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Cardiology > ECG and Arrhythmias > Flashcards

ECG and Arrhythmias Flashcards

1
Q

membrane potential across individual cardiac cells consisting of resting membrane potential, depolarization, and depolarization

A

action potential

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2
Q

steps of an action potential

A

1) Resting membrane potential
2) Depolarization (Na+ influx)
3) Ca2++ influx and K+ efflux
4) Repolarization (K+ efflux)

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3
Q

the electrical field generated by the wave of depolarization or depolarization
changes with time
duration, magnitude, and direction in space

A

cardiac dipole

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4
Q

What is the flow of cardiac depolarization

A

1) Sinus Node
2) Atrial Muscle
3) Atrioventricular Node
4) His Bundle
5) Bundle Branches
6) Purkinje Network
7) Ventricular Muscle

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5
Q

originates at the SA node and moves as a uniform wave
-right to left
-superior to inferior

A

atrial depolarization

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6
Q

originates at the atrioventricular node and moves to His Bundle, Bundle branches, Purkinje Nework, and then the endocardium to the epicardium
-superior to inferior
-right to left)

A

ventricular depolarization

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7
Q

what direction does atrial depolarization move

A

superior to inferior
right to left
(uniform wave)

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8
Q

what direction does ventricular depolarization move

A

endocardium to epicardium
superior to inferior
right to left

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9
Q

what standard position is the animal in for ECG recording

A

right lateral recumbency
-4 limb electrodes and 6 precordial electrodes

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10
Q

recording of the amplitude of cardiac dipole versus time

A

electrocardiogram

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11
Q

what is the size of the small boxes?

what is size of large boxes

A

1mm

5mm

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12
Q

if ECG is recorded at 25mm/sec. How many big boxes is 1 second

A

5 big boxes

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13
Q

What wave is atrial depolarization

A

P wave

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14
Q

What on the ECG is ventricular depolarization

A

the QRS complex

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15
Q

What on the ECG is ventricular repolarization

A

T wave

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16
Q

why is there typically a flat line between the P wave and the QRS complex

A

P wave is atrial depolarization and there is typically a little delay at the AV node before ventricular depolarization (QRS complex)

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17
Q

What is typically the first negative wave on an ECG (of the QRS)

A

Q wave

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18
Q

What is typically the first positive wave of the QRS on ECG

A

R wave

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19
Q

What plane are you looking at in an ECG

A

the frontal plane (right and left, and superior and inferior) only the X plane
sternal area

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20
Q

What leads measure the frontal plane (right and left with superior and inferior)

A

bipolar limb leads (Leads I, II, III)

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21
Q

bipolar limb lead that goes right forelimb (-) to left forelimb (+)

A

lead I

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22
Q

bipolar limb lead that goes right forelimb (-) to left hindlimb (+)

A

lead II

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23
Q

bipolar limb lead that goes left forelimb (-) to left hindlimb (+)

A

lead III

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24
Q

why is it useful to record the ECG with all 3 limb leads

A

each of the limb leads looks at the cardiac wave of depolarization from a different angle in frontal plane

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25
Q

you expect lead _____ to have the largest QRS complex

A

Lead II

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26
Q

if you have a QRS complex going in the opposite direction. What is one example of what might be going on

A

right ventricular hypertrophy

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27
Q

How do you get the augmented limb leads (aVR, aVL, aVF)

A

you take two of the electrodes, average them and put it against the other electrode

gets you 3 more angles

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28
Q

What are the different augmented limb leads

A

aVR: left forelimb and left hindlimb (-) averaged ; right forelimb (+)

aVL: right forelimb and left hindlimb (-) averaged; left forelimb (+)

aVF: right forelimb and left forelimb (-) averaged; left hindlimb (+)

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29
Q

left forelimb and left hindlimb (-) averaged ; right forelimb (+)

A

aVR

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30
Q

right forelimb and left hindlimb (-) averaged; left forelimb (+)

A

aVL

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31
Q

right forelimb and left forelimb (-) averaged; left hindlimb (+)

A

aVF

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32
Q

What is the perfect right to left lead that you can use to see if something is traveling right to left

A

lead I

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33
Q

which leads are negative when there is an impulse traveling downwards

A

aVR and aVL

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34
Q

what is the axis lead of normal depolarization

A

lead II

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35
Q

what is the best lead of superior to inferior movement

A

aVF

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36
Q

what is the best lead of right to left movement

A

lead I

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37
Q

Rank the leads by their amplitude of QRS

A

1) Lead II
2) aVF
3) III
4) I

Negative: aVR and aVL (positive on top)

