chapter 8, Flashcards by Janet Jincy

patients with persistent arrythmia need what ?

establish ECG monitoring
as soon as possible record a good quality 12 lead ECG

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what kind of syncope do not need continuous monitoring ?

situational syncope - during cougar micturition
or orthostatic hypotension

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in which syncope is continuous ECG monitoring required ?

unexplained syncope
esp during exercise
syncope with evidence of structural heart disease
syncope with abnormal ecg - esp prolonged qt

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where to place the electrodes of 12 lead ecg ?

dry , shaven area of skin
over bone not muscle

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in which ecg lead do we most of the time begin monitoring ?

lead 2 - best p , qrs waves
try to minimise muscle movement = relaxed

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in an emergency what is used to detect rhythm?

assess cardiac rhythm by applying defib pads

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in an emergency what is used to detect rhythm?

assess cardiac rhythm by applying defib pads

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WHEN TO PLACE PADS IN AP position

ICD or perm pacemaker jin right side , or chest wall trauma

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When should ECG monitor changes be documented

When patient known to have tacy arrythmia being treated (eg carotid sinus massage and adenosine) - effects of such intervention on a CONTINIOUS ECG SHOULD BE MONITORED

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What should be documented on continuous ECG monitoring ?

When intervention is in place and changes in ECG seen - such as carotid sinus massage , adenosine etc

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What is the potential difference in the myocardium ?

90mV - sudden shift of ions causes depolarisation

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What is sinus rhyth

P WAVE FOLLOWED BY QRS wave

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what des the t wave represent ?

the cells going back to their resting potential

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duration of normal qrs ?

less than 0.12

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a completely straight line indicates ?

lead has been disconnected

during ASYSTOLE THERE IS SLIGHT UNDULATION OF THE BASELINE - may sure interference due to resp movement or chest compression

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what is the normal heart rate ?

60-100

bradycardia <60

tachycardia >100

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what does one large square represent in ecg strip ?

0.25sec

5 large sqaures =1sec

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best way to calculate HR ?

count the number of r waves in 6 seconds =
30 large squares

and multiply by 10

=====
shower ecg strip
divide all by 2 )

(or find one r wave to r wave count how many big boxes and divide it by 300)

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if the RR intervals are totally irregular and qrs complex has constant morphology what is it likely to be ?

afib

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how can you know where ectopic beats come from - whether ventricle or atria ?

ventricle is less <0.12 - it is narrow

broad ectopic beats - maybe ventricle or supra ventricular with bundle branch block

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what is escape rhythm ?

a beat that happens after a long pause - coming from av node or ventricular myocardium

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ectopic beats can occur as ?

single
couplets
triplets

how many amount of ectopic bets are needed for it to be classified as tacyarrythmia ?

more than 3 in rapid succession

what is called an arrythmia that occurs intermittently , interspersed , with periods of normal sinus rhythm ?

paroxysmal

what is called when ectopic beats or arrythmia occurs alternately with sinus beats for a sustained amount of time ?

bigeminy

if qrs duration more than 0.12 where is it coming from ?

origin is from the ventricular myocardium or supra ventricular rhythm transmitted with bad conduction - such as bundle ranch block

why are p wave veryhrd to fid and should not waste time with it and in which lead can p waves be more definingly found

can be present as positive , negative or biphasic deflections u waves mistaken for p waves p wave coincide within qrs or t wave or st segments ===== lead v1 or lead 2

in which leads is atrial flutter best seen ?

inferior leads = 2,3 and avf

how to recognise retrograde activity of p waves

usual p waves positive n lead 2 and aVF negative deflection if retrograde

if af accompanied by regular qrs complies why ?

due to complete av block with AF

in atrial flutter there ca be relationship with atria and ventricles ?

YES most time som instane atrial flutter with variable AV conduction atrial fib - irregularly irregular

how d we know when the ecg strip is VF or artefact ?

if patient conscious and has pulse

rhythm abnormality can mimic vf which are they

polymorphic v tach pre-excited af - WPW (LEFT UNTREATED CAN LEAD TO VF AND VT )

why is it safe to consider all SVT as VT unless proves otherwise

because in presence of bundle branch block - SVT will cause broad complex tacy after MI out broad complex tacy cardia are ventricular in origin

when dp torso de pointes happen ?

prolonged qt interval- ca be inherited or due to drugs less common myocardial ischemia , sme anti - arrhythmic drugs = AMIODARONE (SHOULD BE AVOIDED IN TDP) many patients with TDP - hypo kalemic, magnesia

PEA is defines as what ?

no clinical cardiac output despite normal ectrical activity

causes of pea

HYPOTENSION CARDIAC TAMPONADE 4H AND T'S

which drugs causes bradycardia ?

timing of normal P-R interval

0.12-0.2

what is first degree block ?

prolonged PR interval of more than 0.2sec = usually in trained athletes and can be physiological ! can be due to ischemia and drugs Rarely causesanqy symptoms Rarely requires treatmnet

second degree av block types

mobits type 1 prolonging of pr - until a p wave without qrs complex = can be physiological - in athletes with high vagal tone = most pf the time pathological due tp myocardial infraction = treatment dependant on effect of bradyarrythmia mobitz type 2 constant prolonged PR some p waves not followed by qrs waves = high risk asystole and complete av block

what is third degree av block ?

complete dissociation between atria and ventricles - site of pace maker will decide rate

rate of each side of pacemaker ?

AV node and proximal bundle of his = 40-50 = naeeower qrs complex HISS and purkinje = 3-40 or less

what is idioventricular rhythm ?

rhythm arising from myocardium = including escape rhythm du to complete av block accelerated idioventricular rhythm - just above normal HR = observed after successful thrmbolysis or PCIA

WHEN IS AGONAL RHTHM SEEN?

charachterised by slow irregular broad qrs complexes doe snot have pulse seen in later stages of unsuccful resus attempts

common cause of af ?

alcohol structural heart disease hypertension obesity ==== usually arising from right atrium LIKE MOST OF THE TIME FOR ATRIAL FLUTTER disease like : copd major pulmonary embolism congenital heart disease congestiv heart failure

what inreases risk of vtach going to vfib

ischemia hypokalmeia and hypomagneisa prolonged QT !!!

QT interval shortens as ?

hr increases

what is the corrected qt interval in men and women

men = 0.43 women = 0.45

a QTc of more than 0.5 is a high risk for what ?

cardiac arrest

causes for short qt interval ?

digoxin hypercalcemia

causes for qt prolong

ischemia amiodarone hypo kal/ mag/ cal/ thermia GENETICS class 1 and 3 anti arrhythmic

what is qt period physiological ?

reploraisation