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CPR 2 Exam 1 > Johnston Conduction Disturbances & Hypertrophy of Atria and Ventricle > Flashcards

Johnston Conduction Disturbances & Hypertrophy of Atria and Ventricle Flashcards

1
Q

What is an AV block?

A
  • block in cardiac conduction system that causes a disruption of atrial to ventricular electrical conductioni
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2
Q

What is the criteria for a first degree AV block?

A
  • PR interval more than 0.20 sec
  • P wave precedes QRS
  • Minor AV defect with delay at or below AV node
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3
Q

What causes a 1st degree AV block?

A
  • Atherosclerosis
  • Htn
  • Diabetes
  • FIbrosis
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4
Q

What is happening, what is rate and rhythm?

A

Sinus Bradycardia

PR interval= 7x .04= 0.8 so first degree AV block

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5
Q

What is Mobitz I (Wenchkenbach) 2nd degree AV block?

A
  • Progressive lengthening of PR interval, prolongation prior to a dropped QRS
  • Grouped beats
  • Progressive lengthening of the PR interval results from earlier arrival in relative refractory period of the AV conduction
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6
Q

Etiology of Mobitz I?

A
  • All things that cause 1 AV block
  • Digitalis toxicity
  • Ischemic events particularly Inferior MI
  • Myocarditis
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7
Q

What will a QRS complex look like on a second degree AV block Mobitz type 1?

A

Narrow

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8
Q

What is this

A
  • Inferior wall MI-ST elevations
  • Lead 2 rhythm strip on the bottom has 4 beats followed by dropped QRS
  • Each PR interval before the dropped beat is longer and longer
  • Mobitz I 4:3 (4 atrial beats to 3 ventricular beats)
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9
Q

What is Mobitz type II 2nd degree AV block is seen with what? What is the prognosis and why?

A
  • Seen in anterior wall infarctions
  • Worse prognosis than Mobitz I
  • Because the block is distal to AV node
    • occurs at bundle HIS
    • both bundle branches
    • Fascicular branches
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10
Q

What happens with the PR interval on Mobitz II?

A
  • It is normal, there is no prolongation before dropping a QRS, it occurs randomly
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11
Q

What is third degree heart block? What is the solution if it is sustained? Where does it occur?

A
  • aka complete heart block
  • P waves don’t relate to QRS, two independent rhythms are present
    • pacemaker is solution
  • Can occur above or below AV node
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12
Q

Where does 3rd degree heart block occur and what is the rate of each? What do QRS complexes look like?

A
  • Above has a junctional rhythm with narrow QRS rate of 40-55
  • Below AV has ventricular pacemaker with a wide QRS and rate of 20-40
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13
Q

what is happening?

A
  • complete heart block
  • Independent atrial activity
  • junctional escape rhythm bc QRS is narrow and rate is in 50’s
  • P waves are at rate of 125
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14
Q

what is this?

A

1 AVB

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15
Q

What are the characteristics of bungle branch blocks?

A
  • Wide QRS complex greater than three small squares 0.12 seconds
  • ST segment has T waves sloping off in opposite direction to the QRS
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16
Q

What leads do you look at for a right bundle branch block?

A

V1

AVL

V6

V2

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17
Q

Morphology of leads for a RBBB?

A

R, S, Rprime

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18
Q

Complete right bungle branch block

A

Wide QRS

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19
Q

What is happening

A
  • lead 1 deep S wave and similar on AVL and V6
  • RSR’ on V1 and widening on V2
  • Complete RBBB
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20
Q

What is LBBB?

A
  • Q wave is missisng
  • Should be seen in V5 and V6 but not there
  • monophasic R, wide RS
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21
Q

What leads do you look at for LBBB

A

Leads I

and AVL

V1 and V6

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22
Q

What is a Hemiblock?

A
  • Blockage of one of two main divisions of the left bundle branch
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23
Q

What type of hemiblock is more common?

A

Left anterior hemiblock (LAH)

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24
Q

Criteria for left anterior hemiblock (fascicular) block?

