Rhythm Exam 2

Question 1

Tachyarrhythmias

Answer 1

Rapid rhythms originating in a very irritable automaticity foci that pace is rapidly sometimes more than one active focus is generating pacing stimuli at once. Easily recognized by Rate alone but the specific diagnosis requires that we identify the origin or location of the irritable automaticity focus atrial junctional or ventricular Peroxisomal tachycardia 150 to 250 per minute Flutter 250 to 350 per minute Fibrillation 350 to 450 per minute

Question 2

Peroxisomal sudden tachycardia

Answer 2

A very irritable automaticity foci suddenly pace is rapidly found in Paroxysmal junctional and ventricular tachycardia Usually caused by hypoxia low potassium epinephrine a single premature stimulus from another focus can provoke and irritable focus into Run of paroxysmal tachycardia

Question 3

PAT with AV block

Answer 3

Rapid rate with spiked P prime waves 2 to 1 ratio of P prime to QRS waves suspect digitalis excess or to toxicity. Digitalis inhibits the AV node so that only every second stimulus can dogs to the ventricles Pat with AV block is a tachyarrhythmia that has to P prime waste for each curious response because EV no blocks a conduction of every other atrial stimulus can happen with low serum potassium which can curate or use digitalis antibodies

Question 4

Paroxysmal junctional tachycardia PJT

Answer 4

caused by the sudden rapid pacing of a very irritable automaticity focus in the AV junction with a rhythm of 150 to 250 per minute they can also depolarize P’ from below in retrograde fashion recording inverted P’ immediately before each QRS, or inverted P’ after each QRS, or inverted P’ buried within a QRS. Can create aberrant ventricular conduction depolarizing the left ventricle before the right to reduce a somewhat widened QRS during tachycardia

Question 5

Paroxysmal atrial tachycardia

Answer 5

rapid rate originates in a very irritable focus in atria between 150 to 250 per minute overdrive suppressing the SA node and all other automaticity foci beginning with P prime waves that do not look like the sign is generated P-wavelength. Paroxysmal- burst or run shorter or longer having a start and a stop. Hard to tell if premature atrial or junctional supraventricular Periods of very rapid and regular heart beats that begin and end abruptly During the bouts of PAT/PJT, the heart rate typically speeds up to 150-to-200 beats per minute Supraventricular (SVT) VT vs SVT???

Question 6

Paroxysmal AV junctional tachycardia

Answer 6

Maybe and RT a continuous reentry circuit develops which includes the AV node in the lower atria and rapidly paces the atria and ventricles giving off a depolarization stimulus to the entrance the ventricles with each passing the circuit looks like he JT first records from an origin near the coronary sinus where there is lots of automativity with a punitive reentry circuit around a broad area of the AV node only catheter ablation of Focus late and region can successfully Eliminate this tachycardia

Question 7

Supraventricular tachycardia

Answer 7

The very irritable autumn with a city full site that produce both pair exhaustible atrial tachycardia and junctional originate above the ventricles including Pat and PJT what can be so rapid that the P prime waves run into the preceding T waves to become indistinguishable making differentiation between these two very difficult thankfully there is similar treatment made irritable by adrenergic

Question 8

Paroxysmal ventricular tachycardia

Answer 8

Produced by ventricular automaticity focus that is irritable pieces between 150 to 250 per minute has a characteristic pattern of a Normas consecutive PVC like complexes the SA node still paces the atria but the large Dramatic ventricular complexes Hide individual P waves that can be seen only occasionally with independent pacing of the atria in the ventricles and is a type of AV dissociation. And occasional atrial depolarization catches the AV node in a receptive state and this depolarization stimulates conduct to the ventricles may produce a fusion beat if atrial depolarization and ventricular polarization combined QRS with eight PVC like complex confirming diagnosis of ventricular tachycardia. May signify coronary insufficiency never give medications for SVT to a patient with PT although they look similar

Question 9

Distinguishing wide QRS complex SVT from ventricular tachycardia

Answer 9

Wide QRS is complex SVT does not commonly happen to patients with coronary disease or infection is usually less than 0.14 seconds rarely has AV dissociation showing captures or fusions and rarely the axis is extreme RAD Ventricular tachycardia is commonly found in elderly who suffer from diminished coronary blood flow disease or infarction with signs of AV dissociation or the presence of fusions are captures or extreme RAD -90° to -180° has greater than 0.14 seconds for a QRS width

Question 10

Torsades de pointes

Answer 10

A particular form a very rapid ventricular rhythm caused by low potassium medications a block potassium channels or congenital abnormalities length in the QT segment the rate varies from 250 to 350 per minute and occurs in brief episodes with ventricular complexes that are upward pointing then downward pointing into repeating continuum caused by too competitive irritable foresight in different ventricular areas. If unresolved can lead to a deadly arrhythmia. Torsade de pointes occurs with an underlying prolonged QT interval. It has an undulating, sinusoidal appearance. The axis of the QRS complex changes from positive to negative and back in an irregular pattern. It can convert into a normal rhythm or ventricular fibrillation. V tach in sinusoidal pattern with sine wave wider narrower caused by some medicine. Rate: 200–250 BPM Regularity: Irregular P wave: None P:QRS ratio: None PR interval: None QRS width: Variable Grouping: Variable sinusoidal pattern Dropped beats: None

Question 11

Atrial flutter

Answer 11

Originates in an atrial automaticity focus with rapid succession of identical back to back atrial depolarization waves these flutter waves suggest a reentry origin to some characterized by consecutive identical flutter waves. The baseline appears to vanish between the flutter waves because the waves are identical they are described you have teeth. AV node has a long refractory period so only in a series of water waves conduct to the bathroom close with this rapid series of atrial depolarization’s not driving the ventricles to the same excessive rate usually only one of two or three equal depolarizations reach a Ventricle. The saw-toothed appearance may not be obvious in all 12 leads. Are getting contraction but lots of atrial beats before a ventricular one. Atrial flutter is the same spot not 1/1 ratio, in a wap 1/1. not atrial fibrillation have flutter 2:1 3:1 can name it or be random. Can be irregular irregular but can be regular pattern doesn’t always stick if see a repeating pattern P waves looks the same Rate atrial 250-350 ventricular 60 – 100, may be faster Rhythm regular or irregular P waves “saw-toothed” PR interval variable QRS normal

Question 12

Ventricular flutter

Answer 12

Produced by a single ventricular automaticity focus firing at an exceptionally rapid rate of 250 to 350 per minute produces a rapid series of smooth sine waves of similar amplitude. Ventricular rate is so rapid that they hardly have enough time to fill even partially so it deteriorate into a deadly arrhythmia this really self is resolved and is nearly nearly always a prelude to a dead the arrhythmia

Question 13

Fibrillation

Answer 13

Erratic rhythm caused by continuous rapid rate discharges from numerous automaticity foci in either atrial or ventricles with 350 to 450 discharges per minute caused bye irritable full-size suffering from entrance block or pair systolic can’t be overdrive suppressed all pays rapidly at once with an erotic rhythm and on coordinated that distinct complete waves are not distinguishable rate is Impossible to determine the involve chambers really twitch

Question 14

Atrial fabulation

Answer 14

Caused by many irritable Para systolic atrial foci with entrance block firing at rapid rate producing an exceedingly rapid erratic atrial rhythm with irregular ventricular response. Because so many atrial foci are rapidly firing no single depolarization spread to far only a small portion of atria the polarized by anyone discharge from the atrial focus depolarization from the foci near the AV node conduct to the ventricles producing a very irregular ventricular rhythm usually initiated by Parasystolic site in the pulmonary vein or see out of the left atrium. Appears as a wavy baseline without identifiable P or P prime waves ventricular rate depends upon the AV node’s duration of refractories. The AV node usually allows a relatively normal range of ventricular rate but a regular but sometimes it permits and increase number of the polarization stimuli to pass through producing a rapid ventricular rate that needs to be controlled

Question 15

Ventricular fibrillstion

Answer 15

Caused by rapid rate discharges from many irritable parasystolic ventricular automaticity foci producing an erratic rapid twitching of the ventricles with a rate of 350 to 450 per minute each suffering from an entrance block so they cannot be overdrive suppressed with so many ventricular foci firing rapidly each one repeatedly D polarizes only a small area of ventricles. Tracing is erratic Ventricles do not provide mechanical pumping amplitude of the deflections diminish as the heart dies. Is a type of cardiac arrest requiring immediate CPR and D fibrillation. Torsades or vtach go into. Random waviness because of fibrillation like afib but bigger nothing to measure rate dying shock them to start heart pacemaker cell will take heart out. Rate cannot be determined Rhythm “chaotic” P wave none PR interval none QRS not measurable

Question 16

Cardiac arrest

Answer 16

Cardiac standstill asystole when there is no detectable cardiac activity rare circumstance when the SA node in the scape mechanisms of all the foci at all levels are unableto assume pacing responsibility Pulseless electrical activity PE a present when a dying heart produces week signs of electrical activity on EKG but the moribund heart cannot respond mechanically

Question 17

Implantable cardioverter defibrillator ICD

Answer 17

Implanted under the chest skin a patient likely to develop ventricular fibrillation wire leads are attached from ICD to the heart to detect VF and Dave never a defibrillating shock can identify other arrhythmias and treat them with timed electrical stimuli and can pace if bradycardia ensues

Question 18

Wolf Parkinson White syndrome

Answer 18

And abnormal accessory AV conduction pathway bundle of Kent can short-circuit the usual delay I’ve ventricular conduction in the AV node prematurely depolarizing a portion of the ventricles producing a delta waves just before normal ventricular depolarization begins creating the illusion of a shortened PR interval and link send QRS actually recording the deep polarization of an area of ventricular prexexcitation Can have paroxysmal tachycardia Rapid conduction supra ventricular tachycardia including atrial flutter or iatrial fibrillation maybe rapidly conducted wonder one through this accessory pathway producing dangerously high ventricular rates Kent bundles have been found to contain automaticity foci that can initiate of paroxysmal tachycardia Re-entry ventricular depolarization made immediately re-stimulate the atria in retrograde fashion via the accessory pathway causing a theoretical circus reentry loop. Accessory pathway from atrium to ventricles. WPW: another entrance way through bundle o Kent two ways can get to ventricles QRS look different having arrythmia have a delta wave don’t shoot straight up delta wave on every beat not just an event.

Question 19

Loan ganong Levine LGL syndrome

Answer 19

AV node is bypassed by an extension of the anterior internal tract absent the conduction delay in the AV node this James bundle conducts atrial depolarization‘s directly to the his bundle without delay posing a serious problem with rapid atrial arrhythmias like atrial flutter AV node is bypassed so there is no significant PR interval delay P waves are Adjacent to QRS

Question 20

Rhythm blocks

Answer 20

Sinus, EV, bundle branch, hemi block

Question 21

Blocks

Answer 21

Blocks retard or prevent the conduction of depolarization can occur in the S a node AV node or larger divisions of the ventricular conduction system.

Question 22

Sinus block

Answer 22

And unhealthy SA node may temporarily failed to pay us for at least one cycle considered sinus block then the SA node resumes pacing with no P wave in the missed cycle.After the pause of sinus block pacing resumes at the same rate and timing as prior to the block may induce an escape beat from it automatically foci otherwise the P waves before and after or identical

Question 23

Sick sinus syndrome

Answer 23

Is a waste basket of arrhythmias caused by S a node dysfunction associated with unresponsive supra ventricular atrial and junctional automaticity foci which are also dysfunctional and can’t employed their normal escape mechanism to assume pacing responsibility commonly occurs in elderly individuals who have heart disease with marked sinus bradycardia but without normal escape mechanisms of a drill and junction of those I may also present as recurrent episodes of sinus block or sinus arrest associated with faulty or absent escape mechanism of all supraventricular foci.

Question 24

bradycardia tachycardia syndrome

Answer 24

Patients with SSS may develop into him in episodes of SVT even atrial flutter or atrial fabulation mingled with sinus bradycardia known as

Question 25

AV block first second and third degree

Answer 25

ABC blocks either retard or lemonade or both conduction from the atria to the ventricles. Minor ABC blocks lengthen the brief pause between each girl depolarization and ventricular depolarization. Most AV block is completely block some or all super ventricular impulses from reaching the ventricles. first-degree block lengthens the delay between a drill and ventricular depolarization second-degree block wenckeba hand Mobitz types third-degree block completely blocks the conduction of atrial stimuli to the ventricles

Question 26

First degree AV block

Answer 26

retards AV node conduction, prolonging PR interval more than one large square and consistent in every cycle. some type of AV block is present if any PR interval is longer than 0.2 in tracing. First-degree heart block occurs from prolonged physiological block in the AV node. It can occur because of medication, vagal stimulation, or disease, among other causes. The PR interval will be greater than 0.20 seconds, for that patient it is usually the same length. SA node going to AV node, AV node is slow but letting every impulse through, sinus rhythm w/ long PRI and first degree heart block. Rate 60 or less Rhythm regular P wave 1for each QRS PR interval >.20 QRS normal

Question 27

segment vs. interval

Answer 27

segment is portion of baseline, interval contains at least one wave. PR interval includes P wave and baseline following up to QRS.