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38
Q

what are the two paperspeeds that ECGs are typically recorded at?
what is the standard voltage calibration

A

50mm/sec
25mm/sec

10mm/mV

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39
Q

which leads give a negative P wave

A

aVR and aVL

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40
Q

which leads give a positive P wave

A

those that are inferior:
II, III, aVF

lead I can be positive or biphasic

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41
Q

How can you tell the P wave is originating at the SA node

A

Lead I is important
-it is positive or biphasic
the directionality is important to tell where the origin of the P wave is (SA node) or somewhere below the AV node

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42
Q

which leads give a positive QRS complex

A

the inferior leads (II, III, aVF)

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43
Q

which leads give a negative QRS complex

A

aVR and aVL

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44
Q

what does the QRS look like on lead I

A

very variable
but typically positive or isoelectric

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45
Q

if the ECG is recorded is at 50mm/sec. How many heavy boxes is 1 sec

A

10 heavy boxes

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46
Q

What is the PQ interval important for telling

A

First degree heart block
if prolonged: nx dog <40ms; nx cat is <35ms

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47
Q

What might a wide p wave tell you

A

P mitrale
left atrial dilation

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48
Q

what might a tall p wave tell you

A

P pulmonale
right atrial dilation

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49
Q

the beginning of the P wave to the first deflection of QRS
important for determining first degree atrioventricular block

A

P-Q interval

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50
Q

A P-Q interval of >40ms in the dog or >35 in cat constitutes

A

a prolonged P-Q interval indicative of a First Degree Atrioventricular Block

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51
Q

What might a really short P-Q interval mean

A

there pre-excitation (accessory pathway-AP)

congenital defect where muscle extends from atrium to ventricle around AV nodes that excites the ventricle without delay

concerning when it causes a re-entrant circle and causes intense tachycardia

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52
Q

How would left ventricular hypertrophy influence ECG

A

R wave will be tall ( >2.5mV)

not really diagnostic because there are other ways to know their left heart is increased

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53
Q

what might a really tall R wave mean (>2.5mV)

A

there is left ventricular hypertrophy

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54
Q

Why is the QRS wider when the rhythm is originating in ventricle

A

because it is not using the conducting system

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55
Q

What does a QRS complex that is narrow mean

A

it always means that it has supraventricular origin
*normal conduction

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56
Q

What does a wide-complex QRS typically mean
>70 ms (dog)
>40ms (cat)

A

that there is a ventricular origin (it could also be supraventricular)

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57
Q

A narrow QRS is always ____________ but it is possible for it to be wide if there us

A

narrow complex is always supraventricular origin but it is possible to be wide if there is aberrant conduction

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58
Q

How might there be a wide-complex QRS that is supraventricular in origin

A

Left Bundle Branch block makes abnormal conduction and a wide QRS

distinguish from ventricular tachycardia because supraventricular origin has a P-wave

*Ventricular tachycardia does not have a P-wave

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59
Q

How do you distinguish supraventricular origin with abnormal conduction (Left Bundle branch block) from ventricular tachycardia

A

distinguish from ventricular tachycardia because supraventricular origin has a P-wave

*Ventricular tachycardia does not have a P-wave

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60
Q

Why might you see dominant S waves in leads I, II, and aVF

A

-right axis shift
-right ventricular enlargement

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61
Q

What are the results of cardiac arrhythmias

A

1) Cause exercise/activity intolerance (especially in athletes)
2) Syncope
3) Congestive heart failure (tachycardia induced cardiomyopathy)
4) Sudden cardiac arrest

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62
Q

What are the diagnostic step approach to cardiac arrhythmias (6 steps)

A

1) Determine Heart Rate
2) Is QRS narrow or wide
3) R to R interval (regular or irregular)
4) P wave morphology
5) P-QRS relationship
6) Periodicity

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63
Q

the heart rate determined on two beats

A

instantaneous heart rate
1) determine paper speed
2) determine the ms between complexes
3) 60,000/ total ms

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64
Q

How many heavy boxes in 3 seconds

at 50mm/sec
at 25mm/sec

A

50mm/sec: 30 heavy boxes is 3 seconds

25mm/sec: 15 heavy boxes is 3 seconds

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65
Q

at 50mm/sec. how many heavy boces in 1 second

A

10 heavy boxes

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66
Q

If paperspeed is 25mm/sec and you count 13 QRS in 15 heavy boxes. What is the heart rate

