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Cardiac Pathologies > INTERPRETING EKGs and Recognizing Dysrhythmias > Flashcards

INTERPRETING EKGs and Recognizing Dysrhythmias Flashcards

EKG

1
Q

💡5 types

Types of atrial arrhythmias

A
  1. Premature Atrial Contraction
  2. Atrial Tachycardia
  3. Paroxysmal Atrial Tachycardia
  4. Atrial Flutter
  5. Atrial Fibrillation
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2
Q

diagnosis and treatment

  • Due to a # of different causes
  • Increased Parasympathetic activity
  • Dz of SA node (sick sinus syndrome (SSS))
  • May c/o: dizziness due to decreased CO
A

Sinus pause/arrest causes and treatment

  • Treatment:
    – Need to start treatment while pt has symptoms
    – Treat underlying cause:
    • Decrease Digitalis toxicity
    • Decrease vagal stimulation
    • PPM placement
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3
Q

Premature Atrial Contraction originate from…

A

irritable, sometimes ischemia areas

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4
Q

In a first degree AV Heart Block:

A
  • Impulse start at SA (and is delayed) or AV node prolonged.
  • P wave for every QRS
  • QRS is normal BEeetween 0.04 and 0.10
  • RR is regular
  • HR: 60-100 (but can be bellow 60)
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5
Q
A

Torsades de Pointes

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6
Q

causes of sinus tachycardia

A
  • Typically benign
  • Increased Activity/Exercise (normal response)
  • Hypothermia
  • Hypotension
  • Heart Failure/Insufficient Cardiac Output
  • Anxiety
  • Increased sympathetic stimulation (fear, pain)
  • Stimulants (coffee, nicotine)
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7
Q

Variations of ischemia include:

A
  • Upsloping
  • Horizontal
  • Downsloping
  • Elevation
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8
Q

occur every other beat

A

Bigeminal / Bigeminy

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9
Q

PACs or other arrythmias that occur in pairs or two in a row

A

Couplets

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10
Q
A

atrial flutter

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11
Q

💡3 types

Nodal or Junctional Arrhythmias types

A
  • Premature Junctional Complex/Contraction
  • Junctional Rhythm
  • Junctional Tachycardia
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12
Q
A

Q waves after an inferior MI

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13
Q

How does digoxin work?

A

Digoxin acts by inhibiting cell membrane sodium/potassium ATPase which leads to reversal of the usual sodium/calcium exchange. An increased intracellular calcium level results which, in myocardial muscle, has the effect of enhancing the strength of contraction (positive inotropism). It also affects the electrical physiology of the heart, blocking atrioventricular (AV) conduction and reducing the heart rate by enhancing vagal nerve activity (negative chronotropy).

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14
Q
A
  • Normal Sinus Rhythm
  • Rate is between 60-100 bpm
  • Equal distance between points on the waves
  • One P for every QRS
  • All P waves look the same
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15
Q

Premature Atrial Contraction treatment

A
  • None required
  • unless advances to Supraventricular Tachycardia (SVT) or Afib
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16
Q
A

Junctional Rhythm

  • Rate: 40-60 bpm
  • QRS appears normal w/QRS duration: 0.04-0.10
  • Absent P wave prior to QRS: May get retrograde P’s
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17
Q

diagnosis?

  • Heart disease: MI, CHD, ischemia
  • Dijoxin Toxicity
  • Excesive B blocker
  • Symptoms of decreased CO and HR (dizziness, lightheaded, SOB, fatigue, chest pain)
A

common AV heart block signs, symptoms causes

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18
Q

Premature Junctional Contraction treatment

A
  • None, unless there are symptoms of clinical relevance
  • Treat the cause if indicated
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19
Q

treatment of atrial tachycardia

A
  • Treat the cause (ie: pH)
  • Perform autonomic maneuvers:
    • Valsalva
  • Meds:
    • B Blocker, Digoxin
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20
Q
A

Sinus pause/ sinus arrest:

  • Named w/ underlying rhythm:
    • ex: NSR with sinus pause OR Sinus Bradycardia with pause
    • May see ESCAPE Beat or Rhythm
  • All P waves are identical
  • P for every QRS
  • PR interval is b/t 0.12-0.2 sec
  • QRS complexes are identical w/QRS duration b/t 0.04-0.10 sec
  • R-R interval is regular, but occasional pauses noted
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21
Q

AV node rythym

A

40-60 bpm

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22
Q
A

Premature Junctional Contraction:

  • Premature impulses that arise from the AV node
  • Similar to PAC’s except:
    • Absent, inverted or retrograde P wave → P wave follows QRS instead of preceding it
  • QRS usually identical w/QRS duration: 0.04-0.10
    • BUT the QRS also may be slightly widened in that abnormal beat
  • R-R interval regular, except during premature beat
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23
Q

