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Cardiac monitors and rhythm Flashcards

(75 cards)

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1
Q

What pathway depolarizes the left atrium?

A

Bachmann bundle

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2
Q

What is the electrical pathway through the heart?

A

SA node
Internodal Tracts
AV node
Bundle of His
Bundle Branches
Purkinje fibers

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3
Q

What has the slowest conduction through the heart?

A

SA and AV nodes .02-.1

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4
Q

What has intermediate conduction through the heart?

A

Myocardial muscle cells

.3-1

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5
Q

What has the fastest conduction through the heart?

A

Bundle of His, Bundle branches, Purkinje fibers

1-4

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6
Q

What is conduction velocity a function of?

A
  1. RMP
  2. Amplitude of action potential
  3. Rate of change in membrane potential during phase 0
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7
Q

What affects conduction velocity?

A

ANS tone
Hyperkalemia
Ischemia
Acidosis
Antiarrhythmic drugs

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8
Q

What are accessory pathways?

A

Connective tissue that isolates the atria

Prevents atria from prematurely exciting ventricular tissue

***AV node plays big real

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9
Q

What does the James fiber connect?

A

Atrium to AV node

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10
Q

What does Atrio-hisian fiber connect?

A

Atrium to Bundle of His

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11
Q

What does Kents bundle connect?

A

Atrium to ventricle

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12
Q

What does Mahaims bundle connect?

A

Av node to ventricle

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13
Q

When does the atria repolarize?

A

During the QRS

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14
Q

When does ventricular depolarization begin? end?

A

Beings during QRS

Ends - ST segment

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15
Q

When does ventricular repolarization begin? end?

A

Beings- T wave

Ends - After T wave

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16
Q

Can a stimulus depolarize the myocyte during absolute refractory period?

A

No

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17
Q

Can a stimulus depolarize the myocyte during relative refractory period?

A

Yes but need a larger stimulus

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18
Q

What ion is leaking out to start the depolarization of the myocyte? What phase?

A

Phase 4

Potassium (K funny channels)

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19
Q

What phase does depolarization occur in? What is the ion movement?

A

Phase 0

-Na in

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20
Q

What phase does initial repolarization occur in? What is the ion movement?

A

Phase 1

Cl In

K out

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21
Q

What phase does plateau occur in? What is the ion movement?

A

Phase 2

Ca In

K out

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22
Q

What phase does final repolarization occur in? What is the ion movement?

A

3

K out

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23
Q

What ion moves out of the cell in 4 out of 5 phases of the ventricular action potential?

A

Potassium

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24
Q

What disease causes PR interval depression?

A

Pericarditis

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25
What disease causes a U wave?
Hypokalemia
26
What disease causes a peaked T wave?
Intracranial hemorrhage
27
What disease causes a Delta wave?
Wolff-Parkinson White
28
Where is ST elevation or depression measured?
The J point looking for a change of at least 1.0
29
What segment of the ECG is considered isoelectric?
PR interval
30
What do leads 2, 3, and aVF monitor?
Inferior wall - RCA
31
What do leads 1, aVL, V5, and V6 monitor?
Lateral Circumflex
32
What do leads V1 and V2 monitor?
Septum LAD
33
What do leads V3 and V4 monitor?
Anterior wall LAD
34
What is the mean electrical vector?
The average current flow of all action potentials at one time
35
What are the three bipolar leads?
I II III
36
What are the three limb leads?
aVR aVL aVF
37
Where does the mean electrical current tend to point to?
Away from ischemia Toward Hypertrophy
38
What is the deflection for a normal axis?
+ Lead 1 + Lead aVF Both hands up (YAY)
39
What is the deflection for a left axis deviation?
+ Lead 1 - Lead aVF Left hand up, right down (shake left hand)
40
What is the deflection for a right axis deviation?
- Lead 1 + Lead aVF Right hand up, left down (shake right hand)
41
What two leads are monitored for axis deviations?
Lead 1 Lead aVF
42
What is the deflection for extreme right deviation ?
- Lead 1 - Lead aVF Left hand down, right down (both down, boo)
43
What is a normal axis degree?
-30 to +90
44
What degree is left axis?
< -30
45
What degree is right axis
>+90 degrees
46
What causes L axis deviation?
Problems with the L heart HTN LBBB aortic stenosis and regurg Mitral regurg
47
What causes R axis deviation?
Problems with the R heart (lungs) Pulmonary HTN PE Cor pulmonale Bronchospasm COPD
48
Can adenosine be used for an effective treatment of afib?
NO
49
How to determine 1st degree heart block?
>.20 PR AV node or Bundle of His issue
50
How to determine 2nd degree type 1 heart block?
Longer Longer Longer - Drop Wenckebach Av node issue symptomatic - give atropine
51
How to determine 2nd degree type 2 heart block?
Random dropped qrs - mobitz 2 Problem with bundle branches Treatment - Pacemaker *****High risk for type 3
52
How to determine 3rd degree heart block?
Ps and Qs don't agree Degeneration of atrial conduction system (Lenegre's disease) Can lead to CHF
53
What drugs are class 1? How do they work?
Na channel blockers 1A - Prolong phase 3 1B - Shorten phase 3 1C- Strong depression of phase 0
54
What drugs are class 2? How do they work?
Beta Blockers Slows phase 4
55
What drugs are class 3? How do they work?
K channel blockers Prolongs phase 3
56
What drugs are class 4? How do they work?
Ca channel blockers Slows conduction velocity
57
How does adenosine work?
Endogenous nucleoside that slows AV node conduction through adenosine 1 receptor Can cause bronchospasm
58
What class is quinidine, procainamide, and disopyramide?
1A Na channel blockers Prolong phase 3
59
What class is lidocaine, phenytoin?
1B Na channel blockers Shorten phase 3
60
What class is flecainide, propafenone ?
1C Na channel blocker Shorten phase 0
61
What class are beta blockers?
2 Slows phase 4
62
What class is amiodarone, bretyium?
K channel blockers Class 3 Prolongs phase 3
63
What class is verapamil, diltiazem
Ca channel blockers Class 4 Slows conduction through AV node
64
What disease is associated with atrial-ventricular reentry?
Wolff Parkinson white Through the Kents Bundle
65
What EKG findings are consistent with Wolff Parkison white?
Delta wave Short PR Wide QRS Possible t wave inversion
66
What is a Delta wave?
Slowed, curve upstroke of QRS
67
What are the two ways to disrupt the reentry circuit?
1, Slow the conduction velocity 2. Increase the refractory period
68
What is the most common cause of tachyarrhythmias?
The reentry pathway
69
How can mitral stenosis cause a reentry pathway?
Conduction must occur a longer distance
70
How can ischemia cause a reentry pathway?
Conduction velocity through the damaged tissue is slowed
71
How can epi cause a reentry pathway?
Shortens the duration of the refractory period
72
What is the definitive treatment for WPW?
Ablation **Risk is thermal injury so monitor esophageal temperatures
73
What are other treatments for WPW?
Procainamide Cardioversion
74
What is the most common tachydysrhythmias associated with WPW?
Orthodromic AV nodal reentry 90%
75
Is orthodromic or antidromic more dangerous?
Antidromic ANTI - Av node is bypassed Leads to CHF and Vfib

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