A

for 25mm/sec. 15 heavy boxes is 3 seconds

13x20= 260 bpm (tachycardia)

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67
Q

How do you determine the instantaneous heart rate

A

1) Determine paper speed
50mm/s = 20ms/mm
25mm/s = 40ms/mm
2) Determine ms between complexes
3) 60,000/total ms

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68
Q

What is normal dog heart rate range

A

60-160bpm
Tachycardia >160bpm
Bradycardia <60bpm

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69
Q

What is normal cat heart rate range

A

140-220bpm
Tachycardia >220bpm
Bradycardia <140bpm

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70
Q

Tachycardia in dog is defined as greater than

A

160bpm

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71
Q

Bradycardia in dog is defined as less than

A

60bpm

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72
Q

Tachycardia in cat is defined as greater than

A

220bpm

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73
Q

Bradycardia in cat is defined as less than

A

140bpm

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74
Q

A narrow QRS is < _____ ms in the dog and tells you that it is __________ origin.
The _________ segment is present and the ____ wave can have any configuration

A

A narrow QRS is < 70ms in the dog and tells you that it is SUPRAVENTRICULAR origin.
The ST segment is present and the T wave wave can have any configuration

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75
Q

A wide QRS is >_________ in the dog and tells you that it is _________ OR ___________. It will have a predominately unidrirectional QRS with a “slurred” _____ segment.
There will be a T wave of ___________

A

A wide QRS is >70ms in the dog and tells you that it is VENTRICULAR ORIGIN OR ABERRANT CONDUCTION. It will have a predominately unidrirectional QRS with a “slurred” ST segment.
There will be a T wave of opposite polarity

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76
Q

What are the criteria for having a wide complex QRS

A

1) >70ms in dog >40ms in cat
2) mostly unipolar QRS
3) Tall Twave of opposite polarity
4) Slurred ST segment

Causes: Ventricular origin or Supraventricular origin with abnormal conduction (left or right bundle branch block- anatomic) or aberrant conduction (functional block)

77
Q

What are the causes of wide QRS

A

1) Ventricular origin (Ventricular Ectopic Beats)

2) Supraventricular origin with:
a) abnormal conduction (left or right bundle branch block- anatomic)
b) aberrant conduction (functional block)

78
Q

What is the diagnosis if you have an R to R interval that is irregularly irregular

A

atrial fibrillation

79
Q

How do you recognize a sinus origin P wave

A

Positive P wave in lead II

If you see consistent negative P wave in lead II then it probably isnt a sinus origin P wave

80
Q

What would you see if the P wave is originating from the AV node/junctional

A

negative II, III, and aVF (retrograde P)

81
Q

what do you think when you see a P wave configuration different from the sinus P wave

A

Is it atrial tachycardia?

82
Q

P wave =
P’ wave =
F wave =
f wave =

A

P wave = SA node origin

P’ wave = P wave not originating from SA node a) AV junction origin (retrograde P wave) or b) Atrial origin (different from sinus P wave)

F wave = Atrial flutter (sawtooth pattern)

f wave = atrial fibrillation

83
Q

A P wave of SA node origin

A

P wave

84
Q

A P wave not originating from SA node

A

P’ wave, can be
a) AV junction origin (retrograde P wave)
b) Atrial origin (different from sinus P wave)

85
Q

a P wave seen in atrial flutter

A

F wave (sawtooth flutter)

86
Q

A P wave seen in atrial fibrillation

A

f wave

87
Q

T/F: Atrial fibrillation cannot behave paroxysmally

A

True

88
Q

Considered normal rhythms

A

1) Sinus rhythm
2) Sinus arrhythmia
3) Sinus arrhythmia with wandering pacemaker
4) Sinus rhythm with bundle branch block

*All have normal heart rate

89
Q

What are the characteristics of sinus rhythm

A

1) Normal heart rate
2) Narrow QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

90
Q

1) Normal heart rate
2) Narrow QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

A

Sustained Sinus Rhythm
(normal rhythm)

91
Q

1) Normal heart rate
2) Narrow QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

A

Sustained Sinus arrhythmia (normal rhythm)

-waxing and waning change in heart rate. Vagal response- healthy (associated with a lower heart rate)

