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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
Q

What are the criteria for Multifocal Atrial Tachycardia (i.e., morphology, rate/rhythm, intervals)?

A
  • 3 or more DIFFERENT P waves
  • P-R interval varies
  • Irregular ventricular rhythm
  • Atrial rate >100
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26
Q

List 5 etiologies for Multifocal Atrial Tachycardia?

A
  • Lung disease (COPD, pneumonia, ventilator theophylline)
  • Beta agonists
  • Electrolyte abnormalities (↓K+ and ↓Mg)
  • Digitialis toxicitiy
  • Sepsis
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27
Q

Which EKG abnormality will almost exclusively been seen in COPD patients on ventilator theophylline?

A

Multifocal Atrial Tachycardia

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28
Q

Interpret this EKG

A

Multifocal Atrial Tachycardia

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29
Q

Interpret this EKG

A

Multifocal Atrial Tachycardia

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30
Q

Interpret this pt’s EKG

A

Multifocal Atrial Tachycardia

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31
Q

What are the Tx options for Multifocal Atrial Tachycardia?

A
  • CCB –> nondihydropyridine = Dilitiazem or Verapamil via IV
  • MgSO4 via IV then Amiodarone/Adenosine
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32
Q

What is the atrial rate in Atrial Fibrillation and what are the other characteristics on the EKG (baseline, rhythm, and intervals)?

A
  • Atrial rate >350-600/min
  • Undulating baseline w/ no discernible P waves
  • Irregular RR interval; “irregularly irregular” ventricular rhythm
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33
Q

Interpret this EKG

A

Atrial Fibrillation w/ Complete AV block

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34
Q

Interpret this EKG

A

Atrial Fibrillation

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35
Q

What is the diagnosis based on this EKG?

A

Atrial Fibrillation w/ controlled ventricular response

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36
Q

What is the characteristic appearance of Atrial Flutter and in which leads is it seen best?

A
  • “Saw tooth appearance”
  • Leads II, III, and aVF
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37
Q

Interpret this EKG

A

Atrial Flutter

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38
Q

Interpret this EKG

A
  • 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
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39
Q

Interpret this EKG

A

Atrial Flutter w/ 2:1 AV block

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40
Q

Interpret this EKG

A
  • Atrial flutter with 2:1 AV block
  • Notice every other p wave is NOT followed by a QRS
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41
Q

If you see a premature QRS complex that is slightly widened you should consider that it may be due to what?

A

Premature Junctional (or atrial) beat with aberrant ventricular conduction

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42
Q

A junctional automaticity focus may cause retrograde atrial depolarization and how will the premature P’ wave appear?

A

Inverted P’ wave in leads with upright QRS

43
Q

Interpret this EKG

A

(AV) Junctional Bigeminy

44
Q

Interpret this EKG

A

(AV) junctional trigeminy

45
Q

What is the rate for paroxysmal junctional tachycardia and how will the P wave appear?

A
  • Rate = 150-250/min
  • P wav may be lost (buried), inverted BEFORE or AFTER each QRS
46
Q

What is the dx of his 12 lead EKG?

A
  • Rate is around 220/min
  • Supraventricular Tachycardia, and w/ no p waves is a junctional AVNRT
47
Q

What is the tx for SVT (AVNRT)?

A

Adenosine

48
Q

Interpret this EKG

A

AVNRT or SVT

49
Q

Interpret this EKG

A

Paroxysmal Supraventricular Tachycardia

50
Q

What are the ECG characteristics of Premature Ventricular Contractions (PVC’s)?

A
  • 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
Q

Interpret this EKG

A
  • Multifocal PVCs
  • Multiple, irritable ventricular foci producing their own unique PVC upon firing
52
Q

Interpret this EKG

A
  • Ventricular Bigeminy
  • Every other beat has a PVC
53
Q

Interpret this EKG

A

R on T Phenomena

54
Q

Interpret this EKG; when would you see this?

A
  • Accelerated Idioventricular Rhythm (AIVR)
  • Seen after giving pt a clot bluster (fibrinolytic) and represents reperfusion of a previously ischemic area
55
Q

Interpret this EKG

A

Accelerated Idioventricular Rhythm (AIVR) w/ increasing fusion beats

56
Q

Which drug is used for symptomatic PVC’s or in setting of ACS?

A

Metoprolol IV

57
Q

If pt is unstable and has PVC’s what drugs can be used?

A
  • Amiodarone
  • Lidocaine
  • Procainamide
58
Q

Interpret this pt’s EKG

A

PVC’s; borderline sinus tachy

59
Q

In regards to QRS complexes, ventricular rate, and morphology what characterized Ventricular Tachycardia?

A
  • 3 or more consecutive bizarre QRS complexes
  • Ventriuclar rate = 120-200 (100-250)
  • Usually regular, wide QRS (> 0.12 sec)
60
Q

For ventricular tachycardia or any irregularity to be considered sustained how long must it last for?

A

>30 seconds

61
Q

Interpret this EKG

A

Ventricular Tachycardia

62
Q

Interpret this EKG and what would you do?

