EKG Class 3

Question 1

causes of sinus tachycardia

Answer 1

response to exercise, fever, hypovolemic shock/dehydration, thyroid dz, anxiety, drugs (caffeine, epi, isoproternerol)

Question 2

causes of sinus bradycardia:

Answer 2

hypothermia, drugs (BB), intracranial HTN, vagus nerve stimulation

Question 3

location of dz in sick sinus syndrome:

Answer 3

SA node “forgets to fire”

Question 4

EKG findings of sick sinus:

Answer 4

P waves are present, varying rate (PPintervals)

intermittent normal SR and sinus brady

Question 5

Treadmill test with sick sinus will show:

Answer 5

sinus rate will NOT increase w/ exercise

Question 6

Difference between sick sinus and sinus arrythmia:

Answer 6

sinus arrhythmia does not have long pauses like sick sinus

Question 7

sinus arrhythmia often has cyclical variation a/w:

Answer 7

respiration

Question 8

EKG findings with premature atrial contractions (PACs)

Answer 8

wonky P waves (tall/skinny/variable)

pause after T wave (SA node reset)

Question 9

EKG findings of A fib

Answer 9

fibrillation
no P waves (loss of atrial kick)
irregularly irregular rhythm

Question 10

Clinical advise for pts with PACs

Answer 10

avoid caffeine/stimulants

Question 11

types of Afib:

Answer 11

paroxysmal: <7days
persistent: >7days
permanent: >1 year

Question 12

causes of A fib:

Answer 12

HTN
idiopathic
valvular heart dz
thyroid dysfunction
heart surgery
heart failure
obstructive sleep apnea

Question 13

Tx for Afib if unstable:

Answer 13

cardioversion synchronous biphasic shock

Question 14

Tx for Afib if stable: 2 goals

Answer 14

anticoagulation: protect against stroke, CHADS2VASC >2, NOAC or coumadin (INR2-3)

rate/rhythm control: rate 1st, then consider anti-arrythmic drug or procedure to achieve sinus rhythm

Question 15

CHADS2VASC variables:

Answer 15

CHF
HTN
Age (>65,>75)
diabetes
female sex
stroke/TIA/embolism
vascular hx

Question 16

anatomical region of heart a/w Afib:

Answer 16

posterior left atrium
near pulmonary veins
left atrial appendage

Question 17

Atrial flutter rate

Answer 17

atria: 300-320
ventricular: 150-100
(2: 1 or 3:1)

Question 18

HR difference between A fib and A flutter:

Answer 18

Afib: bounces around (62-97-110-83)
Aflutter: stuck at 150

Question 19

A flutter is what type of pathway?

Answer 19

MACRO re-entrant pathway

Question 20

EKG findings w/ A flutter:

Answer 20

saw tooth waves

Question 21

anatomical region of heart a/w A flutter:

Answer 21

tricuspid annulus

near IVC

Question 22

first line treatment for stable A flutter

Answer 22

radiofrequency ablation (higher success than Afib, disrupt the electrical circuit)

Question 23

duration of paroxysmal SVT

Answer 23

abrupt onset/offset

Question 24

sxs of paroxysmal SVT:

Answer 24

lightheadedness, palpitations, chest pain, anxiety, sweating, SOB (mostly symptomatic)

Question 25

triggers of paroxysmal SVT:

Answer 25

``` idiopathic anxiety stimulants overactive thyroid onset of menstruation ```

Question 26

EKG findings of SVT:

Answer 26

narrow complex tachycardia no p waves (1:1 Q and T waves) regular rhythm HR 160-200

Question 27

Tx for stable SVT:

Answer 27

valsalva maneuver place face in cold water carotid sinus massage

Question 28

Tx for unstable SVT:

Answer 28

adenosine or verapamil | electrical (DC) cardioversion

Question 29

long term treatment of SVT:

Answer 29

BB | radiofrequency ablation

Question 30

Macro re-entrant pathways:

Answer 30

a flutter | AVRT

Question 31

Micro re-entrant pathways:

Answer 31

AVNRT

Question 32

EKG findings AVNRT:

Answer 32

p wave hidden in QRS | 1:1 ratio atrial and ventricular contraction

Question 33

Wolf Parkinson White is a type of:

Answer 33

AVRT

Question 34

EKG findings WPW

Answer 34

delta wave (slurred upstroke with wide QRS) "pre-excitation"

Question 35

MOA atrial tachycardia:

Answer 35

focal source of tachycardia outside of SA node | NOT re-entrant circuit

Question 36

EKG findings Multifocal atrial tachycardia:

Answer 36

at least 3 p wave morphologies rate 100-180 irregular

Question 37

causes of MAT

Answer 37

COPD, hypoxia, pulm HTN

Question 38

Tx MAT

Answer 38

supplement O2 | tx underlying condition

Question 39

Difference between MAT and wandering atrial pacemaker:

Answer 39

wandering HR<100 | MAT HR >100

Question 40

Difference between atrial and sinus tachycardia:

Answer 40

atrial tachycardia does NOT resolve at rest (sinus does)

Question 41

EKG findings for junctional/nodal rhythms

Answer 41

can be brady or tachy absence of P wave or retrograde Ps QRS nl short PR interval