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EKG > Rhythms > Flashcards

Rhythms Flashcards

1
Q

what are the 3 irregularly irregular rhythms

A

Afib, wandering atrial pacemaker, multifocal atrial tachycardia

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2
Q

what is normal sinus rhythm

A

rate 60-100 BPM, regular rhythm, p wave present and upright in lead II, p/QRS ratio: 1:1, QRS width is normal

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3
Q

what is sinus arrhythmia

A

normal respiratory variation; rhythm gets faster on inhalation and slower on exhale; rate is still 60-100 BPM; p waves normal; P/QRS 1:1; and PR interval normal

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4
Q

what is sinus bradycardia

A

rate < 60 BPM; otherwise NSR

regular; p waves present; P/QRS ratio 1:1; PR interval- WNL to slightly prolonged; QRS width- WNL to slightly prolonged

May be caused by medication, vagal stimulation, sick sinus syndrome, inferior ischemia/infarct; also seen in athletes

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5
Q

what is sinus tachycardia

A

rate > 100 BPM; otherwise NSR

regular with p waves present; P/QRS 1:1; PR interval-slightly shortened; QRS width- slightly shortened

Found in high cardiac output states: exercise, fever, hyperthyroidism, hypovolemia

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6
Q

what is sinus pause/ arrest

A

rate varies; rhythm is irregular; p wave is present except in the pause area; P/QRS 1:1; PR interval is normal; QRS width is normal; grouping none; dropped beats YES!!

-time interval is NOT a multiple of the normal P-P interval

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7
Q

what is sinoatrial block

A

a dropped complex that is a multiple of the P-P interval

rate varies; rhythm is irregular; P wave present except in area of dropped beat; P/QRS 1:1; PR interval is normal; QRS width normal; dropped beat YES!!

  • occurs in some multiple of the P-P interval; after the dropped beat the cycle continues on time
  • the pathology is a non conducted beat from the normal pacemaker
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8
Q

what is atrial premature contraction (PAC)

A

PACs occur when another region of the atria depolarizes before the SA node and thus triggers a premature heartbeat

the pause after the PAC is non compensatory; meaning the underlying rhythm is disturbed and does not proceed at the same pace= PAC resets the SA node

rate varies; p waves PRESENT and UPRIGHT except in the PAC may be a diff shape; irregular rhythm; PR interval varies in the PAC otherwise normal; QRS width normal; P/QRS 1:1; grouping sometimes; dropped beats no

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9
Q

what is ectopic atrial tachycardia

A

a run of PACs
ectopic atrial focus fires quicker than the SA node; the p waves and PR intervals within the ectopic rhythmm are different; episodes are not sustained for a long period of time;

rate: 100-180 BPM
rhythm is regular
p wave: morphology of ectopic focus is diff;P/QRS 1:1; PR interval: diff in ectopic focus; QRS width narrow

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10
Q

what is wandering atrial pacemaker

A

irregularly irregular rhythm caused by multiple ectopic pacemakers in the atria

-atleast 3 different p wave morphologies**

-rate < 100 BPM
-P/QRS: 1:1
QRS width: narrow

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11
Q

What is multifocal atrial tachycardia

A

a tachycardic WAP: three or more different ectopic foci in the atria that fire at different rates

  • atleast 3 different p wave morphologies**
  • rate >100 BPM

P/QRS 1:1; QRS width is narrow

found in patients with severe lung disease**

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12
Q

what is atrial flutter

A 
atrial rate 250-350 BPM
ventricular rate 125-175 BPM
usually regular
P wave: saw toothed
P/QRS 2:1, variable
PR interval variable
QRS width normal; grouping none; dropped beats none
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13
Q

what is atrial fibrillation

A

chaotic firing of numerous pacemaker cells in the atria; no discernible p waves and QRS complexes are in irregular pattern

rate: variable
irregularly irregular
p wave: NONE; chaotic atrial actibitiy
P/QRS: none 0;1
PR interval: none
QRS width normal; no grouping or dropped beats
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14
Q

if a p wave is upright what is it’s origin

A

high atria or SA node

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15
Q

if a p wave is inverted what is it’s origin

A

low atria or AV node

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16
Q

if a p wave is absent…
and the QRS is narrow?
or the if the QRS is wide?
what is it it’s origin

A

absent= AV node or ventricle

narrow QRS= AV node ( Junctional)
wide QRS= ventricular origin

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17
Q

what indicates sinus rhythm

A

an upright p wave in lead II

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18
Q

p waves in junctional rhythms: if the retrograde impulse is the same speed as the antegrade impulse then how should the p wave look?

A

there won’t be one

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19
Q

p waves in junctional rhythms: if the retrograde is faster than the ante grade impulse then how will the p wave look?

A

inverted and before QRS

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20
Q

p waves in junctional rhythms: if the retrograde is slower than the ante grade impulse then how will the p wave look?

A

inverted and after the QRS

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21
Q

if you see a narrow QRS with no p wave what should you be thinking….

A

JUNCTIONAL rhythm!

