SMP - Cardiopulmonary Exam 1 > CC 1 - Arrhythmia > Flashcards

CC 1 - Arrhythmia Flashcards

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1
Q

What 4 questions should we ask ourselves to identify arrhythmias?

A
  1. Are the P waves normal?
  2. In the QRS wide or narrow?
  3. What is the relationship between the P wave and the QRS complex?
  4. Is the rhythm regular or irregular?
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2
Q

Sinus tachychardia pattern?

A
  1. Are the P waves normal?
    YES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR

=> all normal except elevated HR (above 100 bpm)

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3
Q

PAC pattern?

A
  1. Are the P waves normal?
    NO, DIFFERENT SHAPE (more spiky)
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    REGULAR
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4
Q

What does PAC stand for?

A

Premature Atrial Contraction

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5
Q

Junctional rhythm pattern?

A
  1. Are the P waves normal?
    NONE OR NEGATIVE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    REGULAR AND NORMAL RATE
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6
Q

What are we talking about when we talk about anything that is junctional?

A

AV node

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7
Q

Would atrial depolarization be possible during junctional rhythm? If so, what would that look like on an EKG?

A

YES!

Would be a negative P wave right after the QRS because could go back up to the SA node after ventricular depolarization

May also be buried in the QRS and be completely absent

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8
Q

What is sinus arrhythmia? What is it due to?

A

Irregular beat generated by the SA node

Due to different vagal stimulation happening on a respiratory pattern

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9
Q

Sinus arrhythmia pattern?

A

LOOK AT RYTHM STRIP:

  1. Are the P waves normal?
    YES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    IRREGULAR
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10
Q

What is atrial flutter?

A

Re-entry counter-clockwise circuit in the RA going 300 bpm causing RA and LA depolarization

AV node protects the ventricles from this very fast bpm by only conducting a certain ratio of the depolarization cycles in a regular or irregular pattern (2:1 in young healthy people)

Overall there is a dissociation of rates between the atria and the ventricles

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11
Q

Atrial flutter EKG pattern?

A
  1. Are the P waves normal?
    NO: FAST, NEGATIVE = SAW-TOOTH PATTERN P WAVES (SOME MISSING BECAUSE BURIED IN QRS COMPLEXES)
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    REGULAR OR IRREGULAR BUT LESS QRS COMPLEXES THAN P WAVES
  4. Is the rhythm regular or irregular?
    REGULAR OR IRREGULAR
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12
Q

What would happen if the 300 bpm in the atria was conducted to the ventricles during atrial flutter?

A

Ventricles would not fill with blood = death

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13
Q

What are the best leads to look at P waves?

A

Inferior leads

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14
Q

What is atrial fibrillation?

A
  1. Atrial depolarization patterns are abnormal: electrical circuits = disorganized wavelets which do not communicate and have no pattern => NO ATRIAL CONTRACTIONS
  2. In pulmonary veins there are triggers that start firing (might be the ones getting the wavelets going) – disorganized electrical activity
  3. AV node protects the ventricles from this very fast bpm by only conducting a certain ratio of the depolarization cycles in an irregular pattern because it’s receiving irregular signals
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15
Q

Atrial fibrillation pattern?

A
  1. Are the P waves normal?
    CLOSE TO NONE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    IRREGULARLY IRREGULAR
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16
Q

Difference between HR and heart rhythm?

A

The heart rate is the number of times the heart beats in a minute.

The heart rhythm is the pattern of the heart beat.

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17
Q

What is the classic irregular heart rhythm?

A

A-fib

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18
Q

What is multifocal atrial tachychardia?

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A

At least 3 foci in the atria are signaling at a fast rate to the other atrial cells

19
Q

Multifocal atrial tachychardia EKG pattern?

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A
  1. Are the P waves normal?
    NOPE, DIFFERENT KINDS OF P WAVES WITH DIFFERENT SHAPE/POLARITY (AT LEAST 3) = 3 MORPHOLOGIES
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    1: 1
  4. Is the rhythm regular or irregular?
    IRREGULAR
20
Q

What does SVT stand for?

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A

Supraventricular tachycardia

21
Q

What is SVT? Mechanism? What arrhythmias does this include? What to note?

