PowerPoint 4

Question 1

Draw and know a normal sinus rhythm?

Answer 1

See book page 52

Question 2

NSR mean?

Answer 2

Normal sinus rhythm

Question 3

Describe the elements of a normal sinus rhythm?

Answer 3

Normal SA Node signal
Organized rhythm – 1 P wave : 1 QRS Complex
Atrial depolarization and Ventricular Depolarization in coordination
PR interval is also normal length consistently

“Normal” is when everything is looking good.
Sinus rhythm can be said about other asymptomatic situations.
Conduction is abnormal but sinus rhythm remains

Question 4

What is sinus bradycardia?

Answer 4

HR < 60BMP
Electrical conduction is normal – 1 P wave : 1 QRS Complex
RR intervals and PP intervals equal

Question 5

What is nonsymptomatic sinus bradycardia?

Answer 5

Healthy heart – HR 50-59
Highly trained athlete – HR <50 bpm

Question 6

What is marked or symptomatic bradycardia?

Answer 6

HR 30-50BPM
Lightheadedness, Hypotension, Syncope
Beta blockers

Question 7

What are 5 conditions presting with bradycardia?

Answer 7

1st ° AV block, bundle branch blocks, hemiblocks, ventricular or atrial ectopy, and chamber enlargements

Question 8

Causes of sinus bradycardia?

Answer 8

Increased Vagal Tone
Inferior Wall MI (occlusion of the R coronary Artery)
Sick Sinus Syndrome
Med – Beta Blockers, Calcium channel blockers, Digitalis glycosides

Question 9

Treatments for sinus bradycardia?

Answer 9

Atropine – increases HR
Pacemaker

Question 10

Describe tachycardia?

Answer 10

HR > 100 bpm
Normal organized electrical conduction
1 Pwave : 1 QRS complex

Question 11

Pathophysiology of sinus tachycardia?

Answer 11

Decreased Vagal tone or Increased sympathetic tone
Asymptomatic
Exercise
Pediatric
Increased Myocardial demand for Oxygen with decreased coronary blood flow
Early sign of Myocardial ischemia or escalating ischemia
Accompanied with angina
Acute MI occurring with exacerbated need for O2

Question 12

Causes of sinus tachycardia?

Answer 12

Asthma
Caffeine
Nicotine
Cocaine
Amphetamines
Stress
Anxiety
Acute MI
Congestive Heart Failure
Pulmonary edema
Pulmonary embolism

Question 13

Treatments for sinus tachycardia?

Answer 13

Most sinus tachycardia is benign
Look for root cause and treat it
Remove drug
Change medication
Eliminate Stress/anxiety
Treat Asthma

Question 14

What are sinus arrhythmias?

Answer 14

Irregular Electrical activity in Atria and/or Ventricles
RR intervals are irregular

Question 15

HR < 60 bpm and irreg sinus = ____ ____?

Answer 15

Sinus bradyarrhythmia

Question 16

HR > 100 bpm and irreg sinus = ____ ____?

Answer 16

Sinus tachyarrhythmia

Question 17

What is automaticity?

Answer 17

Intrinsic ability of myocardial cells to depolarize on their own
Order of depolarization signals, Atria –> AV junction –> Ventricles
The fastest rate wins!
Typical HR 60-100bpm
< 60 Bradycardia
>100 Tachycardia

Question 18

Describe atrial fibrillation?

Answer 18

Most common arrhythmia
Atria beating at 300-400bpm
Quivering of the Atria’s
Note no Pwave
Pt’s susceptible to stroke, blood clots, and pulmonary embolism
Often given an anticoagulant

Question 19

Describe wandering pacemaker/multifocal atrial tachycardia?

Answer 19

One automaticity area depolarizes and suppresses other sites
Followed by another area depolarizing and suppressing
Assuming the SA node is not able to do its job.
P waves look different

Question 20

Describe escape rhythms?

Answer 20

Normal Phenomenon that occurs when there is a sufficient pause to allow a lower pacemaker to depolarize
Escape rhythms show up on ECG with different shapes
Atria escape
Junctional escape
Ventricular escape

Question 21

PAC?

Answer 21

Premature atrial contraction
One Foci (for some reason) does not depolarize with others. Eventually Triggers and sends signal to SA node “resetting Pacemaker”

Question 22

Junctional premature beat?

Answer 22

AV node sends signal up to SA node and down to Ventricles at same time. Resetting Pacemaker.

Question 23

PVC?

Answer 23

Premature ventricular contraction
Ventricle foci goes off sending signal to rest of ventricles. No SA node Reset.

Question 24

Describe a sinus block/pause/arrest?

Answer 24

Impaired conduction from SA Node to Atria then to ventricles
No P wave or QRS Complex
No symptoms
Dizziness or lack of awareness or consciousness show sinus arrest
Scary!!- can happen when sleeping
R-R intervals are consistent before Pause

Question 25

What is a sinus block?

Answer 25

Multiples of 2 or more R-R intervals skipped

Question 26

What is a sinus pause?

Answer 26

Delay is longer than direct multiples of the RR interval

Question 27

What is sinus arrest?

Answer 27

Pause is greater than 2 R-R intervals

Question 28

What causes a sinus block/pause/arrest?

Answer 28

Ischemia disease of SA node
Extreme Vagal Tone
Digitalis
Degenerative changes of electrical conduction system
Aging

Question 29

What are treatments for a sinus block/pause/arrest?

Answer 29

Find Cause and treat
Pacemaker if pause is > 3 sec

Question 30

What is asystole?

Answer 30

Flat line
No electrical activity – no pqrst
DEAD
CPR
AED has to find rhythm
Ventricular fibrillation
Epinephrine every 3-5 min
10 cycles of CPR

Question 31

Causes of asystole H’s and T’s?

Answer 31

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypothermia
Hyperkalemia
Hypoglycemia
Tablets (drug OD)
Tamponade
Tension pneumothorax
Thrombosis (MI)
Thrombosis (pulmonary embolism)
Trauma (blood loss)