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aap upskill > ECG Arrthymias > Flashcards

ECG Arrthymias Flashcards

1
Q

What are the adverse signs of arrthymia?

A
  • Shock
  • Syncope
  • Heart failure
  • Myocardial ischemia
  • Extremes of heart rate
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2
Q

What is sinus bradycardia?

A

Where the electrical signal comes from the sino atrial node at a rate of less than 60.

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3
Q

What are the key 3 lead characteristics of Sinus Bradycardia?

A
  • Rate <60
  • Regular
  • Normal P wave andd PR interval
  • Normal QRS complex.
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4
Q

What are the potential causes of Sinus Bradycardia?

A
  • Physiological
  • Cardiac Origin (Sinus node disease)
  • Drug induced
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5
Q

What is sinus tachycardia?

A

When the electrical signal originates from the sino-atrial node at a rate greater than 100.

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6
Q

What are the causes of sinus tachycardia?

A
  • A Physiological response (Pain, fever or haemorrhage)
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7
Q

What does SVT indicate?

A

A pacemaker site that is above the ventricles but is not the SAN.

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8
Q

What are the likely pacemaker sites in SVT?

A

Atria/ Atrio-ventricular node.

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9
Q

What wave isn’t present in an SVT ECG?

A

P waves

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10
Q

Is SVT always constant throughout patient assessment?

A
  • False
  • SVT may be paroxysmal, Pt may have runs of SVT before returning to normal sinus.
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11
Q

What are the key features of an SVT rhythm?

A
  • Rate 150-220
  • Regular Rhythm
  • Abnormal/ Abscent P waves
  • P-R interval can’t be seen
  • Normal QRS interval
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12
Q

What is an Atrial Tachycardia?

A

Ectopic atrial Rhythm that is more than100 bp,.

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13
Q

What is the maximum rate of SVT in infants?

A

300

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14
Q

What is the rate of SVT in Adults?

A

150-220

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15
Q

What is the pulse rate of Atrial Tachycardia?

A

110 - 180

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16
Q

What are the features of atrial tachycardia?

A
  • 100-180
  • Regular Rhythm
  • Different P wave morphology, may merge into the previous T Wave
  • P-R interval often in normal range
  • Normal QRS.
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17
Q

What is a common ECG feature of Sinus Tachycardia, Supraventicular Tachycardia and Atrial Tachycardia?

A
  • Normal QRS complex
  • Rate over 100
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18
Q

What changes in the AV node during Atrial Tachycardia?

A
  • It doesn’t hold the electrical impulse
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19
Q

What are the likely outcomes of Patients in Atrial Tachycardia?

A
  • Hypotension
  • Poor Perfusion
  • Cerebral Hypoxia
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20
Q

Where is firing as a pacemaker during a PAC?

A
  • the Myocites in the left atrium, not the SAN.
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21
Q

What are the common causes of PACS?

A
  • Stress
  • ischemia
  • Atrial Enlargement
  • Caffine/ Nicotine
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22
Q

What are the features of PACs ?

A
  • Rate may be normal,
  • irregular Rhythm
  • P waves normal, but those before the PAC differ in morphology
  • QRS normal
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23
Q

What is affected if a PT is presenting with frequent PACs?

A

Reduced Cardiac output.

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24
Q

What is a common symptom of a PT presenting with PACs?

A

Palpitations

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25
Q

What is Atrial flutter?

A

When the SAN is firing off at a rapid rate, but the AVN blocks them (As the ventricles can’t respond to the rapid rate of signals) and sends the impulse back across the right atrium.

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26
Q

What shape is given in Atrial flutter?

A
  • Saw tooth appearance.
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27
Q

What are the causes of Atrial flutter?

A

Damage to the heart, increased sympathetic tone.

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28
Q

What are the features of Atrial flutter?

A
  • Atrial rate = 300+ per minute
  • No P waves
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29
Q

What may occur to a PT who is in Atrial flutter?

A
  • A reduced Cardiac output
  • Chest pain due to increased workload and reduced oxygenation
  • increased risk of stroke.
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30
Q

What is Atrial Fibrillation?

A

When electrical impulses fire off from around the atria.

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31
Q

What causes the irregular ventricular rates in patients with AF?

A

The inconsistent conduction at the AV node.

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32
Q

What are the causes of AF?

A
  • Heart disease
  • Congestive heart failure
  • Mitral Stenosis
  • Atrial infarction
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33
Q

What are the features of an AF Rhythm?

A
  • Atrial rate >360
  • Irregular rhythm
  • P waves not present
  • No identifiable PR interval
  • Normal QRS
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34
Q

What is Sinus Arrthymia?

A
  • Variation in heart seen during respiratory action. The rate increases during inspiration and decreases in expiration.
35
Q

What is normal during Sinus Arrthymia?

A
  • QRS complex
  • p wave presentation
  • P-R interval
36
Q

What is the regularity of Sinus Arrthymia?

A
  • irregular, variable rate depending on respiration rate.
37
Q

What is a Wandering Atrial pacemaker?

A

An irregular Rhythm created by multiple trial pacemaker sites.

38
Q

How many different p-wave morphological are found in wandering atrial pacemaker rhythms?

A
  • A Minimum of 3 different P wave
39
Q

What are the common causes of Wandering Atrial pacemaker?

A
  • Pt with an Enlarged atria
  • Pulmonary disease
  • Commonly benign
40
Q

What is Sinus Arrest?

A

Where there is a pause in rhythm due to a failure of the SAN

41
Q

What are the features of Sinus Arrthymia?

