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NSU AA Denver: Winter 2025 (1st Semester) > 2025 ECG Midterm (Need Quizzes 1-3 to Complete Marterial) > Flashcards

2025 ECG Midterm (Need Quizzes 1-3 to Complete Marterial) Flashcards

Arrhythmias of Sinus Origin, Supraventricular & Ventricular Arrhythmias

1
Q

Detection: Event & Ambulatory Monitors

A

Event monitor:
* Records only 3 to 5 minutes
* Initiated by a cardiac event
* ECG recorded and stored internally

Ambulatory monitor:
* Portable ECG with memory
* Has multiple lead options
* 24-48 hours for Holter monitor
* Longer recording periods use patch
* Records and stores data for future analysis

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2
Q

Detection: New Technology

A

Apple watch
* Finger placed on crown creating a
closed circuit
* Assessment of rate and detection of
irregular heart rates such as atrial
fibrillation

Makes a Lead I

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3
Q

Detection: Arrhythmias

A

12 Lead ECG
* Standard 10 second time frame reading of all 12 leads in a single pages

ECG Rhythm Strips
* Long tracing printout of a single lead or multiple select leads
* Easier to quickly identify irregularities or short periods of sus electrical activity over long timeframes

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4
Q

Determining Rate

A

Heart rate can be determined by
measuring length of a complete cardiac
cycle… R-R

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5
Q

Determining Rate: 1500 vs 300 method

A

Memorize this slide

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6
Q

Determining Rate: 10 Second method

A
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7
Q

Practice: 300 Method

A

300/5 = 60 BPM

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8
Q

Practice: 1500 Method

A

1500/20 = 75 BPM

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9
Q

Practice: 10 Second

A

Lead II typically, look at R waves
Bottom row, this case Lead I

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10
Q

Practice

A

VTach
300/1.5 = 200 BPM

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11
Q

Practice

A

Because variable on Lead II (bottom row), going to use 10 seconds… count number of R Waves

13 * 6 =78 bpm

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12
Q

What is an arrhythmia

A

Arrhythmia is a heartbeat that is
irregular, too fast, or too slow

Tachycardia = > 100 bpm
Bradycardia = < 60 bpm

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13
Q

Clinical Presentation of an Arrhythmia

A

Asymptomatic
Palpitations
Light-headedness
Syncopal episode
Angina
May lead to life threatening
conditions

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14
Q

Why Arrhythmias Happen: HIS DEBS

A

Hypoxia
Ischemia & irritability
Sympathetic stimulation
Drugs
Electrolyte disturbances
Bradycardia
Stretch

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15
Q

5 Basic Arrhythmias

A

Arrhythmias of sinus origin

Ectopic (impulse happening outside SA node)

Reentrant (Electrical activity is trapped in heart)

Conduction blocks (AV node, Bundle of His)

Preexcitation syndromes (shortcuts or bypasses of normal pathway)

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16
Q

Normal Sinus Rhythm

A
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17
Q

Sinus Tachycardia

A

SA Node Arrhythmia

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18
Q

Sinus Bradycardia

A

SA Node Arrhythmia

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19
Q

Respiratory Sinus Arrhythmia (RSA)

