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Exam 3 Flashcards

1
Q

SA node inherent rate

A

60-100

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2
Q

AV node inherent rate

A

40-60

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3
Q

AV node location

A

in the wall between the right atrium and right ventricles

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4
Q

AV node relays impulses from ___ to ____

A

SA node to ventricles

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5
Q

Four main cardiac cycle electrical events

A

cardiac action potential
depolarization
repolarization
refractory period

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6
Q

contraction of the heart

A

depolarization; systole

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7
Q

during depolarization, __ flows into cell __ flows out

A

Na; K

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8
Q

resting state of the heart

A

repolarization; diastole

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9
Q

EKG: Positive Deflection

A

impulse moving towards lead

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10
Q

EKG: Negative Deflection

A

impulse moving away from lead

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11
Q

P wave=

A

atrial depolarization

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12
Q

QRS complex=

A

ventricular depolarization

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13
Q

T wave=

A

ventricular repolarization (most sensitive time)

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14
Q

U Wave=

A

final phase of repolarization

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15
Q

PR Interval #

A

0.12-0.20; measure at the beginning of Q

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16
Q

PR Interval measures from ___ to ___

A

beginning of P to beginning of QRS

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17
Q

QRS Interval #

A

0.06-0.12

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18
Q

QRS interval measured from ___ to ___

A

beginning of the Q to the end of the S wave

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19
Q

QT measure from __ to ___

A

beginning of QRS to end of T wave

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20
Q

QT interval #

A

0.32-0.40

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21
Q

Total time from ventricular depolarization to repolarization

A

QT interval

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22
Q

Rule of 10

A

irregular rhythm; count number of R waves in a 6 second strip

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23
Q

Rule of 1500 or 300

A

regular rhythm; count small boxes between R waves

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24
Q

Atrial Dysrhythmias

A

PAC- premature atrial contraction
PAT/SVT- Paroxysmal Atrial Tachycardia/ Supraventricular Tachycardia
A Flutter-
A Fib

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25
Q

Key points of atrial dysrhythmias

A

-originate from foci within atria, not SA node
-different or variable P waves
-NORMAL QRS complexes

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26
Q

Rhythm: a single beat that occurs when an electrical impulse starts in the atrium before next normal SA node impulse
Waves: P wave is early, differs in size and shape, PR interval will be shortened

A

Premature Atrial Contractions (PAC)

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27
Q

Controlled A FIb

A

<100 with ventricular bpm

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28
Q

uncontrolled A fib

A

rate >100 ventricular bpm

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29
Q

Atrial rate is 300-600 per minute and ventricular can be up to 120-200 bpm
no p waves, no measurable PR interval; normal QRS, ventricular rate is irregular and varied

A

A fib

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30
Q

Treatment for A-fib

A

rate and rhythm control
antithrombotic- aspirin
rate control- beta blockers
rhythm control- amiodarone

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31
Q

causes: cardiac or pulmonary diseases, digoxin toxicity, PE
rate: rapid atrial rate (250-400)
rhythm: sawtooth pattern
waves: normal QRS, no p wave, no pr interval

A

A-flutter

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32
Q

pacemaker of the heart

A

SA node

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33
Q

Bundle of His
Junctional Fibers
Purkinjie Fibers

inherent rate #

A

14-20 ventricular contractions; no atrial contractions; not life supporting

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34
Q

do you see atrial repolarization on the rhythm strip?

A

no, only ventricular

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35
Q

Relative refractory period

A

most of T wave,
can be depolarized with a strong stimulus
can cause R on T phenomenon

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36
Q

Absolute refractory period

A

most of QRS complex
cardiac cells can not be stimulated to depolarize

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37
Q

1 little box on EKG strip =

A

0.04 seconds

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38
Q

1 big box on EKG strip=

A

0.20 seconds

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39
Q

To analyze rhythm strip, you always need a ___ second strip

40
Q

P-P interval measures

A

atrial rate and rhythm; measure from the beginning of the p wave

41
Q

To interpret rhythm, measure

A

Regular or Irr [p-p r-r
PR (0.12-0.20)
QRS (0.06-0.12)
QT (0.32-0.40)