A
  • Complexes normal
  • Periods of no electrical activity
42
Q

What are the causes of Sinus Arrthymia?

A
  • increased Parasympathetic tone
  • Digoxin Overdose
  • Ischemic heart disease
43
Q

When is a Delta wave formed?

A
  • A Kent Bundle is formed and it bypasses the AVN.
  • This forms a superimposed wave with the normal wave of excitation
44
Q

Where is the delta wave found?

A

In the QR segment

45
Q

What are the ECG changes associated with Wolf Parkinson White syndome?

A
  • Delta wave
  • Shortened PR intervl
  • QRS complex >12
  • ST-T wave changes
  • Associated with Paroxysmal tachycardia
46
Q

How should a Pt be treated in sinus arrest if their rate is <50?

A

Treated as Bradycardic

47
Q

What is a junctional arrthymia?

A

Where the AVN becomes the natural pacemaker due to a faulty SAN.

48
Q

What are the different types of junctional Arrthymia?

A
  • High nodal
  • mid nodal
  • low nodal
49
Q

What is a high nodal junctional arrythmia?

A

When the AVN fires up into the atria then down in the bundle of his. Characterised by inverted P waves.

50
Q

What is a Mid-nodal junctional arrthymia?

A

When the AVN fires up into the atria and down into the ventricle at the same time. Characterised by a regular rhythm with P waves being hidden by the QRS.

51
Q

What is a low-nodal junctional arrthymia?

A

Where the AVN fires down to the bundle of his and up into the atria. The P wave is inverted after the QRS.

52
Q

What are the key characteristics of a junctional arrthymmia?

A
  • Rate - 40 and 60
  • Accelerated rate - 60 - 100
  • P waves absent or inverted
  • PR interval <0.12
53
Q

What are Premature Junctional contractions (PJC)?

A

Ectopic beat that originate from a focus in the AVN area.

54
Q

What are the characteristics of a PJC?

A
  • Rhythm is regular except the PJC (S)
  • P waves associated with the PJC will be inverted
55
Q

What are the common causes of PJC?

A
  • Drug Toxicity
  • Ichemia
  • Hypoxia
  • Electrolyte imbalance
55
Q

What are the likely outcomes of regular PJCs?

A
  • Palpitations
  • Reduced cardiac output
56
Q

What are premature ventricular contractions?

A

When the electrical impulse originates somewhere in the ventricular myocardium

57
Q

Where does a PVC normally occur?

A

Before the next sinus beat

58
Q

What are the features of a PVC?

A
  • Regular rhythm except the ectopic beat
  • PR interval absent in the PVC
  • Wide and bizarre QRS in ectopic beat
59
Q

What is a Premature ventricular contraction?

A

An Ecptopic beat where the electrical signal originates from somewhere in the ventricular myocardium.

60
Q

Where does a PVC normally occur?

A

Before the next sinus beat.

61
Q

What are the features of a PVC?

A
  • The main rhythm is regular except the PVC
  • The P-R interval is absent in the PVC
  • Wide and bizarre QRS in ectopic beat
62
Q

What is a multifocal PVC?

A

An eptopic beat where the electrical signal originates from muliple points within the ventricular myocardium, generating different morphologies of ectopic beats.

63
Q

What are the types of PVC pattern?

A

Couplet - 2 in succession
Salvos - 3 or more in succession
Bigeminal - Every second beat is a PVC
Trigeminal - Every third beat is a PVC

64
Q

What are the common causes of PVC?

A
  • Ischemic heart disease
  • Hypoxia
  • Overdose
  • Increased parasympathetic/ Sympathetic activity
  • Acidosis
65
Q

What is a R on T ectopic?

A

When the R wave of the PVC is seen to be impacting on the proceeding T Wave.This is due to the ventricular depolarisation taking place before repolarisation is complete.

66
Q

What may an R on T wave come before?

A

VF

67
Q

What is an Ideoventricular rhythm?

A

Where the electrical rhythm originates fro within the ventricles.

68
Q

What are the causes of idovetricular rhythms?

A
  • Toxity
  • MI
69
Q

What rate is considered an accelerated idioventriular rhythm?

A

40-100

70
Q

What is discordance?

A

When the QRS and ST-T heads in opposite directions.

71
Q

What are the causes of Idioventricular Rhythm?

A
  • Drug Toxicity
  • MI
72
Q

What is the QRS of Ventricular Tachycardia?

A

100 - 300

72
Q

Where does Ventricular Tachycardia originate from?

A

1x Foci in the Ventricles

73
Q

What are the characteristics of Ventricular Tachycardia?

A
  • Rate > 100BPM
  • Regular
  • Pwaves present but buried within the QRS
  • Wide and Bizarre QRS complex
74
Q

What is Torsade De Points arrhythmia?

A

A ford of VT caused by a prolonged QT interval.

75
Q

What is the clinical significance of a Torsade De points arrhythmia?

A
  • Insuffcient time for the ventricles to refil
  • May often be pulseless and lead to WF
76
Q

What is Torsade De Points arrhythmia often a sign of?

A

Myocardial excitement due to hypoxia

77
Q

What is the cause of VF?

A

A Large number of myocytes depolarizing with no coordination.

78
Q

What is ventricular standstill?

A

Where the impulse isn’t transmitted from the atria to the ventricles, meaning the ventricles don’t contract.

79
Q

What is Pulseless electrical activity (PEA)?

A

Electircal activity on an ECG that doesn’t produce a contraction.

80
Q

What are the features of PEA?

A
  • Complexes with no pulses
  • Complexes may be wide and bizarre
81
Q

Where are pacing spikes normally viewed?

A

Before the QRS

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