(Paroxysmal) Junctional Tachycardia, Signs/Symptoms/Causes:

A
  • Hyperventilation
  • CAD, MI, s/p CT surgery, digoxin toxicity, myocarditis, caffeine, nicotine, overexertion, emotional stuff
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24
Q

In an atrial flutter, P-waves are identical because…

A

it’s the same foci firing

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25
three PVCs in a row
Triplet
26
**First Degree AV Heart Block** * Lengthened PR interval (\>0.20 sec), every time
27
Types of SVT including:
* Atrial Tachycardia * Paroxysmal Supraventricular Tachycardia * Atrial Flutter * Atrial Fibrillation
28
Atrial tachycardia
29
diagnosis and treatment
**3rd Degree AV Heart Block:** * This is a medical emergency * Meds: Atropine, B blocker * Pacemaker (usually dual chamber)
30
**Atrial Tachycardia:** signs/Symptoms/Causes:
* Same as PAC’s * Hypoxemia, pulm HTN, altered pH * COPD pts * Can result in decreased CO: * Dizziness, Fatigue, SOB
31
Junctional rhythm, causes/signs/symptoms
* SA node dz, Increase in vagal tone, digoxin toxicity, MI or ischemia to conduction system * Decrease CO if rate too slow * Dizziness, fatigue
32
**Third Degree AV Heart Block**
33
called STEMI, Q wave MI, Full Thickness MI
Transmural MI
34
In a **premature atria contraction**, the P wave of early beat may get buried in \_\_\_\_\_\_\_\_\_
T wave of prior complex
35
control atrial fib: treat or not to treat?
treat
36
treatment of atrial flutter
* Assess signs and symptoms * Call RN, NP, MD, PA * Medical Management: * B blocker, digoxin, verapamil * Rhythm Conversion (cardioversion) * Anticoagulation
37
originate from multiple/different foci
Multifocal
38
# numerous... **Atrial Fibrillation,** signs/symptoms/causes:
* Numerous factors: * Age * CHF * ischemia/infarction * CM * digoxin toxicity * drug use * stress * pain * and more...
39
**First Degree AV Heart Block**
40
* **Sinus Tachycardia** * Rate – greater than 100 bpm * Rhythm – regular * Relationship P Wave to QRS complex – 1:1 * All P Waves look the same
41
**Paroxysmal Atrial Tachycardia** signs/symptoms/sauses:
* Emotional factors * Overexertion * Hyperventilation * Caffeine/Nicotine * RHD, MVP, PE * Digitalis toxicity * Dizziness, weakness, SOB * Chest pain, fainting/vomiting * May lead to “panic attack”
42
Series of rapid heartbeats that begin in or involve the atria
Supraventricular Tachycardia
43
* tip: if there is no T wave on an abnormal beat is PJC * For PJC, QRS will be slightly lengthened because it is closer to ventricle compared to PAC * tip: if there is T, it is either PAC or PVC. but PVC has wide bizarre QRS.
* Top: PAC * Bottom: PJC
44
**Junctional Rhythm**
45
diagnosis, cause
**_Paroxysmal Atrial Tachycardia (PAT or PSVT)_** * Sudden onset of atrial tachycardia * Underlying NSR w/ a burst of atrial tach that eventually returns to NSR * Abrupt start and stop * P wave may be present or merged with T wave * R hard to measure * QRS are identical w/QRS duration b/t 0.04-.010 sec * R-R usually regular * Rapid HR usually \>160 bpm
46
**Premature Junctional Contraction** signs/symptoms/causes:
* Decreased automaticity and conductivity of SA node * Irritable AV node or Junctional tissue * Cardiac dz, MV dz * Frequent PJCs may be precursor to other abnormal rhythms
47
In a **premature atrial contraction** an ectopic atrial focus depolarizes \_\_\_\_\_\_\_\_, ahead of the\_\_\_\_\_\_\_\_\_\_
1. prematurely 2. SA node
48
Similar to Junctional rhythm, but rate is higher (usually greater than 100)
(Paroxysmal) Junctional Tachycardia
49
new onset a-fib: treat or not to treat
wait untill is controlled
50
diagnosis
**_Second Degree AV block, Type I_** * AKA **Wenckebach** or **Mobitz I** * Progressive lengthening of PR interval until QRS gets dropped
51
Rhythms that Originate in the SA Node, Atria, or AV Node
**Supraventricular Rhythms**
52
# type I and type II **Second degree AV block** treatment
* **Type I (Wenckebach or Mobitz I):** * May be unnecessary * Meds: atropine * Temporary PPM placement * May resolve with correction of ischemia in RCA * **Type II (Mobitz II):** * Frequently needs PPM placement * Meds to relieve symptoms: Atropine, B blocker
