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CPR-2 > Lecture 6: Cardiac Rhythm Disturbances (Atrial, Junctional, Ventricular) > Flashcards

Lecture 6: Cardiac Rhythm Disturbances (Atrial, Junctional, Ventricular) Flashcards

1
Q

What is your interpretation?

A

Sinus Arrhythmia

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2
Q

What is Sinus Arrythmia due to?

A

Normal, but minimal, increase in HR during inspiration and decrease in HR during exhalation

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3
Q

Bile salt accumulation in obstructive jaundice can have an affect on the SA node and lead to what type of HR?

A

Bradycardia

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4
Q

What is the effect of hyperkalemia on HR?

A

Bradycardia

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5
Q

List some drugs that can cause bradycardia?

A
  • Quinidine
  • Digitalis
  • HTN drugs –> clonidine, methyldop, and reserpine
  • Beta-blockers —> propranolol and metoprolol
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6
Q

Sinus bradycardia is a common finding with what type of MI?

A

Acute inferior MI (increased vagal tone, N/V)

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7
Q

Sick sinus syndrome has what effect on HR?

A

Bradycardia

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8
Q

Which HR is considered bradycardia?

A

HR < 60/min

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9
Q

What are characteristic ECG findings of someone with Sick Sinus Syndrome?

A
  • Periods of inappropriate, and often, severe bradycardia
  • Sinus pauses, arrest, and sinoatrial (SA) exit block with, and often without, appropriate atrial and junctional escape rhythms
  • Alternating bradycardia and atrial tachyarrhythmias
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10
Q

For each of these parameters, pO2, pCO2, pH, and BP, use (↑↓) to describe which is associated with bradycardia

A
  • ↓pO2
  • ↑pCO2
  • ↓pH
  • ↑BP
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11
Q

What is the most common cause of unexplained pause on an EKG tracing?

A

Nonconducted PAC

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12
Q

What is the tx of choice for pt with sinus bradycardia, if HR <45-50 with hemodynamic compromise/unstable acute situations?

Use caution in which pt’s?

A
  • Atropine
  • Use caution in glaucoma –> can ↑ IOP
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13
Q

If atropine is given to someone with hemodynamically unstable sinus bradycardia and fails to work, what are the next 3 options for tx?

A
  • Epinephrine
  • Isoproterenol
  • Pacemaker
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14
Q

Define automaticity in regards to cardiac cells

A

Property of cardiac cells to depolarize spontaneously during phase 4 of AP/leads to generation of an impulse

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15
Q

What characteristics are used to determine if a PAB is present and to help differentiate it from something more serious?

A
  • Appears early in the cycle
  • Morphologically distinct from the previous P waves
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16
Q

What is the characteristic finding on an EKG of a PAB with aberrant ventricular conduction?

A

Wide QRS following PAB

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17
Q

What is this known as?

A

Atrial Bigeminy

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18
Q

Interpret the tracing in A and B

A
  • A) 1st degree AV block w/ non-conducted PAC
  • B) 1st degree AV block w/ non-conducted PAC occurring in trigeminal rhythm
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19
Q

Interpret this EKG

A

Non-conducted PAC in Bigeminal rhythm

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20
Q

What is the tx for PAC’s if symptomatic?

A
  • Reverse causes (i.e., coffee, alcohol, other contributors)
  • Beta-blocker —> Metoprolol
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21
Q

Paroxysmal atrial tachycardia has a sudden onset and what is the HR?

A

Rate = 150-250/min

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22
Q

What are the criteria for paroxysmal atrial tachycardia with AV block?

What should you suspect as underlying cause?

A
  • Greater than one P’ wave per QRS complex; 2 P’ waves for each QRS
  • Rapid rate with spike P’ waves
  • Suspect digitalis toxicitiy
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23
Q

