EKG Rhythms Flashcards

Question

PVC | Cause & Treatment

Answer 1

``` Electrolyte imbalance Drug toxicity Cardiac Injury Tumor Cardiomyopathy Myocarditis Acidosis Hypoxia CHD Prolonged QT Mitral Valve Prolapse ``` Isolated, unifocal: No treatment Frequent, multifocal: - Correct underlying cause (Hypoxia, Electrolyte imbalance, Acidosis) - Beta Blockers - Procainamide - Lidocaine - Amiodarone

Answer 2

Series of 3 or more PVCs + HR 120 – 200 BPM • HR usually < 250 BPM ``` Sustained • > 10 seconds Non-sustained • < 10 seconds Unifocal Multifocal • Torsade de Pointes (Undulating QRS complexes, Appear to be spiraling along an axis) ```

Answer 3

Cardiac surgery • Right ventriculostomy (Early and late postoperative VT) ``` Torsade de Pointes causes • Drugs/chemicals that prolong QT interval o Antiarrhythmics o Phenothiazines o Tricyclic antidepressants o Antibiotics (Ampicillin) o Organophosphate insecticides ``` S/S - Hemodynamic compromise - VT can quickly deteriorate to VF ***

Answer 4

Reversible causes ``` Unstable (hemodynamically) or Unconscious • Synchronized Cardioversion o 0.5 – 1 J/Kg Pulseless VT • Immediate Defibrillation o 2 – 4 J/kg Uncontrollable VT • ECMO ``` Stable, conscious patient • Amiodarone • Sotalol • Lidocaine

Answer 5

Shorten the QT Interval by increasing HR • Cardiac Pacing • Isoproterenol gtt Unstable (hemodynamically) • IV Magnesium

Answer 6

Implantable cardioverter-defibrillator (ICD) Ablation procedures ``` For patients with • Cardiomyopathy • LQTS • Life-threatening VT • Resuscitated patients following sudden cardiac death ```

Answer 7

ECG - Bizarre, wavy ventricular pattern with varying sizes and configurations of the QRS complex Results from erratic firing of multiple foci within the ventricles - Leads to infective circulation, pulselessness, death Causes - Hypoxia - Hyperkalemia - Digoxin toxicity - Quinidine Toxicity - MI - Myocarditis - Cardiothoracic surgery complications Acute Management - CPR - Defibrillation following PALS guidelines

Answer 8

ECG • NSR (P wave present before every QRS complex, QRS normal in duration and appearance) • 1:1 Conduction (No dropped beats) Prolonged PR Interval • Due to abnormal delay in conduction through AV node Can occur in healthy children

Answer 9

``` Causes • Conduction disturbance • Rheumatic Fever Cardiomyopathies • Congenital Heart Defects o ASD o Ebsteins Anomaly o Endocardial Cushion Defect • Myocarditis • Digoxin Toxicity* o First degree AV block is a sing of digoxin toxicity o Most common cause in pediatric patients** • Lyme Disease* o PR Interval > 280 seconds** ``` Signs and Symptoms • Increased Vagal Tone • Usually asymptomatic & hemodynamically stable Treatment • None • Unless digoxin toxicity

Answer 10

ECG • Some P waves are followed by QRS complex o Dopped Beats Mobitz Type I Mobitz Type II

Answer 11

PR interval becomes progressively prolonged until 1 QRS complex is eventually dropped --> Missed beat o Dysfunction of AV node, but does not progress to complete heart block ``` Causes o CHD o Myocarditis o MI o Cardiomyopathy o Drug Toxicity (Digoxin, BB, CCB, Quinidine) o Cardiac Surgery ``` Can occur in healthy children (11%) o Sleep Symptoms o No hemodynamic compromise Management o Underlying cause (toxicity) o Otherwise, treatment unnecessary