A

SA Node Arrhythmia

Occurs with Greater than 10% of R-R activity

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20
Q

RSA x Anesthesia

A

RSA is reversed during positive pressure ventilation

Decreased HR during PPV inspiration

Increased HR during expiration

Can utilize to our advantage with Valsalva maneuver

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21
Q

Sinus Arrest

A

SA Node Arrhythmia

Sinus node fails to send out electrical activity

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22
Q

Sinus Arrest vs Sinus Exit Block

A

SA Node Arrhythmia

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23
Q

Asystole

A

SA Node Arrhythmia… whole heart

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24
Q

Latent Pacemakers

A
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25
Junctional Escape Rhythm
SA Node Arrhythmia… because SA node didn’t fire Key is the no P Wave
26
Pulseless Electrical Activity (PEA)
SA Node Arrhythmia… whole heart issue
27
H's of ACLS
28
T's of ACLS
29
Practice
First Check R-R Intervals Regular vs Irregular Rate 300/5 = 60 BPM P wave followed by QRS Yes, looks good T waves Looks slightly abnormal NSR
30
Practice
First Check R-R Intervals Regular vs Irregular Rate 115 BPM P wave followed by QRS Yes, looks good T waves Looks slightly abnormal Sinus Tachycardia
31
Practice
First Check R-R Intervals Regular vs Irregular Rate 300/7.5 = 40 BPM P wave followed by QRS Yes, looks good T waves Looks slightly abnormal Sinus Brady
32
Practice
Sinus Arrest to Asystole
33
Practice
Sinus Arrest/Sinus Exit Block followed by Junctional Escape Rhythm
34
4 Questions to Ask to Determine
MY SUMMATION: Regular vs Irregular Rate? P- Wave 1:1 to QRS? Absent? Abnormal? QRS Width Questions 1 & 2 help us make the distinction of whether the arrhythmia is atrial or ventricular in origin First question: Are normal P waves present? * P wave is positive in lead II and negative in lead aVR = atrial in origin * No P wave = origin is below the atria * P wave with abnormal axis Origin from atrial foci other than SA node Retrograde activation from AV node or ventricles Second Question: Are QRS complexes narrow (< 0.12 seconds) or wide (> 0.12 seconds)? * Narrow means normal depolarization path * Wide usually means ventricular origin, but not conduction system Third Question: What is the relationship between the P waves and QRS complex? * 1:1 ratio means sinus or atrial origin * No correlation means atria and ventricles contracting independently of each other * AV dissociation Fourth Question Regular or Irregular
34
Ectopic Rhythms
34
Physiology of Non-Sinus Arrhythmias
35
Reentrant Rhythms
36
Premature Atrial Contractions
Ectopic arrhythmia Supraventricular arrhythmia
37
Premature Junctional Contractions
Ectopic arrhythmia Supraventricular arrhythmia
38
PJC vs Junctional Escape Beat
39
PJC vs PAC
40
Atrial or Junctional
Third beat is early Lacks P-Wave Premature Junctional Beat
41
Atrial or Junctional
Third Beat comes after a pause Lacks a P wave Lacks subsequent wave? Junctional Escapee followed by Junctional rhythm
42
Atrial or Junctional
R-R appears to be early A P wave is abnormal Premature Atrial Contraction
43
Sustained Supraventricular Arrhythmias
44
AV Nodal Reentrant Tachycardia (1)
Supraventricular arrhythmia
45
AV Nodal Reentrant Tachycardia (2)
Supraventricular arrhythmia
46
Carotid Sinus Massage
CSM can help terminate as well as diagnose AVNRT CSM has no effect on Paroxysmal atrial tachycardia CSM increase diagnosis of Atrial flutter but increasing number of Ps, but not treat CSM has no effect on Multifocal atrial tachycardia Interrupts reentrant circuits May slow arrhythmia, aiding in diagnosis Application of gentle pressure to the carotid area Mimics rise in blood pressure Stimulates vagal input to heart, slowing sinus node firing and conduction through AV node
47
How to Perform CSM
Know what rhythms CSM works on
48
Paroxysmal Atrial Tachycardia
Ectopic arrhythmia Supraventricular arrhythmia
49
Atrial Flutter (1)
Reentrant arrhythmia Supraventricular arrhythmia Risk factors include HTN, DM, obesity, polysubstance abuse Clinical significance * Probability of converting to NSR is low * Rarely lethal, but may result in or exacerbate CHF * Conscious patients may experience SOB, angina, weakness, dizziness Treatment * Consult cardiology for asymptomatic or mildly symptomatic presentation * Definitive treatment is radiofrequency ablation * Synchronized cardioversion if unstable
50
Atrial Flutter (2)
51
Atrial Flutter (3)
52
Atrial Flutter (4)
53
Atrial Flutter x CSM
54
Atrial Fibrillation (1)
Supraventricular arrhythmia Characterized by chaotic atrial activity AV node is flooded with impulses up to 500+ per minute, atrial rate cant be determined Multiple tiny reentrant circuits, creating fibrillation waves Rhythm is irregularly irregular Ventricular rate may vary, but usually between 120-180bpm Normal QRS No P waves Flat or undulating baseline
55
A-Fib (2)
56
A-Fib (3)
57
Multifocal Atrial Tachycardia
Ectopic arrhythmia Supraventricular arrhythmia
58
Wandering Atrial Pacemakers
Ectopic arrhythmia
59
Atrial Arrythmias Review
60
Premature Ventricular Contractions
Ventricular arrhythmia
61
Classification of PVCs (1)
Unifocal PVCs arise from a single firing ectopic foci, and display a constant timing and morphology Polymorphic PVCs arise from a single ectopic foci, and display constant timing and varied morphology Multifocal PVCs arise from two or more foci, and display varied timing and varied morphology
62
Classification of PVCs (2)
Unifocal
63
Classification of PVCs (3)
Polymorphic
64
Classification of PVCs (4)
Multifocal
65
When to be Concerned about PVCs (1)
66
When to be Concerned about PVCs (2)
67
Ventricular Tachycardia (1)
Ventricular arrhythmia
68
Ventricular Tachycardia
69
Uniform vs Polymorphic
70
Uniform vs Polymorphic (2)
71
Fusion Beats
72
Clinical Significance of VT
Sustained VT severely compromises CO and coronary artery perfusion Medical emergency indicating imminent cardiac arrest, requires immediate interventions VT may be a perfusing (pulsatile) or non perfusing (pulseless) Treatment Pulseless – Defibrillate/ACLS VT with a pulse Stable-procainamide or amiodarone Unstable- synchronized cardioversion
73
Ventricular Fibrillation (1)
Ventricular arrhythmia
74
Ventricular Fibrillation (2)
75
Course vs Fine V-Fib
76
Course vs Fine V-Fib
77
Course vs Fine V-Fib
78
Clinical Significance of V-Fib
79
V-fib to D-fib
80
Implantable Defibrillators
81
External Defibrillators
82
Accelerated Idioventricular Rhythm (1)
Ventricular arrhythmia
83
Accelerated Idioventricular Rhythm
84
Torsade de Pointes (1)
85
Torsade de Pointes
86
Prolonged QTI x Torsade
87
Torsade de Pointes (3)
88
Medications that Prolong the QTI
89
Aberrant Ventricular Contraction vs PVC
90
Supraventricular vs Ventricular arrhythmias
91
Clinical Clues for Aberrancy
92
ECG Clues
93
Quick Differential Diagnosis Tips
94
Remember the 4 Questions
Are normal P waves present? Are the QRS complexes narrow or wide? What is the relationship between the P waves and QRS complexes? Is the rhythm regular or irregular?
95
Practice
Normal Sinus Rhythm Brady (poor strip demarcation to determine)
96
Practice
A Fib
97
Practice
V Tach
98
Highly Missed Question: Respiratory Sinus Arrythmia
Only difference is it positive or negative ventilation Just because someone is asleep and intubated doesn't mean they are breathing positive
99
Highly Missed Question: ST Depression?
ST depression sharp one side, gradual other... ... find the slide it is referencing in this deck!!!
100
Highly Missed Question: Exploring and Reference Electrodes
Can be asked this way for what way a wave will deflect

NSU AA Denver: Winter 2025 (1st Semester) (45 decks)

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