A
  • Left axis deviation, usually >-60
  • Small Q in leads I and AVL
  • Small R in II, III and AVF
  • Increased QRS voltage in limb leads
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25
What is the crierria for left posterior hemiblock?
* Right axis deviation greater than 120 * Small R in leads I and AVL * Small Q in II III and AVF * Usually normal QRS * Increased voltage in QRS limb leads
26
Etiology of LAH?
* Conduction system often associated with MI (LAD occlusion)
27
what is this?
* Left Anterior Hemiblock * Left axis deviation * small Q leads in I and AVL * Small R in II III and AVF
28
what is this?
* Left posterior hemiblock * Right axis * Small R in I and AVL * Small Q in II III and AVF
29
What causes Atrial enlargement?
* Response to increase volume in the chamber * Increase resistance to blood flow out of the chamber
30
What will RAE show on an ECG?
* Tall & pointed
31
What causes Right atrial enlargement?
* Tricuspid valve disease or underlying pulmonary disease * Mitral Stenosis or Mitral Regurgitation cause pulmonary hypertension
32
What is this?
Right atrial enlargement
33
What will LAE show on ECG?
* P mitrale ("M" signs to P wave) Notched P wave
34
What causes LAE?
* MS * MR
35
What is this?
* LAE * B is wide and deep negative component of P wave * A has M shaped P wave
36
What are A B and C?
* A is LAE * B is RAE * C is P waves originating out of AV node
37
What is the most common cause of LVH?
* Hypertension * other causes include AS, AR, hypertrophic cardiomyopathy and coarctation of aorta
38
HOw will QRSS respond to LVH?
* QRS voltage and interval will increase producing deeper S waves over RV and taller R waves over LV
39
what is this?
* R wave in AVL is 17 mm in height * R wave in V6 is 25+ * ST segment in V6 slopes down (strain pattern) * **Left ventricle hypertrophy**
40
Voltage is huge usually indicates hypertrophy this is LVH
41
What are some indications for RVH?
* RAD 90 or more * R voltage increased * R:S ratio greater than 1
42
What causes RVH?
* Chronic lung disease * RVOT obstruction * VSD * Tetralogoy of fallot * Pulmonic stenoisis * Tratnsposition vessels * MS * TR
43
What does having a low or high K do to the heart?
* High: slows conduction, raises resting membrane potential, and widens QRS * Low: lowers resting mem pot, enhances automaticity
44
What does having a high or low Ca do the heart?
* Low: prolongs QT interval, triggers arrhythmias * High: shortens QT
45
What causes hypokalemia?
* Diuretics * Metabolic alkalosis * high aldosterone * Beta agonist OD * Diarrhea
46
What does ECG of hypokalemia show?
* U waves * Increase QT interval * Flat or inverted T
47
What do arrows show?
U waves of Hypokalemia
48
Etiology of hyperkalemia?
* Renal failure * Metabolic acidosis * DKA * cell breakdown
49
ECG of hyperkalemia?
* Peaked T wave * Wide QRS * Increased PR interval * Loss of P wave
50
what is happening, what could be wrong with this patient?
* Hyperkalemia possibly due to CKD * no P waves * Wide bizzarre QRS * Magnitude of T wave is very tall pointed and peaked
51
Etiology of Hypercalcemia?
* Hyperparathyroidism * Malignancy * Granulomatous disorder * Endocrine disorders such as adrenal insufficiency and hyperthyroid
52
What does ECG of Hypercalcemia show?
* QT interval shortened * Short ST segment
53
Helpful pic
54
How will hypothermia present?
* Bradycardia * J wave (notch of T wave) * Temp less than 35 (95)
55
Pulmonary embolus symptoms?
* Sudden dyspnea clear lung normal x ray * Tachy
56
What will PE show on ECG?
* S1 Q3 T3 * T wave inversion seen on V1-V4 * Transient RBBB * Non specific ST-T changes
57
What is wolff parkinson-White syndrome (WPW)?
* Short PR interval * Slurred upstroke of QRS (delta wave) * Accessory AV conduction pathway (bypasses normal AV conduction) * They are prone to suddenly develop fast heart rates, born with it
58
What is Brugada syndrome?
* RBBB with ST elevation (looks like skii slope) * These people are susceptible to deadly arrhythmias * Asian males AD * Due to sodium channelopathy
59
WPW
60
What is Wellens syndrome?
* diffuse T wave inversion in V2 and V3 * LAD stenosis
61
Long QT syndrome?
* QT interval more than half of the cardiac cycle * Predisposed to ventricular arrhythmias

CPR 2 Exam 1 (21 decks)

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