CH 5: Rhythms Flashcards Preview

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Flashcards in CH 5: Rhythms Deck (43):
1

Inherent Rate of Atrial Foci

60-80 bpm

2

Inherent Rate of Junctional Foci

40-60 bpm

3

Inherent Rate of Ventricular Foci

40-20 bpm

4

Irregular Rhythms (list)

1) Wandering Pacemaker
2) Multifocal Atrial Tachycardia
3) Atrial Fibrillation

5

-p wave shape varies
-atrial rate is less than 100
-irregular ventricular rhythm

Wandering Pacemaker

6

-p wave shape varies
-atrial rate is greater than 100
-irregular ventricular rhythm

Multifocal Atrial Tachycardia
**rhythm of pts w/ COPD

7

-continuous chaotic atrial spikes
-irregular ventricular rhythm

Atrial Fibrillation
**continuous rapid firing of multiple atrial automaticity foci, suffering from entrance block, pacing rapidly (parasystolic/insensitive to overdrive suppression)

8

List Escape Rhythms

1) Atrial Escape Rhythm
2) Junctional Escape Rhythm
3) Ventricular Escape Rhythm

(escape = response of an automaticity focus to a pause in pacemaking activity)

9

Junctional Escape Rhythm conducts mainly to the

ventricles.
-produces a series of long QRS complexes

10

Ventricular Escape Rhythm results from (list)

1) complete conduction block high in ventricular conduction syndrome but below AV node (so atrial depol still occurs but not transmitted to ventricles)
2) Downward Displacement of the pacemaker (rare and grave)

11

Stokes Adam Syndrome

when pacing from a ventricular focus is so slow that blood flow to the brain is significantly reduced to the point of syncope.

12

List Escape Beats

1) Atrial Escape Beat
2) Junctional Escape Beat
3) Ventricular Escape Beat
*escape beats occur when there is a pause in the normal conduction

13

Ventricular Escape Beat Physiology

Parasympathetic Innervation inhibits the SA node and also inhibits the atrial and junctional foci but NOT the ventricular foci

14

List Premature Beats

1) Premature Atrial Beat
2) Premature Junctional Beat
3) Premature Ventricular Beat
*an irritable focus SPONTANEOUSLY fires a single stimulus

15

Most sensitive O2 sensors =

Ventricular automaticity foci

16

Atrial and Junctional Foci become irritable because of

***most commonly = adrenergic substances
1) adrenaline (EPI) from adrenals
2) increased SYMPATHETIC stim
3) caffein, amphet, cocaine, other B1 stim
4) escess digitalis
5) hyperthyroidism
6) Stretch
7) to some extent low O2

17

Premature Atrial Beat w/ Aberrant Ventricular conduction

-if a PAB occurs and when one bundle branch has not completely depolarized a slightly widened QRS occurs = aberrant ventricular conduction
-after this one weird QRS they go back to normal
**aberrant ventricular conduction can occur due to PAB or PJB

18

Nonconducted PAB

this occurs when the AV node is still in the refractory period of its depolarization
***this can look very ominous and like "some kind of block" BUT it is harmless because it RESETS ON CYCLE after the PAB

19

Atrial Bigeminy (def)

-irritable automaticity focus fires a PAB the couples to the end of a normal cycle

20

Atrial Trigeminy (def)

-irritable automaticity focus fires prematures after two normal cycles

21

A ventricular focus can be made irritable by:

1) Low O2 (from multiple causes)
2) Low K+
3) Pathology like MVP, stretch, myocarditis
4) and to a lesser degree B1 adrenergic stimulants (epi)
**most likely cause = hypoxia

22

PVCs appearance

giant ventricular complex on EKG

23

Multiple PVC's from an irritable focus =

1) Ventricular Bigeminy
2) Ventricular Trigeminy
3) Ventricular Quadrigeminy

24

6 PVC's per minute

= pathological

25

Ventricular Parasystole

-Produced by a ventricular automaticity focus that suffers from entrance block but is not irritable.
-Not vulnerable to overdrive suppression
-interval is not always consistent

26

A run of 3 or more PVCs =

Ventricular Tachycardia
(if it lasts longer than 30 seconds it = SUSTAINED ventricular tachycardia)

27

Barlow Syndrome =

Mitral Valve Prolapse

28

MVP murmur and phenotype

-Women > Men
-Symptoms at age 20 y/o
-slender body w/ a slight chest deformity
-experience dizzy spells and are anxiety prone

29

Paroxysmal Tachycardia

150-250
-arrise suddenly
-differentiate between atrial, junctional, ventricular

30

Flutter

250-350

31

Fibrillation

350-450 (multiple foci discharging)

32

rapid rate
spiked p-waves
2 P: 1 QRS

PAT w/ AV block

33

PAT w/ AV block you suspect

Digitalis excess or toxicity

34

What paces the atria in Ventricular tachycardia?

The SA node but because the rate is so rapid the individual P waves are hidden in the QRS.

35

Runs of ventricular tachycardia may indicate:

-coronary insufficiency (ischemia)
-other cause of cardiac hypoxia

36

SVT vs Ventricular Tachy

V-tach
- is very common in pts w/ coronary disease or infarction
-QRS are greater than .14
-av dissociation w/ captures or fusions
-extreme right axis deviation

37

Torsades de Pointes

-looks like a twisted ribbon
-caused by low potassium, meds that block potassium channels, or congenital abnormalities
-rate is 250-350
-no effective ventricular pumping
-self limited

38

Atrial flutter

-sawtooth pattern

39

Ventricular flutter

-rate of 250 to 350
-wine waves of similar amplitude
-nearly always leads to ventricular fibrillation

40

Rate of fibrillations

350-450

41

Ventricular fibrillation

-type of cardiac arrest (DIRE EMERGENCY)
-requires immediate defibrillation
-requires CPR

42

Wolff-Parkinson-White Syndrome

-bundle of kent is present = accessory pathway
-you see a delta wave
-can have paroxysmal tachycardia via 3 mech

43

Lown-Gangong-Levine Syndrome

-AV node is bypassed by an extension of the Anterior Internodal Tract
-depolarization of Bundle of His directly
-can pose a serious problem with rapid atrial arrhythmias like atrial flutter