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EKG > E1: Atrial And Ventricular Dysrhythmias > Flashcards

E1: Atrial And Ventricular Dysrhythmias Flashcards

1
Q

Where do sinus rhythms originate?

A

The sinoatrial node

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2
Q

Why can sinus tachycardia be dangerous?

A

It can increase myocardial oxygen consumption, which can aggravate ischemia and infarction, particularly in those with cardiovascular disease

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3
Q

What is sinus dysrhythmia?

A

Same as NSR, but with patterned irregularity

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4
Q

When does the rate in a sinus dysrhythmia increase and decrease?

A

Increases during inspiration and decreases during expiration

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5
Q

What is the difference between a sinus pause and a sinus arrest?

A

A sinus pause is when 1-2 beats are dropped, and a sinus arrest is when 3 or more beasts are dropped

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6
Q

What is sinus node dysfunction (sick sinus syndrome) characterized by?

A

Characterized by periods of bradycardia, tachycardia, prolonged pauses or alternating bradycardia and tachycardia

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7
Q

What is the treatment for sinus node dysfunction?

A

Treatment may require a pacemaker for the slow rhythms and medication for the fast rhythms

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8
Q

What are the 3 mechanisms that cause atrial dysrhythmias?

A

1) automaticity
2) triggered activity
3) reentry

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9
Q

What are the 3 key characteristics of atrial dysrhythmias?

A

1) P waves that differ in appearance from the normal sinus P waves
2) Abnormal, shortened, or prolonged PR intervals
3) QRS complexes that appear narrow and normal

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10
Q

What is a wandering atrial pacemaker?

A
  • When the pacemaker site shifts between the SA node, Atria, and/or the AV junction
  • produces characteristic features of P waves that change in appearance frequently
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11
Q

What causes wandering atrial pacemaker?

A

Inhibitory vagal effect of respiration on the SA node and AV junction

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12
Q

What are premature atrial complexes (PACs)?

A

Early ectopic beats that originate outside the SA node

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13
Q

How can you identify PACs on EKG?

A

There are P waves that are upright preceding each QRS complex, but have a different morphology than the normal P waves of the underlying rhythm
-There is also a non-compensatory response

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14
Q

What is a non-compensatory response?

A

A pause where there are less than two full R-R intervals between the R wave of the normal beat which precedes the PAC and the R wave of the first normal beat which follows it

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15
Q

What are PACs called when they are associated with wide QRS complexes?

A

PACs with aberrant ventricular conduction

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16
Q

What is atrial tachycardia?

A
  • Rapid dysrhythmia that arises from the atria

- rate is so fast that is overrides the SA node

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17
Q

What is paroxysmal atrial tachycardia?

A

Short bursts of atrial tachycardia

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18
Q

What is multifocal atrial tachycardia?

A
  • A pathological condition that presents with changing P wave morphology and heart rate of 120-150 bpm
  • the rhythm is irregular due to multiple foci
  • Same features as wandering atrial pacemaker, but faster rate
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19
Q

What is SVT?

A

Tachycardia that arises from above the ventricles but cannot be definitely identified as atrial or junctional tachycardia because the P waves cannot be seem sufficiently

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20
Q

What causes atrial flutter?

A

Rapid depolarization reentry circuit in the atrial at a rate of 250-350 bpm

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21
Q

If you see a saw tooth appearance on EKG, what should you think of?

A

Atrial flutter

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22
Q

What is atrial fibrillation?

A

Chaotic, asynchronous firing of multiple areas within the atria
-totally irregular rhythm with no discernible P waves

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23
Q

What are patients with atrial fibrillation at increased risk for?

A

Patients may develop intra-atrial emboli as the atria are not contracting and blood stagnates in the atrial chambers forming a thrombus
-predisposes patients to systemic emboli and stroke

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24
Q

What are junctional dysrhythmias?

A

Dysrhythmias that originate in the AV junction

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25
Q

What are the key characteristics of junctional dysrhythmias?

A

1) P waves may be inverted with a short PR interval, they may be absent (buried within he QRS), or they may follow the QRS
2) QRS complexes are usually normal

26
Q

What are premature junctional complexes (PJCs)?

A

Single early electrical impulse that arises from the AV junction

27
Q

What is the typical rate of a junctional escape rhythm?

A

40-60

-arises from AV junction

28
Q

What is the typical rate of an accelerated junctional rhythm?

A

60-100

-arises from the AV junction

29
Q

What is junctional tachycardia?

A

A fast ectopic rhythm that arises from bundle of His at a rate of 100-180

30
Q

When do ventricular dysrhythmias occur?