Question 28

second-degree AV block

Answer 28

second-degree AV block is allow some atrial depolarization’s or P waves to conduct to the ventricles producing a QRS response was some issue of the polarizations are blocked leaving loan P waves without associated QRS there are two kinds there was occutin the AV node in those that occurred below the AV node. Wenckebach is considered innocuos mobitz is pathological. wenckebach has longer PR with no wide QRS Mobitz is in the bundle branch has a normal PR with a widened QRS. With a 2 to 1 block might fit both secondary blocks so use vagal maneuver to differentiate big maneuvers increase Parasympathetic and inhibition of the AV node increasing the number of cycles series to reduce work and back but if the 2:one block is Mobitz vagal maneuvers illuminate the block or have no effect

Question 29

Wenckbach second-degree block

Answer 29

second-degree blocks of the AV node produced a series of cycles with Progressive blocking of AV node conduction until the final P wave is totally blocked in the AV node eliminating the QRS each repeating series has a consistent P: QRS ratio like 3:2 4:3 5:4 etc. with one less QRS then Psin the series. PR interval gradually link fence and success of cycles with less P waves feeling to conduct to the ventricle repeating. Caused by parasympathetic excess or drugs that mimic or induce parasympathetic effects can produce group meeting that looks like couplets of premature beats. Mobitz I second-degree heart block is also known as Wenckebach. It is caused by a diseased AV node with a long refractory period. The result is that the PR interval lengthens between successive beats until a beat is dropped, then the cycle starts again. The R to R interval lengthens with each beat. Rate <60 Rhythm Irregular because of dropped beats, more Ps than QRS P wave some not followed by QRS PR interval lengthens until P wave not followed by QRS QRS normal

Question 30

Mobitz second-degree block

Answer 30

second-degree block of Purkinje fibers bundles the house bundle or bundle branches usually produce a series of cycles consisting of one normal PQRST cycle preceded by a series of paced P waves that failed to conduct throughout the AV node with no QRS response each repeating Mobitz series has a consistent P: QRS ratio like 3 to 1 4 to 1 five to 1 Totally blocks a number of paced atrial depolarization‘s before conduction to the ventricle is successful producing 2212 P waves or one curious etc. repeating is serious poor conduction rates 4 to 15 to 1 relate to increase severity of the blockage in our advanced never has a premature P wave. In Mobitz II second-degree heart block, there are grouped beats with one beat dropped between each group. Key point: The PR interval is the same in all conducted beats. This rhythm is caused by a diseased AV node. Normal sinus rhythm every now and then a beat is dropped P with nothing. Both have dropped QRS no PRI changes, Ps march out unlike nonconducted PAC (because earlier) Do ventricular rate Rate less than 60 Rhythm regular P wave more Ps than QRS PR interval constant on conducted QRS QRS Slightly widened

Question 31

Complete third-degree AV block

Answer 31

When the conduction of super ventricular depolarization‘s to the ventricle is totally blocked in automaticity focus escapes to pace the ventricles and it’s inherent rate can be complete but more distally in the ventricular conduction system there must be complete block of all subdivisions to illuminate conduction to the ventricles AV doing own thing, normal P waves and atrial rate and ventricle rate normal but superimpose together but no communication going on just superimposed in it. No dropped beats, Ps and QRSs dropped out, more Ps for QRSs why is second of third degree or blocked PAC. If second changes in PR no dropping QRS regular, Nice and narrow because it is a jnctional rhythm Rate less than 60 Rhythm P to P interval regular R to R interval regular P waves more Ps than QRS PR interval varies QRS .12 - .20

Question 32

Forms of 3rddegree AV block

Answer 32

Complete block in the upper AV no leaves junctional foci to escape and paste the ventricles. With a complete AV block if the QRS is appear normal because each pacing stimulus passes down the ventricular conduction system we know that a junction of focus is pacing the ventricles sometimes it may have to pass or disease reasons delaying the polarization in some areas producing wide QRS complex is if the rate is between 40 and 60 Complete block of the entire av node or in the his bundle leaves only ventricular focus to pace. Pieces between 20 to 40 bpm causing cerebral blood flow compromise and syncope to ensue with separate P and ventricular waves check QRSs if wide PVC like complexes we know it is this. Stokes Adams syndrome need continuous surveillance and maintenance of airway need artificial pacemaker Blow to his bundle all parts are completely box or ventricular focus escapes Regardless of the location of the focus that escapes to pace the ventricles the atrium remains independently placed by the SA node so we will see a sinus paste atrial rate in a totally independent focused paced slower ventricular rate creating an AV dissociation

