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Block 3 physiology > Cardiac Conduction Disorders: Other > Flashcards

Cardiac Conduction Disorders: Other Flashcards

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1
Q

type of arrhythmia that begins at one or more irritable focus/foci pacing very rapidly

A

“tachy” arrhythmia

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2
Q

How are “tachy” arrhythmias defined?

A
  1. rate

2. site of origin

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3
Q

What are “tachy” arrhythmias associated with?

A

reduced cardiac output

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4
Q

What does paroxysmal mean?

A

suddenly occurring

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5
Q

sudden onset of rapid heart rate, between 150 and 250 BPM

A

paroxysmal tachycardia

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6
Q

originates from an irritable automaticity focus in the atria

A

paroxysmal atrial tachycardia

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7
Q

In PAT- P wave before each QRS, different origin therefore different ___ wave shape, and different __ interval

A

P wave before each QRS, different origin therefore different P wave shape, different PR interval

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8
Q

originates from an irritable automaticity focus at the AV junction

A

paroxysmal junctional tachycardia

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9
Q

EKG changes with paroxysmal junctional tachycardia

A

-May or may not have P waves, placement before, overlayed with, or after QRS
Possible QRS widening due to depolarization of one bundle branch before the other

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10
Q

originates above the ventricles, i.e., from the atria or the junction

A

supraventricular rhythm

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11
Q

encompasses both PAT and PJT

A

paroxysmal supra ventricular tachycardia (SVT)

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12
Q

when is paroxysmal supra ventricular tachycardia used?

A

used when P waves are not visible (high rates) and/or unable to differentiate (normal QRS width)

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13
Q

Causes of atrial and junctional focus irritability include:

A
  • Epinephrine
  • Sympathetic stimulation
  • B1 stimulants (caffeine, amphetamines, cocaine)
  • Drugs (excess digitalis, ethanol)
  • Hyperthyroidism
  • Cardiac stretch (heart failure)
  • Low oxygen
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14
Q

originates from an irritable automaticity focus below the AV junction

A

paroxysmal ventricular tachycardia

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15
Q

EKG changes with paroxysmal ventricular tachycardia

A
  • Very wide, PVC-like QRS complexes

- P waves are hidden in the QRS complexes (P waves are dissociated from QRS)

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16
Q

are defined as having a rate of 250-350 BPM

A

flutter rhythms

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17
Q

With flutter rhythms, _____ function of the affected part of the heart (atria, ventricles) is always _____

A

With flutter rhythms, pump function of the affected part of the heart (atria, ventricles) is always reduced

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18
Q

results from rapid atrial depolarization caused by an ectopic focus

A

atrial flutter

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19
Q

In atrial flutter, atria cannot ____ effectively and AV node cannot transmit all __________ to the ventricles

A

In atrial flutter, atria cannot pump effectively and AV node cannot transmit all depolarization to the ventricles

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20
Q

Characterized by number of P waves to each QRS (2:1 or 3:1 here)

A

atrial flutter

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21
Q

Sometimes difficult to detect, may be more recognizable if the ECG is flipped (top) or if a vagal maneuver is used (e.g., bear down)

A

atrial flutter

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22
Q 
Atrial flutter:
vagal maneuver (PNS stimulation) increases AV node delay (more “refractory”) and decreases SA node firing, thereby decreasing \_\_\_\_ \_\_\_\_ (separating QRS peaks), resulting in more flutter waves per QRS
A 
Atrial flutter:
Vagal maneuver (PNS stimulation) increases AV node delay (more “refractory”) and decreases SA node firing, thereby decreasing heart rate (separating QRS peaks), resulting in more flutter waves per QRS
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23
Q

results from rapid ventricular depolarization caused by an ectopic focus

A

ventricular flutter

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24
Q

What tachyarrhythmia usually degenerates to ventricular fibrillation?

