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ALU 301 > ELECTROCARDIOGRAPHY AND CARDIAC ARRHYTMIAS > Flashcards

ELECTROCARDIOGRAPHY AND CARDIAC ARRHYTMIAS Flashcards

1
Q

Which four condition does the heart need to function properly?

A
  1. Contraction of the muscle cells must occur at regular intervals and be synchronized
  2. Ventricular contraction must be forceful
  3. Heart valves must be competent allowing one-directional flow
  4. Ventricles must fill adequately during systole
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2
Q

What are the two different system of cells in the heart?

A

Myocardial cells and pacemaker cells

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3
Q

What does the myocardial cells do?

A

Generate the contractile force necessary to propel blood through cardiac system

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4
Q

What does pacemaker cells do?

A

Provide electrical stimulus necessary to initiate contraction

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5
Q

What are the four components of the conduction system?

A

Sinoatrial node/sinus node
atrioventricular node
Bundle of His
Purkinje Fibers

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6
Q

Where and what does the sinoatrial node do?

A

Superior/Posterior wall of right atrium
Initiate each electrical impulse and governs the heart rate.

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7
Q

Where and what does the atrioventricular node do?

A

Located at the AV junction
It delays the transmission to bundle of HIS so it allows the valves to open.

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8
Q

Where and what does the bundle of His do?

A

Septum and divides into the right bundle branch and the left bundle branch.
Allows the impulse to be rapidly transmitted throughout ventricles.

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9
Q

Where and what does the Purkinje fibre do?

A

Network of conducting strands that lie beneath endocardium.
Responsible for conduction of impulses of the myocardial cells.

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10
Q

What does the P wave represents?

A

Atrial depolarization

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11
Q

What are some characteristic of the P wave?

A

Gently rounded
Less than 3mm, width less than 0.11 sec
Normally upright in leads I,II, AVF and V4 though V6
Negative AVR and can be in V1

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12
Q

What does PR interval represent?

A

Time required for depolarization of the atria to the onset of depolarization of the ventricles.

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13
Q

What are some characteristic of the PR interval?

A

Measured fro beginning of P wave to beginning of the QRS.
Normal Range 0.12-0.2 second.

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14
Q

What does the QRS complex represent?

A

Ventricular depolarization.

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15
Q

What are some characteristic of the QRS interval?

A

Less than 0.1 sec
Duration 0.1-0.11 sec is incomplete BBB
Greater than 0.12 is complete BBB or intraventricular conduction abnormality.

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16
Q

What are some characteristic of the ST segment?

A

Horizontal and isoelectric
ST elevation or depression of 1mm or more can show underlying cardiac pathology
Slight displacement of the ST segment can occur as normal

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17
Q

What does the ST segment represents?

A

Completion of ventricular depolarization and beginning of ventricular depolarization.

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18
Q

What does the T wave represent?

A

Ventricular Repolarization

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19
Q

What are some characteristic the T wave?

A

Same direction of QRS complex
Slightly rounded and asymmetrical, smooth take off
minor or flat
abnormal if invested

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20
Q

What are some characteristic
of the QT interval?

A

Measured from beginning of the QRS to the end of the T wave
normal ranges 0.35-0.45secs

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21
Q

What does the QT interval represents?

A

Total time required for both repolarization and repolarization.

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22
Q

What is the U wave?

A

Small deflection following T wave, significance unknown!

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23
Q

You’re doing great!

A

Keep Going!

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24
Q

EKG Criteria for sinus Rhythm?

A

HR 60-100
P waves: identical/normal, regular rhythm, consistent PR interval of 0.1-0.2 sec
Each P wave is followed by QRS complex

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25
Q

Sinus arrhythmia is?

A

normal varian of sinus rhythm.
HR increases during inspiration and decreases with expiration.
Normal P wave followed by normal QRS complexes.

26
Q

Atrial Arrhytmias is defined by ?

A

A Variation from the normal rhythm of the heart, encompassing abnormalities of rate, regularity, site of impulse origin, and sequence of activation.

27
Q

Atrial Arrhythmia occurs as a result of which ectopic impulse?

A

Atria but not by the SA node.

28
Q

Criteria for PAC are?

A
  1. Impulse occurs prior to the next expected sinus impulse
  2. P wave morphology is abnormal
  3. PR interval is inconsistent
29
Q

What is atrial tachycardia?

A

Paroxysmal/sudden onset, rapid rhythm originating from ectopic foci in the atria and outside the SA node.

30
Q

In atrial Tachycardia, the rate is rapid, but is the rhythm regular?

A

It is regular, 1 P wave for 1 QRS complex.

31
Q

What are treatments for atrial tachycardia?

A

Beta-blockers, antiarrhytmics, calcium channel blockers and digoxin.

32
Q

AF is described as irregular rhythm, what are the EKG findings?

A
  1. irregular R-R intervals
  2. loss of P waves
  3. fine, fibrillary waves along baseline
  4. QRS complexes are normal except when conduction through the ventricles is abnormal
  5. ST-T wave abnormalities can be due to abnormal repolarization, rate-induced schema or medication effects.
33
Q

Causes of AF includes?