Question 33

Downward displacement of the Pacemaker

Answer 33

Absence of a drill activity with wide complex bradycardia indicates that neither the SA node North supra ventricular foci are viable enough to piece the atria failure of all automaticity centers above ventricles carries an unfavorable prognosis make certain that the flat baseline is not a fib caused by extremely high serum potassium concentration can depress the SA node and supra ventricular foci producing same EKG can cause cardiac asystole

Question 34

Artificial pacemakers

Answer 34

Have a pulse generator with long-lasting lithium battery designed for ventricular or atrial pacing modalities and can sense a wide variety of features. Are surgically implanted as a permanent pacemaker electrode. Lead wire is passed transvenouslyinto the right side of the heart were attached to epicardial surface of the heart emits regular patient stimuli which required on the EKG is a narrow vertical spike meaning regular paced electrical stimulation Depolarizing the mile cardio tissue in contact with the electrode

Question 35

Demand a pacemaker

Answer 35

Imitate physiological mechanisms of an automatic three focus programs with inherent rate that is overjoyed suppressed by normal sinus pacing should the sinus rate drop below programs inherent rate pacemaker escapes to assume pacemaking responsibility at inherent freight if sinus resumes demand is over strive suppressed and stops resetting like an automatic city focus provides for on interrupted cardiac function resetting after sensing a PVC

Question 36

Atrial pacing

Answer 36

Failure of the SA node intro pacing used when the AV node and ventricular conduction system function normally so artificially paste a trust in life are properly conducted from atria to ventricles a complete AV block prevents normal sinus pacing from conducting to ventricles may require P-wave trigger pacing sensing patients P-wave then after a brief pause imitating normal AV conduction generating stimulus for ventricular depolarization. I see no nail function combined with complete AV block necessitates AV sequential pacing provides a stimulus for atrial depolarization followed by a brief pause in the

Question 37

Peacemaking electrode positions

Answer 37

Right ventricular electrode used for cardiac pacemaking tip of lead is positioned with in the cavity of the right ventricle tip of right ventricular pacemaker eight packs of right ventricle result QRS complex has a left bundle branch block pattern with left axis deviation when paste curious shows LBBB pattern with normal access the electric tip is in the mid info tract of the right ventricle implantable

Question 38

Implantable cardioverter defibrillator

Answer 38

Can pace detect and interpret rhythm disturbances and treat tacky arrhythmias by overdrive pacing or cardioversion even defend bully in the event of ventricular Fibrillation. Self contained computerize device instantly analyze and treat most dangerous cardiac arrhythmias stimulate normal sinus pacing institute overdrive suppression pacing to treat ventricular tachycardia provide cardioversion and defibrillator .

Question 39

Automated external defibrillator AED

Answer 39

Records and analyzes the patient’s EKG and then automatically defibrillator patient if a deadly arrhythmia is detected very accurate in computerize recognition of ventricular defibrillation and high rate ventricular tech Cardia external noninvasive peacemaking device affectively delivers pacing seem like too hard to intact skin in emergency situations for temporary pacing requires an impulsive longer duration than that of into cardiac pacemaker is sweet pacing Spike is wide with a flat end

Question 40

ventricular tachicardia

Answer 40

Ventricular tachycardia is a very fast ventricular rate that is usually dissociated from an underlying atrial rate. The irregularities are the underlying sinus beats. Blue dots indicate sinus beats. Arrows pinpoint the irregularities. Notches indicate P wave trying to come through and atria is working, regular fast, and QRS wide. Rate 140-220 or faster Rhythm regular P wave none PR interval none QRS Wide >0.16, bizarre

Question 41

VTach: Fusion Beats

Answer 41

A hybrid complex with some features of both areas of the ventricle being stimulated simultaneously Has morphology between abnormal ventricular beat and normal QRS complex Caused by two pacemakers: SA node Ventricular pacer Not testable: A fusion beat occurs when a sinus beat falls on a spot that allows some innervation of the ventricle to occur through the normal ventricular conduction system.

