Johnston- Cardiac Rhythm Disturbances (atrial, junctional, ventricular) Flashcards
cor pulmonale
right heart failure due to lung disease
ecg in cor pulmonale
low voltage
tall pointed, peaked p waves
sometimes intermitent RBBB
ECG in hypothyroidism
bradycardia
low voltage
flattening of T wave
wpw
pre excitation syndrome, congenital from extra bypass tract
what constitutes bradycardia
under 60 bpm
medical conditions/situations associated with bradycardia
diseases of atrium or SA node CAD inflammation invsive neoplasm cardiomyoptahy muscular dystrophy amyloidosis
drugs associated with bradycardia
digitalis, quinidine, hyperkalemia
drugs for hypertension
beta blockers
bradycardia and MI
acute inferior MI (RCA lesion)
-related to sinus node ischemia or to a vagal reflex initiated in the ischemic area
sick sinus syndrome
treatment
tachy alternating with bradycardia
SA node undergoing inflamation, ischemia, hypoxia
- seen in people who have vascular disease, advanced heart disease and older pts
- use pacemaker to treat slow rate and meds to suppress fast
what is the most common cause of an unexplained beat pause on ECG
nonconducted PAC
what is a nonconducted PAC
beat not conducted to the ventricle
atrial (p wave) is abnormal from ectopic focus
nonconducted atrial bigeminy
every other beat is from ectopic and not concducted
what can SSS cause
syncope, dizziness, fatigue, heart failure
treatment of sinus bradycardia
atropine .3–>.5—>1—>2mg IV
- repeat 10 min
- use caution in glaucoma
- AE = urinary retention, abd distension
Epinephrin
isproterenol
pacemaker
what is automaticity
property of a cardiac cell to depolarize spontaneously during phase 4 of AP and leads to generation of an impulse
what are PAC (premature atrial contraction) associated with
stress alcohol tobacco coffee COPD CAD
premature atrial beat ecg
biphasic p wave and premature
or different morphology
treatment of PAC
if symptomatic
beta bloker
metoprolol 25-50 mg BID-TID
paroxysmal atrial tachycadria
sudden heart rate greater than 100
rate is 150-250
identify irritable focus. P’ wave
atrial tachy
junctional tachy
ventricular tachy
can have p and t waves superimposed on each other
PAT with block (AV block)
2 P’ waves for each QRS
suspect digitalis toxicity
can have T wave superimposed on P wave
P’ waves are spiked
multifocal atrial tachycardia
3 or more different P waves (3 or more diff morph in a row)
P-R interval varies
irregular ventricular rhythm
atrial rate over 100
MAT associated with
copd, pneumonia, beta agonists, electrolyte abnormalties, digitalis tox, sepsis
treatment for multifocal atrial tachycardia
CCB - nondihydropyridine
diltiazem 20 mg IV
verapamil
Magnesium sulfate
amiodarone/adenosine
caution with beta blocker (pulmonary problems)
A fib
not well defined p wave and irregular ventricular response
continuous chaotic atrial spikes
atrial flutter
saw tooth appearance
leads II,III, aVF, V best leads
premature junctional beat
may cause retrograde atrial depolarization
- each P’ is inverted in leads with an upright qrs
- and p’ wave can come beofre or after qrs
paroxysmal junctional tachycardia
150-250 bpm
p wave may be lost, inverted before or after each qrs
SVT
T wave is high and have narrow QRS complex
svt with no p wave
AVNRT
PVC ecg
premature bizarre wide QRS
no preceding p wave
may produce retrograde p wave in st segment
ST-T wave in opp direction of QRS
usually have full compensatory pause
multifocal ventricular ectopics
each irritable focus produces its own distinctive PVC
____ PVCs in a row is start of ____
3, vtac
V tac is sutained longer than ___ seconds of fast ventricular activity
30 seconds
accelerated idioventircular rhythm
- rate is fast, qrs is wide
- see this in people who have received thrombolytic therapy
- fusion beat
treatment of PVCs
if stable no rx
if symptomatic or in setting of ACS- metoprolol
if unstable then amiodarone, lidocaine, procainamide
(PAL for unstable PVCs)
ventricular tachycardia
3 or more consectutive bizarre qrs complexes ventricular rate of 120-200 usually regular, wide qrs p wave often lost last longer than 30 seconds
ventricular fibrillation cliniclal setting
Acute MI IHD K+ disturbance Heart failure disorganized depolarization
ventricular flutter
250-350 bpm
sine waves
leads to v fib
torsades de pointes
qrs swings from positive to negative direciton may be inherited (prolonged QT) or acquired (class I, II,, antiarrhytmias, alcohol, tca, electrolyte imbalance
what do you always check with torsades de pointes
electrolye levels
K, Ca, Mg
treatment for torsades de pointes
MgSO4
overdrive pacing
isoproternol
asystole
no rhythm
start cpr
hyper or hypokalemia widens qrs
hyperkalemia
low calcium causes
prolonged AT, triggers arrhythmias (torsades)
high calcium
shortens qt interval
low mg and qt
prolongs it
high mg and qt
shortens it
u waves, increased qt interval, flat or inverted t wavre
hypokalemia
hyperkalemia ecg
tall pointed T wave
wide qrs
increased pr
loss p wave
treatment for hyperkalemia
dialysis insulin and glucose na hco3 albuterol rezin binding agents
hypocalcemia etiology
chronic renal failure vitamin D deficiency hypoparathyroidism acute pancreatitis hypomagnesium
hypocalcemia and ecg
prolonged QT
hypercalcemia etiology
hyperparathyroidism
malignancy
granulomatous disorders
endocrine
ecg and hypercalcemia
short qt
short st
etiology of hypomagnesemia
alcholosim and diuretics are big ones
ecg of hypomagnesemia
prolonged PR
wide QRS
prolonged QT
decreased T wave
hypotehemia and ecg
j wave
osborne wave
wide bizzarre and have a little notch in downslope of QRS
PE and ECG
S1 Q3 T3 (inverted T in V1-V4)
large S in lead I
ST depression in lead II
large Q wave in III with T wave invesion
transient RBBB
low voltage in QRS is what
lung disease until proven otherwise
cerebral hemorrhage and ecg
t waves are prominent and followed by a funny notch
impressive ST-T changes
Widespread giant T wave inversions
hypothyroidism ecg hallmark
widespread flattening or mild inversion of T waves without associated ST segment displacement
most other constant ECG finding in myxedema (from hypothyroidism) is
low voltage of QRS complex
brugada syndrome
people of asian decent prone to sudden death
RBBB with ST elevation in V1,V2,V3
bizarre “ski slope” to QRS
wolff parkinson white syndrome
short P-R interval
slurred upstroke (delta wave) of QRS complex
accessory av conduction pathway
(bundle of kent)