A

ventricular flutter

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25
Ventricular flutter: | Ventricular pumping markedly ______ (insufficient fill time) leading to ______
Ventricular flutter: | Ventricular pumping markedly inhibited (insufficient fill time) leading to hypoxia
26
As ventricular oxygenation falls, additional ventricular automaticity foci are recruited to produce ventricular ______.
As ventricular oxygenation falls, additional ventricular automaticity foci are recruited to produce ventricular fibrillation.
27
What is a specific pattern of ventricular flutter?
Torsades de Pointes
28
What is characteristic of Torsades de Pointes?
undulating pattern of the flutter waves
29
What do conditions associated with Torsades de Pointes present with on EKG?
-prolonged QT segment, which can be due to hypokalemia, long QT syndrome`
30
Fibrillation rhythms are defined as having a rate of ___-___ BPM
350-450 bpm
31
Caused by multiple foci firing rapidly and simultaneously and NO pumping from affected chambers
fibrillation
32
Characterized by rapid, erratic atrial rate (uneven baseline) and irregular ventricular rhythm caused by irregular conduction through the AV node
atrial fibrillation
33
With afib, there is a _____ of ____ pumping action
With afib, there is a LOSS of atrial pumping action
34
With fib, there is a ____ risk of atrial blood __________ (stroke risk)
With fib, there is a HIGH risk of atrial blood coagulation (stroke risk)
35
Characterized by rapid, erratic ventricular rhythm caused by firing of multiple foci
ventricular fibrillation
36
Vfib results in ________ motion of ventricular muscle and ______ of all pumping action
Vfib results in quivering motion of ventricular muscle and LOSS of all pumping action
37
What EKG changes are seen with vfib?
Loss of identifiable wave patterns
38
syndromes associated with tachyarrhythmia (2)
- Wolfe-Parkinson-White (WPW) syndrome | - Lown-Ganong-Levine (LGL) syndrome
39
occurs because of an accessory conduction pathway (bundle of Kent) between the atria and ventricles
WPW syndrome
40
Results in ventricular pre-excitation, characterized by a “delta” wave on leading shoulder of QRS wave
WPW syndrome
41
EKG changes with WPW syndrome
- Apparent PR interval shortening | - QRS widening
42
WPW can be associated with _____ and _______
WPW can be associated with SVT and AVNRT
43
Very high ______ rates associated with supraventricular tachycardia when conduction bypassing ___ node approaches 1:1
Very high ventricular rates associated with supraventricular tachycardia when conduction bypassing AV node approaches 1:1
44
Ventricular depolarization may conduct through bundle of ____, activating ___ node before SA node fires
Ventricular depolarization may conduct through bundle of Kent, activating AV node before SA node fires
45
occurs because of an accessory conduction pathway (James bundle) between an atrial intranodal tract and the His bundle (bypassing AV node)
LGL syndrome
46
EKG changes with LGL syndrome
- short PR interval | - NO delta wave
47
atrial tachycardia can be transmitted in a 1:1 pattern to ventricles, resulting in ventricular ______
Atrial tachycardia can be transmitted in a 1:1 pattern to ventricles, resulting in ventricular flutter
48
occur when defects in the heart’s pacemaker nodes or conduction system retard or prevent achieving the depolarization threshold by the conductive cells
conduction blocks
49
Occur in the SA or AV nodes, bundle of His, right or left bundle branches, or in the subdivisions of the left bundle branch (hemiblock)
conduction blocks
50
Occurs when the unhealthy SA node fails to pace for at least one cycle, pacing recovers after skipping a beat, retaining its rate
sinus block
51
Sinus block may induce an _____ ______ (atrial, junctional, or ventricular) from a focus other than the ___ node
Sinus block may induce an escape rhythm (atrial, junctional, or ventricular) from a focus other than the SA node
52
EKG changes with sinus block
-P wave may be the same or different (SA or atrial escape), or absent (junctional or ventricular escape)
53
3 types of AV blocks
- first degree - second degree - third degree
