Patho EKG stuff

Question 1

With what arrythmia does pacemaker activity shift between the SA node, other foci within the atria, and/or the AV node

Answer 1

Wandering pacemaker activity

Question 2

What arrhythmia occurs when a wandering pacemaker rhythm occurs in conjunction with tachycardia

Answer 2

Multifocal Atrial Tachycardia

Question 3

What arrhythmia occurs bc of a rapidly firing ectopic atrial foci resulting in uncoordinated, ineffective, irregular atrial contraction and only occasional impulses resulting in AV node discharge

Answer 3

Atrial fibrillation

Question 4

What is it called when the controlling automaticity focus (usually the SA node) stops pacing, another automaticity focus must take over pacing

Answer 4

Escape beat and/or escape rhythm

Question 5

When an sinus arrest happens what three places can the escape beat come from?

Answer 5

-SA node or another atrial focus (different shaped Ps)
-AV node or junctional area (no P waves or wrong place)
-Ventricle

Question 6

What type of beats originate from automaticity focus – “jumpy”

Answer 6

Premature beats

Question 7

What can these stimulations cause?

Sympathetic stimulation (epinephrine), B1 stimulants (caffeine, amphetamines, cocaine)
Drugs (excess digitalis, ethanol)
Hyperthyroidism
Cardiac hypertrophy (heart failure)
Low oxygen

Answer 7

Atrial and or ventricular premature beats

Question 8

Ventricular automaticity foci (premature ventricle beats) are especially likely to occur if what three things happen?

Answer 8

Hypoxia
Hypokalemia
Excess heart stretch (HF, mitral valve prolapse)

Question 9

What are the three types of premature beats?

Answer 9

PACs
PJCs
PVCs

Question 10

Why does a PVC have a wide QRS?

Answer 10

Because the ventricular wall conducts slowly (via cardiomyocyte conduction rather than through the conduction system) it takes a long time for full depolarization to occur (i.e., wide wave form)

Question 11

What two drugs mentioned specifically can make your patient have more PVCs?

Answer 11

Epi
Beta agonists

Question 12

What are the three labels do we have for tachy arrhythmias over 150?

Answer 12

Paroxysmal atrial

Paroxysmal junctional

Paroxysmal Supraventricular tachycardia (SVT)
(umbrella term used when you can’t tell if the P wave is atrial or junctional bc rate is so fast)

Paroxysmal Ventricular

Question 13

What does Paroxysmal mean?

Answer 13

Sudden onset

Question 14

What category of rhythm is defined as having a rate of 250-350?

Answer 14

Flutters

-atrial
-ventricular

Question 15

How does the vagal maneuver work?

Answer 15

increases AV node delay (more “refractory”) and decreases SA node firing,

thereby decreasing heart rate (separating QRS peaks), resulting in more flutter waves per QRS

Question 16

what conditions lead to a prolonged QT segment (and increased risk of v flutter?)

Answer 16

Hypokalemia
Long QT syndrome

Question 17

What category of rhythm is defined as having a rate of 350-450?

Answer 17

Fibs!

Afib
Vfib

Question 18

What arrhythmia occurs because of an accessory conduction pathway (bundle of Kent) between the atria and ventricles

Answer 18

Wolfe-Parkinson-White syndrome (WPW)

Question 19

What arrhythmia occurs because of an accessory conduction pathway (James bundle) between an atrial intranodal tract and the His bundle (bypassing AV node)

Answer 19

Lown-Ganong-Levine syndrome (LGL)

Question 20

What arrhythmia occurs when the unhealthy SA node fails to pace for at least one cycle

Answer 20

Sinus block

Question 21

What is a sinus block called if it recovers?

Answer 21

Sinus arrest

Question 22

What are Atrioventricular Blocks commonly called?

Answer 22

Heart blocks

Question 23

When is dilation typically seen?

Answer 23

valvular regurgitation
and congestive heart failure BOTH lead to volume overload

Question 24

When is hypertrophy typically seen?

Answer 24

Valve stenosis and HTN
BOTH lead to pressure overload

Question 25

What slows transmission to bundle of His?

Answer 25

AV node

Question 26

What does the PR segment on an EKG represent in terms of heart conduction?

Answer 26

The delay that happens at the AV node

Question 27

What is the flat line after the T wave represent in terms of heart conduction activity?

Answer 27

No electrical conduction at that millisecond

Question 28

What leads are calculated as the perpendicular value to the limb leads?

Answer 28

The augmented leads

Question 29

Anterior MI (LAD)

Answer 29

V1-V4

Question 30

Lateral MI (Circumflex)

Answer 30

I, AvL, & V5-V6

Question 31

Anterolateral MI (LAD)

Answer 31

I, aVL, V1-V6

Question 32

Inferior MI (RCA & LC)

Answer 32

II, III, aVF

Question 33

Inferolateral MI

Answer 33

everything except aVR

Question 34

Acute posterior MI

Answer 34

Dominate R waves AND ST depression V1-V3
Tall upright T waves

Question 35

STEMI evolution (3 steps)

Answer 35

Tall peaked T waves
STE in contingent leads (Concave, convex, merge with T waves)
Development Q and T wave inversions as ST returns to baseline

Question 36

Where are T waves NORMALLY inverted?

Answer 36

aVR & V1
(V2 youth, V3 ethnicity, III expiration)

Question 37

What shows ischemia?

Answer 37

Inverted T waves >0.1mV

Question 38

What defines a tall T wave

Answer 38

1/2 or greater of QRS

Question 39

LVH is seen in what leads?

Answer 39

V5, V6, AvL, I

Question 40

RVH is seen in what leads?

Answer 40

II, III, & aVF

Question 41

LBBB

Answer 41

V1:W
V6:M

Question 42

RBBB

Answer 42

L1: M
L6: W