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ECG > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What is the cardiac axis?

A

The average direction of electrical activity within the heart during ventricular depolarisation

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2
Q

What leads are used to determine the heart’s axis?

A

6 frontal leads

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3
Q

Left axis deviation has an angle of what?

A

beyond -30 degrees

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4
Q

Causes of left axis deviation?

A
  1. right sided WPW
  2. left anterior hemi-block
  3. inferior myocardial infarction
  4. ventricular tachycardia
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5
Q

Can left ventricular hypertrophy cause LAD?

A

Yes, but not because of increased muscle mass but instead left anterior hemi-block due to fibrosis

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6
Q

Most common cause of left axis deviation?

A

left-anterior hemi block

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7
Q

Block of the RBB and left anterior hemi block is called what?

A

A bifascicular block

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8
Q

Why does inferior MI cause LAD?

A

Fibrotic tissue doesn’t conduct activity and so the cardiac axis becomes directed away from this

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9
Q

How does left ventricular tachycardia cause left axis deviation?

A

When an electrical impulse arises in the LV, the wave of depolarisation spreads through the rest of the myocardium from that point, resulting in LAD.

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10
Q

When is right axis deviation diagnosed?

A

+ 90 degrees

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11
Q

What is ventricular asystole?

A

Ventricular standstill - no electrical activity in the heart - no cardiac output

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12
Q

What does asystole look like on the ECG?

A

A flat line

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13
Q

What is the immediate treatment for asystole?

A

CPR

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14
Q

Should asystole be confirmed in more than one lead?

A

Yes

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15
Q

What is another name for asystole

A

Arrhythmia of death - client is in cardiopulmonary arrest

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16
Q

What is sinus bradycardia?

A

Sinus rhythm below 60bpm - originating in SA node

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17
Q

Heart rate must be below what to be a contraindication to EECG?

A

40 bpm unless they are extremely fit individuals

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18
Q

What group of people might get bradycardia?

A

Athletes - increase in vagal tone

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19
Q

By what mechanism does vagal done reduce HR?

A

Vagal done reduces the automaticity (speed of depolarisation) of pacemaker cells

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20
Q

What are the 3 characteristics of sinus bradycardia?

A
  1. P wave proceeds QRS complex
  2. P wave is upright in lead II and inverted aVR
  3. HR is less than 60bpm
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21
Q

Causes of bradycardia?

A
  1. Drugs (digoxin and beta-blockers)
  2. Hypothyroidism
  3. ischemic heart disease/MI - AV node/Purkinji fibre escape rhythms
    4.
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22
Q

When is treatment for bradycardia significant?

A

when CO becomes reduced

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23
Q

What are the symptoms of reduced CO?

A

hypotension, syncope, dizziness,

24
Q

Can bradycardia predispose individuals to more serious arrhythmias?

A

Yes, e.g. V.fib as irritable focus has an opportunity to fire

25
Q

In acute inferior wall MI, is bradycardia a good or bad prognosis?

A

Good unless it’s associated with hypotension

26
Q

What drugs can enhance HR?

A

Dopamine, atropine and adrenalin

27
Q

What are 4 non-cardiac causes of sinus bradycardia?

A

(1) increased intracranial pressure (2) glaucoma (3) sleep (4) hypothermia

28
Q

What is ventricular tachycardia?

A

3 or more successive beats of HR > 120bpm

29
Q

Is ventricular tachycardia wide or narrow QRS complex?

A

Wide

30
Q

What causes ventricular tachycardia?

A

Re-entry or increased automaticity of ventricular foci

31
Q

A ventricular tachycardia episode is considered sustained if it’s longer than?

A

30 seconds

32
Q

What are the two characteristics of ventricular tachycardia?

A
  1. broad QRS

2. Ventricular rate above 120 bpm

33
Q

Sustained VT usually has a rate between what?

A

150-250bpm

34
Q

How might VT be corrected?

A
  1. drugs
  2. DV cardioversion
  3. pacing
35
Q

What is torsade de points?

A

A variant of polymophic ventricular tachycardia, associated with a prolonged QT interval

36
Q

What does torsade de points carry the risk of?

A

Abrupt deterioration into v. fib

37
Q

What is ventricular fibrillation?

A

A chaotic pattern of electrical activity within the ventricles originating from a number of foci

38
Q

What is the mechanical consequence of V.fib?

A

No co-ordinated muscular contraction and therefore reduced CO

39
Q

How does V.fib appear on the ECG?

A

Fibrillatory waves and no intervals can be determined

40
Q

Are smaller or larger fibrillatory waves better prognosis and why?

A

Large - they are easier to converted back to sinus rhythm as there is more electrical activity within the heart.

41
Q

Is an individual in V.fib in full cardiac arrest?

A

Yes, the ventricles are not delivery blood to the body, no pulse will be measurable

42
Q

What can mimic v.fib?

A

Interference from electric razor and muscle movement

43
Q

How do you treat v.fib?

A

Defibrillation

44
Q

What is sick sinus syndrome?

A

Abnormalities in the generation and conduction of impulses from the SA node

45
Q

What are 4 causes of v.fib?

A

(1) myocardial ischemia (2) electric shock (3) untreated ventricular tachycardia (4) myocardial infarction

46
Q

what is another name for sick sinus syndrome?

A

Sinus nodal dysfunction

47
Q

How does sick sinus syndrome usually present?

A

Bradycardia with episodes of sinus arrest interspersed with sudden atrial fib.

48
Q

What does sick sinus syndrome arise?

A

Dysfunction of SA node’s ANS due to degeneration

49
Q

Causes of SSS?

A
  1. fibrosis of SA node (age, atherosclerosis, hypertension)
  2. Trauma to SA node due to surgery/pericarditis
  3. drugs - digoxin, beta-blockers, calcium channel blockers
50
Q

What is a bad prognosis in SSS?

A

When atrial fibrillation is present

51
Q

Sinus tachycardia rate?

A

above 100bpm

52
Q

In sinus tachycardia what should be reduced?

A

In take of stimulants

53
Q

Symptoms of sinus tachycardia?

A

(1) anxiety (2) reduced CO (3) palpitations (4) chest pain

54
Q

Is tachycardia considered good or bad following MI?

A

bad - signals massive heart damage - seen in around 30% of people

55
Q

Causes of tachycardia

A

(1) hemorrage, hypovolemia
(2) heart failure, MI,
(3) compensatory mechanism in shock, anaemia, hyperthyroidism

ECG (8 decks)

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