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MED233 Cardiovascular > PMT, Johnston - Cardiac Rhythm Disturbances > Flashcards

PMT, Johnston - Cardiac Rhythm Disturbances Flashcards

1
Q 
Sinus bradycardia
Rate - 
Rhythm - 
Axis - 
Other -
A

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

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2
Q

Tx of sinus bradycardia - when and what

A

Treat when symptomatic.

Atropine, Epinephrine, Isoprotenerol, Pacemaker

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3
Q 
Sinus Arrhythmia
Rate - 
Rhythm - 
Axis - 
Other -
A

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

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4
Q

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

A

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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5
Q

What is automaticity?

A

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

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6
Q

Atrial arrhythmia

A

PAC

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

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7
Q 
Paroxysmal Atrial Tachycardia 
Rate - 
Rhythm - 
Axis - 
Other -
A 
An irritable atrial foci suddenly pacing rapidly.
Rate - 150-250
Rhythm - sudden rapid pace
Axis - 
Other -
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8
Q 
PAT with AV Block
Rate - 
Rhythm - 
Axis - 
Other -
A

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

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9
Q

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

A

Digitalis or toxicity

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10
Q 
Paroxysmal Junctional Tachycardia (PJT)
Rate - 
Rhythm - 
Axis - 
Other -
A 
AVJunction sudden rapid pace
Rate - 150-250
Rhythm - sudden rapid pace
Axis - 
Other - Inverted P wave??
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11
Q

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

A

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

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12
Q

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

A

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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13
Q 
Paroxysmal Ventricular Tachy (PVT)
Rate - 
Rhythm - 
Axis - 
Other -
A

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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14
Q 
Ventricular Tachycardia (VT)
What does VT indicate?
Rate - 
Rhythm - 
Axis - 
Other -
A

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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15
Q

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

coronary disease, QRS width, AV dissociation, Axis

A

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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16
Q

Torsades: RRAO, caused by, tx

A

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

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17
Q 
Atrial flutter
Rate - 
Rhythm - 
Axis - 
Other -
A

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

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18
Q 
Ventricular flutter
Rate - 
Rhythm - 
Axis - 
Other -
A

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

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19
Q

Afib - three things

A

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

20
Q

Vfib

A

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

21
Q 
Wandering pacemaker
Rate - 
Rhythm - 
Axis - 
Other -
A

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.

22
Q 
Multifocal Atrial Tachycardia (MAT).  
Rate - 
Rhythm - 
Axis - 
Other -
A

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

23
Q

MAT is associated with what disease?

Tx for MAT.

A

Associated with COPD

Tx - DC theophylline, IV MgSO4, IV verapamil

24
Q

Types of Premature Atrial Beats

A

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

25
Q

Tx of Blocked PACs - when and with what?

A

Treat if symptomatic with metroprolol, BB.

26
Q

Premature junctional beat

A

Premature, INVERTED P’ before the QRS.

27
Q

Premature Ventricular Beat/Contraction (PVC).

A

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

28
Q

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

A

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

29
Q

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

A

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

30
Q

What is the R on T phenomenon?

A

When a PVC falls on a T wave.

Particularly with low serum potassium and hypoxic situations. Vulnerable period where dangerous arrhythmias may result.

31
Q

Hyperkalemia

A
  • Wider QRS
  • Tombstone T wave = peaked/huge
  • flatter to no P wave
32
Q

Hypokalemia

A
  • Flat or inverted T

- U wave

33
Q

Short QT indicative of what 2 possible electrolyte imbalances?

A

Hypercalcemia

HyperMg

34
Q

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

A

Hypocalcemia or HypoMg

Can trigger torsades

35
Q

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

A

Brugada

familial, deadly arrhythmias

36
Q

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

A

WPW

Accessory bundle of kent - accessory AV conduction pathway that provides ventricular “pre-excitation”.

37
Q

Hypothermia on ECG

A

Bradycardia

J-wave (Osborne Wave)

38
Q

Pulmonary embolus (and acute cor pulmonale)

A

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

39
Q

What is S1 Q3 inverted T3?

A

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)!

40
Q

Cerebral hemorrhage on ECG

A

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

41
Q

Hypothyroidism

A

flattening or inversion of T waves WITHOUT ST-displasement

42
Q

**Low voltage in limb leads, think what?

High voltage in limb leads, think what?

A

Low, think COPD, MYXEDEMA/hypothyroid, amyloidosis,

High, think hypertrophy

43
Q

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

A

Junctional tachycardia

44
Q

SVT is the most common in what age group?

A

Young people

45
Q

How do you treat vtach?

How do you treat third degree block?

A

Shock.

Pacemaker.

MED233 Cardiovascular (18 decks)

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