A
  • When the atria, AV junction, or both are unable to initiate an electrical impulse
  • Or when there is enhances automaticity of the ventricular myocardium
31
Q

What are the 3 key features of ventricular dysrhythmias?

A

1) wide and bizarre QRS complexes
2) T waves in the opposite direction of the R wave
3) absence of P waves

32
Q

What are premature ventricular complexes (PVCs)?

A
  • Early ectopic beats that interrupt the normal rhythm
  • originate from an irritable focus in the ventricular conduction system or muscle tissue
  • retrograde impulse inhibits conduction of a normally fired SA node impulse; SA node timing is unaffected
33
Q

PVCs that look the same are called **. PVCs that look different from each other are called **.

A

Unifocal

Multifocal

34
Q

Two PVCs in a row are called a ***.

What does this indicate?

A

Couplet

Extremely Irritable ventricles

35
Q

PVCs that fall between two regular complexes and do not disrupt the normal cardiac cycle are called ***.

A

Interpolated PVCs

36
Q

What is an idioventricular rhythm?

A

A slow dysrhythmia (20-40) with wide QRS complexes that arise from the ventricles
-Rhythm of last resort

37
Q

What is an accelerated idioventricular rhythm?

A

An idioventricular rhythm that exceeds the inherent rate of the ventricles (40-100)

38
Q

What is ventricular tachycardia?

A 
Fast dysrhythmia (100-250) that arises from the ventricles 
-always clinically significant, potentially unstable, and may lead to cardiac arrest
39
Q

Ventricular tachycardia is present when there are 3 or more *** in a row?

A

PVCs

40
Q

What is torsades de pointes?

A

A unique variant of polymorphic ventricular tachycardia

  • may be associated with prolonged QT
  • may be drug induced or associated with electrolyte abnormalities
41
Q

What is the management of torsades if the patient is in cardiac arrest?

A

Defibrillation

42
Q

What is the management of torsades if the patient is not in cardiac arrest?

A

Infusion of magnesium sulfate

43
Q

What happens in ventricular fibrillation?

A
  • results from chaotic firing of multiple sites in the ventricles
  • causes heart muscle to quiver rather than contract efficiently, producing no effective muscular contraction and no cardiac output
44
Q

What is the clinical presentation of someone in ventricular fibrillation?

A

Cardiac arrest, unresponsive, and pulseless

45
Q

What is the most common cause of prehospital death in adults?

A

Ventricular fibrillation

46
Q

What is pulseless electrical activity?

A

A condition that has an organized electrical rhythm on the ECG monitor, but patient is pulseless and apneic

47
Q

What is a heart block?

A

A partial delay or complete interruption in the cardiac conduction pathway between the atria and ventricles

48
Q

What are the common causes of heart blocks?

A

Ischemia, myocardial necrosis, degenerative disease of the conduction system, congenital anomalies, and drugs

49
Q

What is 1st degree heart block?

A
  • a consistent delay in conduction at the level of the AV node
  • not a true block
50
Q

What will you see on EKG if the patient has 1st degree heart block?

A

Prolonged PR interval

51
Q

What is 2nd degree heart block type 1 also known as?

A

Wenckebach or Mobitz 1

52
Q

What is 2nd degree heart block type 1?

A

An intermittent block at the level of the AV node

53
Q

What will you see on EKG if the patient has 2nd degree heart block type 1?

A
  • More P waves than QRS complexes and rhythm has patterned irregularity
  • PR interval progressively increases until a QRS complex is dropped
  • after dropped beat, the next PR interval is shorter
54
Q

What is 2nd degree heart block type 2 also known as?

A

Mobitz II

55
Q

What is 2nd degree heart block type 2?

A

Intermittent block at the level of the bundle of his or bundle branches resulting in atrial impulses that are not conducted to the ventricles

56
Q

What will you see on EKG if a patient has 2nd degree heart block type 2?

A
  • More p waves than QRS complexes
  • PR interval is prolonged and the duration of the PR interval remains constant
  • Intermittently a P wave occurs and is not followed by a QRS complex
57
Q

What does 2nd degree heart block type 2 often progress to?

A

3rd degree (complete) heart block

58
Q

What is 3rd degree heart block?

A

Complete block of conduction at or below the AV node

-impulses from the atria cannot reach the ventricles

59
Q

What happens in 3rd degree heart block?

A

The atrial pacemaker is the SA node (60-100) and the ventricle pacemaker is an escape rhythm from the AV junction (40-60) or from the ventricles (20-40)

60
Q

What will you see on EKG if the patient has 3rd degree heart block?

A
  • Upright and round P waves seem to “march right through the QRS complexes”
  • No association between the P waves and the QRS complexes

EKG (8 decks)

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