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A

An umbrella term used to describe atrial and/or ventricular tachycardias with rates in excess of 100 bpm at rest: very narrow, rapid, and regular rhythm

Mechanism: increased rate generated by tissue from the His bundle or above.

Includes:

  1. Sinus tachycardia
  2. Atrial tachycardias (focal and multifocal)
  3. Atrial flutter
  4. Junctional tachycardia
  5. AV nodal re-entry tachychardia (AVRT)

Note: while atrial fibrillation is technically an SVT, the term does not generally include Atrial Fibrillation

22
Q

What is a subtype of AVRT? Explain it.

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A

Wolff–Parkinson–White syndrome (WPW syndrome): accessory pathway is on the lateral wall of the heart between the LV and the LA

23
Q

Describe AVRT.

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A

Re-entry circuit: AV node => His-Purkinje system => ventricular myocytes => accessory pathway of abnormal tissue connecting the atria and ventricles (developed in utero) => atria

24
Q

AVRT EKG pattern?

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A
  1. Are the P waves normal?
    NONE
  2. In the QRS wide or narrow?
    NARROW
  3. What is the relationship between the P wave and the QRS complex?
    N/A
  4. Is the rhythm regular or irregular?
    REGULAR AND FAST
25
Other name for delta wave?
Pre-excitation wave
26
What is the pattern on the EKG when you have abnormal tissue connecting the atria and ventricles?
Delta waves: up-slur of the QRS complex because as the atria contract the signal goes down through 2 different pathways => combination of the 2 is the delta wave
27
What does PVC stand for?
Premature ventricular contraction
28
What is PVC?
An area or more of the ventricle fires outside of the conduction system and depolarizes the ventricles
29
PVC EKG pattern?
1. Are the P waves normal? NORMAL 2. In the QRS wide or narrow? WIDE AND PREMATURE 3. What is the relationship between the P wave and the QRS complex? IRREGULAR 4. Is the rhythm regular or irregular? IRREGULAR
30
Ventricular tachycardia (VT) EKG pattern?
1. Are the P waves normal? NONE 2. In the QRS wide or narrow? WIDE 3. What is the relationship between the P wave and the QRS complex? N/A 4. Is the rhythm regular or irregular? REGULAR BUT FAST RATE
31
What is always true on an EKG if the signal is coming from someplace in the ventricles?
WIDE QRS complex
32
What arrhythmia do people die from during heart attacks?
Ventricular fibrillation causing ischemia
33
What is ventricular fibrillation?
Disorganized rhythm with ventricular foci firing all over the place and very fast=> No pulse and heart cannot fill with blood
34
Ventricular fibrillation EKG pattern?
1. Are the P waves normal? NONE 2. In the QRS wide or narrow? NARROW 3. What is the relationship between the P wave and the QRS complex? NA 4. Is the rhythm regular or irregular? IRREGULAR and FAST
35
Sinus bradycardia EKG pattern?
1. Are the P waves normal?YES 2. In the QRS wide or narrow? NARROW 3. What is the relationship between the P wave and the QRS complex? 1: 1 4. Is the rhythm regular or irregular? REGULAR BUT SLOWER
36
What is bradycardia by definition?
HR < 60 bpm
37
What is a first degree AV block?
1. Are the P waves normal? YES 2. In the QRS wide or narrow? NARROW BUT LONGER PR INTERVAL (>200 ms) 3. What is the relationship between the P wave and the QRS complex? 1: 1 4. Is the rhythm regular or irregular? REGULAR
38
Is the irregular P wave seen in PAC generated by the SA node?
NOPE
39
What does intermittent jugular venous pulse mean?
Complete heart block because the atria are sometimes contracting against mitral valves
40
When there is a disconnect between the atria and ventricles contracting, which do you pick for HR?
Ventricular rate of contraction = HR
41
What would an "occasionally" explosive S1 mean?
Complete heart block because the AV valve closes on a different amount of blood each time
42
What often causes syncope?
Heart blocks
43
What type of second degree AV block is bad?
Type II
44
How is SV affected by AV block?
Increased because ventricles do not fire as frequently as atria
SMP - Cardiopulmonary Exam 1
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