2. Type 2
84
Atrial impulses encounter what in Type 1 Second-Degree AV block?
Encounter progressively longer delays in AV-node
85
Which atrial impulse fails to get through in Type 1 Second-Degree AV block?
3rd or fourth
86
What happens to PR-interval in Type 1 Second-Degree AV block? ____ isn’t followed by ___
Progressively lengthens until atrial impulse fails to get through. P-wave not followed by QRS
87
Is pacemaker indicated in Type 1 Second-Degree AV block?
No indication for pacemaker
88
Where is block in Type 2 Second-Degree AV block? (where? in?)
Below AV-node in His Bundle
89
Does all atrial impulses get to ventricles in Type 2 Second-Degree AV block?
Nope
90
Ratio of atrial impulses to ventricle in Type 2 Second-Degree AV block?
Varies!
91
Which rhythm: Two or more beats with normal PR-interval then P-wave without QRS?
Type 2 Second-Degree AV block
92
Pacemaker indicated in Type 2 Second-Degree AV block?
Yes
93
Do atrial impulses get through to the ventricles in Third-Degree AV block?
Nope
94
Which block when Atria and Ventricles driven by different pacemakers?
Third-Degree AV block
| “AV-dissociation”
95
Where is block in Third-Degree AV block?
At AV-node or lower
96
Where is the escape rhythm generated in Third-Degree AV block?
Below conduction block
97
QRS if escape rhythm is generated within conduction pathway in Third-Degree AV block?
Narrow QRS
98
QRS if escape rhythm is generated within ventricles in Third-Degree AV block?
Wide QRS
99
Is the QRS generated within conduction pathway in complete heart block reliable or not?
Unreliable
100
Is the QRS generated within ventricles in complete heart block fast enough?
Too slow! 30-45bpm
101
Is pacemaker indicated in Third Degree AV-block?
Yes!
102
What is obstructed in Right Bundle Branch Block?
Conduction through Right Bundle
103
QRS in Right Bundle Branch Block?
Widens
104
Why does QRS widen in Right Bundle Branch Block?
RV depolarization delays
105
Which leads are r-R’ (rSR’) created in Right Bundle Branch Block?
V1 and V1
106
What does the S-wave in V6 look like in Right Bundle Branch Block?
Wide S-wave
107
Can Right Bundle Branch Block be found in a normal heart?
Yes
108
What is obstructed in Left Bundle Branch Block?
Conduction through Left Bundle
109
What causes widened QRS in Left Bundle Branch Block?
LV depolarization delay
110
What does QRS-complex look like in leads over LV in Left Bundle Branch Block?
Broad or notched
111
Broad or notched QRS seen in which leads in Left Bundle Branch Block?
Leads overlying LV
112
Broad or notched QRS in Left Bundle Branch Block due to which wave being prolonged?
Prolonged R-wave rise
113
Left Bundle Branch Block had broad S-wave in leads over which ventricle?
RV
114
What does Left Bundle Branch Block suggest to arteries?
Coronary artery dz
115
ST-depression indicates?
Cardiac ischemia
116
STEMI height criteria in limb leads? Precordial leads?
Limb leads=1mm height
| Precordial leads=2mm height
117
Pathologic Q-waves due to?
Irreversible myocardial damage
118
Patholotic Q-wave criteria? (Hint: R-wave, duration)
≥0.04sec duration
| ≥1/3 height of R-wave