Interpret this EKG

A

Atrial Tachycardia with 2:1 AV block

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24
Q

Interpret this EKG

A

Atrial Tachycardia w/ 2:1 AV block

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25
What are the criteria for Multifocal Atrial Tachycardia (i.e., morphology, rate/rhythm, intervals)?
- **3 or more DIFFERENT P waves** - **P-R** interval **varies** - **Irregular ventricular rhythm** - **Atrial rate \>100**
26
List 5 etiologies for Multifocal Atrial Tachycardia?
- Lung disease (COPD, pneumonia, ventilator **theophylline**) - Beta agonists - Electrolyte abnormalities (↓K+ and ↓Mg) - Digitialis toxicitiy - Sepsis
27
Which EKG abnormality will almost exclusively been seen in COPD patients on ventilator theophylline?
Multifocal Atrial Tachycardia
28
Interpret this EKG
Multifocal Atrial Tachycardia
29
Interpret this EKG
Multifocal Atrial Tachycardia
30
Interpret this pt's EKG
Multifocal Atrial Tachycardia
31
What are the Tx options for Multifocal Atrial Tachycardia?
- **CCB** --\> **non**dihydropyridine **=** **Dilitiazem** or **Verapamil** via **IV** - **MgSO4** via **IV** then **Amiodarone/Adenosine**
32
What is the atrial rate in Atrial Fibrillation and what are the other characteristics on the EKG (baseline, rhythm, and intervals)?
- Atrial rate **\>350-600/min** - **Undulating** baseline w/ **no discernible P waves** - **Irregular** RR interval; **"irregularly irregular" ventricular rhythm**
33
Interpret this EKG
Atrial Fibrillation w/ Complete AV block
34
Interpret this EKG
Atrial Fibrillation
35
What is the diagnosis based on this EKG?
Atrial Fibrillation w/ controlled ventricular response
36
What is the characteristic appearance of Atrial Flutter and in which leads is it seen best?
- "**Saw tooth appearance**" - Leads **II, III**, and **aVF**
37
Interpret this EKG
Atrial Flutter
38
Interpret this EKG
- Acute Pericarditis w/ Atrial Flutter - Pericardiits will show **diffuse ST elevations** in **multiple leads** - Atrial flutter is best seen in **leads II, III,** and **aVF**
39
Interpret this EKG
Atrial Flutter w/ 2:1 AV block
40
Interpret this EKG
- Atrial flutter with 2:1 AV block - Notice every other p wave is NOT followed by a QRS
41
If you see a premature QRS complex that is slightly widened you should consider that it may be due to what?
Premature Junctional (or atrial) beat with **aberrant** ventricular conduction
42
A junctional automaticity focus may cause retrograde atrial depolarization and how will the premature P' wave appear?
**Inverted P' wave** in leads with **upright QRS**
43
Interpret this EKG
(AV) Junctional Bigeminy
44
Interpret this EKG
(AV) junctional trigeminy
45
What is the rate for paroxysmal junctional tachycardia and how will the P wave appear?
- Rate = **150-250/min** - P wav may be **lost (buried), inverted** BEFORE or AFTER each QRS
46
What is the dx of his 12 lead EKG?
- Rate is around 220/min - **Supraventricular Tachycardia**, and **w/ no p waves** is a junctional **AVNRT**
47
What is the tx for SVT (AVNRT)?
Adenosine
48
Interpret this EKG
AVNRT or SVT
49
Interpret this EKG
Paroxysmal Supraventricular Tachycardia
50
What are the ECG characteristics of Premature Ventricular Contractions (PVC's)?
- **Premature** + **bizarre** + **wide QRS** - **No** preceding P wave; may produce retrograde P wave in ST segment - **ST-T wave** moves in **opposite** direction of **QRS** - **Usually full compensatory pause!**
51
Interpret this EKG
- **Multifocal** PVCs - **Multiple**, irritable ventricular foci producing their own unique PVC upon firing
52
Interpret this EKG
- Ventricular **Bi**geminy - Every other beat has a **PVC**
53
Interpret this EKG
**R on T Phenomena**
54
Interpret this EKG; when would you see this?
- Accelerated Idioventricular Rhythm (AIVR) - Seen after giving pt a clot bluster (fibrinolytic) and represents reperfusion of a previously ischemic area
55
Interpret this EKG
Accelerated Idioventricular Rhythm **(AIVR)** w/ increasing **fusion beats**
56
Which drug is used for symptomatic PVC's or in setting of ACS?
Metoprolol IV
57
If pt is unstable and has PVC's what drugs can be used?
- Amiodarone - Lidocaine - Procainamide
58
Interpret this pt's EKG
PVC's; borderline sinus tachy
59
In regards to QRS complexes, ventricular rate, and morphology what characterized Ventricular Tachycardia?
- **3 or more** consecutive **bizarre QRS complexes** - Ventriuclar **rate** = **120-200 (100-250)** - Usually regular, **wide QRS (\> 0.12 sec)**
60
For ventricular tachycardia or any irregularity to be considered sustained how long must it last for?
**\>30 seconds**
61
Interpret this EKG
Ventricular Tachycardia
62
Interpret this EKG and **what would you do**?
- **Sustained Ventricular Tachycardia** - **Cardioversion** (ie., shock the heart back into rhythm)
63
Interpret this EKG
Ventricular Fibrillation
64