42
Q

ST segment info

A

-early ventricular repolarization
-end of QRS complex to start of T wave
-should be isoelectric

43
Q

sinus arrhythmia: everything is regular except ___

44
Q

Sinus: if interruption lasts <3 seconds =

A

sinus pause

45
Q

P wave that came too soon

46
Q

SInus: if interruption lasts >3 seconds =

A

sinus arrest

47
Q

Premature Atrial Contraction (PAC) causes

A

caffeine, alcohol, hypokalemia, pregnancy, atrial MI, and w/tachycardia

48
Q

A Fib causes

A

-heart valve disorders, cardiomyopathy, MI, COPD/lung diseases, CHF, pericarditis

49
Q

Causes loss of atrial kick (decreased CO by 30%)

50
Q

Paroxysmal Afib

A

its transient, comes and goes

51
Q

possible treatment for A flutter

52
Q

Junctional Rhythms originate within the ___ ___

53
Q

Junctional Rhythm HR

54
Q

Accelerated Junctional Rhythm HR

A

> 60-100 bpm

55
Q

Junctional Tachycardia HR

56
Q

-occurs when irritable site within AV node fires impulse before SA node fire
-impulse interrupts sinus rhythm
-narrow QRS, absent or unidentifiable P wave
-just monitor

A

Premature Junctional Complexes (PJC)

57
Q

Junctional rhythm causes

A

-digoxin toxicity
-Av node ischemia
-isoproterenol infusion

58
Q

Rhythm: AV node is pacemaker
Waves: P wave may occur just before QRS, during QRS, or not at all
Narrow QRS with normal QRS intervals

A

Junctional Rhythm

59
Q

If person with Junctional Rhythm is symptomatic, treat like

A

bradycardia

60
Q

with junctional rhythm, patient loses ___

A

atrial kick

61
Q

SA-AV-SA-AV

A

AVNRT-SVT-Paroxysmal Atrial Tachycardia

62
Q

AVNRT-SVT-Paroxysmal Atrial Tachycardia causes

A

caffeine, nicotine, hypoxemia, stress, CAD, cardiomyopathy

63
Q

rate: 151-250
rhythm: an impulse that is re-routed repeatedly back to the same area
waves: P waves are difficult to see hidden T waves from previous beat
Normal QRS

A

AVNRT-SVT-Paroxysmal Atrial Tachycardia

64
Q

Symptoms of unstable patient with AVNRT-SVT-Paroxysmal Atrial Tachycardia

A

decreased CO, decreased BP, decreased urine output
cold/clammy skin, dizziness, decreased LOC

65
Q

treatment for stable AVNRT-SVT-Paroxysmal Atrial Tachycardia

A

vagal maneuvers, adenosine, CCB, BB

66
Q

treatment for unstable AVNRT-SVT-Paroxysmal Atrial Tachycardia

A

Vagal maneuvers, synchronized cardioversion

67
Q

ventricular dysrhythmias

A

-Premature Ventricular contraction
-Idioventricular rhythm
-Polymorphic VT/ Torsades de Pointe
-VFib
-Agonal
-Asystole/Ventricular standstill

68
Q

Premature Ventricular Contraction (PVC) causes

A

electrolytes (hypokalemia), MI, acidosis, dig toxicity

69
Q

Rate: variable
Rhythm: irregular
waves: no p waves, QRS complex is wide and bizarre,
types: multifocal, bigeminy (every other beat), trigeminy (every third beat), couplets, salvo, runs of VT (>4 or more), concerned with 6/min…uni (one type of deflection) vs multifocal (different deflections)

70
Q

increased PVC is warning sign for

A

Ventricular tachycardia (V tach)

71
Q

Rate: >100 bpm
Rhythm: regular rhythm, monomorphic
Waves: no P-waves, wide QRS complex, T wave opposite QRS

