EKG - Exam 2

Question 1

What anatomic site does first degree AV block occur?

Answer 1

in the AV node of His bundle

Question 2

AV dissociation occurs most often with what kind of block?

Answer 2

3rd degree AV

Question 3

What will an incomplete right BBB look like on EKG? What leads should you look at?

Answer 3

RSR’ pattern but the QRS will NOT be wide like it is in a normal RBBB

leads V1 and V2

Question 4

What arrhythmia are commonly seen with increased frequency in WPW?

Answer 4

atrial fib AND paroxysmal SVT (both wide and narrow complext)

Question 5

What arrhythmia are commonly seen with increased frequency in LGL?

Answer 5

atrial fib AND paroxysmal SVT (both wide and narrow complext)

Question 6

What is the delta wave of WPW syndrome a result of?

Answer 6

premature ventricular depolarization

Question 7

What are some characteristics of the atrial fib that is associated with WPW?

Answer 7

It can induce ventricular fibrillation

Ventricular rates can rise as high as 300 bpm

It can cause syncope or sudden death

Question 8

______ is likely to be present in torsades before the patient starts to have s/s?

Answer 8

long QT interval due to a prolonged ventricular repolarization

Question 9

What are some EKG characteristics of a patient with hypothermia?

Answer 9

Prolongation of the PR interval
Prolongation of the QT interval
sinus bradycardia
prolongation of the QRS complex

Question 10

What is the unusually shaped QRS complexes shown reveal what abormality? What lead should you look at?

Answer 10

the osborne wave of hypothermia?

can see rsr’ in V5

Question 11

EKG changes associated with therapeutic levels of digitalis include?

Answer 11

ST segment depression

Question 12

T/F: The length of the QT interval varies with the heart rate?

Answer 12

True

Question 13

What are 4 things Brugada syndrome is characterized by?

Answer 13

Inherited as an autosomal dominant trait
A pattern resembling right bundle branch block
ST segment elevation in leads V1, V2, and V3
It is a cause of sudden cardiac death in persons with seemingly normal hearts.

Question 14

a pt taking a TCA, what abnormality may present on an EKG?

Answer 14

prolonged QT interval

Question 15

What are the 4 questions you need to ask yourself at the start?

Answer 15

normal P waves?
QRS narrow/wide?
what is the relationship between P and QRS complex?
is the rhythm regular or irregular?

Question 16

What are reentrant rhythms due to?

Answer 16

due to accessory pathways, reenter the cycle of condition

Question 17

What is recentrant impulse formation?

Answer 17

new impluses are formed elsewhere other than the sinus node

Question 18

What is reentrant impulse transmission?

Answer 18

reentrant reentry

Question 19

What is the reentrant reentry loop?

Answer 19

electric impulse that spins in a loop and send out wave of depolarization in all directions (can over ride sinus mechanism)

Question 20

What rate is sinus tachycardia? what does a deep breath do to your heart rate? How many boxes?

Answer 20

101-149

deep breath in= increases HR

less than 3 big boxes

Question 21

What rate is considered sinus bradycardia? What happens when you exhale? By how many boxes?

Answer 21

less than 60

exhale out = decrease HR

greater than 5 big boxes

Question 22

What is the MC escape node?

Answer 22

junctional escape (AV node)

Question 23

what rate is associated with atrial pacemaker?

Answer 23

60-75 bpm

Question 24

What rate is associated with a junctional pacemaker?

Answer 24

40-60 bpm

Question 25

What rate is associated with ventricular pacemaker?

Answer 25

30-45 bpm

Question 26

What is the rate associated with mulitfocal atrial rhythm?

Answer 26

100-200 bpm and need at least 3 different P waves

Question 27

What is the rate associated with atrial flutter?

Answer 27

250-350 bpm

Question 28

What are PAC characterized by?

Answer 28

abnormal P wave followed by narrow QRS, some P wave can be embedded in the T wave

Question 29

What is the difference between junctional escape and premature junctional?

Answer 29

junctional escape occurs late following a pause and premature happens early

Question 30

What is accelerated idioventricular rhythm characterized by?

Answer 30

sustained VT but slower between 50-100 bpm less than 50, loss the accelerated

Question 31

T/F: Any rhythm can become regularly irregular`

Answer 31

TRUE

Question 32

What is the normal length of PR interval?

Answer 32

0.12- 0.2

Question 33

If you have a RBBB, what leads should QRS be positive?

Answer 33

V1, V2, aVR, III

Question 34

If you have a LBBB, what leads should have positive QRS?

Answer 34

V5, V6, I, aVF

Question 35

What is a bifascular block?

Answer 35

RBBB with combo of either left anterior or left posterior hemiblock

Question 36

What is the criteria for nonspecific intraventricular conduction delay?

Answer 36

QRS wider than 0.1 but no other criteria are met

Question 37

What is the criteria for incomplete RBBB?

Answer 37

rsr' pattern but normal width QRS

Question 38

What is the accessory pathway for WPW? LGL?

Answer 38

bundle of kent - WPW james fibers = LGL

Question 39

How wide is QRS in WPW? in LGL?

Answer 39

WPW= QRS is wider than 2.5 boxes (greater than 0.1 seconds) LGL= QRS is normal

Question 40

What is an orthodromic tachycardia? What will the QRS look like?

Answer 40

a rapid, NARROW complex tachycardia that occurs when electrical signal loop through the AV node and accessory pathway

Question 41

What is antidromic tachycardia? What will the QRS look like?

Answer 41

activates ventricles through accessory pathways will have WIDE QRS

Question 42

What is characteristic EKG finding for a pt with hypothermia?

Answer 42

everything slows down!! sinus brady!! can see rsr' in V5 on EKG abrupt rise at J point and then sudden depression back = J wave/Osborn wave ST elevation with J point elevation

Question 43

What is characteristic to find for digoxin effect on EKG?

Answer 43

ST segment depression with flattening/inverted T waves DIFFUSE across all leads

Question 44

What can the digoxin effect lead to? What is it commonly seen with?

Answer 44

can result in bradyarrythmias/tacharrythmias commonly seen with AV blocks

Question 45

How many boxes is 1 second?

Answer 45

5 big boxes = 1 second

Question 46

What leads are digitalis effect more prominent in? What AV blocks are they associated iwth?

Answer 46

leads with tall R waves Digitalis slows conduction through the AV node and can therefore cause first-, second-, and even third-degree AV block.

Question 47

What is the most characteristic rhythm disturbances of digitalis intoxication?

Answer 47

PAT with second-degree AV block

Question 48

What are causes of a prolonged QTc interval?

Answer 48

Question 49

What does Brugada syndrome resember? MC in men or women? What is the underlying cause?

Answer 49

long QT syndromes men genetic mutation affecting voltage-dependent sodium channels during repolarization.

Question 50

How do you identify the Brugada pattern?

Answer 50

(1) a pattern resembling right bundle branch block with a slow, prolonged downslope of the R′ component of the QRS complex (2) T-wave inversion in leads V1 and/or V2 (3) ST-segment elevation in leads V1, V2, and V3.

Question 51

in Brugada pattern, describe the ST-segment elevation pattern?

Answer 51

The ST-segment elevation is often concave and descends into an inverted T wave, a pattern referred to as coving.

Question 52

What is this?

Answer 52

brugada pattern in lead V1