Other ECG

Question 1

Junctional premature complex (3)

Answer 1

P wave usually inverted, absent, or retrograde
PR interval short
QRS rate less than .12 for premature beat (usually 60-100 bpm)

Question 2

Junctional premature complex - P wave inverted in what leads

Answer 2

II, III, aVF

Question 3

Common etiology for junctional premature complex

Answer 3

normal finding 
stress, caffeine, alcohol
Heart failure, MI, pericarditis 
Valvular heart disease
Chronic lung disease, hyperthyroidism
Electrolyte abnormalities 
Excessive vagal tone

Question 4

Clinical signs and symptoms - junctional premature complex

Answer 4

seldom produces any
maybe irregular pulse
serious if frequent
might be warning for serious junctional dysrhythmias

Question 5

Tx for junctional premature complex

Answer 5

no specific tx indicated

Question 6

junctional rhythm (3)

Answer 6

P wave for every QRS (inverted, absent, retrograde)
PR interval short
QRS rate - between 40-60, QRS narrow

Question 7

Junctional rhythm common etiology

Answer 7

IWMI
Heart failure
Valvular heart disease
Cardiomyopathy 
Sick sinus syndrome

Question 8

Clinical signs and symptoms - junctional rhythm

Answer 8

slow irregular pulse

often temporary dysrhythmia

Question 9

Treatment for junctional rhythm

Answer 9

determine underlying cause
withhold digoxin
may need to accelerate heart rate if low
pacemaker

Question 10

3 possible places to find P wave in junctional rhythm

Answer 10

Retrograde
Absent (buried in QRS)
Inverted

Question 11

Where in cardiac cycle does PJC occur

Answer 11

PR interval

Question 12

What is digoxin

Answer 12

Glucoside
Slows HR, improves flow of Ca in and out
At toxic levels, increases HR

Question 13

Sinus block (3)

Answer 13

P wave is normal and upright
PR interval .12 to .20 sec
QRS rate - less than .12

Question 14

Etiology of sinus block

Answer 14

inc vagal tone
IWMI
Excess digoxin
Hyperkalemia
Myocarditis

Question 15

Clinical signs and sx of sinus block

Answer 15

pt usually unaware

may sense skipped beat

Question 16

First degree AV block (3)

Answer 16

P wave before each WRS
PR interval .21 or more
QRS rate - regular

Question 17

Where is the block with first degree AV block

Answer 17

at the top of the AV node

Long PR interval - telling us AV node

Question 18

Common etiology of first degree AV block

Answer 18

Insult to AV node
Hypoxemia
MI
Digitalis toxicity 
Ischemic disease
Right coronary artery disease
Rheumatic heart disease

Question 19

Clinical signs and sx of first degree AV block

Answer 19

None - unless HR is too low

May progress into 2nd or 3rd degree block

Question 20

First degree AV block treatment

Answer 20

usually not indicated since asymptomatic

Question 21

Second degree AV block - Type 1 (3)

Answer 21

P wave before every QRS
PR interval - progressively lengthens
QRS rate - often slow, regular with dropped beat

Question 22

Common etiology of second degree AV block

Answer 22

Parasympathetic excess
Drugs that mimic or induce 
Right coronary artery disease
Digoxin toxicity 
Might be transient with severe ischemia

Question 23

Second Degree AV block Type 1 - treatment

Answer 23

patients usually are asymptomatic
if drug toxicity is cause - hold drugs
Pacemaker if rate too low

Question 24

Second degree AV block Type 2 (3)

Answer 24

P wave before each QRS
PR interval wide and fixed
QRS - dropped QRS every 2nd, 3rd, or 4th P wave

Question 25

Second degree AV block Type 2 - common etiology

Answer 25

Insult to AV node Common with IWMI Hypoxemia Inc vagal tone on AV ndoe

Question 26

Second degree AV block type 2 - signs and sx

Answer 26

Usually none | If HR dec then dec CO too

Question 27

Second degree AV block type 2 - treatment

Answer 27

pacemaker withhold causative drugs atrophine to accelerate underlying rate Can progress to be more lethal

Question 28

Third AV block (3)

Answer 28

P wave - regular PR - variable QRS - usually below 60

Question 29

Third degree heart block - common etiologfy

Answer 29

Insult to AV Cardiac drugs Acute MI Ischemic disease of conduction system

Question 30

Third degree AV block - clinical signs and sx

Answer 30

``` Extremely dangerous Rate is slow Drop in CO Can progress to ventricular asystole Ventrcular escape or irritability may ocur Can cause Stokes Adams attack ```

Question 31

Third degree AV block tx

Answer 31

Administer atropine Epinephrine Withhold drug Pacemaker

Question 32

Prolonged PR interval makes you think -

Answer 32

First degree AV block | Second degree AV block type 1 and 2

Question 33

ECK with missing QRS makes you think

Answer 33

Second degree AV block type 1 or 2

Question 34

Right bundle branch block

Answer 34

P wave and PR int depend on underlying rhythm QRS - 0.12 s or higher Wide QRS and pos in lead V1

Question 35

Common etiology with R bundle branch block

Answer 35

``` R vent hypertrophy R vent strain CAD Myocarditis Cardiac contusion Idiopathic Wolff Parkinson white syndrome PE COPD ```

Question 36

Right bundle branch block - signs and sx

Answer 36

Usually none | If all three bundle branches blocked - can lead to complete heart block or ventricular standstill

Question 37

Right bundle branch block - tx

Answer 37

None unless associated with MI or syncope

Question 38

Left bundle branch block (3)

Answer 38

P wve and PR int depend on underlying rhythm | QRS - .12 or higher, QRS wide and negative in V1

Question 39

What does the deep S wave signify in left bundle branch block

Answer 39

delayed activation of left ventricle

Question 40

Common etiology of left bundle branch block

Answer 40

``` L vent hypertrophy Cardiomyopathy Hypertension CAD Myocarditis WPW syndrome Aortic valve disease ```

Question 41

Clinical signs and sx for left bundle branch block

Answer 41

usually none unless with syncope or MI

Question 42

Tx for left bundle branch block

Answer 42

usually unnecessary

Question 43

Dx of bundle branch block is based on what

Answer 43

widened QRS

Question 44

Myocardial ischemia produces

Answer 44

inverted and symmetrical T wave OR ST depression

Question 45

Myocardial injury produces

Answer 45

ST elevation

Question 46

Myocardial infarction produces

Answer 46

Widened and deepened Q wave OR ST elevation OR depression in V1 and V2

Question 47

Subendocardial only effects

Answer 47

the subendocardium so significant Q wave will not appear on ECG