A
  1. age
  2. valvular and congenital disease
  3. cardiomyopathy
  4. Sick sinus syndrome
  5. hypertension
  6. pulmonary disease
  7. alcohol use
    8 hyperthyroidism
  8. idiopathic causes
34
Q

Complications of AF?

A

Embolic strokes and ischemia/infarction.

35
Q

AF: one complication are schema and infarction, why does it impairs it?

A

a) incomplete emptying of the atria
b) reduced filling of the ventricles
c) inadequate emptying of the ventricles during systole

36
Q

What are treatments for AF?

A

Medications
Anti-platelet/coagulants for stroke/thrombus protection
Catheter ablation of focal triggers of AF
Surgical ablation
Pacemaker

37
Q

What occurs as a result of an early impulse discharging from ectopic focus in the ventricle?

A

Premature ventricular contraction/PVC

38
Q

What are the EKG characteristics of a PVC?

A
  1. impulse is early
  2. no p wave
  3. QRS complex is wide and abnormal
  4. often compensatory pause
39
Q

What determines the significance of PVCs?

A
  1. frequency
  2. pattern (bigemy/trigemy etc)
  3. morphology
  4. presence during exercise
    proximity to the previous T wave
40
Q

What are heart blocks?

A
  1. Sick Sinus Syndrome
  2. Sinoatrial Block/Arrest
  3. AV Blocks
41
Q

What is a first-degree AV block characterized by?

A

Perisistently prolonged PR interval of more than 0.2 sec that occurs due to a partial block within the AV node.

42
Q

What is a second-degree AV block/Mobitz type 1?

A

A disorder of intermittent conduction between the atria and ventricles.

43
Q

What’s a second-degree AV block/Mobitx type 2?

A

Intermittent and sudden loss of conduction between the atria and ventricles for one or more cardiac cycles.

44
Q

What is a third degree AV block?

A

Complete absence of conduction between atria and ventricles.

45
Q

EKG findings of third degree AV block?

A
  1. consistent P-P intervals
  2. consistent R-R intervals
  3. atrial rate is different than the ventricular rate
  4. no relationship between P waves and QRS complexes because SA node and ventricular escape pacemaker are firing independently.
46
Q

Causes of third-degree AV block?

A
  1. drugs
  2. excessive vagal tone
  3. acute MI
  4. age-related degeneration of the conduction system
  5. congenital disorder
47
Q

An abnormal axis LAFB can be normal or show?

A
  1. hypertensive heart disease
  2. coronary artery disease
  3. aortic valve disease
  4. degenerative fibrotic disease
  5. emphysema
48
Q

Right axis deviation/RAD can be normal in children and tall/thin adults, or show?

A
  1. chronic lung disease
  2. atrial or ventricular septal defect
  3. right ventricular hypertrophy
  4. left posterior hemiblock
49
Q

What does bundle branch blocks represents?

A

Defect in intraventricular conduction.

50
Q

What causes complete right bundle branch block?

A
  1. Right ventricular hypertrophy
  2. atrial septal defect
  3. CAD
  4. chronic lung disease
51
Q

Hallmark of a BBB?

A

Abnormally wide QRS complex (more than 0.12 sec)

52
Q

CRBBB in isolation isn’t significant, but adding those TWO what makes it more likely to be CAD?

A

left anterior OR posterior fascicular block.

53
Q

Left bundle branch block/LBBB results from a conduction delay or block within the left bundle branch, and can be caused by?

A
  1. left ventricular hypertrophy LVH
  2. Cardiomyopathy
  3. hypertension
  4. CAD
54
Q

Fascicular blocks represent disturbed conduction in either the anterior or posterior division, or fascicle of the LBB. LAFB is the most common one, can be cause by?

A
  1. CAD
  2. Myocardial infarction
  3. congenital heart disease
  4. prior cardiac surgery.
55
Q

EKG characteristic for LAFB are?

A
  1. QRS duration can be slightly prolonged 0.08-0.11
  2. left axis deviation
  3. small Q wave and tall R wave in leads I and AVL
  4. small R wave and deep S wave in leads II III and AVF
  5. poor R wave progression
56
Q

EKG criteria for LPFB?

A
  1. QRS duration can be slightly prolonged
  2. right axis deviation between 90-180 degrees
  3. small Q wave and tall R wave
  4. small R wave and dip S wave in I and AVL
57
Q

Common causes of atrial enlargement?

A
  1. valvular stenosis or regurgitation
  2. Congenital heart defects
  3. chronic pulmonary disease
58
Q

Myocardial ischemia is represented on the EKG by which wave

A

the T-wave

59
Q

Myocardial injury is represented by what in an EKG?

A

ST elevation and myocardial ischemia by ST depression

60
Q

What does WPW syndrome represents?

A

Form of ventricular pre excitation in which the ventricles are depolarized using both a congenital accessory bypass tract and normal AV conduction pathways.

61
Q

What is Lown-Ganong-Levine Syndrome?

A

Intranodal bypass tract syndrome, often accompanied by recurrent SVT.

62
Q

Prolonged QT syndrome represents?

A

Time it takes for depolarization and repolarization of the ventricles during one cardiac cycle.

ALU 301 (10 decks)

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