92
Q

What are the characteristics of Sinus arrhythmia

A

1) Normal heart rate
2) Narrow QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

*normal rhythm
-waxing and waning change in heart rate. Vagal response- healthy (associated with a lower heart rate)

93
Q

What are the characteristics of Sinus arrhythmia with wandering pacemaker

A

1) Normal heart rate
2) Narrow QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave is variable
6) Sustained

*Normal rhythm

94
Q

1) Normal heart rate
2) Narrow QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave is variable
6) Sustained

A

Sinus arrhythmia with wandering pacemaker

(normal rhythm)
some variability in P wave configuration is okay in dogs

95
Q

1) Normal heart rate
2) Wide Complex QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

A

Sinus Rhythm with Left Bundle Branch Block

96
Q

What will you see with
Sinus Rhythm with Left Bundle Branch Block

A

1) Normal heart rate
2) Wide Complex QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

97
Q

What breed gets right ventricular-origin ventricular premature complexes (VPC)

A

Boxers
-Boxer Cardiomyopathy
an arrhythmogenic Right Ventricular Cardiomyopathy

98
Q

Boxer Cardiomyopathy

A

arrhythmogenic Right Ventricular Cardiomyopathy where there are ventricular premature complexes (VPCs)
serious cardiac condition

99
Q

Premature QRS complexes coming unusually from the right side of the heart

A

Right ventricular origin ventricular premature complex
-arrhythmogenic right ventricular cardiomyopathy seen in Boxers

100
Q

premature narrow complex ectopic beats that originate in the atrium

A

atrial premature complexes

101
Q

What distinguishes a ventricular premature beat from an atrial premature beat

A

Atrial Premature: narrow and comes in early

Ventricular Premature: wide

102
Q

What are characteristics of Atrial Premature Complexes

A

P’ wave different from sinus P wave
Narrow-complex ectopic beats that originate from the atrium

103
Q

How do you tell a left ventricular origin VPC from a right ventricular origin VPC

A

both will be wide QRS complexes but right VPC will be positive in lead II and the left VPC will be negative in lead II

104
Q

single ectopic beats that occur early (premature) after a normal complex (shortened R-R) generally followed by a wider than normal R-R interval before the next normal complex

A

Premature Ectopic Complexes.
a) VPC
b) APC

105
Q

APCs originate in the _____ and are ________ complex QRS

VPCs originate in the ______- and are ______ complex QRS

A

atria (narrow-complex QRS)

ventricles (wide complex QRS)

106
Q

What are the types of tachycardias

A

1) ventricular tachycardia
2) Atrial fibrillation
3) Sinus tachycardia
4) Supraventricular tachycardias (SVT)

107
Q

What is an abnormal ectopic beat that originates in the ventricles
-only 1 beat

A

premature ventricular complex (VPC)

108
Q

What is an abnormal ectopic rhythm that originates in the ventricles
-only 2 beats

A

ventricular couplet

109
Q

What is an abnormal ectopic rhythm that originates in the ventricles
-only 3 beats

A

ventricular triplet

110
Q

What is an abnormal ectopic rhythm that originates in the ventricles
-4+ beats
-HR: 60-160bpm

A

accelerated idioventricular rhythm

111
Q

What is an abnormal ectopic rhythm that originates in the ventricles
-4+ beats
-HR >160bpm

A

Ventricular Tachycardia

112
Q

Monomorphic Ventricular rhythm

A

ectopic ventricular rhythm only occurring at one place in the ventricle

113
Q

pleopmorphic ventricular rhythm

A

ectopic ventricular rhythm only occurring at multiple places in the ventricle

114
Q

what makes a ventricular rhythm sustained

A

if it is >30 seconds

115
Q

paroxysmal

A

start and stop abruptly

116
Q

What are the characteristics of Monomorphic ventricular tachycardia

A

1) Fast heart rate
2) Wide Complex QRS
3) Regular R-R
4) Av dissociation (No association with P wave and QRS)
5) Random P waves
6) Sustained

117
Q

1) Fast heart rate
2) Wide Complex QRS
3) Regular R-R
4) Av dissociation (No association with P wave and QRS)
5) Random P waves
6) Sustained

