Cardiac Rhythm and Monitors

Question 1

What portion of the heart do leads II, III, and aVF monitor? What artery?

Answer 1

Inferior
RCA

Question 2

What portion of the heart do leads I, aVL, V5 and V6 monitor? And what artery?

Answer 2

Lateral
Circumflex

Question 3

What portion of the heart do leads V1 and V2 monitor? What artery?

Answer 3

Septum
LAD

Question 4

What portion of the heart do leads V3 and V4 monitor? What artery?

Answer 4

Anterior heart
LAD

Question 5

What are 3 bipolar leads?

Answer 5

I, II, III

Question 6

What are 3 limb leads?

Answer 6

aVR
aVF
aVL

Question 7

In extreme right axis deviation, what is the position of lead I and Lead aVF?

Answer 7

Both arrows pointing down 👇

(Just think…it’s the opposite of a normal axis, which is both leads pointing up ^^)

Question 8

In left axis deviation, what is the position of lead I and lead aVF?

Answer 8

Leaving each other in Left axis deviation

Lead I ^
Lead aVF 👇

Question 9

In right axis deviation, what is the position of lead I and lead aVF?

Answer 9

reaching each other in right axis deviation
(like a little puzzle piece)

(Lead I 👇 but lead aVF ^)

Question 10

In normal axis, what is the position of lead I and lead aVF?

Answer 10

Both are upright ^^

Question 11

What is normal axis in degrees?

Answer 11

-30 to +90

Question 12

What is left axis deviation in degrees?

Answer 12

< - 30 degrees

Question 13

What are some causes of right axis deviation?

Answer 13

COPD
Acute Bronchospasm
Cor Pulmonale
Pulmonary hypertension
Pulmonary Embolus

Question 14

What are some causes of left axis deviation?

Answer 14

Chronic htn
LBBB
Aortic stenosis
Aortic insufficiency
Mitral regurge

Question 15

What does the mean electrical vector point towards? The hat what does it shy away from?

Answer 15

Towards hypertrophy
Away MI

Question 16

What is a useful medication in the setting of beta-blocker overdose or calcium channel overdose?

Answer 16

Glucagon

Question 17

What are some treatment options for afib?

Answer 17

Beta-blockers, calcium channel blockers, and digoxin

Question 18

What is acute onset afib treated with?

Answer 18

Cardioversion (100 joules)

Question 19

What must be performed if the onset of afib is > 48 hours?

Answer 19

TEE to rule out thrombus

Question 20

What is the most common postoperative tachydysrhythmia?

Answer 20

Afib

Question 21

What should hemodynamically unstable atrial flutter treated with?

Answer 21

Cardioversion (start at 50 joules)

Question 22

What are PVCs that arise from a single location?

Answer 22

Unifocal

Question 23

What are PVCs that arise from multiple locations?

Answer 23

Multifocal

Question 24

What is the most common cause of sudden cardiac death?

Answer 24

Vfib

Question 25

what is brugada syndrome?

Answer 25

Sodium ion channelopathy in the heart. Common cause of nocturnal death d/t vtach/vfib

Question 26

During Sinus arrhythmia, heart rate increases during what?

Answer 26

***Inhalation ~ decrease in intrathoracic pressure —> increase venous return —> increase heart rate Exhalation ~ increase in intrathoracic pressure —> decrease venous return —> decrease heart rate

Question 27

What reflex initiates sinus arrhythmia?

Answer 27

Bain ridge reflex

Question 28

What is a 1st degree heart block?

Answer 28

PR interval > .20 sec (AV node or bundle of his is affect) Tx: nothing

Question 29

What is a second degree heart block (type 1)?

Answer 29

Longer, longer, longer, and drop PR becomes progressively longer and then drops a QRS (AV node affected) Tx: asymptomatic ~ monitor Symptomatic ~ atropine

Question 30

What is a 2nd degree heart block (Mobitz II)?

Answer 30

All the QRS have ps, but not all the ps go through resulting in a QRS. (Affects bundle of his/BB) Tx: pacemaker (atropine is NOT effective)

Question 31

What is a 3rd degree heart block?