A
  • Sustained Ventricular Tachycardia
  • Cardioversion (ie., shock the heart back into rhythm)
63
Q

Interpret this EKG

A

Ventricular Fibrillation

64
Q

Interpret this EKG

A

Ventricular Fibrillation

65
Q

What is your interpretation and what do you do?

A
  • Ventricular fibrillation
  • CPR —> Defibrillation
66
Q

What is the rate of ventricular flutter and how can you tell it apart from fibrillation?

A
  • Rate = 250-350/min
  • Smooth, sine waves
  • Fibrillation will be more irregular
67
Q

Interpret this EKG and how do you know?

A
  • 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
Q

Interpret this EKG

A

Torsades de Pointes

69
Q

What are 3 treatment options for Torsades de Pointes?

A
  • MgSO4 IV bolus
  • Overdrive pacing
  • Isoproteronol (beta-agonist)
70
Q

What are 3 characteristic findings of Hypokalemia on an EKG?

A
  • “U” waves
  • ↑ QT interval
  • Flat or inverted T wave
71
Q

Interpret this EKG

A

Hypokalemia

72
Q

Interpret the abnormalities

A
  • Hypokalemia
  • Prominent “U” wave
73
Q

What are the major EKG features of Hyperkalemia?

A
  • Peaked “T” wave = most prominent feature
  • Wide QRS
  • ↑ PR interval
  • Loss of P wave
74
Q

What is wrong with this patient, based off the EKG?

A

Hyperkalemia (peaked T waves and wide QRS)

75
Q

Which abnormality is responsible for this?

A

HYPERkalemia

76
Q

What is the characteristic finding on an EKG with HYPOcalcemia vs. HYPERcalcemia?

A
  • Hypocalcemia = prolongation of QT interval
  • Hypercalcemia = short QT interval; short ST segment
77
Q

What is the quick and dirty way of determining hypocalcemia from an EKG?

A
  • 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
Q

What is the underlying abnormality?

A

Hypocalcemia

79
Q

Which electrolyte disturbance does this represent?

A

Hypercalcemia

80
Q

Characteristic EKG findings of hypomagnesemia?

A
  • Prolonged PR and QT
  • Wide QRS
  • Everything is slowed down
81
Q

Which electrolyte abnormality is represented here?

A

Hyperkalemia

82
Q

What is the characteristic rate and finding on the EKG for hypothermia?

A
  • Bradycardia
  • J wave (Osborne wave)
83
Q

What is the status of the pt based on this EKG?

A

Hypothermia

84
Q

A patient presents with sudden dyspnea, but the lungs are clear and the XR is normal, what should you suspect?

A

Pulmonary embolism

85
Q

What is the most common rate on an EKG and characteristic findings of pulmonary embolism?

Associated with what kind of block?

A
  • Sinus tachycardia
  • S1; Q3; inverted T3 (rhymes)
  • Transient RBBB
86
Q

What is seen in leads V1-V4 with a pulmonary embolism?

A
  • T wave inversion
  • Transient RBBB
87
Q

Patient presents with sudden dyspnea and has this EKG, what do you suspect?

A

Pulmonary Embolism (S1; Q3; T3)

88
Q

What will be seen on EKG of someone with Cerebral Hemorrhage?

A

Impressive ST-T changes

89
Q

What underlying pathology would produce an EKG like this?

A

Cerebral hemorrhage

90
Q

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?

A

Hypothyroidism

91
Q

What are the characteristic EKG findings in Brugada Syndrome?

A

RBBB w/ ST elevation in V1-V3

92
Q

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?

A
  • Brugada Syndrome
  • At risk for sudden death; needs implanted ICD
93
Q

What are the characteristic EKG findings in Wolff-Parkinson-White Syndrome?

A
  • Short P-R interval
  • Slurred upstroke (delta wave) of QRS
  • Accessory AV conduction pathway (Bundle of Kent)
94
Q

What is your interpretation of this EKG?

A

Wolff-Parkinson-White Syndrome

95
Q

What underlying dz is associated w/ MAT?

A

pulmonary dz

96
Q

How would you tx A fib?

A

if unstable, cardiovert

Beta blocker

amiodarone

anticoagulate

(cath lab if ACS suspected)

97
Q

How would you tx PVCs?

A

amiodarone

procainamide

lidocaine

cath lab if ACS suspected

98
Q

How would you tx V tach?

V fib?

A

if unstable –> cardiovert

amiodarone, lidocaine, procainamide

V fib - CPR, defibrillate

99
Q

How would you tx A fib w/ rapid ventricular response?

A

BB

CCB

digoxin?

100
Q

How would you tx 3rd degree AV block?

A

pacemaker

101
Q

What is RBBB associated with?

A

normal health pts

pulmonary dz (PHtn, COPD, PE, cor pulmonale)

102
Q

What underlying dzs are associated with LBBB (5)?

A

HTN

CAD

myocarditis

cardiomyopathy

aortic valve dz

103
Q

How would you tx someone with cardiac abnormalities due to hyperkalemia?

A

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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