A

Monomorphic Ventricular Tachycardia

118
Q

What are the characteristics of Pleomorphic (multifocal) ventricular tachycardia

A

1) Fast heart rate
2) Wide Complex QRS
some are positive and some are negative
3) Regular R-R
4) Av dissociation (No association with P wave and QRS)
5) Random P waves
6) Sustained

119
Q

1) Fast heart rate
2) Wide Complex QRS
some are positive and some are negative
3) Regular R-R
4) Av dissociation (No association with P wave and QRS)
5) Random P waves
6) Sustained

A

Pleomorphic (multifocal) ventricular tachycardia

120
Q

24 hour ambulatory ECG that helps tell you the arrhythmias occuring over a long time period

A

holter monitor

121
Q

when ventricular tachycardia gets so fast you cant tell the difference between complexes
monomorphic ventricular origin tachycardia >350bpm
not far from cardiac arrest

A

ventricular flutter

122
Q

a form of cardiac arrest
disorganized electrical activity in the ventricles
a result of ventricular tachycardia
treat with shock

A

ventricular fibrillation

123
Q

1) Fast to very fast rate (160-350bpm)
2) always have a wide QRS compatible with ventricular origin
3) R-R interval is typically regular once tachycardia becomes established
4) P wave are disassociated from wide QRS complexes (appear intermittently)
5) can be sustained or show paroxysmal periodicity
6) response to IV lidocainr supports diagnosis
7) can be monomorphic, pleomorphic (multifocal) or polymorphic

A

ventricular tachycardia

124
Q

What treats ventricular tachycardia

A

IV bolus of lidocaine

used for diagnosis because it isnt good at treating other forms of tachycardia

125
Q

1) Fast heart rate
2) Narrow complex QRS
3) irregularly irregular R-R
4) P and QRS associated
5) f waves (no P wave)
6) Sustained

A

Atrial fibrillation

126
Q

What is the pathogenesis of atrial fibrillation

A

atria has chaotic electrical activity that is bombarding the AV node.

Atria cant generate P wave because requires slow conduction- you get a f wave instead

127
Q

What do you see with atrial fibrillation

A

1) Fast heart rate
2) Narrow complex QRS
3) irregularly irregular R-R
4) P and QRS associated
5) f waves (no P wave)
6) Sustained

128
Q

1) fast to very fast rate (120-300bpm)
2) typically have narrow QRS compatible with supraventricular origin but can have wide QRS if conduction abnormal
3) irregularly (choatic) irregular R-R interval is hallmark
4) P waves are not present (por possible) fine f waves may be present in baseline
5) Sustained rhythm (paroxysmal atrial fibrillation rarely observed in animals)

A

Atrial fibrillation

129
Q

1) Fast heart rate
2) Narrow complex QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

A

Sinus Tachycardia

130
Q

What do you see in sinus tachycardia

A

1) Fast heart rate
2) Narrow complex QRS
3) Regular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

131
Q

What occurs on ECG when the sinus tachycardia is too fast

A

the P and T waves become superimposed

positive P waves are hidden in the T waves

132
Q

T/F: with sinus tachycardia you see fast heart rates but not very fast

A

true it is only 160-240 and not extreme

133
Q

1) fast but usually not very fast (160-240)
2) typically have a narrow QRS compatible with supraventricular origin but can be wide QRS if conduction is abnormal
3) P waves are present in front of QRS and compatible with sinus origin (II, III, aVF)
4) If the rate is at upper limit, P waves may be superimposed on previous T waves
5) Does not show paroxysms
6) vagal maneiver may slow but does not terminate tachycardia

A

Sinus tachycardia

134
Q

T/F: Sinus tachycardia does not show paroxysms

A

True- they dont stop abruptly but will slow down over time

135
Q

when you massage the carotid sinus or push on the eyeballs
trying to elicit vagal tone

A

vagal maneuver

136
Q

T/F: Atrial fibrillation does not show paroxysms

A

True

137
Q

T/F: supraventircular tachycardia does not show paroxysms

A

false

138
Q

What are the characteristics of Supraventricular Tachycardia

A

1) Fast heart rate
2) Narrow complex QRS
3) Regular R-R
4) P’ wave and position is variable
5) Paroxysmal or Sustained

139
Q

T/F: vagal maneuver may terminate supraventricular tachycardia

A

true

140
Q

T/F: vagal maneuver may terminate sinus tachycardia

A

False- it may slow it but it does not terminate the tachycardia

141
Q

The only possible diagnosis if you see a regular sinus rhythm and then immediately go into a tachycardia is:

A

Supraventricular tachycardia

142
Q

1) Usually fast to very fast (240-300bpm)
2) Narrow QRS compatible with supraventricular origin
3) R-R interval is typically very regular once tachycardia is established
4) P’ wave morphology and position is variable depending on mechanism
5) Can be sustained or paroxysmal periodicity
6) Vagal maneuver may terminate

A

Supraventricular Tachycardia

143
Q

What are the 4 types of SVT

A

1) Focal Atrial Tachycardia (FAT)
2) Atrial Flutter (Macro-reentrant Atrial Tachycardia) **
3) Atrioventricular Reciprocating Tachycardia (AVRT)
4) Atrioventricular Junctional Tachycardia (AVJT)

144
Q

How does atrial flutter occur

A

Re-entrant pathway is circulating around the atrium generating F waves (sawtooth pattern)

145
Q

1) Fast heart rate
2) Narrow complex QRS
3) Irregular/Regular R-R
4) F wave (sawtooth)
5) Paroxysmal or Sustained

A

Atrial Flutter (Marco-Reentrant Atrial Tachycardia)

irregular RR because of coupling to F waves but not chaotically

146
Q

What are the characteristics of Atrial Flutter (Marco-Reentrant Atrial Tachycardia)

A

1) Fast heart rate
2) Narrow complex QRS
3) Irregular/Regular R-R
4) F wave (sawtooth)
5) Paroxysmal or Sustained

147
Q

if you see a paroxysmal narrow-complex tachycardia, it is likely

A

supraventricular tachycardia

148
Q

If you have a wide complex rhythm and you arent sure about the cause, what can you do?

A

Give a bolus of lidocaine
if it goes away it’s ventricular tachycardia
if not its a supraventricular rhythm
a) sinus rhythm with LBBB
b) atrial fibrillation with aberrant conduction
c) wide complex tachycardia

149
Q

What are the 4 kinds of bradycardias

A

1) Sinus bradycardia
2) Sinus Pause (with Junctional Escape)
3) Atrial standstill
4) Atrioventricular block

150
Q

What are the characteristics of sinus bradycardia

A

1) Slow heart rate
2) Narrow complex QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

151
Q

1) Slow heart rate <60bpm
2) Narrow complex QRS
3) Irregular R-R
4) P and QRS associated
5) Sinus axis P wave
6) Sustained

A

Sinus bradycardia

152
Q

Why might animal have bradycardia

A

they are super fit or inappropriate vagal tone (respiratory or GI disease)
drugs (ex: opioids, alpha2 agonists, digoxin, b blockers)
normal in sleeping dogs
vasovagal reflex (cough, urination, vomiting, defecation, emotion)

153
Q

T/F: sinus bradycardia has some degree of sinus arrhythmia

A

true -vagal mediated

154
Q

1) Sinus origin rhythm with slow heart rate (dog <60bpm, cat <140bpm)
2) often accompanied by sinus arrhythmia and wandering pacemaker
3) Can be physiological, pathological, or pharmacological
a) normal in sleeping dogs, vasovagal reflex (cough, urination, vomiting, defecation, emotion, bradycardia and hypotension > syncope
b) Drugs: alpha-2 agonist, opioids, digoxin, b blockers

A

Sinus bradycardia

155
Q

A normal sinus rhythm that becomes paused and then resumes with a retrograde P’ behind QRS

A

Sinus pause with junctional escape

156
Q

In Sinus pause with junctional escape once there is junctional escape there is ______

A

a retrograde P’ behind the QRS

157
Q

Where is the retrograde P’ after a junctional escape with sinus pause

A

after the QRS

158
Q

unexpected interruption with SA node activity (2-8seconds)
often terminate with junctional escape beat

A

Sinus pause

159
Q

What terminates a sinus pause

A

junctional escape
-retrograde P’ wave behind QRS

160
Q

What does a sinus pause mean

A

there is sinus node dysfunction - intrinsic disease of the sinus node
-frequent sinus pauses with escape beats >3000/day
-tachycardia-bradycardia

161
Q

Sick Sinus Syndrome

A

condition where the animal is fainting (syncope) due to sinus node dysfunction and experiencing long sinus
Pause >8 seconds
mini schnauzers and other small breed dogs

162
Q

condition where the animal is fainting (syncope) due to sinus node dysfunction and experiencing long sinus
Pause >8 seconds
common in mini schnauzer and other small breed dogs

A

Sick Sinus syndrome

163
Q

What dog breeds are predisposed to have sick sinus syndrome ( sinus node dysfunction)

A

miniature Schnauzers and other small breed dogs

164
Q

What is seen in atrial standstill from hyperkalemia

A

1) Slow heart rate
2) Narrow-complex QRS
3) Irregular RR
4) No P waves

165
Q

What is number one cause of atrial standstill

A

hyperkalemia
-urinary obstruction?

