Cardiac Rhythm Abnormalities - EKG

Question 1

what does atrial flutter appear as on an EKG

Answer 1

saw tooth appearance
- repeating P waves

Question 2

how are atrial rhythm abnormalities treated

Answer 2

cardioversion
ablation
antiarrhythmic
antithrombotic

Question 3

for those with atrial rhythm what does exercise tolerance depend upon

Answer 3

rate control due to loss of atrial kick

Question 4

explain atrial fibrilliation

Answer 4

rate varies and is always irregular
= due to SA node not setting the pace

Question 5

how to treat atrial fibrillation

Answer 5

rate control digoxin, beta blockers, or calcium channel blockers

Question 6

if atrial fibrillation is found to be new, what needs to be done / why?

Answer 6

notify medical provider immediately

cardiac stroke

Question 7

what medications are indicated for A-Fib? what can this affect in regard to PT

Answer 7

cardioversion / anticoagulants
CO and decrease exercise tolerance

if new, may be accompanied in BP drop with lightheadedness

Question 8

if the rate is controlled during A-Fib, what is the implication of PT? what may the patient report?

Answer 8

low-moderate exercise with slow progression

• may report palpitations, angina, SOB and fatigue

Question 9

explain HR associated with supraventricular tachycardia

Answer 9

<150 bpm but normal sinus rhyhtm

Question 10

how is supraventricular tachycardia treated

Answer 10

self-limitations typically

Question 11

what do patients typically report with supraventricular tachycardia

Answer 11

palpitations
dizziness
fatigue
SOB
chest discomfort
possible syncope

Question 12

what is the treatment for premature ventricular contraction

Answer 12

none required if asymptomatic
- if >6-12 in one minute = underlying cardiac pathology may be indicated

Question 13

if premature ventricular contractions occur in a run, what is the indication

Answer 13

may precede ventricular tachycardia
then V-fib

Question 14

patterned preventricular contractions effect on SV

Answer 14

decreased –> then CO

Question 15

for those with patterned PVCs, what is the PT indication?

Answer 15

low to moderate range
- monitor closely

Question 16

what red flags are associated with PVCs

Answer 16

increased frequency of PVS
increased pattern changes
PVCs accompanied by symptoms
– maybe BP and/or syncope

Question 17

what is the defining feature of ventricular tachycardia

Answer 17

three or more PVCs in a row

Question 18

explain what ventricular tachycardia is

Answer 18

ventricles being in a constant state of contraction-relaxation

Question 19

what to do if you notice ventricular tachycardia?

Answer 19

stop exercising
CPR/defibrillation
call a code

Question 20

ventricular fibrillation is described as

Answer 20

chaotic and asynchronous electrical activity
– no CO

Question 21

what do to if ventricular fibrillation is noticed

Answer 21

life threatening, stop call code and do CPR/defibrillation

Question 22

asystole is described as ____? what is done in response?

Answer 22

cardiac standstill

CPR

Question 23

first degree atrioventricular blocks are described as

Answer 23

PT interval is prolonged by >0.2 seconds
then normal conduction occurs

Question 24

explain why 1st degree AV blocks occur

Answer 24

conduction through AV node is affected (slowed)

Question 25

how do 1st degree AV blocks impair a pt

Answer 25

generally do not produce significant CO or exercise tolerance impairments

Question 26

how are second degree AV blocks described

Answer 26

when not all P waves are followed by a QRS PR Interval is progressively longer and longer until there is one without a QRS

Question 27

for those with 2nd degree AV blocks, what is the PT indication?

Answer 27

submaximal testing with gradual progression to set exercise response baseline - moderate intensity - do what makes sense with symptoms (ie more symptomatic, less intervention)

Question 28

what are second degree AV blocks also called?

Answer 28

Mobitz 1 and 2

Question 29

how are second degree (mobitz 2) AV blocks described

Answer 29

P waves that appear normal - end up being more P waves than QRS complexes PT interval normal or prolonged, but consistent

Question 30

comparing rate of ventricle and atria, what does a mobitz 2 AV block suggest

Answer 30

atrial rate > ventricle rate

Question 31

explain QRS complexes in Mobitz 2 AV block

Answer 31

QRS is often wider than normal

Question 32

explain CO in those with Mobitz 2 - what is often associated with Mobitz 2 AV blocks/what is done to treat this?

Answer 32

CO is significantly compromised, patient will be symptomatic structural heart disease / higher risk of negative events pacemaker placement

Question 33

explain atria / ventricle relationship in 3rd degree AV block

Answer 33

completely disassociated

Question 34

explain P wave and QRS complex relationship in 3rd degree AV block

Answer 34

if activated by P wave, QRS looks normal if not, wide and bizarre QRS complex

Question 35

what is atrial and ventricular rate

Answer 35

atria = 60-100 bpm ventricle = 20-40 bpm

Question 36

explain PT intervention for those with 3rd degree AV block

Answer 36

need pacemaker, do not do anything until then

Question 37

what is a bundle branch block

Answer 37

block of conduction in the right or left bundle branch

Question 38

explain the differnce between RBBB and LBBB

Answer 38

RBBB = typically benign LBBB = structural heart disease

Question 39

ST elevation is described as _____? this indicates _____?

Answer 39

ST segment higher than normal as assessed from J point STEMI = requires immediate medical attention

Question 40

ST depression is described as __? it indicates _____?

Answer 40

ST segment lower than normal Ischemia

Question 41

T wave changes indicate

Answer 41

ischemia ventricular hypertrophy non-coronary/cardiac conditions

Question 42

are T wave changes ever normal

Answer 42

yea, in children

Question 43

explain the evolution of STEMI in regard to EKG changes and times associated

Answer 43

hyperacute T wave = within minutes ST elevation = minutes to hours ST elevation & Q wave = 1-12 hrs ST elevation & T wave inversion = days T-wave recovery & Q-wave = weeks/months