53
5 lead EKG is used for
monitoring
54
AV node AKA
junctional focci
55
**Paroxysmal Atrial Tachycardia** (PAT or PSVT)
56
Causes of sinus bradycardia:
* Good conditioning in athletes (normal) * Decreased oxynegation during sleep * Vagal stimulation * Medication (B blocker) * Suctioning/gagging/vomiting
57
**(Paroxysmal) Junctional Tachycardia,** treatment
– Identify cause and Tx – Digoxin is given if not cause – Vagal stimulation – Meds: B blocker, Verapamil
58
**_Atrial Tachycardia_** * HR usually \>100 and as high as 200 or more bpm * P waves may or may not look the same * P may not be present for every QRS * P-R interval \<0.20 sec * QRS are identical w/QRS duration b/t 0.04-0.10 sec – WHY? * R-R intervals vary
59
diagnosis
**_2nd Degree AV block, Type II (Mobitz II)_** * →see dropped QRS w/ fixed PR intervals * P waves are regular * R-waves are irregular
60
**_Atrial Fibrillation_** * Rate: variable * Rhythm: irregular * Ratio of P to QRS: not applicable (due to no discernible P waves) * QRS duration: 0.04-0.10 * R-R interval: Irregular
61
Occurs when AV node takes over as pacemaker
**Junctional Rhythm**
62
Torsades de Pointes are seen only during...
**toxic** **antiarrhythmia** **therapy**
63
**Junctional Rhythm** AKA
**Junctional Escape Rhythm**
64
diagnosis
**_3rd Degree AV Heart Block_** * P-waves are regukar * R-waves are regular * But both are INDEPENDENT of each other
65
Paroxysmal Atrial Tachycardia (PAT or PSVT) treatment
* Determine underlying cause and tx * Discontinue meds * Autonomic stimulation: * Valsalva, coughing, gagging, * drink an ice cold liquid * B blockers
66
SA node fires but impulse is delayed on it’s way to AV node OR it’s initiated in AV node and conduction is prolonged
First Degree AV Heart Block
67
Every normal beat (normal R-R) is followed by a premature contraction (PVC)
**bigenemy**
68
Type of arrythmia
**_Sinus Arrhythmia:_** * All P waves are identical * P for every QRS * PR interval is b/t 0.12-0.2 sec * QRS complexes are identical w/QRS duration b/t 0.04-0.10 sec * **R-R interval varies** * HR is between 60-100 bpm but varies
69
Diagnosis, cause, type of rhythym,
**_Atrial Flutter:_** * Cause: rapid firing of ectopic foci in the atria * Rate: atrial 250-350 bpm * Rhythm: regular * P waves are identical b/c it’s the same foci firing * Relationship between P wave “saw tooth flutter waves” and QRS complex: 2,3,4 or more flutter waves for each QRS * QRS is usually normal w/ QRS duration 0.04-0.12 sec * R to R intervals vary * May be regular or irregular * Often when palpate pulse will feel “regularly irregular” rhythm
70
positive QRS in V1 and negative QRS in V6
Right Bundle Branch Block
71
# ⚡️ **Cardioversion** is a medical procedure done to restore a normal heart rhythm for people who have certain types of abnormal heartbeats (arrhythmias). Cardioversionis most often done by sending\_\_\_\_\_\_\_\_\_\_ to your heart through electrodes placed on your chest.
**electric shocks**
72
occur every third beat
Trigeminal / Trigeminy
73
**_Premature Atrial Contraction (PAC)_** * Underlying Sinus Rhythm * Normal complexes have P for every QRS
74
intra-atrial tracts rythym
60-80 bpm
75
12 lead EKG is used for
Diagnostic purposes
76
# 💡diagnosis * Commonly related w/respiratory cycle: * Increase HR: inspiration * Decrease HR: exhalation * Irregularity with vagal stimulation * Common in young/elderly * Decrease with exertion * Treatment: None normally needed
**Sinus Arrhythmia**
77
# In hypertrophic heart Lead ____ is used to assess electrical activity in both ventricles
V1
78
R Bundle Branch Block is best seen in whihc leads?
* V1 & V2 * See “Rabbit ear” appearance of R wave
79
count down method
300-150-100-75-60-50-43-37-33-30
80
Treatment implication of sinus bradycardia
– If symptomatic, call RN → Expect pt to be tx’d medically and/or pacemaker placement
81
ST segment elevation = earliest consistent sign + Significant Q waves \>.04 sec (all leads except AVR) **Diagnosis?**
**Infarction**
82
bundle of His, R and L Bundle Branches and Purkingje fibers **rythym**
**20-40**
83