54
AV conduction intact but delayed
first degree AV block
55
partial or variable conduction through the AV node or bundle of His or left bundle bra
second degree AV block
56
2 subtypes of second degree AV block
- Wenckebach (Type 1) | - Mobitz (Type 2)
57
complete block of atrial impulses, resulting in atrial and ventricular dissociation
third degree AV block
58
occur because an incorrectly functioning AV node may conduct depolarizations in a delayed fashion
first degree AV block
59
EKG changes with first degree AV block
- P waves look the same (from SA node) | - PR interval is increased, i.e., > 0.2 sec (> 1 large block or 5 mm) and consistent in length
60
occur because atrial depolarizations are delayed or stopped as they pass through the AV node or distal fibers (bundle of His or left bundle branch)
second degree AV block
61
occurs in the AV node, when the AV delay becomes progressively longer until an escape rhythm occurs, then the process repeats
second degree AV block, type 1
62
occurs in the distal fibers, when one or several atrial depolarizations (P waves) fail to conduct to the ventricles
second degree AV block, type 2
63
EKG changes with second degree AV block, type 1 (Wenckebach)
progressively longer PR intervals until the last P wave of the series fails to conduct (absence of a QRS complex following the P wave)
64
second degree AV block, type 1 (Wenckebach) can look like ______ or trigeminy except for ______ PR interval, final P wave without _____
second degree AV block, type 1 (Wenckebach) can look like bigeminy or trigeminy except for increasing PR interval, final P wave without QRS
65
EKG changes with second degree AV block, type 2 (Mobitz)
normal P wave/PR interval and QRS, followed by one or more P waves without QRS complexes
66
Second degree AV block, type 2 is characterized by the number of __ waves associated with each normal ____, e.g., 2:1, 3:1, 4:1, 5:1; Higher ratios associated with _____ severity
Second degree AV block, type 2 is characterized by the number of P waves associated with each normal QRS, e.g., 2:1, 3:1, 4:1, 5:1; Higher ratios associated with increased severity
67
occur because atrial depolarizations do not conduct through the AV node, therefore atrial contractions (P waves) are disassociated from QRS waves
third degree AV block
68
EKG changes with third degree AV block
- P-P distance uniform, QRS-QRS distance uniform - QRS may be narrow (junctional automaticity focus) or wide (ventricular automaticity focus) - Junctional or ventricular foci have different QRS complex shapes and inherent rates
69
Third degree AV block with junctional focus has ____ QRS complexes with a rate between __-__ BPM
Third degree AV block with junctional focus has narrow QRS complexes with a rate between 40-60 BPM
70
Third degree AV block with ventricular focus has ___, ___-like QRS complexes with a rate between __-__ BPM
Third degree AV block with ventricular focus has wide, PVC-like QRS complexes with a rate between 20-40 BPM
71
Block in the conduction through one bundle branch (a BBB) delays conduction to the affected chamber (conduction via muscle), resulting in __________ of the chambers at different times
Block in the conduction through one bundle branch (a BBB) delays conduction to the affected chamber (conduction via muscle), resulting in depolarization of the chambers at different times
72
EKG changes with BBB
-wide and deformed QRS wave ≥ 0.12 sec (3 mm)
73
what leads is an abnormal RBBB wave form best seen?
V1 and V2 since the right ventricle is under these leads
74
what leads is an abnormal LBBB wave form best seen?
V5 and V6 since the left ventricle is under these leads
75
With RBBB, R=___ ventricle and R’=____ ventricle
With RBBB, R=left ventricle and R’=right ventricle
76
With LBBB, R=___ ventricle and R’=___ ventricle
With LBBB, R=right ventricle and R’=left ventricle
77
If an R, R’ pattern is noted but QRS interval is not prolonged this is called an __________ ___
If an R, R’ pattern is noted but QRS interval is not prolonged this is called an incomplete BBB

Block 3 physiology (6 decks)

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