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22
Q

why do we want to see if the p wave and the QRS wave are married

A

it tells you the atria depolarized before the ventricles; if they aren’t married then it could be AV block

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23
Q

if the QRS is narrow what is the origin of the impulse

A

supraventricular

  • sinus
  • atrial
  • junctional
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24
Q

if the QRS is wide what is the origin of the impulse

A

ventricular OR abnormal conduction (BBB)

25
Q

what is the normal width of the QRS complex to be considered narrow

A

< .12 seconds or 3 small boxes

26
Q

what is an ectopic beat

A

an impulse forming from somewhere other than the SA node

27
Q

what is a premature beat

A

when another pacemaker cell fires at a rate faster than the SA node

happens before expected beat

EARLY ectopic beat

28
Q

what is an escape beat

A

slowing of the SA node allows a faster pacemaker focus to pick up the beat

happens later than an expected beat

LATE ectopic beat

29
Q

what is junctional premature contraction (PJC)

A

an premature beat that originates in the AV node
no p wave!! (sometimes inverted after QRS)
QRS is narrow

-if a beat occurs quicker than you expected look for the p wave….if it’s not there=PJC

30
Q

what is ventricular premature complex (PVC)

A 
beat that originates from ventricles
no p wave
WIDE QRS
followed by long compensatory pause
looks WIDE & WEIRD!

can be benign or malignant- if new onset in the setting of ischemic heart disease

31
Q

what is 2 PVCs called

A

a couplet

32
Q

what is >3 PVCs but lasting less than 30 seconds called

A

non-sustained ventricular tachycardia (NSVT)

33
Q

what is a pattern of PVCs that is every other beat

A

ventricular bigeminy

34
Q

what is a pattern of PVCs that is every third beat

A

ventricular trigeminy

35
Q

what are the three premature beats

A

atrial premature contraction
junctional premature contraction
premature ventricular complex

36
Q

what is a junctional escape beat

A

SA node fails to fire and AV node is next available
no p wave/ or inverted
narrow QRS
single dropped beat

37
Q

what is a junctional escape rhythm

A 
both the SA node and atria fail
rate 40-60 BPM
regular rhythm
no p wave/ or inverted
narrow QRS
continuous rhythm
38
Q

what is junctional tachycardia

A

otherwise similar to junctional escape rhythm just faster than >100 BPM

most common cause is digoxin toxicity!

39
Q

what is accelerated junctional rhythm

A

otherwise junctional escape rhythm just faster; 60-100 BPM
no p wave/ inverted
narrow QRS
regular rhythm

40
Q

what is a ventricular escape beat

A 
occurs when the SA node fails to fire
no p wave
wide QRS
wide & weird!
dropped beat= occurs late
41
Q

what is idioventricular escape rhythm

A

everything above the ventricles fail; so ventricles are pacemaker

rate 20-40 BPM
no p wave
wide QRS
rhythm is regular

42
Q

what is accelerated idioventricular rhythm (AIVR)

A

otherwise similar to idioventricular escape rhythm except FASTERRR 40-100 BPM

43
Q

what is the supra ventricular reentrant rhythm with abnormal conduction

A

WPW

44
Q

what are the characteristics of PSVT

A 
narrow QRS
regular rhythm
no p wave
begins and ends abruptly
rate 150-220 bpm

can be present even in pts without structural heart abnormalities

45
Q

what is the most common Paroxysmal tachycardia

A

PSVT

46
Q

what are the supraventricular reentrant rhythms that are regularly irregular

A

PSVT and Atrial flutter

47
Q

what is an irregularly irregular supra ventricular rhythm

A

Afib

48
Q

what are the characteristics of ventricular tachycardia

A

rate >120 bpm
regular
wide QRS
no p waves: AV dissociation

fusion and capture beats are diagnostic!!

49
Q

what is a capture beat

A

found in ventricular tachycardia; it is a completely normal looking beat

50
Q

what is a fusion beat

A

found in vtach; it is a 1/2 normal looking beat but 1/2 weird looking too. this is because both the SA and ventricular impulse fire at the same time

51
Q

what could ventricular tachycardia be also….

A

SVT with aberrancy:
BBB
WPW
pacemaker/defibrillator: this would have a spacer spike line followed by a wide complex

52
Q

what are the ways to help you distinguish v tach from SVT with abberancy

A

Vtach does not have p waves/ possible fusion & caption beats seen/ the first complex is always in the opposite direction from what the pts normal first complex is

SVT does have a p wave

53
Q

describe torsades de pointes

A

polymorphic vtach
very fast >200 bpm
begins from a prolonged QT interval

54
Q

what are the causes of torsades de pointes

A

drugs, congenital heart dz, or electrolyte disturbances

55
Q

what is the treatment for torsades de pointes

A

IV magnesium

56
Q

which rhythm is classified as cardiac arrest

A

ventricular fibrillation

57
Q

what is the term for flatline

A

asystole

58
Q

what is the term for NSR without a pulse

A

pulseless electrical activity

EKG (5 decks)

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