72
Q

V Tach causes

A

myocardial irritability, R on T phenomenon, ACS/MI, ischemia, prolonged QT(i), heart failure, CMO, electrolyte imbalance,

73
Q

V Tach treatment

A

Pulse: RRT, amiodarone, procainamide, lidocaine, cardioversion,
No pulse: CPR, defib

74
Q

Polymorphic VT/ Torsades de Pointes causes

A

hypomagnesemia,
meds: Cipro, methadone, haloperidol, erythromycin,

75
Q

Waves: No p-waves, associated with prolonged QT(i), Mg+ levels, and meds
Rhythm: twisting of the points
rate: >100 bpm

A

Polymorphic VT (Torsades de Pointes)

76
Q

___ = D fib

77
Q

Rate: >100 bpm
Rhythm: fine or coarse, rapid chaotic irregular rhythm, no organized
Waves: no measurable P waves, PR intervals, no measurable QRS complexes, ST or T waves
no CO= clinical death

A

Ventricular Fibrillation (V Fib)

78
Q

Rate: 20-40 (from ventricles)
Rhythm: usually regular, SA/AV node not initiating, beat coming from Bundle of HIS or Perkinje fibers
Waves: no p waves, wide abnormal QRS

A

Idioventricular- Ventricular Escape Rhythm

79
Q

Causes: End of Life, multi-system organ failure,
rate: <20 bpm
rhythm: irregular
waves: no p waves, QRS extremely wide and slurred, often not treated

A

Agonal Rhythm

80
Q

Rate: <20 bpm
Rhythm: no electrical activity, requires 2 lead confirmation
waves: standstill, only p waves noted

A

Ventricular standstill/ Asystole

81
Q

PEA is treated like___

82
Q

PEA & Asystole are shockable rhythms: true or false

83
Q

Conduction abnormalities

A

heart blocks:
-1st degree
-2nd degree type 1 (wenchebach)
2nd degree type 2
3rd degree (complete Hb)

84
Q

Conduction abnormalities facts

A

hemodynamics worse as degree worsens
causes: lyme disease , dig toxicity, CCB, MI and ischemia

85
Q

R coronary artery feeds blood to the

86
Q

Rate: regular, atrial impulse is slower than normal
Rhythm: regular
waves: P wave normal size, shape, QRS- normal, PR(i) CONSISTENTLY PROLONGED >0.20 seconds and the same for all

A

First Degree AV Heart Block

87
Q

2nd degree HB type 1 [wenchebach] treatment for asymptomatic

A

no treatment

88
Q

2nd Degree HB type 1 [wenchebach] symptomatic treatment

89
Q

Rate: Regular
Rhythm: atrial regular, ventricular irregular, patterned 1 beat loss,
Waves: p waves present but all conducted, PR (i) lengthens until one is not conducted, QRS normal, but periodically dropped, sa/av node not carrying consistently

A

2nd degree HB type 1 [wenchebach]

90
Q

Rate: atrial rate regular, ventricular rate slower than atrial,
rhythm: atrial regular, ventricular rhythm irregular, patterned 1 beat loss,
Waves: p waves normal, but not all conducted, PR(i) is normal or prolonged all PR(i) are the same, THERE is NO LENGTHENING of PR(i)
waves: QRS normal, but occasionally dropped

A

2nd degree HB type 2 (mobitz II)

91
Q

2nd Degree HB Type II (Mobitz II) treatment

A

temp pacemaker
AVOID ATROPINE

92
Q

Lethal Rhythms

A

V FIb
V tach
3rd degree AV Block (complete HB)
idioventricular
asystole
PEA

93
Q

Rate: A and V rate regular but not the same (no association)
Rhythm: A rate faster than V rate and are regular. 2 independent rhythms @ same time
waves: P waves present but have no relationship w/ QRS complex, P waves march on, PR(i) not measurable, QRS wide or narrow

A

3rd Degree HB (complete HB)

94
Q

There are 2 independent rhythms happening at the same time

A

3rd degree HB

95
Q

3rd degree HB treatment

A

AVOID atropine, pacemaker at bedside

331 (7 decks)

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