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CP1.06_Cardio_ZACHOW > Lecture 3/4 (Arrhythmias) > Flashcards

Lecture 3/4 (Arrhythmias) Flashcards

1
Q

Ectopic pacemakers:

A
  • pacemakers cells in the atrium that are not SA nodal.
  • lead to premature atrial contraction.
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2
Q

What causes sinus tachycardia or sinus bradycardia?

A
  • rate of SA nodal firing is increased or delayed.
    1. SNS/PSNS input.
    2. HCN channels (slow depolarization of pacemaker).
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3
Q

What arrythmia is this?

A
  • Sinus tachycardia.
    • Sinus rhythm (PQRST; only one P per QRS).
    • HR > 100.
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4
Q

What arrythmia is this?

A
  • Sinus bradycardia.
    • Sinus rhythm (PQRST; only one P per QRS).
    • HR < 60.
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5
Q

What kind of rhythm is this?

A
  • normal sinus rhythm
    • Sinus rhythm (PQRST; only one P per QRS).
    • HR between 60-100
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6
Q

Primary heart block cause and ECG manifestation:

A
  • Cause: delayed conduction through AV node or bundle of His.
  • ECG: increased/lengthened PR interval.
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7
Q

What arrythmia is this?

A
  • Primary heart block.
  • note increased PR interval.
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8
Q

Secondary heart block cause and ECG manifestation:

A
  • Cause: increased AV nodal refractory time; Not every atrial impulse is conducted through the AV node, His-Purkinje.
  • ECG: more than one P wave per QRS complex.
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9
Q

What kind of arrythmia is this?

A
  • Secondary heart block.
  • >1 P wave per QRS complex.
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10
Q

Tertiary (complete) heart block cause and ECG manifestation:

A
  • Cause: Atrial impulses are not conducted through AV node.
    • Atria beat at one rate and rhythm and ventricles beat at another.
    • Ventricular contraction is driven by escape rhythm.
  • ECG: P and QRS waves at regular intervals, but not coordinated.
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11
Q

What drives ventricular depolarization in tertiary (complete) heart block?

A
  • escape rhythm.
  • pacemaker cells in either AV node, bundle of his, or in ventricuar myocardium itself.
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12
Q

The three pacemakers of the heart:

A
  1. SA node.
    • Normal rate.
  2. AV junctional.
    • Moderate rate.
  3. Ventricular (his, purkinje, myocardium itself).
    • Very slow rate - not sustainable.
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13
Q

Normal sequence of electrical conduction through myocytes:

A
  1. Impulse travels unidirectionally in direction of excitable myocytes.
    • Refractory myocytes behind impulse prevent immediate reexcitation.
  2. Impulse can only either:
    • continue forward or
    • collide with itself and extinguish.
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14
Q

An ectopic pacemaker is:

A
  • any pacemaker that forms in the heart outside of the SA node.
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15
Q

Steps in formation of a reentry loop/circus rhythm:

A
  1. Impulse reaches healthy and damaged cells.
  2. Damaged cells only allow retrograde conduction, not anterograde.
  3. Anterograde conduction through healthy cells.
  4. Retrograde conduction through damaged cells.
  5. Time for retrograde conduction longer than effective refractory period of previously excited healthy cells.
  6. Healthy cells re-excited by retrograde conduction through damaged cells.
  7. Reentry loop/circus rhythm formed.
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16
Q

How does a reentry loop/ectopic pacemaker lead to the formation of an ectopic pacemaker?

A
  • circus rhythm created by reentry loop exits reentrant loop and depolarizes
    adjacent myocardium and spreads.
  • APs and contractions become uncoordinated, fibrillation can result.
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17
Q

When does relative refraction of the fast Na+ channels involved in plateau potentials and myocardium depolarization occur on an ECG?

A
  • mid-end T wave.
  • cell may be prematurely depolarized by rogue circus rhythm during relative refraction.
18
Q

What causes atrial fibrillation?

