Rapid EKG IV

Question 1

runs of VT

Answer 1

coronary insufficiency (ischemia)
-irritable ventricular foci

**junctional or atrial SVT can mimic VT with wide QRS

also BBB with SVT can widen QRS to give same impression

NEVER give meds for SVT to a patient with VT

Question 2

VT vs. wide QRS SVT

Answer 2

coronary artery disease - VT
QRS .14 - VT
captures or fusions - VT
RAD - VT

Question 3

torsades de pointes

Answer 3

twisted ribbon

• rapid ventricular rhythm
• low K, long QT syndrome
• rapid rate 250-350
• brief self-terminating bursts

-gradual changes in amplitude

theory - two competitive irritable foci

Question 4

atrial flutter

Answer 4

rapid rate 250-350

• sawtooth pattern
• atrial auto foci

AV node in refractory - so only one in series of flutter conducts to ventricles

Question 5

vagal maneuver

Answer 5

will reveal atrial flutter

-slow AV conduction - cause fewer flutter waves to be conducted to ventricles

Question 6

maze surgery

Answer 6

cut atria into maze of channels for conduction

-eliminates possibility of reentry

Question 7

ventricular flutter

Answer 7

rapid rate 250-350

• ventricular auto foci
• smooth sine waves of similar amplitude

**will likely deteriorate to V-fib

Question 8

fibrillation

Answer 8

multi foci firing rapidly

• rate 350-450
• foci either atrial or ventricles
• parasystolic - entrance block

Question 9

atrial fibrillation

Answer 9

erratic rhythm

• rate 350-450
• wavy baseline with no P waves
• irregular QRS complexes

**determine rate - QRS per 6 second strip x 10

Question 10

ventricular fibrillation

Answer 10

irritable parasystolic ventricualr foci

• rapid rate 350-450
• twitching of ventricle
• non-discernible QRS complexes
• bag of worms

-amplitude decreases as heart dies

Question 11

cardiac arrest

Answer 11

no pumping of heart

-V-fib - requires CPR and defib

Question 12

cardiac standstill

Answer 12

asystole

-no cardiac activity on EKG

Question 13

pulseless electrical activity

Answer 13

weak electrical signals - but heart can’t respond

Question 14

wolf-parkinson-white syndrome

Answer 14

alternate AV pathway- bundle of kent

• rapidly through AV node - no delay
• premature depolarization of ventricles
• delta wave forms
• shortened PR interval and lengthened QRS

Question 15

bundle of kent

Answer 15

in WPW syndrome

Question 16

delta wave

Answer 16

forms in WPW syndrome

Question 17

patients with WPW

Answer 17

can have paroxysmal tachycardia by three mechanisms

• rapid conduction
• kent bundle auto foci
• re-entry

Question 18

lown-ganong levine syndrome

Answer 18

AV node bypassed by extension of anterior internodal tract

• james bundle
• skips delay at AV node
• directly to His bundle
• serious problem - rapid atrial arrhythmia like atrial flutter

Question 19

james bundle

Answer 19

extension of anterior internodal tract

• skips AV node
• in LGL syndrome

Question 20

sinus block

Answer 20

SA node fails to pace for at least 1 cycle
-skip P wave

• before and after - identical P waves
• may get escape beat from auto foci

Question 21

sick sinus syndrome

Answer 21

SA node dysfunction
-unresponsive supraventricular auto foci

• elderly with heart disease
• sinus bradycardia

Question 22

excessive PS activity

Answer 22

depresses SA, atrial, and junctional foci

-seen in athletes - pseudo SSS

Question 23

bradycardia-tachycardia

Answer 23

patients with SSS

-intermittent SVT (or A-flutter, A-fib)

Question 24

first degree AV block

Answer 24

lengthened PR interval

• longer than 0.2s***
• consistent lengthened interval

Question 25

AV blocks

Answer 25

delayed conduction from atrial to ventricles

Question 26

PR interval > 0.2s

Answer 26

AV block

Question 27

segment

Answer 27

portion of baseline

Question 28

interval

Answer 28

contains at least one wave

Question 29

PR interval

Answer 29

beginning P wave to beginning of QRS complex

Question 30

second degree AV block

Answer 30

some depolarizations blocked at AV node | -two types - wenckebach and mobitz

Question 31

type I second degree AV block

Answer 31

wenckebach - progressively longer PR intervals - with dropped QRS complex - consistent P:QRS ration - narrow QRS

Question 32

wenckebach

Answer 32

type I second degree AV block | -progressively longer PR intervals with dropped QRS complex

Question 33

type II second degree AV block

Answer 33

mobitz - single P-QRS-T followed by series of P waves that fail to conduct - consistent P:QRS ratio - widened QRS

Question 34

progressively longer P intervals with eventual dropped QRS

Answer 34

wenckeback | -second degree AV block type I

Question 35

normal P waves that fail to conduct QRS

Answer 35

consistent ratio | -mobitz block

Question 36

wenckebach origin

Answer 36

AV node

Question 37

mobitz origin

Answer 37

below AV node - His bundle or bundle branches - widened QRS

Question 38

vagal maneuver and mobitz vs. wenckebach

Answer 38

2: 1 AV block?? - vagal maneuver - increasead PS will inhibit AV node - cause wencekebach to increase cycles to 3:2 or 4:3 - causes mobitz to become 1:1 - wenckebach

Question 39

third degree AV block

Answer 39

complete block -conduction atria to ventricles totally blocked atria and ventricular paced independently -ventricles at junctional or ventricualr foci

Question 40

third degree block with junctional foci

Answer 40

ventricular rate 40-60 | -narrows QRS

Question 41

third degree block with ventricular foci

Answer 41

ventricular rate 20-40 | -PVC like QRS

Question 42

forms of complete third degree block

Answer 42

- upper AV node block - junctional foci can escape - complete AV node block - ventricular foci only - below His bundle - ventricular foci onyl