ECG arrythmias

Question 1

Which symptoms can be associated with arrythmias?

Answer 1

Palpitations
Light- headedness
syncope
angina
precipitation of congestive HF
Sudden death

Question 2

Name 7 causes of arrythmia

Answer 2

HIS DEBS:

Hypoxia
Ischemia and Irritability
Sympathetic stimulation

Drugs
Electrolyte Disturbances
Bradycardia
Stretch

Question 3

Name 3 causes of sinus tachycardia

Answer 3

Congestive heart failure
severe lung disease
hyperthyroidism (may be the only sign)

Question 4

What is the most common rhytm disturbance in early stages of acute MI?

Answer 4

Sinus bradycardia

Question 5

What is sinus arrythmia?

Answer 5

Variation in heart rate with inspiration/expiration

Diminishes with aging, obesity, long standing hypertension, autonomic neuropathy

Question 6

What are junctional escape beats?

Answer 6

A rescue depolarization from near the AV node area. Seen as a beat without normal P wave
(might be a retrograde P wave with inverted axis)

Question 7

Which four questions should be asked in order to asses any ECG rhytm disturbance?

Answer 7

1. Are normal P waves present?
2. Are QRS complexes narrow or wide? (< or > than 0.12 s)
3. What is the P and QRS relationship?
4. Is the rhytm regular or irregular?

Question 8

What are atrial and junctional premature beats?

Answer 8

Single ectopic supraventricular beast from atria or around AV node.

P wave may have differnt morphology, timing or axis
Junctional - usually no P wave
Common non-pathological phenomena

Question 9

What is the difference between a junctional premmature beat and a junctional escape beat?

Answer 9

Premature beat - occurs early within the normal sinus
(may be so early AV node is not repolarized -> no QRS)

Escape beat - ocurs late after sinus failed to fire

Question 10

What is Paroxysmal supraventricular Tachycardia? (PSVT)

Answer 10

Absolute regular rhytm with hr between 150-250bpm

can occur in perfectly normal hearts (alcohol, cofee or excitement)

Presents with palpatations, SOB, dizzines, syncope (rarely)

Most common type: AV nodal reentrant tachycardia

Carotid massage -> terminates and diagnose >
adenosine bolus > Bblock, CCB, conversion

Question 11

How is a carotid massage done?

Answer 11

1. If carotid bruits -> don’t do it
2. Patient flat, extend neck, rotate head away
3. Palpate at jaw angle, gentle pressure 10-15s
4. Never both arteries at the same time!
5. Try right carotid first
6. Have a rhytm strip running
7. Have resucitation equipment available

Question 12

What is the mechanism behind atrial flutter?

Answer 12

Reentrant circuit, most commonly around tricuspid annulus

Question 13

What is the ECG pattern in atrial flutter?

Answer 13

Flutter waves
Saw-tooth pattern in II, III
AV block ( commonly 2:1)

Counterclockwise - neg saw tooth
250-350 bpm

Question 14

Name 9 causes of atrial flutter

Answer 14

Hypertension
Obesity
Diabetes melitus 
Electrolyte imbalance 
Alcohol intox 
Drugs ( cocaine, amphetamine)
Pulmonary( COPD, PE)
Thyrotoxicosis
Various cardiac conditions

Question 15

How is atrial fibrillation diagnosed on ECG?

Answer 15

Irregular irregular QRS complexes in absence of p waves

120-180 bpm

Question 16

What are the causes of atrial fibrillation?

Answer 16

Like atrial flutter, but high incidence of cardiac conditions

Acute: PE, thyrotox, pericarditis

Question 17

How is atrial fibrilation treated?

Answer 17

Anticoagulation: warfarin, dabigatran, rivaroxaban

Restoration of sinus rhythm (drugs, electro)

Question 18

What is CHADSVASC?

Answer 18

A risk score in afib determining if the patient needs anticoagulation.
CHF
Hypertension
Age > 75 ->2 , > 65 -> 1
Diabetes
Stroke/TIA/thromboembolism - 2
Vascular disease
Sex female

2 point -> anticoagulation
1 point -> should have anticoag ( not if just for female)