A
  • circus rhythm (formed from reentry loop) occurs in the atria and spreads.
  • atrial myocardium depolarize and contract randomly.
  • fibrillation results.
19
Q

Atrial fibrillation ECG manifestation (2):

A
  • No P waves.
  • Irregularly irregular rhythm.
20
Q

What arrhythmia is this?

A

A-Fib

  • no P waves
  • Irregularly irregular
21
Q

Why does the ventricular depolarization rate remain relatively low in comparison to atrial depolarization rate in atrial fibrillation?

A
  • AV nodal delay.
  • AV node pacemaker cells experience refraction, and so all atrial impulses are not relayed through the AV node to the ventricles.
22
Q

Atrial flutter ECG manifestation (4):

A
  1. Sawtooth appearance.
  2. rapid and regular P waves.
  3. P waves before QRS.
  4. >1 P wave per QRS.
23
Q

Primary difference between A-Fib and atrial flutter:

A
  • Atrial flutter has:
    • P waves (>1 per QRS).
    • rapid and regular rhythm (PQRS).
    • slower rate.
24
Q

What arrhythmia is this?

A

Atrial flutter w/ 2:1 ventricular response

(2 P waves per QRS)

25
Q

What kind of arrhythmia is this?

A

Atrial flutter w/ variable ventricular response

26
Q

Cause of ventricular fibrillation:

A
  • Ectopic pacemaker forms in ventricle and stimulates ventricular myocytes in relative refraction (downslope of T wave) to depolarize.
  • Ventricle does not contract simultaneously, it just quivers.
  • Cardiac ventricular output decreases / does not occur.
27
Q

What type of arrhythmia is this?

A
  1. Normal rhythm
  2. Event occurs
  3. Ventricular tachycardia
  4. Ventricular fibrillation
28
Q

Cause of ventricular tachycardia:

A
  • Scarred/injured myocardium allows reentrant phenomoenon.
  • Ectopic pacemaker forms in the ventricles fires at a very high rate causing ventricles to enter tachycardia.
    • 300 BPM
29
Q

Cardiac output is impaired in V-Tach because:

A
  • there is not enough time between ventricular contractions to allow for diastole.
30
Q

There are no P waves in V-tach or any other waves besides QRS because:

A
  • they are masked by the sheer size of ventricular depolarization.
  • they are still occurring.
31
Q

What arrhythmia is this?

A

V-Tach

  • regular and rapid
  • wide QRS
32
Q

Cause of bundle branch block:

A
  • Delayed/blocked conduction within a right or left bundle branch.
  • Conductance relayed from the unaffected ventricle to impaired side via interventricular septum myocytes (SLOW).
  • Widened QRS.
33
Q

What causes the wide QRS complex on bundle branch block ECGs?

A
  • Delayed/blocked conduction within a bundle branch.
  • Conductance relayed from the unaffected ventricle to impaired side via interventricular septum myocytes, which have slow conduction rates.
  • Ventricular depolarization is longer, widened QRS complex.
34
Q

Right BBB ECG manifestation:

A

widened QRS on lead III, V1 and V2.

35
Q

Left BBB ECG manifestation:

A

widened QRS on lead I, lead II, and V5 and V6.

36
Q

What arrhythmia is this?

A

BBB

widened QRS

37
Q

What arrhythmia is this?

A

BBB

widened QRS

38
Q

Split R waves on an ECG (see image) are indicative of what type of arrhythmia?

A

BBB

39
Q

What type of arrhythmia is this?

A

right BBB

  • Split R waves
  • Lengthened QRS complex
  • V1 and V2 analyze right ventricle
40
Q

Premature ventricular contractions (PVCs) are:

(include ECG manifestation)

A
  • rogue ventricular contractions that arise from ectopic pacemaker in ventricle.
  • Widened QRS complex; no P waves associated with QRS complexes.
41
Q

What kind of arrhythmia is this?

A

premature ventricular contractions

  • widened QRS
  • no P wave
  • random QRS complexes

CP1.06_Cardio_ZACHOW (10 decks)

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