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CVNOTES > Quiz 2 -- Rhythm > Flashcards

Quiz 2 -- Rhythm Flashcards

1
Q

Questions to ask about rhythm?

A
  1. Is the rhythm fast or slow?
  2. Is the rhythm regular or irregular
  3. Are there P waves?
  4. Is the QRS wide or narrow?
  5. Is the P “married” to the QRS?
  6. Do all P waves look the same?
  7. Are the PR intervals constant?
  8. Is there a P wave for every QRS complex?
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2
Q

What do you look for to see if the rhythm is regular or irregular?

A

R-R Intervals

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3
Q

When there is a repeating pattern of irregular beats, what is this called?

A

Regularly irregular

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4
Q

When there is no pattern of irregular beats, what is this called?

A

Irregularly irregular

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5
Q

What are the 3 exclusive irregularly irregular rhythms?

A
  1. A. Fib
  2. Wandering Atrial Pacemaker
  3. Multifocal Atrial Tachycardia
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6
Q

What does an upright P wave in lead II indicate?

A

Sinus Rhythm

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7
Q

If P waves are present, where are they coming from?

A

Supraventricular Origin

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8
Q

If the P wave is present and upright, then what does this mean?

A

Sinus Node or High Atrial

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9
Q

If the P wave is present and inverted, then what does this mean?

A

Low Atrial or AV Nodal (aka Junctional)

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10
Q

If there is no P wave present and a NARROW QRS, what does this indicate?

A

AV Nodal (Junctional)

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11
Q

If there is no P wave present and a WIDE QRS, what does this indicate?

A

Ventricular

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12
Q

What does the P wave represent?

A

Atrial Depolarization

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13
Q

Why is the normal P wave upright in lead II?

A

It’s going towards the positive direction (down the electrical axis).

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14
Q

Impulse originates in _________ then travels _______ to depolarize atria as well as ______ to depolarize ventricles.

A

AV Node; Retrograde; Antegrade

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15
Q

If retrograde conduction of the impulse is FAST (depolarizing the atria), what would we see?

A

Negative P wave BEFORE QRS (short PR interval)

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16
Q

If retrograde conduction of the impulse is SLOW (depolarizing the atria), what would we see?

A

Negative P AFTER QRS

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17
Q

If retrograde conduction (depolarizing the atria) of the impulse is the same as the antegrade conduction (depolarizing the ventricles), what would we see?

A

NO P wave (it is hidden in the QRS)

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18
Q

If there is a narrow QRS and NO P wave, what should we think?

A

Junctional (AV Nodal)

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19
Q

What are the most common types of P wave anomalies in Junctional Rhythms?

A
  1. No P wave at all

2. Negative P wave after QRS

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20
Q

Why is it important to know if there is a QRS for each P wave?

A

To recognize heart block!

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21
Q

Tell me everything you know about the Normal Sinus Rhythm!

A
  1. Rate: 60-100 bpm
  2. Regular
  3. P wave present
  4. QRS narrow
  5. P and QRS are married (1:1 ratio)
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22
Q

Tell me everything you know about the Normal Sinus Arrhythmia!

A
  1. Rate: 60-100 bpm
  2. Irregular and varies with respiration

**Otherwise the same as NSR, and this is benign!

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23
Q

Tell me everything you know about the Normal Sinus Bradycardia!

A
  1. Rate: < 60 bom
    Otherwise similar to NSR

Caused by? Medication, Vagal Stimulation, SSS, Inferior Ichemia/Infarct.
Commonly seen in athletes

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24
Q

Tell me everything you know about the Normal Sinus Tachycardia!

A
  1. Rate > 100 bpm
  2. Otherwise Similar to NSR
  3. Found in high cardiac output states (exercise, fever, hyperthyroidism, hypovolemia)
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25
Q

This is a rhythm that deals with impulse formation and originates from tissue other than the SA Node.

A

Ectopic Rhythm

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26
Q

Faster automaticity focus will suppress slower one.

A

Overdrive Suppression

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27
Q

What are two causes of ectopic rhythms?

A
  1. Another pacemaker cell fires at a rate faster than SA node = premature beat
  2. Slowing of SA node rate allowing slower focus to take control = escape beat
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28
Q

This is the term for an ectopic beat that occurs early before the scheduled sinus beat.

A

Premature Beats

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29
Q

Impulse originating in the atria that occurs early (before the scheduled sinus beat).

A

Atrial Premature Contraction (APC)

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30
Q

Impulse originating in or near the AV Node/Junction that occurs early (before the scheduled sinus beat).

A

Junctional Premature Contraction (JPC)

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31
Q

Impulse originating in the ventricular that occurs early (before the scheduled sinus beat).

A

Ventricular Premature Contractions

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32
Q

Tell me about Atrial Premature Contraction

A
  1. Another atrial pacemaker cell fires faster than SA node
  2. Noncompensatory pause- PAC resets SA node
  3. P wave may be different morphology
  4. Narrow QRS
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33
Q

Tell me about Ectopic Atrial Tachycardia

A
  1. Run of atrial premature complexes
  2. Rates: 100-180 bpm
  3. Regular
  4. P wave has different morphology
  5. Narrow QRS
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34
Q

When you have a rate less than 100 pm, it is IRREGULARLY irregular with no consistent pacemaker. P waves present with 3+ morphologies and a narrow QRS.

A

Wandering Atrial Pacemaker

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35
Q

When you have a rate greater than 100 pm, it is IRREGULARLY irregular with no consistent pacemaker. P waves present with 3+ morphologies and a narrow QRS. This is commonly found in patients with severe lung dz.

A

Multifocal Atrial Tachycardia

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36
Q

What do you want to do if you see Multifocal Atrial Tachycardia?

A

Treat the underlying pulmonary process.

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37
Q

This is a beat that originates in or near AV node. There is no P wave visible (it is hidden within the QRS complex). Sometimes it is inverted after QRS. QRS will be narrow.

A

Junctional Premature Contraction

38
Q

Tell me about Ventricular Premature Complex

A
  • Beat that originates from ventricular cell
  • No P wave
  • QRS wide (different conduction pathway)
  • Because ventricles in refractory state when normal pacemaker fires, followed by compensatory pause
39
Q

This is a complex where there is one group of premature beats.

A

Premature Ventricular Complex

40
Q

This is a complex where there is two groups of premature beats.

A

Couplet Premature Ventricular Compelxes

41
Q

This is a complex where there are three or more groups of premature beats lasting less than 30 seconds

A

Nonsustained Ventricular Techycardia (NSVT)

42
Q

This is a pattern of Premature Ventricular Complexes that happen every other beat.

A

Ventricular Bigeminy

43
Q

This is a pattern of Premature Ventricular Complexes that happen every third beat.

A

Ventricular Trigeminy

44
Q

What does a PVC mean?

A

It can be benign or malignant depending on the patient.

A new onset of PVCs or frequent PVCs in the setting of ischemic heart disease should be evaluated further.

45
Q

What are types of atrial ectopic rhythms?

A
  1. Atrial Premature Complex (APC or PAC)
  2. Ectopic Atrial Tachycardia
  3. Wandering Atrial Pacemaker
  4. Multifocal Atrial Tachycardia
46
Q

What are escape beats and what do they represent?

A

Escape beats are ectopic beats that occurs late! They represent “rescue” beats after normal pacemaker delays or is temporarily failing.

47
Q

Are escape beats dangerous?

A

Not necessarily, they are more necessary because without them you wouldn’t have a beat at all if there was a delay or temp. failure.

48
Q

Examples of Escape Beats

A
  1. Atrial Escape: 60-75 bpm
  2. AV Node/Junctional: 40-60 bpm
  3. Ventricular: 20-40 bpm
49
Q

This is an escape beat that occurs when the SA node fails to fire and the AV nodal cell is the next available pacemaker

A

Junctional Escape Beat

50
Q

How would you see a junctional escape beat on an EKG?

A
  1. P wave would be hidden in the QRS complex
  2. Narrow QRS complex

Inverted P can be after or before QRS, but this is rare

51
Q

This is an escape beat where the AV/junctional pacemaker fires faster that normal causing a rate of 60-100 bom. Similar to the junctional rhythm

A

Accelerated Junctional Rhythm

52
Q

This is defined as a rate of 100+ bpm and similar to a junctional rhythm.

A

Junctional Tachycardia

53
Q

What is the most common cause of junctional tachycardia and accelerated junctional rhythm?

A

Digoxin Toxicity

54
Q

This is an escape beat that occurs when the SA node fails to fire and the next available pacemaker cell is ventricular.

A

Ventricular Escape Beat

55
Q

How would a Ventricular Escape Beat present on an EKG?

A

No P wave and a Wide QRS

56
Q

This is an escape beat that occurs when the ventircular focus acts as the primary pacemaker for the heart (everything above it has not failed). It causes a bpm of 20-40.

A

Idioventricular Escape Rhythm

57
Q

How would an idioventricular escape rhythm present on an EKG?

A

No P wave and a Wide QRS in a regular pattern.

58
Q

This is an idioventricular rhythm that is at a rate of 40-100 bpm

A

Accelerated Idioventricular rhythm

59
Q

Deals with impulse transmission and is usually initiated by a critically times premature beat which precipitates reentry. This commonly produces tachycardia.

A

Reentrant Rhythm

60
Q

This type of beat has a rate of 150-220 bpm. The pattern is regular with no P wave and a narrow QRS.

A

PSVT (Paroxysmal Supraventricular Tachycardia)

61
Q

What is the hallmark of a PSVT?

A

Begins and ends abruptly.

62
Q

What commonly causes PSVT?

A

Generally due to AV nodal reentry mechanism: The impulse circulates in the AV node until terminated. No P wave will be seen because it is a retrograde atrial depolarization.

63
Q

T/F: You will commonly see PSVTs in patients that have a structural heart dz or defect.

A

False, see in pts without this.

64
Q

Difference between SVT and PSVT

A

SVT - broad term, and sometimes underlying rhythm is atrial flutter or atrial fibrillation.

PSVT - abrupt beginning and end, and AV node re-entry tachy.

65
Q

Where does Atrial Flutter originate?

A

Right Atrium

66
Q

This is a type of beat that consists of regular, fast atrial activity (250-350 bpm). And the ventricular rate depends on conduction through the AV node (often 150 bpm).

A

Atrial Flutter

67
Q

What will you see on an EKG for Atrial Flutter?

A

P wave present at at times buried in a saw tooth pattern.

Narrow QRS

68
Q

Rule of thumb: When the rate is close to 150 bpm, look for buried P waves of atrial flutter with 2:1 conduction.

A

2:1 means, if the atrial is roughly 300 bpm, then the ventricular is 150 bpm.

***Sometimes A. Flutter is 3:1 or 4:1, but mostly 2:1

69
Q

Where does atrial fibrillation commonly originate?

A

Around the Pulmonary Veins

70
Q

What can A.Fib cause?

A
  • Chaotic Atrial Activity – No atrial contraction

- Irregular ventricular contraction

71
Q

How would A. Fib appear on an EKG?

A
  • Rate variable – usually fast
  • Irregularly irregular
  • No P wave
  • Narrow QRS
72
Q

How is A. Fib classified?

A

By Ventricular Rhythm:

  • Afib with rapid ventricular response/”RVR”
  • Afib with controlled ventricular response
  • Afib with slow ventricular response- generally due to medication or sick sinus syndrome.
73
Q

This type of heart beat is a re-entrant rhythm due to an accessory pathway between atrium and ventricle called the “Bundle of Kent.” It is commonly associated with tachycardias. Sometimes referred to as the “pre-exciteation” syndrome.

A

Wolff-Parkinson-White Syndrome

74
Q

How would Wolff-Parkinson-White Syndrome appear on an EKG?

A
  • Normal P wave
  • PR interval is SHORT <0.12 seconds
  • Impulse bypasses the AV Node through accessory pathway
  • Wide QRS
  • Delta Wave
  • ST-T wave changes
75
Q

This is a fatal rhythm and is a medical emergency!

A

Ventricular Tachycardia

76
Q

How would V. Tach appear on an EKG?

A
  • Rate > 120 bpm (usually 150-300 bpm)
  • Regular
  • Wide QRS
  • No marriage of P and QRS = AV dissociation (P is commonly hidden in the QRS)
77
Q

This is a complex in V. Tach that is caused by a combination of both Sa and Ventricular pacemaker

A

Fusion Beat

78
Q

This is a beat in V.Tach that is a normally conducted sinus beat.

A

Capture Beat

79
Q

What can cause Wide Complex Tachycardias?

A
  1. Ventricular Tachycardias!
  2. SVT with aberrancy (aka Pre-existing BBB, rate-related aberrancy, preexcitation syndrome/accessory pathway (WPW))
  3. Pacemakers/Defibrillators
  4. Artifact mimicking Ventricular tachycardia
80
Q

EKG findings of REGULARITY in V. Tach vs. SVT with Aberrancy

A

V. Tach - May be slightly irregular

SVT with Aberrancy - Always regular

81
Q

EKG findings of AV DISSOCIATION in V. Tach vs. SVT with Aberrancy

A

V. Tach - Often seen

SVT with Aberrancy - Never seen

82
Q

EKG findings of FUSION BEATS in V. Tach vs. SVT with Aberrancy

A

V. Tach - Often seen

SVT with Aberrancy - Never seen

83
Q

EKG findings of INITIAL QRS DEFLECTION in V. Tach vs. SVT with Aberrancy

A

V. Tach - Often opposite pts usual QRS deflection

SVT with Aberrancy - Same as PTs usual QRS deflection

84
Q

Rule of thumb with Wide Complex Tachy:

A

Ventricular Tachycardia until proven otherwise

85
Q

This is a polymorphic Ventricular Tachycardia with a rate of 200-250 bpm. The QRS morphology of this twists around the baseline like a party streamer

A

Torsades de Pointes

86
Q

What is an EKG finding with Torsades de Pointes?

A

Assc with prolonged QT interval. Usually due to Congenital, drugs, or electrolyte disturbances.

87
Q

How do you treat Torsades de Pointes? Is it dangerous?

A

It is very serious and often degenerated to Ventricular Fibrillation.

Tx: IV Magnesium

88
Q

This type of rhythm is define as chaotic ventricular activity with no discernible rate.

A

Ventricular Fibrillation

89
Q

What will you see on Ventricular Fibrillation on an EKG?

A

No P or QRS = Cardiac Arrest

90
Q

A flatline with death or disconnected lead is called?

A

Asystole

91
Q

T/F: You can have a rhythm without a pulse

A

True. It’s called a Pulseless Electrical Activity

CVNOTES (57 decks)

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