Rapid EKG III

Question 1

premature atrial beat

Answer 1

irritable atrial foci

-produces P’ wave earlier than expected

Question 2

reset rhythm

Answer 2

SA node will pace one cycle length after a premature beat
-bc dominant center depolarized by premature beat

reality - first cycle after PAB lengthened - due to PS on SA node

Question 3

premature atrial beat with aberrant ventricular conduction

Answer 3

widened QRS

-one bundle branch is not completely repolarized when PAB sends signal

Question 4

non-conducted premature atrial beat

Answer 4

has no QRS complex following

-will see reset pacing

Question 5

atrial bigeminy

Answer 5

auto foci fires PAB after each cycle

• couples to end of normal cycle
• process repeats
• see a couplet

Question 6

atrial trigeminy

Answer 6

auto foci fires PAB after each two cycles

-group beatings in patterns

Question 7

premature junctional beat

Answer 7

irritable junctional foci firesa

• right bundle branch - more likely to be in refractory
• can lead to aberrant ventricular conduction
• may see inverted P’ wave
• before, during, after QRS complex
• retrograde atrial depolarization

Question 8

aberrant ventricular conduction

Answer 8

• signal fired before both bundle branches are repolarized
• results in widened QRS

-right bundle branch - slower to recover

Question 9

junctional bigeminy

Answer 9

premature junctional beat with each sinus cycle

-see absent or inverted P’

Question 10

junctional trigeminy

Answer 10

premature junctional beat coupled with every two sinus cycles

-see absent or inverted P’

Question 11

irritable ventricular

Answer 11

low O2
low K
pathology - mitral valve prolapse, stretch, myocarditis

Question 12

premature ventricular contraction

Answer 12

sudden wide QRS complex
-opposite polarity of the sinus QRS

**often with hypoxia

Question 13

compensatory pause

Answer 13

not resetting

-but it is the repolarization of ventricles

Question 14

interpolated PVC

Answer 14

sandwiched between two normal beats

-no pause and no rhythm disturbance

Question 15

slender QRS

Answer 15

due to simulataneous depolarization of both ventricles

Question 16

pathologic PVCs

Answer 16

six or more per minute

Question 17

ventricle bigeminy

Answer 17

PVC couples to single cycle

Question 18

ventricle trigeminy

Answer 18

PVC couples to two cycles

Question 19

ventricle quadrigeminy

Answer 19

PVC couples to three cycles

Question 20

ventricular parasystole

Answer 20

ventricular foci with entrance block

• can’t be overdrive suppressed
• paces at its own rate

-see pacing at its own rate with PVC

Question 21

very irritable ventricular foci

Answer 21

can emit consecutive stimuli

Question 22

run of three or more PVCs

Answer 22

ventricular tachycardia

Question 23

sustained VT

Answer 23

sustained ventricular tachycardia
-VT lasts longer than 30 seconds

runs of PVCs

Question 24

multifocal PVCs

Answer 24

severe cardiac hypoxia

• distinct QRS complexes
• multiple irritable ventricle foci

Question 25

barlow syndrome

Answer 25

mitral valve prolapse -can cause PVCs floppy valve that billows into left atrium during ventricular systole more in females - slender, chest deformity - dizzy spells - anxiety prone - after age 20 theory - chordae tension from valve prolapse stretches ventricular foci

Question 26

R on T phenomenon

Answer 26

PVC falls on T wave - hypoxia or hypokalemia - dangerous -extends purkinje repolarization further

Question 27

paroxysmal tachycardia

Answer 27

rate 150-250

Question 28

flutter

Answer 28

rate 250-350

Question 29

fibrillation

Answer 29

rate 350-450

Question 30

paroxysmal tachycardia

Answer 30

sudden irritable foci paces rapidly | -atrial, junctional, ventricular

Question 31

epinephrine

Answer 31

irritable atrial/junctional foci

Question 32

hypoxia and low K

Answer 32

ventricular foci irritable

Question 33

paroxysmal atrial tachycardia

Answer 33

rapid rate 150-250 - irritable atrial foci - P' waves not like sinus

Question 34

PAT with AV block

Answer 34

more than one P' for every QRS - digitalis excess or toxicity - 2:1 ratio of P':QRS

Question 35

digitalis

Answer 35

- can make atrial foci irritable | - also inhibits AV node

Question 36

paroxysmal junctional tachycardia

Answer 36

- rapid rate 150-250 - irritable junction foci - lacking P' wave - or P' before, during, after QRS may cause aberrant ventricular contraction -somewhat widened QRS

Question 37

AV nodal reentry tachycardia

Answer 37

continuous reentry circuit develops -AV node and lower atria -foci - near coronary sinus

Question 38

supraventricular tachycardia

Answer 38

irritable foci in both atrial and junctional paroxysmal tachycardia -because above ventricles -Tx is similar - umbrella term is used

Question 39

paroxysmal ventricular tachycardia

Answer 39

- rapid rate 150-250 - sudden irritable ventricular foci - enormous rapid PVCs - SA node can still be pacing atria - AV dissociation

Question 40

AV dissociation

Answer 40

SA depolarization to atria - finds ventricular receptive - produces normal appearing QRS - capture beat*** - among the VT also - atrial depolarization -finds receptive AV node - ventricular depolarization only goes so far - meets ventricular depolarization from ventricular foci - fusion beat*** confirm diagnosis of VT

Question 41

confirm diagnosis of VT

Answer 41

capture and fusion beats