**_(Paroxysmal) Junctional Tachycardia_** * Similar to Junctional rhythm, but rate is higher: * Rate usually greater than 100 (Dubin: 150-250 bpm) * P waves are absent except for retrograde * QRS identical w/QRS duration: 0.04-0.10 * R-R is regular * AVNRT (AV Nodal Reentry Tachycardia)
84
originate from one focus
Unifocal (P-waves looks the the same or different?)
85
# 👉🏻type of problem Sinus bradycardia is often seen in...
heart block problems
86
Abnormal quivering or twitching of atria due to multiple ectopic atrial foci. Produce rapid, erratic atrial rhythm. Atria do NOT fully depolarize → AV node controls impulses which “get through” and creates an **irregular rhythm**
**Atrial Fibrillation (AF)**
87
Transmural MI, Acute (min to hours)
* ST segment elevation * Hyper-acute T waves
88
occur as a single event
Isolated
89
Negative QRS in V1 and a positive QRS in V6
Left bundle branch block
90
atrial flutter
91
SA node rythym
**60-100 bpm**
92
What is the cause of **atrial flutter**?
Rapid firing of ectopic foci in the atria
93
Decreased CO can result:
* fatigue, dizzy, lightheaded, sob
94
In a **junctional rhythm**, **\_\_\_\_\_\_\_\_ P-wave** prior to QRS. And may see retrograde P’s.
**absent**
95
# 💡similar to another **Atrial fibrilation** treatment:
* **Same as for a-flutter** * Medication: digoxin, verapamil, anticoagulants * Cardioversion (shock) * Possible PPM (pace maker)
96
**Atrial Flutter,** signs/symptoms/sauses:
* Numerous pathologies: * RHD, MV dz, CAD, MI, Renal dz, hypoxemia, pericarditis, stress, drugs * May lead to a-fib
97
**Right Bundle Branch Block**
98
# diagnosis * Stress * Stimulants (tobacco, ETOH, caffeine) * Abnormal blood levels of magnesium &/or potassium * Underlying heart disease (HTN, valve d/o, prior MI) * Irregularities may be palpated * Patient may feel “palpitations”
**Premature Atrial Contraction**
99
**1st Degree AV block**
100
Treatment of sinus tachycardia
* Assess Vitals and Signs and Symptoms for Decreased CO * Team to Assess and Treat Underlying Cause
101
2, 3, 4 or more flutter waves for each QRS
**atrail flutter**
102
Dangers of afib:
* Peripheral and Pulmonary emboli (30% can develop emboli) * Need to ANTICOAGULATE * Precipitate or aggravate CHF * CO can decrease
103
**Junctional rhythm** treament
* (atropine) – PPM * Identify problem and tx * Meds to increase HR
104
QRS appears normal. w/QRS duration: 0.04-0.10. R-R interval is regular. **Rate: 40-60 bpm**
**Junctional Rhythm**
105
can cause the heart to beat very rapidly or erratically →the heart may beat inefficiently→ the body may receive an inadequate blood supply
Supraventricular Tachycardia
106
ST segment depression and inverted T waves, but come back to normal with rest
Ischemia
107
atrial fibrilation
108
**_Sinus Bradycardia_** * Rate – Less than 60 bpm * Rhythm – regular * Relationship of P wave to QRS Complex – 1:1
109
Asystole **CALL A CODE** * Cardiac Arrest – circulation stops * Need some electrical activity in order to use a defibrillator, t**herefore not warranted in asystole**
110
**_Ventricular Fibrillation (_****_V Fib_****_)_** * No pulse, No BP, No Cardiac Output * CALL A CODE, begin CPR * **Defibrillate** * Medical management
111
Ventricular Tachycardia (VT or VTach) * Medical Emergency * Sustained Vtach (\> 30 sec) * Non-Sustained Vtach (duration of less than 30 sec)
112
Series of 3 or more PVCs in a row
**Ventricular Tachycardia (VT or VTach)**
113
PVCs Couplet & Triplet
114
Appears as a “spike” on the EKG or rhythm strip, at regular intervals
Pacemakers
115
Ventricular Pacing
116
**A-V Sequential Demand**
117
* Ischemia, acute infarction, hypertensive heart dz, cardiomyopathy, med toxicity (digoxin) * Occasionally happens w/ athletes-? Electrolyte imbalance during exercise * Medical emergency: can lead to V-fib – Symptoms of decreased CO and BP → lightheadedness, syncope * Weak, thready pulse can be palpated
Ventricular Tachycardia
118
treatment of ventricular tachycardia
* Meds: lidocaine, procanimide * Cardioversion/Defibrillation * Get pt back to bed ASAP and call for help; assess pulse
119
120
left bundle branch block is best seen in which leads?
V5 and V6? **W**illia**M**

Cardiac Pathologies (13 decks)

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