Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MED233 Cardiovascular > PMT, Johnston - AV, BBB, Hemiblocks, Hypertrophy > Flashcards

PMT, Johnston - AV, BBB, Hemiblocks, Hypertrophy Flashcards

1
Q

Normal PRi

Normal QRS

A
  1. 2sec (5 small box)

0. 06-0.12sec (2 small boxes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Etiology of 1st degree AV Block (AVB)

A

atherosclerosis, HTN, diabetes, fibrosis CHD, degeneration of conduction system
Thyroid, SLE, infiltrative (amyloid, sarcoid), mitral/aortiv valvular calcificaiton, myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ECG of 1st degree AVB

A

PRi constantly greater than 0.2sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2nd degree AVB Mobitz 1 (Wenckebach) - what do you see?

A
  • Progressive PRi prolongation prior to dropped QRS.
  • “Grouped beats”.
  • Narrow QRS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes a Mobitz 1?

A

Digitalis toxicity, ischemic events (Inferior MI due to RCA), myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mobitz 1 (Wenckebach) - what is it?

A

2nd degree AVB

  • INFERIOR aMI (RCA).
  • Level of block is at AVN, resulting in transient, impairment of AVN conduction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Etiology of 2nd degree AV Block - Mobitz 2

A
  • IHD
  • ANTERIOR MI (LAD)
  • Degeneration of conduction system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2nd degree AVB Mobitz 2 - what do you see?

A
  • PRi is uniform

- Dropped QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2nd degree AVB Mobitz 2 - what level does it occur at and what is it seen with?

A
  • Distal to AVN: Bundle of His, both bundle branches, fascicular branches.
  • Seen with ANTERIOR MI.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does Mobitz 1 or 2 have worse prognosis?

A

Mobitz 2 is progressive and worse, irreverisble.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Third degree heart block looks like what, on ECG?

A

Two independent rhythms - p waves never related to QRS, so rate of atria and vents are different. Waves are normal size.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where do third degree heart blocks occur?

A

Above or below the AVN.

  • Above = Junctional rhythm, narrow QRS, rate 40-60
  • Below AVN = Ventricular pacemaker, wide QRS, rate 20-40
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Etiology of third degree heart block

A
  • Ischemic
  • Infiltrative diseases
  • Cardiac surgery (bypass, valve replacement, myocarditis, degenerative)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat a third degree AVB?

A

Pacemaker!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What direction is the septum normally activated?

In LBBB, which ventricle is activated first?

A
  • Left to right

- Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common features of BBB

A
  • Wide QRS (greater than 0.12sec)

- ST segment - T waves slope off in opposite direction to QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What side of the septum is activated first in RBBB? LBBB?

A

RBBB - Left is first

LBBB - Right is first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

RBBB see what on ECG?

A

V1 has small(er) R and larger S than in LBBB
V1, V2 = R - S(deep/big) - R’

  • *V1rSR or rsR
  • *L1 or V6 slurred S wave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sequence of ventricular activation in LBBB.

A

Septum activated from R side, nearly same time as RV activated. Strong septal force, so negative deflection in V1. Positive deflection V6 results in monophasic R.

20
Q

What issues is LBBB more apt to occur with?

A
  • HTN
  • Ischemia
  • AS
  • Cardiomyopathy (**LBBB + Right axis deviation)
21
Q

LBBB + LAD is associated with what?

LBBB + RAD** is associated with what?

A
  • Myocardial dysfunction, conduction system disease.

- Congestive Cardiomyopathy**

22
Q

In addition to V1, what two other leads have the same features in BBB?

A

1 and AVL

23
Q

What leads do you look at in LBBB and what do you see?

A

V5 and V6, see the notched R-R’

24
Q

Why is there T wave change in BBB (T wave opposite of QRS)?

A

Polarity is opposite QRS direction. If T wave polarity is in the same direction of QRS, it is a PRIMARY T wave change, usually due to ISCHEMIA.

25
Q

LBBB on ECG looks like what?

A
  • L1/V6 upright monophasic or notched QRS
  • V1 has negative QRS
  • QRS > 0.12
  • V5-V6 tall R-R’
26
Q

Which two limb leads look like V6 in LBBB?

A

Lead 1 and AVL

27
Q

What is a hemiblock?

A

Blockage of one of the two main divisions of the left bundle branch block.
Hemiblock: LAH (more common), LPH

28
Q

Criteria for LAH

A
  • Left axis deviation (greater than -60 degrees).
  • Small Q in leads 1 and AVL
  • Small R in 2, 3, AVF
  • Normal QRS duration or slightly widened Q1S3
29
Q

Criteria for LPH

A
  • Right axis deviation (greater than +120 degrees=AVR+, L3 smallest).
  • Small r in leads 1 and AVL
  • Small Q in 2, 3, AVF
  • S1Q3
  • No evidence of RVH
30
Q

Etiology of LAH

A
  • Disease in conduction system.

- Often associated with MI (LAD occlusion)

31
Q

Etiology of LPH

A

Disease in conduction system

32
Q

P wave in RAE and LAE

A

RAE: L2, L3, aVF have P tall, pointed (L3 taller than L1), P-pulmonale
LAE: P broad, notched (L1 taller than L3), P-mitrale, diphasic P in V1 or L3

33
Q

RAE is associated with what?

A

Pulmonary HTN, caused by COPD, PE, MS, MR

34
Q

P-wave in RAE (p-pulmonale) on ECG

A
  • L2, L3, AVF = pointed and taller than 0.25
  • V1, V2 = taller than 0.1
  • P wave is pointed and tall
35
Q

P-wave in LAE (p-mitrale) onECG

A

V1 = Broad, notched P wave duration >0.11sec of terminal negativity
- P wave is “M-sign” or diphasic

36
Q

Causes of LAE

A

MS, MR

37
Q

Most common cause of LVH

A

HTN (other: AS, AI, hypertrophic cardiomyopathy, coarctation of the aorta)

38
Q

Sokolow Lyon Criteria for LVH

A
  1. R-wave in L1 + S-wave in L3 > 25mm
  2. R-wave in AVL > 11mm
  3. R-wave in V6 > 26mm
39
Q

LVH: Rule of 35 and 12

A

Deepest S (V1 or V2) + Tallest R (V5 or V6) >35
OR
R>12 in AVL

40
Q

Causes of RVH

A
  • Chronic lung disease, like COPD.
  • RVOT obstruction, VSD
  • Congenital = Tet of Fallot, PS, trasnposition
  • MS, TR
41
Q

RVH on ECG

A
  • R waves prominent in RIGHT precordial leads
  • Deep S waves in LEFT precordial leads
  • R:S >1
  • *RAD
  • *V1 = Tall R wave with inverted T wave
  • *low voltage
42
Q

Causes of Dominant R waves in V1

A

RVH, Posterior or lateral MI, WPW, hypertrophic cardiomyopathy, muscular dystrophy, normal variant

43
Q

Strain (ST depression) associated with what change in the heart?

A

Hypertrophy

44
Q

See what in ECG of LVH with strain?

See what in ECG of RVH with strain?

A

LVH with strain, see ST-morphological changes and R:S>1 (positive) in LEFT chest leads.
RVH with strain, see ST-morphological changes and R:S>1 (positive) in RIGHT chest leads.

45
Q

What pulls ST-segment down?

A

Digitalis or hypertrophy strain (and t wave inversion).

MED233 Cardiovascular (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions