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EKG & Rhythms Flashcards

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1
Q

Steps in Rhythm Analysis

A
  1. Is the patient sick?
  2. What is the heart rate?
  3. Is the rhythm regular?
  4. Are there normal-looking QRS complexes?
  5. Are there normal-looking P waves?
  6. What is the relationship between the P waves and the QRS complexes?
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2
Q
A

Wandering Atrial Pacemaker

-HR <100
-Irregularly irregular
-Different P wave morphology

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3
Q
A

Sinus Dysrhythmia

-Heart rate speeds up, then slows slows down all on its own
-Often benign

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4
Q
A

Sinus Block = Pause equal to or less than 2 P-P intervals

Sinus Arrest = Pause more than 2 P-P intervals

TX:
Treat if PT is symptomatic bradycardic

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5
Q
A

Junctional Rhythm

-HR 40-60
-Narrow QRS
-Inverted/absent P waves

TX:
-Atropine
-Pace
-Epi

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6
Q
A

Accelerated Junctional Rhythm

-HR 60-100
-Narrow QRS
-Absent P waves

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7
Q
A

Junctional Tachycardia

-HR >100
-Narrow QRS
-Absent P waves

TX:
-Diltiazem
-Adenosine

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8
Q
A

Idioventricular (IVR)

-HR 20-40
-Wide QRS
-Absent P waves

TX:
-Pace
-TX for shock
(Epi, Fluids, O2)

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9
Q
A

Accelerated Idioventricular (AIVR)

-HR 40-100
-Wide QRS
-Absent P waves

TX:
-Same as IVR if indicated

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10
Q
A

A fib w/ RVR

-HR no >150

TX:
-Diltiazem
-Sync Cardiovert

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11
Q
A

Premature Atrial Complex

-Different P wave morphology

TX:
-TX for Bradycardia if indicated

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12
Q
A

Premature Junctional Complex (Rare)

-Inverted/absent P wave

TX:
-TX for Bradycardia if indicated

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13
Q
A

Premature Ventricular Complex
(Benign)

3 or more consecutive is considered VT

TX:
Bradycardic = Pace if Symptomatic

Vtach = Amiodarone

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14
Q

1st Degree HB PR interval

A

5 small boxes

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15
Q

1st & 2nd Degree type I MI’s

A

Inferior

TX:
-Atropine
-Pace

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16
Q

2nd Degree type II & 3rd Degree Block MI’s

A

Anterior

TX:
-Pace (unstable)
-Epi

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17
Q
A

2nd Degree Type 2 “Mobitz 2”

Intermittent block below AV node
Occasional “dropped” beats
Regular P, irregular R
Requires close monitoring

TX:
Pace
Epi

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18
Q
A

Complete Heart Block (3rd Degree)

TX:
-Pace
-Epi

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19
Q

SVT rates in Peds

A

Infants: 220

Children: 190

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20
Q

Polarity of Leads I,II,III

A

Bipolar

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21
Q

Polarity of Leads aVr, aVL, aVf

A

Unipolar

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22
Q

Polarity of Leads V1 - V6

A

Unipolar

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23
Q

1 small box (1mm) time

A

0.04 seconds

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24
Q

5 small boxes (1 big box) time

A

0.2 seconds

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25
5 big boxes time
1 second
26
Normal P wave duration
0.12 - 0.20 seconds 3-5 small boxes
27
Normal QRS complex duration
0.08 - 0.10 seconds 2-2.5 small boxes
28
Tall peaked P waves (Lead 2)
Right atrial enlargement, usually due to pulmonary hypertension
29
Peaked T waves
Acute myocardial ischemia onset Hyperkalemia
30
ST Depression
Ischemia *Horizontal/downsloping in 2 continuos leads Hypokalemia *Downsloping w/ T-wave flattening/inversion, prominent U waves and a prolonged QU interval Digoxin *Downsloping ST depression with a “sagging” morphology
31
ST elevation
Injury (prolonged ischemia)
32
Pathological Q waves (25% or more bigger than R wave, 2 continuos leads minimum)
Myocardial Infarction
33
Most common Pathological Q wave location
V 1-3
34
Inverted T waves (deep/symmetrical)
Ischemia
35
V1-3 Inverted T waves in Peds-Juveniles
Normal Finding
36
Calling a STEMI
2 consecutive leads or 2 or more leads 1 anterior lead (V3 or V4)
37
ST elevation criteria
1mm in any Lead except V2 & V3
38
If seen in LBBB..
Concordant ST elevation ≥ 1 mm in ≥ 1 lead Coronary Occlusion MI (STEMI equivalent) Criteria A Modified Sgarbossa
39
If seen in LBBB..
Concordant ST depression ≥ 1 mm in ≥ 1 lead of V1-V3 Coronary Occlusion MI (STEMI equivalent) Criteria B Modified Sgarbossa
40
If seen in LBBB..
Any lead discordant where the STE is ≥ 25% than the depth of the R point Coronary Occlusion MI (STEMI equivalent) Criteria C Modified Sgarbossa
41
Inferior STEMI
Inverted T waves Reciprocality (ST depression) in: -aVL -(maybe lead I)
42
Lateral or anterolateral STEMI
Inverted T waves: Lateral = I, aVL, V5-6 Anterior = V2-6 Reciprocality (ST depression) in: -Lead III -aVF -(maybe lead II)
43
Horizontal ST depression in V1-3 (or 4) with upright T waves and tall R waves
Posterior MI
44
Wellen’s A Up Down Biphasic T wave due to ischemia
45
ST depression w/ variable morphology in leads V4-6 + I,II, & aVL
Subendocardial ischemia
46
De winter T wave *Anterior STEMI equivalent seen in 2% of acute LAD occlusions
47
Widespread ST depression with ST elevation in aVR
Left main coronary artery occlusion Severe triple vessel disease
48
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy -May cause VT & sudden death in young, apparently healthy individuals
49
Sodium Channel Blockade -Amitriptyline, imipramine, or insecticide induced -Deadly
50
Bruguda syndrome Deadly Cause: -Heart defects -Anti Depressants/Psychotics -Stimulants (Drugs) -Electrolyte disbalance S/S: -Blackouts or Syncope -VT
51
Electrical Alternants (alternating QRS amplitude)
Pericardial Effusion Cardiac Tamponade
52
Intracranial Hemorrhage/Increased ICP -Widespread T wave inversion -QT prolongation
53
Hypertrophic Cardiomyopathy -High precordial voltage -T wave inversion on all precordial leads, Inferior & Lateral leads
54
Down Up Biphasic T wave due to Hyperkalemia
55
Hyperkalemia
56
T-wave inversions in the right precordial (V1-3) and inferior (II, III, aVF) leads
PE
57
S wave in lead I, Q wave in lead III, T-wave inversion in lead III
PE S1 Q3 T3
58
PE S1 Q3 T3 S wave in lead I, Q wave in lead III, T-wave inversion in lead III
59
Bunny ears?
Go to V1 UP = RBBB DOWN = LBBB
60
RBBB causes
Right ventricular hypertrophy Pulmonary embolus Ischemic heart disease Rheumatic heart disease Congenital heart disease Myocarditis Cardiomyopathy Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system Heart disease due to high blood pressure in the lungs (pulmonary hypertension) COPD
61
RBBB discordance
ST depression and T wave inversion in V1-3
62
LBBB causes
Anterior MI Dilated cardiomyopathy Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system Hyperkalemia Digoxin toxicity
63
Axis Deviation?
Lead I & aVF
64
Right Axis deviation causes
Left posterior fascicular block Lateral myocardial infarction Right ventricular hypertrophy Acute lung disease (e.g. Pulmonary Embolus) Chronic lung disease (e.g. COPD) Ventricular ectopy Hyperkalemia Sodium-channel blocker toxicity WPW syndrome Normal in children or thin adults with a horizontally positioned heart
65
Left Axis deviation causes
Left anterior fascicular block Left bundle branch block Left ventricular hypertrophy Inferior MI Ventricular ectopy Paced rhythm Wolff-Parkinson White syndrome
66
HYPOKALEMIA Slightly peaked P wave Prolonged PR interval Widespread ST depression & T wave flattening/inversion Prominent U waves (best seen in V2-V3) Long QU interval
67
Hypokalemia Could Lead to: -Frequent Supraventricular & Ventricular ectopics -AF, A flutter, AT -VT, VF, Torsades
68
Hypokalemia
69
Hyperkalemia
70
Progression of Hyperkalemia Could Lead to: -Bradyarrythmias -Sine Wave -Asystole -VF -PEA (bizarre wide complex rhythm)
71
Hyperkalemia
72
Hyperkalemia
73
Long QT intervals
Hypocalcemia Hypomagnesemia
74
Short QT interval J wave
Hypercalcemia
75
-Early Prolonged PR interval (early sign) -Sinus bradycardia -1st degree, 2nd degree and 3rd degree AV block -Junctional bradycardia -Ventricular bradycardia
Beta Blocker & Calcium Channel Blocker OD
76
BB or CCB OD
77
BB or CCB OD
78
Sinus tachycardia, widened QRS, dominant terminal R wave in aVR
TCA OD (has Sodium Blockage effect)
79
TCA OD

Pathophys (18 decks)

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