Question 42

VTach: Capture Beats

Answer 42

Occur in the middle of VTach Caused by chance timing of sinus beat to “capture” or transmit through AV node Depolarize ventricles through normal conduction system This beat is completely innervated by the sinus beat and is indistinguishable from the patient’s normal complex. Both fusion and capture beats are hallmarks of ventricular tachycardia. Atrium firing trying to get the beats thorugh and ventricle is taking over

Question 43

Polymorphic VT – Torsades de Pointe

Answer 43

Some causes: Low potassium, Long QT interval - (beginning of QRS to end of T wave) should be less than half of the preceding RR interval. For normal rates QT < 0.4 . Ventricular rate is often >200bpm and ventricular fibrillation is a consequence. Not a number but a pattern. Torsades then easily goes into vfib with no contraction getting to blood at all in vfibb. Flipping of QRS’s in sinusoid pattern

Question 44

atrial fibrillation

Answer 44

Irregular no distinct P waves, QRS narrow Rate atrial >350 ventricular varies Rhythm “irregularly irregular” P waves not discernible PR interval not measurable QRS normal A-fib irregularly irregular Flutter- distinct Ps regular or irregular,

Question 45

asystole and things that lead up to it

Answer 45

Asystole- no contraction or cardiac electrical activity Ventricular standstill- atria activia but ventricle not working, see just P waves Agonal- heart trying every so often Asystole—straight Vfib- wavy line before asystole

Question 46

R on T phenomenon

Answer 46

If R wave falls on T wave can send someone into vtach ventricles werent repolarized putting them into a vtach can be caused by any premature beat, certain drugs make more likely than other.

Question 47

sick sinus

Answer 47

Arrhythmias Associated with Sick Sinus Syndrome Atrial bradyarrhythmias Sinus bradycardia Sinus arrest (with or without junctional escape) Mobitz type I block (Wenckebach block) Mobitz type II block Ectopic atrial bradycardia Atrial fibrillation with slow ventricular response Greater-than 3-second pause following carotid massage Long pause following cardioversion of atrial tachyarrhythmias Atrial tachyarrhythmias Atrial fibrillation Atrial flutter Atrial tachycardia Paroxysmal supraventricular tachycardia Ventricular (escape) tachyarrhythmia Alternating bradycardias and tachycardias Bradycardia-tachycardia syndrome

Question 48

pacemaker rhythms

Answer 48

Symptomatic, slow heart rates(sinus brady, slow Afib) or someone with third degree. Implant under skin and feed wires into heart conduction battery fire a current to the heart and get it to throw and conduct a beat might look like PVC. Can have atrial, ventricle wires either or both, single or dual pacer. Can sense and pace has to know whether person has QRS coming if doesn’t throw it they will. Program pacemaker to do what you need to if heart ever falls below 80 want them to pace it for 80, sit in ventricle look for QRSs at 80 throwing beat at rate. May need to pace people all the time without ever sensing cheaper device to sense but not pace. Sense atrium and pace ventricle everythime see P wave sense atirum pacing ventricle or sense and pace both of them. Phone can tell when you are jogging, if someone has activity pacemaker can sense have heart rate go up to 100 increasing heart rate with activity sensors at night slow it down to 60 beats/minute. Wires can have problems, dislodge tongs and can thread into heart scarring around it holding it in place, screw into heart, if dislodged send out pacing signal with nothing happen. Rate can vary depending on reason for device Rhythm should be regular P waves may be absent, may see pacer spike prior to P wave PR Interval may vary QRS wide, bizarre, presence of pacer spike prior to QRS. Lines are pacing spikes, depending upon lead, will give you a picture not able to see spiikes in every lead some leads you cant see them and some you can. 100% vpaced at rate of 100. Firing for Atria, then ventricular. Second pacing and not sensing, shouldn’t be on top of P wave to see if it was supposed to fire w/out sensing or if it was not correct, buttons to change sensitivity to make it more sensitive and see these things. Set everything as low as possible to save battery and not eat it up. Magnet over pacemake will stop it, wont have to worry about currents in cautory Third lead for heart failure in a different spot pacing for heart failure or defibrillators. Defibrillator has to be much bigger implanting underneath skin thread wires up is a shocking wire sensing a vtach above a certain rate could pace, sense, and shock

Question 49

Wolff-Parkinson-White (WPW) Syndrome

Answer 49

Wont ask you to identify, may ask a concept question.

Accessory pathway from atrium to ventricles.

WPW: another entrance way through bundle o Kent two ways can get to ventricles QRS look different having arrythmia have a delta wave don’t shoot straight up delta wave on every beat not just an event.