PMT, Johnston - Cardiac Rhythm Disturbances Flashcards by Elise Wolff

Sinus bradycardia
Rate - 
Rhythm - 
Axis - 
Other -

Rate - less than 60
Rhythm - sinus
Axis -
Other -

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Tx of sinus bradycardia - when and what

Treat when symptomatic.

Atropine, Epinephrine, Isoprotenerol, Pacemaker

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Sinus Arrhythmia
Rate - 
Rhythm - 
Axis - 
Other -

Rate -
Rhythm - sinus, identical P waves
Axis -
Other - SAN pacing waxes and wanes with respiration

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Sick Sinus Syndrome - caused by, demographic, s/s, rate

Caused by unresponsive Supraventricular automaticity foci.
Demo - elderly who have heart disease
s/s - syncope, dizziness, fatigue, HF
Rate - alternating SSS-tachy-brady

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What is automaticity?

Property of a cardiac cell to depol spontaneously during phase4&raquo_space; generation of an impulse.

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Atrial arrhythmia

PAC

Seen in absence of significant HD - associated with stress, alcohol, tobacco, caffeine, cOPD, CAD

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Paroxysmal Atrial Tachycardia 
Rate - 
Rhythm - 
Axis - 
Other -

An irritable atrial foci suddenly pacing rapidly.
Rate - 150-250
Rhythm - sudden rapid pace
Axis - 
Other -

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PAT with AV Block
Rate - 
Rhythm - 
Axis - 
Other -

Paroxysmal Atrial Tachycardia - atrial foci.
Rate - rapid
Rhythm - see 2:1 ratio of P:QRS (spiked P)
Axis -
Other -

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What should you suspect as the cause of PAT with AV Block?

Digitalis or toxicity

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Paroxysmal Junctional Tachycardia (PJT)
Rate - 
Rhythm - 
Axis - 
Other -

AVJunction sudden rapid pace
Rate - 150-250
Rhythm - sudden rapid pace
Axis - 
Other - Inverted P wave??

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AVN Reentry Tachycardia (AVNRT) - what is it and what do you not see?

Continuous reentry circuit develops and rapidly paces atria and ventricles.
No P waves seen.

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Paroxysmal Supraventricular Tachy (PSVT). What is it and what does it look like?

When both PAT and PJT originate above the ventricles - (ESW: non-QRS almost looks like Chinaman’s Hat)
QRS less than 0.14.

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Paroxysmal Ventricular Tachy (PVT)
Rate - 
Rhythm - 
Axis - 
Other -

Rate - 150-250
Rhythm - sudden rapid pace, QRS more than 0.14 sec
Axis - extreme RAD
Other - enormous, consecutive runs of PVC-like complexes. Wide QRS complex. (tall/wide mountains - no QRS/P discernable)

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Ventricular Tachycardia (VT)
What does VT indicate?
Rate - 
Rhythm - 
Axis - 
Other -

Rate -
Rhythm - QRS wider than 0.14sec
Axis - extreme RAD
Other - indicates coronary insufficiency, which causes poor oxygenation of the foci.

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How to distinguish “Wide QRS Complex SVT” from VT:

coronary disease, QRS width, AV dissociation, Axis

VT occurs in elderly, indicating diminished coronary blood flow.
QRS: SVT 0.14
Has signs of AV dissociation (irregular rhythm on ECG).

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Torsades: RRAO, caused by, tx

Rate - 250-350
Rhythm - twisting
Axis -
Other - Tx is MgSO4, overdrive acing, isoprotenerol

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Atrial flutter
Rate - 
Rhythm - 
Axis - 
Other -

Rate - 250-350
Rhythm - sawtooth appearance
Axis -
Other - best seen in 2, 3, AVF, 5

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Ventricular flutter
Rate - 
Rhythm - 
Axis - 
Other -

Rate - 250-350
Rhythm -
Axis - sine waves
Other - leads to vfib

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Afib - three things

1) Irregular rhythm, 2) rate is tachycardic (300). 3) NO P WAVES
(ESW: undulating baseline). “Irregularly irregular” Continuously chaotic atrial spikes.