Answer 31

Ps and Qs don’t agree ~ no connection (Degeneration of atrial conduction system) Tx: pacemaker or isoproterenol

Question 32

What do class 1 antiarrhythmic drugs inhibit?

Answer 32

Inhibit fast sodium channels (think lidocaine)

Question 33

What do class 2 antiarrhythmic drugs inhibit?

Answer 33

Decrease the rate of depolarization (beta blockers)

Question 34

What are class 3 antiarrhythmic agents?

Answer 34

Inhibit potassium ion channels (amiodarone)

Question 35

What are class 4 antiarrhythmic drugs?

Answer 35

Inhibit slow calcium channels (CCB)

Question 36

What are the common EKG characteristics in WPW?

Answer 36

DELTA wave Short PR (bypass the AV) Wide QRS complex Possible T wave inversion

Question 37

What is Orthodromic AVNRT?

Answer 37

(Type of WPW) Orthodromic AV nodal recently Tachycardia More common ~ atrium —> AV node —> ventricle —> accessory pathway —> atrium Block conduction at the AV node (vagal, cardioversion, adenosine, BB, verapamil, amiodarone)

Question 38

What is antidromic AVNRT?

Answer 38

Antidromic AV node reentry tachy (WPW) Atrium —> accessory pathway —> ventricle —> AV node —> atrium Tx: cardioversion or procainamide (AVOID: ADENOSINE, LIDO, CCBS, BBS, and DIGOXIN)

Question 39

What is the definite treatment of WPW?

Answer 39

Ablation.

Question 40

What are some conditions that prolong the QTc?

Answer 40

Hypokalemia Hypomagnesemia Hypocalcemia

Question 41

What are some drugs that increase the QTc?

Answer 41

Methadone Droperidol Haloperidol Ondansetron Amiodarone Quinidine

Question 42

What are some cardiac conditions that increase the QTc?

Answer 42

Hypertrophic cardiomyopathy Subarachnoid hemorrhage Bradycardia

Question 43

What is position 1 of n the pacemaker?

Answer 43

This is the chamber being paced O: none A: atrium V: ventricular D: Dual

Question 44

What is position 2 of the pacemaker?

Answer 44

This is the chamber that is sensed O: none A: atrium V: ventricle D: Dual

Question 45

What is position 3 of the pacemaker?

Answer 45

This is the response to the sensed native cardiac activity T: tells the pacemaker to fire I: tells pacemaker NOT to fire D: if native activity is sensed ~ pacing is inhibited; if native activity is not sense ~ pacemaker fires

Question 46

What is position 4 of the pacemaker?

Answer 46

Indicated the programmability of the pacemaker O: none R: rate modulation

Question 47

What are examples of asynchronous pacing?

Answer 47

AOO, VOO, DOO Pacemaker delivers at a constant rate No sense/inhibition Can result in R on T

Question 48

What are examples of single-chamber demand pacing?

Answer 48

AAI or VVI Back-up mode Only fires when the native heart rates falls below a predetermined rate

Question 49

What are examples of dual-chamber AV Sequential demand Pacing?

Answer 49

DDD Mode is very flexible and is the most common mode of pacing. Makes sure the atrium contracts first followed by the ventricle Improves AV synchrony

Question 50

What does placing a magnet over a pacemaker do to the pacemaker portion?

Answer 50

Usually converts it to an asynchronous mode

Question 51

What does placing a magnet of a device due to the ICD?

Answer 51

Suspends the ICD and prevents shock delivery

Question 52

What does placing a magnet do for a pacemaker + ICD?

Answer 52

Suspends the ICD and prevents shock. Has no effect on pacemaker function

Question 53

What is the only contraindication for a pacemaker or ICD?

Answer 53

MRI?

Question 54

What are not contraindications for a Pacemaker or ICD?

Answer 54

Lithotripsy Electroconvulsive therapy

Question 55

Which setting of electrocautery causes more EMI?

Answer 55

The coagulation setting is the worst.

Question 56

Which cautery causes more EMI (think bipolar vs monopolar)

Answer 56

Monopolar cautery