Dysrhythmias Below The AV Node

Question 1

Ectopic focus from ventricle (cell decides to contract early/out of order)
Ventricular depolarization occurs BEFORE SA node fires
WIDE QRS bc stimulation occurs BELOW AV node
NO P wave
COMPENSATORY PAUSE to reorganize SA and AV nodes for impulse conduction

Answer 1

PVC

Question 2

PVC

Answer 2

Ectopic focus from a ventricle (cell decides to contract early/out of order)
Ventricular depolarization occurs BEFORE SA node fires
WIDE QRS bc stimulation occurs BELOW AV node
NO P wave
COMPENSATORY PAUSE after the PVC to reorganize SA and AV for impulse conduction

Question 3

Are PVCs abnormal?

Answer 3

No

Question 4

PVC telemetry characteristics…

Answer 4

Compensatory pause ==> beat after PVC feels like a "thump in the chest" bc the ventricles have a lot of time to fill c blood bc of the compensatory pause 
Bigeminy 
Trigeminy 
Couplet 
Unifocal 
Multifocal

Question 5

Bigeminy

Answer 5

Every OTHER beat is PVC

Question 6

Trigeminy

Answer 6

Every THIRD beat PVC

Question 7

Couplet

Answer 7

TWO PVCs paired together

Question 8

Unifocal

Answer 8

PVCs all the same –> same irritated area in Vs causing the early contraction

Question 9

Multifocal

Answer 9

PVCs appear different –> more than one area irritated and they all contribute to early contraction

Question 10

PVC potential causes…

Answer 10

Caffeine/energy drinks
Nicotine
Stress
Overexertion
Hypo- or hyperkalemia
Ischemia
Cardiomyopathy
Cardiac irritation

Question 11

PVC characteristics

Answer 11

Increased frequency ==> decreased filling time ==> DECREASED PRELOAD ==> decreased SV ==> decreased CO

Question 12

Decreased CO is dangerous c PVCs when…

Answer 12

Couplet
Multifocal
> 6/min.
Triplets 
*termination points for activity ==> can degrade to life-threatening rhythm*

May progress to V-tach or V-fib
Anti-arrhythmia

Question 13

It is important to note if PVCs…

Answer 13

Increase c exercise
Decrease c exercise
Stay the same c exercise

monitor BP and sx for termination points

Question 14

Should premature beats be taken into consideration when calculating HR?

Answer 14

No - HR should be calculated on a part of the strip that does not contain the PVCs

Question 15

3 or more consecutive PVCs
NO P wave
WIDE QRS (bc impulse BELOW AV node)
V rate 100-250bpm

Answer 15

V-tach

Question 16

When is the QRS wide?

Answer 16

When the impulse comes from BELOW the AV node

Question 17

V-tach

Answer 17

3 or more consecutive PVCs
NO P wave
WIDE QRS (bc impulse comes from BELOW AV node)
V rate 100-250bpm

Question 18

V-tach V rate…

Answer 18

100-250bpm

Question 19

V-TACH =

Answer 19

EMERGENCY

Question 20

V-tach possible causes…

Answer 20

Ischemia/infarction
CAD
HTN
Digoxin
Electrolyte imbalance

Question 21

V-tach management

Answer 21

Cardioversion (time c QRS)

Defibrillation (increased Joules of energy to reset the rhythm)

Question 22

V-tach characteristics

Answer 22

CO greatly affected ==> decreased HR, decreased filling time, NO atrial contraction
Lightheadedness
Syncope
Angina
Weak, thready pulse
Disorientation

Question 23

V-tach telemetry characteristics…

Answer 23

NO P wave

WIDE QRS

Question 24

“Twisting of the points”

Answer 24

Torsades de Pointes

Question 25

Torsades is a characteristic of...

Answer 25

V-tach

Question 26

Torsades occurs when...

Answer 26

V-tach changes axis ==> bad prognostic factor that makes the V-tach harder to defibrillate

Question 27

Characteristics of torsades

Answer 27

Twisting around the isoelectric line Occurs during V-tach Significant drop in CO Cardioversion

Question 28

Quivering of ventricles, so no real contraction, and the atria do not really contract much NO CO Multiple ectopic foci --> contractions not synchronous Zig-zag pattern Progression of V-tach

Answer 28

V-fib

Question 29

V-fib

Answer 29

Quivering of ventricles, so no real contraction, and the atria don't really contract much NO CO Multiple ectopic foci c no synchronous contraction Zig-zag pattern Progression of V-tach

Question 30

V-FIB =

Answer 30

EMERGENCY

Question 31

V-fib possible causes...

Answer 31

Progression of V-tach Infarction/ischemia HTN Digoxin toxicity

Question 32

V-fib management

Answer 32

Defibrillation CPR O2 Meds

Question 33

Altered electrical conduction during angina T wave inversion T wave flattened or peaked Changes in ST segment at least 1mm (elevation is STEMI; depression if NSTEMI)

Answer 33

MI

Question 34

The zone of ischemia in an MI looks like what on a telemetry strip?

Answer 34

T wave inversion or flattening

Question 35

The zone of infarction in an MI looks like what on a telemetry strip?

Answer 35

Q wave/STEMI (elevated) (transmural MI) --> > 0.04 sec; at least 1/4 the heigh of R wave in same QRS Non Q-wave/NSTEMI (depressed) (sub-endocardial MI) --> area of myocardium can re-infarct if not managed Bundle branch blocks