Interpret this EKG
Ventricular Fibrillation
65
What is your interpretation and what do you do?
- Ventricular fibrillation - CPR ---\> Defibrillation
66
What is the rate of ventricular flutter and how can you tell it apart from fibrillation?
- Rate = **250-350/min** - **Smooth**, sine waves - Fibrillation will be more **irregular**
67
Interpret this EKG and how do you know?
- Paroxysmal Atrial Tachycardia - There are **narrow, normal** looking QRS's, so it could **not** have originated in an irritable **ventricular** focus; therefore is supraventricular
68
Interpret this EKG
Torsades de Pointes
69
What are 3 treatment options for Torsades de Pointes?
- **MgSO4** IV bolus - Overdrive pacing - Isoproteronol (beta-agonist)
70
What are 3 characteristic findings of Hypokalemia on an EKG?
- **"U" waves** - ↑ QT interval - **Flat** or **inverted T wave**
71
Interpret this EKG
Hypokalemia
72
Interpret the abnormalities
- Hypokalemia - Prominent "U" wave
73
What are the major EKG features of Hyperkalemia?
- **Peaked "T" wave** = most prominent feature - **Wide QRS** - ↑ **PR interval** - Loss of P wave
74
What is wrong with this patient, based off the EKG?
Hyperkalemia (**peaked T waves** and **wide QRS**)
75
Which abnormality is responsible for this?
**HYPERkalemia**
76
What is the characteristic finding on an EKG with HYPOcalcemia vs. HYPERcalcemia?
- **Hypo**calcemia = **prolongation** of **QT** interval - **Hyper**calcemia = **short QT** interval; **short ST** segment
77
What is the quick and dirty way of determining **hypo**calcemia from an EKG?
- Measure the **R-R interval** and measure the **Q-T interval** - If **Q-T interval is \>1/2 the R-R** than its likely hypocalcemia
78
What is the underlying abnormality?
Hypocalcemia
79
Which electrolyte disturbance does this represent?
Hypercalcemia
80
Characteristic EKG findings of hypomagnesemia?
- **Prolonged PR and QT** - **Wide QRS** - Everything is **slowed down**
81
Which electrolyte abnormality is represented here?
Hyperkalemia
82
What is the characteristic rate and finding on the EKG for hypothermia?
- Bradycardia - **J wave (Osborne wave)**
83
What is the status of the pt based on this EKG?
Hypothermia
84
A patient presents with **sudden** dyspnea, but the lungs are clear and the XR is normal, what should you suspect?
Pulmonary embolism
85
What is the most common rate on an EKG and characteristic findings of pulmonary embolism? Associated with what kind of block?
- **Sinus tachycardia** - S1; Q3; inverted T3 (**rhymes**) - Transient **RBBB**
86
What is seen in leads V1-V4 with a pulmonary embolism?
- T wave **inversion** - **Transient RBBB**
87
Patient presents with sudden dyspnea and has this EKG, what do you suspect?
Pulmonary Embolism (S1; Q3; T3)
88
What will be seen on EKG of someone with Cerebral Hemorrhage?
Impressive ST-T changes
89
What underlying pathology would produce an EKG like this?
Cerebral hemorrhage
90
Whenever you see widespread flattening or mild inversion of T waves **without** associated ST segment displacement + **low voltage QRS**, you should always think about what underlying problem?
**Hypo**thyroidism
91
What are the characteristic EKG findings in Brugada Syndrome?
**RBBB** w/ **ST elevation** in **V1-V3**
92
A 21 yo male presents to the ED following an episode of syncope. He feels fine now and wants to go home. His EKG looks like this. What is your interpretation?
- Brugada Syndrome - At risk for sudden death; needs implanted ICD
93
What are the characteristic EKG findings in Wolff-Parkinson-White Syndrome?
- **Short** P-R interval - **Slurred upstroke** (**delta wave**) of QRS - **Accessory AV conduction** pathway (Bundle of **Kent**)
94
What is your interpretation of this EKG?
Wolff-Parkinson-White Syndrome
95
What underlying dz is associated w/ MAT?
pulmonary dz
96
How would you tx A fib?
if unstable, cardiovert Beta blocker amiodarone anticoagulate (cath lab if ACS suspected)
97
How would you tx PVCs?
amiodarone procainamide lidocaine cath lab if ACS suspected
98
How would you tx V tach? V fib?
if unstable --\> cardiovert amiodarone, lidocaine, procainamide V fib - CPR, defibrillate
99
How would you tx A fib w/ rapid ventricular response?
BB CCB digoxin?
100
How would you tx 3rd degree AV block?
pacemaker
101
What is RBBB associated with?
normal health pts pulmonary dz (PHtn, COPD, PE, cor pulmonale)
102
What underlying dzs are associated with LBBB (5)?
HTN CAD myocarditis cardiomyopathy aortic valve dz
103
How would you tx someone with cardiac abnormalities due to hyperkalemia?
dialysis if necessary/underlying dz 10 cc calcium gluconate or calcium chloride 10% sol'n over 3 min (to stabilize myocardial cell membrane) IV glucose and insulin to shift K+ back into cells NaHCO3 for metabolic acidosis Beta adrenergic agonist

CPR-2 (28 decks)

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