Supraventricular Tachyarrythmias

Question 1

What is ventricular pre-excitation?

Answer 1

Widening of the QRS interval

Abnoramal ventricular activation occurs LATE as a BBB

Ventricular Activation occurs EARLY (PRE-EXCITATION) resulting in a delta wave.

Question 2

Where can the extra pathway be in pre-excitation?

Answer 2

in the AV node or or via an accessory pathway (budle of kent)

Question 3

What is the ECG result of pre-excitation?

Answer 3

Short PR (.10 sec)

Question 4

What are the charicteristics of Wolf-Parkinson-White Syndrome?

Answer 4

Pre-excitation plus the classic supraventricular arrhythmia

Without SVA it’s just the WPW pattern

Question 5

What other pathology can mimic Ventricular Pre-Excitation?

Answer 5

BBB (Widens QRS) or MI

Question 6

What Is seen in an inferior MI?

Answer 6

Wide Q wave

Question 7

Where is the kent bundle located?

Answer 7

In the right AV area.

Question 8

What type of depolarization gets rid of the Delta wave in Vent. Pre-Excitation

Answer 8

Conduction is via the normal pathway, until the arrythmia converts
Macro re-entrant tachy arrythmia

Question 9

What can cause a tall upright R wave in lead V1?

Answer 9

• Right ventricular hypertrophy with reversal of the precordial pattern
• Wolf Park White (pre-excitation)
• Dextrocardia (situsinversus)
• RBBB

Question 10

What does a delta wave look like?

Answer 10

It is a little spike on the upslope of the R wave

Question 11

What is the most common mechanism of tachy-arrythmias?

Answer 11

Re-entry

Question 12

What is required for re-entry to take place?

Answer 12

A bifurcated pathway
Different refractory peroid for each pathway
Unilateral slow conduction

Question 13

What is the mechanism of arrythmias concerning the refractory period?

Answer 13

The refractory peroid can either be lengthened or shortened depending on the slope of the funny current.

Question 14

What are charicteristics of early beats?

Answer 14

Occur early in the cycle
Prevent occurrence of the next normal
Generate a pause of varying length.

Question 15

What differentiates Early ATRIAL Beats

Answer 15

Early in cycle
Abnormally shaped P wave(may be difficult to see)
Normal QRS
No compensatory pause

Question 16

What is the the most common cause of a paue on an ECG?

Answer 16

Non-conducted atrial premature doesn’t conduct to the AV junction or ventricle.

Question 17

How is a Ventricualr Premature different than atrial?

Answer 17

Has a compansatory pause A-B = B-C
Premature beat has a big irregular R wave with opposite vector as the rest

Atrial A-B > B-C and preceded by a P wave

Question 18

What is unique about a supreventricular premature?

Answer 18

Premature beat has no P wave

Question 19

What pathology is associated with “grouped beating”?

Answer 19

2nd Degree AV block (have to be sure theres no prematurity)

Question 20

What differentiates an AV block from Atrial Prematures?

Answer 20

P wave in prematures are Early compared to the rest.

AV block P waves are in the normal place.

Question 21

What is distinctive about ventricular prematures?

Answer 21

Wide, bizarre QRS, complexes >.12sec (FLBs)
NO Preceding P wave
ST seg slopes away from QRS
Compensatory pause unusual

Question 22

What is ventricular bigemeny?

Answer 22

Fixed coupling interval between the normal complexes and the extrasystoles. Strongly supports reentry as mech of arrythmia

Question 23

What is the worst type of ventricular premature?

Answer 23

R wave found on the Terminal portion of the T wave. (Grade 5)

Question 24

What arrythmia is the Lown Classification used for?

Answer 24

Ventricular Prematures
0-None
1- 30/hr
3- Multiform
4A- Two Consecutive
4B- 3 or more consecutive
5- R-on-T

Question 25

What side of the heart do ventricular prematures associated with Heart disease occur?

Answer 25

Left sided VP. More likely to cause V-fib especially during an acute MI
Show a monophasic R or qR in V1 and a qS or monophasic QS in V6

RVP occurrs in normal people.

Question 26

How will a inferior-posterior MI present?

Answer 26

With ST depression in the V leads

Question 27

What does the presence of Q waves tell you?

Answer 27

Resolved MI

Question 28

What portion of the heart does the RCA supply?

Answer 28

Inferior wall and posterior segment

Question 29

What is the difference between atrial flutter and atrial fibrillation?

Answer 29

Flutter is regular(200-350bpm) F waves give a sawtooth baseline

Fibrillation can be course or fine
Much faster (450-600 bpm)
More common in the elderly
Will come in waves

Question 30

What is the Ratio of AV conduction in Atrial Flutter?

Answer 30

2:1
300:150
(Can also be 3+ to 1 ratio)

Question 31

What is the difference between V-fib and V tach?

Answer 31

V fib will have narrow QRS waves (All Supraventricular Tachycardias)

Question 32

What is unique about Atrial Fibrillation?

Answer 32

Most common Arrhythmia in the US

F waves make a variable baseline from coarse to Isoelectric

Question 33

What are the risks of A fib?

Answer 33

Thrombo-embolic Stroke

Question 34

What is the difference between coarse and fine Atrial fibrillation?

Answer 34

Has to do with the appearance of the baseline

Question 35

Where is the Best place to look at P waves?

Answer 35

Lead 2

Question 36

What is unique about P waves in Atrial Fibrillation.

Answer 36

No P waves in A-fib

Question 37

What is the criteria for “Low Voltage”?

Answer 37

R waves are