Rapid EKG IV Flashcards
runs of VT
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
VT vs. wide QRS SVT
coronary artery disease - VT
QRS .14 - VT
captures or fusions - VT
RAD - VT
torsades de pointes
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
atrial flutter
rapid rate 250-350
- sawtooth pattern
- atrial auto foci
AV node in refractory - so only one in series of flutter conducts to ventricles
vagal maneuver
will reveal atrial flutter
-slow AV conduction - cause fewer flutter waves to be conducted to ventricles
maze surgery
cut atria into maze of channels for conduction
-eliminates possibility of reentry
ventricular flutter
rapid rate 250-350
- ventricular auto foci
- smooth sine waves of similar amplitude
**will likely deteriorate to V-fib
fibrillation
multi foci firing rapidly
- rate 350-450
- foci either atrial or ventricles
- parasystolic - entrance block
atrial fibrillation
erratic rhythm
- rate 350-450
- wavy baseline with no P waves
- irregular QRS complexes
**determine rate - QRS per 6 second strip x 10
ventricular fibrillation
irritable parasystolic ventricualr foci
- rapid rate 350-450
- twitching of ventricle
- non-discernible QRS complexes
- bag of worms
-amplitude decreases as heart dies
cardiac arrest
no pumping of heart
-V-fib - requires CPR and defib
cardiac standstill
asystole
-no cardiac activity on EKG
pulseless electrical activity
weak electrical signals - but heart can’t respond
wolf-parkinson-white syndrome
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
bundle of kent
in WPW syndrome
delta wave
forms in WPW syndrome
patients with WPW
can have paroxysmal tachycardia by three mechanisms
- rapid conduction
- kent bundle auto foci
- re-entry
lown-ganong levine syndrome
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
james bundle
extension of anterior internodal tract
- skips AV node
- in LGL syndrome
sinus block
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
sick sinus syndrome
SA node dysfunction
-unresponsive supraventricular auto foci
- elderly with heart disease
- sinus bradycardia
excessive PS activity
depresses SA, atrial, and junctional foci
-seen in athletes - pseudo SSS
bradycardia-tachycardia
patients with SSS
-intermittent SVT (or A-flutter, A-fib)
first degree AV block
lengthened PR interval
- longer than 0.2s***
- consistent lengthened interval
AV blocks
delayed conduction from atrial to ventricles
PR interval > 0.2s
AV block
segment
portion of baseline
interval
contains at least one wave
PR interval
beginning P wave to beginning of QRS complex
second degree AV block
some depolarizations blocked at AV node
-two types - wenckebach and mobitz
type I second degree AV block
wenckebach
- progressively longer PR intervals
- with dropped QRS complex
- consistent P:QRS ration
- narrow QRS
wenckebach
type I second degree AV block
-progressively longer PR intervals with dropped QRS complex
type II second degree AV block
mobitz
- single P-QRS-T followed by series of P waves that fail to conduct
- consistent P:QRS ratio
- widened QRS
progressively longer P intervals with eventual dropped QRS
wenckeback
-second degree AV block type I
normal P waves that fail to conduct QRS
consistent ratio
-mobitz block
wenckebach origin
AV node
mobitz origin
below AV node
- His bundle or bundle branches
- widened QRS
vagal maneuver and mobitz vs. wenckebach
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
third degree AV block
complete block
-conduction atria to ventricles totally blocked
atria and ventricular paced independently
-ventricles at junctional or ventricualr foci
third degree block with junctional foci
ventricular rate 40-60
-narrows QRS
third degree block with ventricular foci
ventricular rate 20-40
-PVC like QRS
forms of complete third degree block
- upper AV node block - junctional foci can escape
- complete AV node block
- ventricular foci only
- below His bundle - ventricular foci onyl