Answer 12

Characteristics can be one of the following o 1. Normal AV conduction with normal PR Interval o 2. Conduction is completely blocked - Ventricular rate depends solely on number of conducted atrial impulses, AV block at the level of Bundle of His Causes o Same as Mobitz Type I Treatment o Asymptomatic - Prophylactic pacemaker therapy (Risk for complete heart block) o Symptomatic - Pacemaker therapy

Answer 13

``` ECG • P waves regular o Normal R-R interval o Slower rate than normal for age • Congenital o QRS duration & impulse normal appearing o Ventricular rate higher: 50 – 80 BPM • Acquired o QRS duration prolonged o Ventricular rate slower: 40 – 50 BPM o May appear as PVC ``` Complete Heart Block • Complete failure of impulse conduction from Atria to Ventricles • Atria and Ventricles beat independently from each other

Answer 14

Causes - Congenital o With or without structural heart disease o Maternal Lupus o L Transposition of the great arteries Causes - Acquired o Cardiac surgical complications (VSD, TOF) o Rheumatic Fever o Lyme Disease ``` Signs & Symptoms • Low CO o Fatigue o Dizziness o Syncope o Exercise intolerance • Infants o CHF ``` ``` Treatment • CHB o Permanent pacemaker • Surgically induced post-op CHB o Temporary pacing o Permanent pacemaker (If CHB > 7 days) ```

Answer 15

ECG Prolongation of QT Interval - Delayed ventricular repolarization Corrected QT Interval (QTc) Measurements • Normal QTc = < 440 ms • Long QT Syndrome: QTc > 460 ms T Wave • Abnormal • Notched, Biphasic

Answer 16

Diagnosis requires ALL of the following: ECG Findings • May sometimes have normal QT interval* Symptoms Family history • Positive family history for LQTS or premature, sudden death reported in 60% of patients* Genetic testing (sometimes) • All blood relatives of patients with congenital LQTS should have screening ECG in addition to genetic testing** o Regardless of symptoms

Answer 17

``` Congenital • Jervell & Lange-Nielsen Syndrome o Congenital deafness (Autosomal recessive) • Romano-Ward Syndrome o No deafness (Autosomal dominant) ``` ``` Acquired • Antibiotics • Antidepressants • Antipsychotics • Electrolyte disturbances • Hypokalemia • Hypocalcemia • Hypomagnesemia • Hypothyroidism • Anorexia nervosa • Head trauma ```

Answer 18

Signs and Symptoms - Syncope - Palpitations - Dizziness - Cardiac arrest - Most symptoms coincide with exercise, emotion, or sudden auditory stimuli** (doorbell, alarm) Risk -Ventricular Arrhythmias (High risk) -Sinus bradycardia (Frequently associated with Long QT syndrome ) -Sudden Death • QTc Interval > 500 msc = 5 – 8 x increased risk of cardiac event **

Answer 19

Reduce sympathetic activity ``` Beta Blockers • Propanolol o 2 – 4 mg/kg/day • Atenolol o 0.5 mg/kg/day ``` Cardiac Pacemaker ICD • Only if high risk • Previous cardiac arrest • Failed medication therapy Left cardiac sympathetic denervation surgery ``` LQTS + VT or Torsade de Pointes • IV Magnesium o 20 – 50 mg/kg o Max 2 g • Serum electrolytes • Toxicology screen ```

Answer 20

Congenital Diseases accompanied with - Ebstein’s Anomaly - L-TGA (corrected transposition) - Hypertrophic Cardiomyopathy ``` Diagnostic - ECHO - Evaluation if • Syncope with WPW - Risk Stratification • Exercise Treadmill Testing o Monitor loss of pre-excitation with increased heart rates • Electrophysiology study o Evaluate accessory pathway with potential ablation therapy ```

Answer 21

At risk for - Sudden death 48% children - A Fib --> VF - A Flutter --> VF - Intermitted pre-excitation or SVT Contraindications - Digoxin - Verapamil - Both medications shorten refractory period of WPW accessory pathway Restrictions -Competitive Sports

EKG Rhythms Flashcards

(45 cards)