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Clinical Patient Care 2023 > Ventricular Arrhythmias And BBB > Flashcards

Ventricular Arrhythmias And BBB Flashcards

1
Q

Where do SUPRAventricular rhythms send their impulse to, and what is the QRS complex characteristics?

A
  1. Send impulse through AV node and into the conduction system
  2. Narrow QRS duration
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2
Q

Where do ventricular rhythms originate from, and what is the QRS complex characteristics?

A
  1. Originate below the bundle of HIS or the ventricular myocytes
    *There will be lower conduction
    *flows in retrograde fashion
  2. Wide QRS duration
    *>0.12
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3
Q

What is the major characteristics of Ventricular Arrhythmias?

A
  1. There will be changes in ST segment and T waves
    *they will slope in the opposite direction of the main QRS deflection
  2. Ventricular repolarization is also abnormal
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4
Q

What are the different types of ventricular arrhythmias?

A
  1. Premature ventricular contractions (PVCs)
  2. Ventricular Tachycardia (VT)
  3. Ventricular Fibrillation (VF)
  4. Idioventricular rhythm
  5. Accelerated idioventricular rhythm
  6. Ventricular standstills (asystole)
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5
Q

Where do PVC arise from?

A
  1. Below the bundle of HIS in the ventricle
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6
Q

What are the PVC characteristics (QRS)?

A
  1. QRS is premature
  2. QRS is wide >0.12
  3. QRS morphology is different from QRS in underlying rhythm
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7
Q

What are the PVC characteristics (P-wave)?

A
  1. Sinus (BR)
    *can be obscured within PVC
    *can appear just before or in the ST segment of T wave
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8
Q

What are the PVC characteristics (ST segment and T wave)?

A
  1. ST segment and T wave slope in the opposite direction from the main QRS
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9
Q

What are the patterns of then PVCs?

A
  1. Every other beat = Bigeminy
  2. Every third beat = trigeminal pattern
  3. Every fourth beat = quadrigmeinal pattern
  4. Pairs = couplets
  5. Runs = 3 or more PVCs in a run constitutes a pattern
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10
Q

What are the PVC rhythms that have more >3 PVCs in a row?

A
  1. Idioventricular rhythm
    *30-45 beats per minute
  2. Accelerated idioventricular rhythm
    *40-100 beats per minute
  3. Ventricular tachycardia
    *140-250 beats per minute
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11
Q

What are the different type of morphology a PVC could have?

A
  1. Unifocal
  2. Multifocal
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12
Q

What is a Unifocal PVC?

A
  1. Originates from a single focus
  2. The PVC look identical in the same lead
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13
Q

What is a Multifocal PVC?

A
  1. Different morphologies in different leads
  2. The PVCs look different (arise from different foci)
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14
Q

What is an interpolated PVC?

A
  1. PVC occurring between beats that does not disturb underlying rhythm
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15
Q

What is a R-On-T PVC?

A
  1. PVC falling on the downslope of preceding T wave
    *may precipitate a malignant rhythm
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16
Q

Why do ventricular escape beats happen?

A
  1. The sinus node fails to produce an impulse AND
  2. Junctional tissue must fail to generate an impulse THEN
  3. The ventricular pacemaker then fires
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17
Q

What is the rate and rhythm of ventricular tachycardia?

A

Rate = 140-250bpm
Rhythm = regular
*can occur in short runs or as continuous rhythms

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18
Q

What are the ST segment and T wave characteristics of Ventricular Tachycardia

A
  1. They both slope in the opposite direction of the normal QRS complexes
19
Q

What is the rate of ventricular flutter?

A

Rate = >250bpm
*looks like v-tach except for the rate
*there is no cardiac output

20
Q

What is the difference between “non-sustained” and “sustained” VT

A

Non-sustained = VT lasts <30secs
Sustained = VT last >30secs
*life-threatening

21
Q

What do you call VT if there are 3 or more CONSECUTIVE PVCs

A

Run/burst of nonsustained VT

22
Q

What is Torsades DE Pointe?

A
  1. Polymorphic ventricular tachycardia
    *the QRS complexes gradually gets narrow and wider
    *There will be varying amplitudes of the QRS complexes
23
Q

What is the treatment for Torsades De Pointe?

A
  1. Magnesium
  2. Defibrillation
24
Q

What is the difference between course VF and Fine VF?

A

Course
1. Usually more irregular
2. More of a recent onset
Fine
1. resembles asystole
2. Check multiple leads
3. Will progress to asystole without treatment

25
Q

What is the treatment for V-Fib

A
  1. CPR
  2. Defibrillation
26
Q

What is the rate and rhythm of “idioventricular” rhythm

A

Rate = 30-40bpm (sometimes less)
Rhythm = regular

27
Q

What are the P-wave characteristics of Idioventricular rhythm?

A

Absent

28
Q

What is the PR interval duration of idioventricular rhythm?

A
  1. NA
29
Q

What is the QRS duration for Idioventricular rhythm?

A
  1. Wide >0.12
30
Q

What is the rate and rhythm of Accelerated Idioventricular rhythm?

A

Rate = 40-100bpm
Rhythm = regular

31
Q

What is the P-wave characteristics and PR duration of Accelerated Idioventricular rhythms?

A

P-waves= Absent
PR = NA

32
Q

What is the QRS duration for Accelerated Idioventricular Rhythms

A

Wide >0.12secs

33
Q

What is ventricular standstill?

A
  1. Absence of electrical activity in ventricles
    *No QRS complexes
34
Q

What are the two presentations of ventricular standstill? (Asystole)

A
  1. P-waves with no QRS complexes
  2. Straight line
35
Q

What is a BBB?

A
  1. A BBB is caused by a block in right or left bundle branch
    *The depolarization to the ventricles will be delayed
36
Q

What causes the R R’

A
  1. The ventricles are contracting asynchronously so
  2. One ventricle depolarizes slightly later than the other
  3. Which causes two “joined QRS”
37
Q

If there is a BBB what must happen next?

A

Need to determine if it is a right or left BBB
*obtain a 12 lead EKG

38
Q

Which leads will show a Right BBB?

A

V1
V2
*will have a more prominent R R’

39
Q

What leads show a Left BBB?

A

V5
V6
*less prominent R R’ (depolarization of the left ventricle)

40
Q

What is the rate and rhythm of a BBB?

A

Rhythm = regular
Rate = that of the underlying rhythm (sinus)

41
Q

What is the P-wave characteristics and PR duration for BBB?

A

P= Sinus
PR = normal (0.12-0.20)

42
Q

What is the QRS duration for BBB?

A

Wide

43
Q

Can vector and hypertrophy be determined accurately in the presence of a BBB?

A

NO

44
Q

What are capture and fusion beats?

A

BOTH HAPPEN DURING V-tach
Capture: ventricular conduction system is receptive during V-tach and will produce a normal appearing QRS complex
Fusion: Blending of a normal QRS with a PVC like complexes

Clinical Patient Care 2023 (33 decks)

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