Leahs VERY BASIC Cards for Wehner the Weiner

Question 1

What is UAT?

Answer 1

• 3+ pre-mature atrial beats of the SAME shape.
• Pacemaker is present but it is NOT the SA node, so the rate isn’t 60-100. It’s higher.

*NOTE: you can “lose” a P wave within the QRS complex, lose a QRS wave in the case of a block, or see wide QRS waves. However, these are the exceptions and NOT THE RULE.

Question 2

What is a PAC?

What is its general cause?

Answer 2

One or two early beats followed by an abnormal P wave.
Sinus rhythm, meaning the AV node is the pacemaker (= rate of 60-100 BPM)

Can be normal, caused by something simple like caffeine, OR a sign of organic disease. Wide range of causes, not always pathogenic.

Question 3

What is MAT? How is it any different from PAC? What causes it?

Answer 3

• MAT is kind of like 3+ PACs in a row, but all three with different shapes.
• MAT has no pacemaker, so the rate is not a normal 60-100 BPM
• It is always pathogenic.
• It always has an isoelectric P line.

Caused most generally by pulmonary/cardiac pathologies, or may be observed in sepsis.

Question 4

What is the difference between PAC, MAT, UAT, and sinus tachycardia with PACs?

Answer 4

1. PAC- 2 or less early P waves of a consistent shape, SA pacemaker
2. MAT- 3+ early P waves, all DIFFERENT shapes, NO pacemaker.
3. UAT- 3+ early P waves all of the SAME shape, pacemaker IS NOT the SA node.
4. Sinus Tach with PACs- 3+ early P waves of the SAME shape with an SA NODE pacemaker.

Note: SA pacemaker = rate of 60-100 BPM

Question 5

What does it mean if there is a not a QRS wave for every P wave present?

Answer 5

This is called a conduction BLOCK.
Describe it as a ratio.
Ex 3:1 means there are 3 P waves for every 1 QRS wave.

Question 6

What is AFIB?

What causes it?

Answer 6

Pattern of ABSENT p waves, constant quivering on the trace (NO baseline), and v rate of 100-180.

It has a very wide range of causes but it is important to note that AFIB is NEVER NORMAL. Most benign causes include post op status, alcohol, and hypertension.

Question 7

What is atrial flutter? (3)

What causes it?

Answer 7

• “Saw tooth pattern”, loss of isoelectric baseline.
• Usually Assc with conduction block MEANING there is not a QRS for every P wave. Our homework example was a 4:1 block, meaning there were four P waves for every 1 QRS.
• Atrial rate of 240-340.

Same pathologies as AFIB, wide range of causes but important to note this is always always pathogenic.

Question 8

Quick and easy way to distinguish AFIB/FLUTT from MAT or UAT?

Answer 8

Is there an isoelectric baseline?
If so, it cannot be A fib or flutter.
Definition of a fib and flutter includes loss of baseline/constant quivering on the trace!!

Question 9

What is one general difference between atrial arrhythmias and ventricular arrhythmias?

Answer 9

• Atrial arrythmias have THIN/NARROW QRS waves.
• Ventricular arrythmias have WIDE QRS waves.
• Note: yes, atrial arrythmias occasionally hVe wide QRS waves during a condition called aberrant conduction, but this is the exception and NOT the rule.

Question 10

#1 cause of UAT with block?
What might it be mistaken for?
How do you NOT fall for this trap?

Answer 10

-UAT with block is caused by digitalis toxicity in 75% of cases

• It may look a lot like atrial flutter.
• You will know it is NOT a-flutter because you will be a smart student and notice the ISOELECTIC baseline which is NEVER EVER present in a flutter or a fib!!!!

Question 11

What is a pre-mature junctional complex? Is it pathologic?

What is a junctional rhythm? Is it pathologic?

Answer 11

-early narrow QRS wave w/inverted P waves in II, III, and aVF. (yes, QRS may be wide if there is a block or another complication, but this is not the rule)
-Like PAC, PJC can be normal.
-Junctional rhythm is like several PJCs in a row. HR is 40-60.
P waves are gone or inverted at II, III, and aVF. It is pathologic always.

Question 13

What’s the difference between a premature junctional complex and a junctional escape rhythm?

Answer 13

They’re essentially the same but you call it an “escape beat” if it follows a long pause.

Question 14

Atrial flutter or atrial fibrillation with a REGULAR R:R interval:

• common cause?
• what is happening?

Answer 14

Digitalis tox.

The regular R:R rhythm is often actually a full heart block compensated for with a junctional rhythm!

Question 15

Three EKG patterns that could be caused by digitalis toxicity?

Answer 15

1. A fib or flutter with regular R-R interval.
2. Junctional rhythm.
3. UAT with block.

Question 16

Technically, because Wehner is a Weiner, where could the P wave be in junctional rhythm?

Answer 16

• could be before the QRS, after the QRS or buried/hidden.

- commonly inverted in leads II, III, and aVF.

Question 17

Hypertrophy:

What does left ventricular hypertrophy look like? Right?

Answer 17

• Left: heart normally depolarizes to the left first, so making this side bigger exaggerates normal findings. Look for huge S waves in V2-3.
• Right: this will invert normal findings. Look for inverted S waves in I, upright waves in V1.

Question 18

Common EKG finding in hypothermia?

Answer 18

AFIB.

Question 19

Three EKG findings Assc with ischemia?

Answer 19

• ST elevation/depression
• pathologic Q waves
• t wave inversion.