Vfib

Rapid rate discharges, irritable parastolic ventricular foci - erratic rapid switching of ventricles.

Wandering pacemaker
Rate - 
Rhythm - 
Axis - 
Other -

Pacemaking activity wanders from SAN to atrial foci.
Rate - LESS than 100
Rhythm - irregular ventricular rhythm
Axis -
Other - P’ wave shape varies. If rate accelerated, it becomes a MAT.

Multifocal Atrial Tachycardia (MAT).  
Rate - 
Rhythm - 
Axis - 
Other -

Rate - OVER 100
Rhythm -
Axis -
Other - P’ wave shape varies. Three or more consecutive times.

MAT is associated with what disease?

Tx for MAT.

Associated with COPD

Tx - DC theophylline, IV MgSO4, IV verapamil

Types of Premature Atrial Beats

1) PAB with abberant ventricular conduction - wide QRS after the PAB
2) Non-conducted PAC - no QRS after the PAB
3) Atrial bigeminy or trigeminy - two P waves before every 2nd or 3rd QRS
4) PACs - big, peaked P waves, or small inverted p-waves
5) Blocked PACs

Tx of Blocked PACs - when and with what?

Treat if symptomatic with metroprolol, BB.

Premature junctional beat

Premature, INVERTED P' before the QRS.

Premature Ventricular Beat/Contraction (PVC).

Lost P wave with a giant ventricular complex, followed by a compensatory pause.

What are PVCs caused by? How many PVCs per minute is considered pathological? PVC tx?

Caused by MVP. 6+/min Tx: if unstable, Amiodarone, Lidocaine, Procainamide

What can multifocal PVCs be caused by and why is this dangerous?

Can be caused by severe hypoxia, especially in infarction patients. Greater change of developing a dangerous or deadly arrhythmia.

What is the R on T phenomenon?

When a PVC falls on a T wave. | Particularly with low serum potassium and hypoxic situations. Vulnerable period where dangerous arrhythmias may result.

Hyperkalemia

- Wider QRS - Tombstone T wave = peaked/huge - flatter to no P wave

Hypokalemia

- Flat or inverted T | - U wave

Short QT indicative of what 2 possible electrolyte imbalances?

Hypercalcemia | HyperMg

Prolonged QT indicative of what 2 possible electrolyte imbalances? What can this trigger?

Hypocalcemia or HypoMg | Can trigger torsades

See a "ski slope" ST-segment in V1-3 with ST elevation

Brugada | familial, deadly arrhythmias

See a short PRi with a slurred upstroke (delta) of QRS complex. PE of palpitations and near fainting spells for several months.

WPW | Accessory bundle of kent - accessory AV conduction pathway that provides ventricular "pre-excitation".

Hypothermia on ECG

Bradycardia | J-wave (Osborne Wave)

Pulmonary embolus (and acute cor pulmonale)

1) S1 Q3 inverted T3 2) T wave inversion on V1-4 3) RBBB

What is S1 Q3 inverted T3?

Lead 1 = Large S wave Lead 3 = Large Q wave, T inversion (Lead 2 = ST depression) Acute cor pulmonale = low voltage (less than 5mm avg in L1-3)!

Cerebral hemorrhage on ECG

ST-T changes (i.e. deep inversion of T in V2-4)

Hypothyroidism

flattening or inversion of T waves WITHOUT ST-displasement

**Low voltage in limb leads, think what? | High voltage in limb leads, think what?

Low, think COPD, MYXEDEMA/hypothyroid, amyloidosis, | High, think hypertrophy

**If aVR is not downward and L2, L3, aVF are not upright, think what?

Junctional tachycardia

SVT is the most common in what age group?

Young people

How do you treat vtach? | How do you treat third degree block?

Shock. | Pacemaker.