EKG 4 pt 2 highlights

Question 1

“Easily identifiable P waves: vary in shape (3 or more), vary in PR duration, irregular ventricular rate”

This describes what condition?

Answer 1

MAT

Question 2

What is the most common irregular rhythm?

Answer 2

Atrial fibrillation

Question 3

Multifocal atrial tachycardia (MAT):
1) Is it regular or irregular rhythm?
2) How many P wave morphologies is it?
3) Are the PR intervals regular?
4) Does carotid massage have any effect?

Answer 3

1) Irregular
2) At least 3 diff. P wave morphologies (shapes)
3) PR intervals vary in duration
4) No effect (atrial origin)

Question 4

Does MAT have a 1:1 P wave to QRS ratio? Explain

Answer 4

1P:1QRS; varying PR interval and P wave morphology

Question 5

What is the biggest difference between PAT (Paroxysmal atrial tachycardia) and AVNRT?

Answer 5

“Warm up and cool down” period, not abrupt like AVNRT

Question 6

Premature ventricular contractions (PVC): What does the QRS complex appear as?

Answer 6

Wide and bizarre

Question 7

A PVC is usually followed by ___________________ prior to next beat

Answer 7

compensatory pause

Question 8

What are the PVC rules of “malignancy”?

(meaning more likely to result in life threatening arrhythmia)

Answer 8

1) Frequent PVCs
2) Runs of 3 or more PVCs
3) Multiform PVCs
4) “R on T” (more likely to result in V-tach)
5) PVC occurring in the setting of acute myocardial infarction

Question 9

Ventricular tachycardia (V-TACH):
1) What is it?
2) What is sustained V tach?
3) What makes it look different from AVNRT?

Answer 9

1) A run of 3+ PVC = V Tach
2) Sustained V Tach = run of 30 seconds or more
3) Unlike AVNRT, it may be slightly irregular (difficult to appreciate)

Question 10

What 2 kinds of V tach are ACLS emergencies?

Answer 10

1) Asymptomatic sustained V Tach (with a pulse) and
2) Unstable V Tach (Hemodynamically unstable: weak or no a pulse, diminished CO)

Question 11

Ventricular fibrillation (VF/VFIB):
1) What is it and who is it common in?
2) Describe VFIB

Answer 11

1) Pre-terminal event seen in dying hearts; sudden death patients
2) No cardiac output
-No true QRS complexes
-Course to fine VF
-CPR and Electrical Defibrillation must be performed emergently - SHOCKABLE

Question 12

Accelerated idioventricular rhythm: Is this benign or idiopathic?

Answer 12

Benign

Question 13

Name a specific type of V-Tach often seen in patients with prolonged QT interval

Answer 13

Torsade de Pointes

Question 14

List 4 reasons for a pt to have Torsade de Pointes

Answer 14

1) Congenital
2) Post MI
3) Electrolyte imbalances – hypo Ca, K, Mg
4) Rx