166
Q

Why might there be no P waves in any lead

A

Atrial Standstill from hyperkalemia

Atrial Standstill- AV muscular dystropgy

167
Q

What is seen in atrial standstill from AV muscular dystrophy

A

1) Slow heart rate
2) Narrow-complex QRS
3) Irregular RR
4) No P waves

168
Q

complete absence of P waves in all limb and precordial leads
transient (hyperkalemia) or permanent (AV muscular dystrophy in spring spaniels)

A

atrial standstill

169
Q

what breed do you get permanent atrial standstill in?

A

Springer spaniel

170
Q

What is a result of atrioventricular muscular dystrophy seen in springer spaniels

A

Permanent Atrial Standstill
-complete absence of P waves

171
Q

prolonged PQ interval
dog: >130ms
cat >90ms

A

first degree AV block

172
Q

What is characteristic of a dog with first degree AV block

A

prolonged PQ interval
>130ms

173
Q

What is characteristic of a cat with first degree AV block

A

prolonged PQ interval >90ms

174
Q

intermittent interruption of AV conduction
-All QRS are followed by P waves but some P waves are blocked

A

Second degree AV block

-mobitz type I (Wenchkebach) or type II

175
Q

intermittent interruption of AV conduction
-All QRS are followed by P waves but some P waves are blocked and there isnt a subsequent QRS
<2:1 are blocked

A

Second degree AV block
low grade

176
Q

intermittent interruption of AV conduction
-All QRS are followed by P waves but some P waves are blocked and there isnt a subsequent QRS
>2:1 are blocked

A

Second degree AV block
high grade

177
Q

complete interruption of AV conduction
ventricular escape rhythm with AV dissociation
perkinje fibers are automatic and trigger bradycardia escape

A

Third Degree AV block

178
Q

What are the characteristics of a Second Degree AV block- Low grade

A

1) Bradycardia possibly
2) Narrow complex QRS
3) Sinus axis P
4) Intermittent P waves not followed by QRS
5) Every QRS came from a P wave
6) <2:1 P waves not followed by QRS

179
Q

What is the difference from Mobitz I from Mobitz II Second Degree AV block

A

I: gradual prolongation of PQ prior to block

II: fixed PQ interval prior to the block

180
Q

What are the characteristics of a Second Degree AV block- High grade

A

1) Bradycardia
2) Wide complex QRS
3) Sinus axis P waves
4) Regular R-R
5) AV dissociation not present
6) P waves not followed by QRS >2:1

181
Q

What are the characteristics of Third Degree AV block

A

1) Bradycardia
2) Wide complex QRS
3) Sinus origin P
4) Regular R-R
5) Sustained
6) Complete AV dissociation
7) 160bpm P wave
*No relationship between P waves and ventricles
*ventricular escape rhythm

182
Q

How do you treat third degree AV block

A

pacemaker

183
Q

How do you treat atrial fibrillation

A

1) rate control - slow AV node conduction (decrease ventricular rate) with diltiazem or +/- digoxin or beta blocker

2) rhythm control/cardioversion- prolong repolarization
with class Ia (quinidine or procainamide) or class III (amiodarone)
DC cardiosynchronous electrical shock

184
Q

How do you treat different bradycardia

A

1) Sinus bradycardia- no treatment
2) sick sinus syndrome- pacemaker
3) High grade 2 or 3 AV block- pacemaker
4) Atrial standstill
temporary- NaHCO3, Ca2++
permanent- pacemaker

185
Q

How do you treat a high grade second degree AV block

A

pacemaker

186
Q

How do you treat acute ventricular tachycardia

A

lidocaine -IV bolus or CRI

187
Q

How do you treat chronic tachycardia (oral)

A

-sotalol
-mexiletine
atenolol, metoprolol
amiodarone
procainamid
felcanide, proafenone
Mg 2+ torsade de pointe

188
Q
A

Cardiology (8 decks)

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