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Cardiology YR3 > ECG - Rhythms > Flashcards

ECG - Rhythms Flashcards

1
Q

3 things to check with rhythms

A
  1. What are the atria doing?
  2. What are the ventricles doing?
  3. Relationship between the ventricles and atria?
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2
Q

Best leads to check for atria activity

A

V1 and lead II - anatomically closest to heart

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3
Q

Two types of bradycardia

A

Sinus bradycardia
AV block bradycardia

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4
Q

What is chronotropic incompetence?

A

Inability for heart to speed up when needed eg when exercising

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5
Q

Causes of sinus bradycardia

A
  • Sick sinus syndrome / inappropriate sinus bradycardia
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6
Q

When do we insert pacemaker for bradycardia?

A
  • Treat when symptomatic
  • Dizzy/blackouts + sinus pause for more than 3 seconds in the daytime (more than 3 seconds between P waves)
  • OR chronotropic incompetence - if cannot get HR above 75
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7
Q

How do pacemakers work?

A
  • 2 wires
  • One in RA one in RV
  • Enter via subclavian or axillary veins percutaneously - stay within veins to ensure no clots etc enter arterial system
  • Electrodes listen for P waves and QRS complexes
  • If none - they kick in
  • Have a set demand rate for 60bpm
  • We do not pace continiously as pacing causes LBBB (due to wires being on R) can mess up left ventricle
  • Pacemakers contain rate responsive element which means demand rate can change 60-130bpm depending on movement
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8
Q

What should you always rule out as causes of bradycardia rather than a cardiac problem?

A
  • Medication eg bisoprolol, diltiazem, memantine, timolol eye drops
  • Hypothyroidism
  • Addisons
  • Anorexia nervosa
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9
Q

3 types of AV nodal block

A
  • 1st degree - PR prolongation
  • 2nd degree - Mobitz type 1 (Wenckebach) Mobitz type 2
  • 3rd degree - complete heart block
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10
Q

What is 2nd degree heart block Wenckeback (type 1)?

A
  • Gradual PR prolongation then QRS drop (drop a beat)
  • Usually a benign phenomena
  • Due to increased vagal tone which blocks AV node
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11
Q

What is 2nd degree heart block mobitz type 2?

A
  • PR is fixed but prolonged, sudden drop of QRS
  • Something wrong with AV node
  • 2:1 ratio sometimes
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12
Q

Which AV node blocks need pacemaker?

A

Complete heart block
2nd degree Mobitz Type 2

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13
Q

What is complete heart block?

A
  • Complete block of AV node conduction - no atrial impulses through
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14
Q

What happens in complete heart block?

A
  • Automaticity of cardiac cells are always there
  • These take over if there is no AV nodal depolarisation
  • Escape rhythm (should be called rescue rhythm) takes over
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15
Q

Different origins of escape rhythm

A
  • If from ventricle just below AV node - QRS will still be narrow and HR will be 45-55 - this is ok
  • If from middle ventricles - 35bpm
  • If from apex of ventricles - BROAD QRS and HR 20-35pm - NOT stable
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16
Q

When to call cardiologist for 3rd degree heart block for urgent pacemaker?

A
  • Ask pt if lost conscioussness or nearly lost consciousness - if yes CALL
  • Check how fast and how broad QRS - if BROAD and slow - CALL
  • If narrow and fast rate - this is ok, can wait until morning
17
Q

When is AF + complete heart block on ECG?

A
  • AF rhythm is always irregular
  • If rhythm is still regular with AF - complete heart block is present
18
Q

What is bigeminy on ECG?

A
  • Normal beat with extra beat and then pause
  • Can indicate heart is unhappy
  • If after MI signals that VT will be soon
  • Can also get trigeminy if normal beat normal beat extra beat and pause
19
Q

4 types of tachyarrhythmias

A
  • Narrow complex - irregular and regular
  • Broad complex - irregular and regular
20
Q

Examples of narrow complex regular tachycardia

A
  • Sinus tachycardia
  • SVT - orthodromic AVRT or AVNRT
  • Atrial flutter

atrioventricular re-entrant tachycardia + AV nodal RT

21
Q

What is orthodromic atrioventricular re-entrant tachycarda (AVRT)?

A
  • Accessory pathway - AV node and accessory pathway conduct to ventricles
  • Same speed at each ‘attack’
  • Adrenergic state can maybe change speed
  • Often happens when bend and stand back up
  • Accessory pathway goes down AV node and back up (normal direction)
22
Q

What is atrioventricular node re-entrant tachycardia?

A
  • Accessory pathway through AV node - two ways through
  • Circuit is smaller
  • Benign often
23
Q

How to tell difference between orthodromic AVRT and AVNRT?

A
  • In orthodromic AVRT there will be retrograde P waves after QRS comples
  • Retrograde P waves are inverted btw ella
24
Q

What is electrical alterans?

A
  • Alternating QRS complex amplitudes in any or all leads
  • Signal of poor ventricular output
25
Q

Typical atrial flutter pattern

A
  • Flutter usually at 300bpm
  • usually conducted at 2:1 - HR will be 150
  • 3:1 - HR will be 100
  • 4:1 - HR will be 75
26
Q

Atypical flutter

A

Rhythm can be 240-350
Problem occurs if AV node lets HR of 240 through to ventricles

27
Q

Narrow complex irregular tachycardia examples

A
  • Atrial fibrillation
  • Atrial flutter with variable conduction - occurs when drugs to block AV node have been given
28
Q

Examples of broad complex regular tachycardias

A
  • Antidromic AVRT - rare
  • Ventricular tachycardia
  • SVT plus abberancy (conduction block)
29
Q

How to tell the difference between VT and SVT + BBB?

A
  • In VT there will be atrioventricular dissassociation - can have capture beats in ECG when atria capture ventricles and cause a narrow QRS complex AND P waves can change shape of QRS - not all uniform
  • In SVT + BBB QRS will all be uniform, atria and ventricles will be working together
30
Q

Example of VT with capture beat

A
31
Q

Examples of broad complex irregular tachycardia

A
  • Pre-excitation AF
  • Torsade de pointes
32
Q

What is pre-excitation AF?

A
  • AF occurs alongside accessory pathway meaning some beats are allowed through AV node
  • Ventricles are pre-excited leading to VF
  • MUST stay in hosp until ablated
33
Q

What is torsade de pointes?

A
  • Form of VF occuring only in context of prolonged QT
  • Can self terminate - only VF which can do this
  • Depolarisation is whizzing around in one spot
34
Q

Cause of prolonged QT which can cause torsade de pointe

A
  • Ischaemia
  • Clarithrymycin/erythromycin
  • Ciprofloxacin
  • Sertraline
  • Haloperidol
  • Amiodarone
  • Chlorpromazine
35
Q
A

Cardiology YR3 (21 decks)

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