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SSM Dysrhythmia Course > Exam Review > Flashcards

Exam Review Flashcards

1
Q

Inherent rate of SA node

A

60 to 100

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2
Q

Inherent rate of AV node

A

40 to 60
“Junctional tissue”

AV node + bundle of his can combine to become the pacemaker of the heart, if necessary.

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3
Q

Inherent rate of Purkinje fibers

A

20 to 40

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4
Q

Sympathetic Nervous System

A
  1. Innervation affects both atria and ventricles
  2. Causes coronary artery vasodilation, increases HR, increases speed of conduction through the AV node, increases force of contraction
  3. “Speeds up”
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5
Q

Parasympathetic

A
  1. Innervation effect atria
  2. Causes decrease in HR, decrease speed of conduction through the AV node, decreases force of contraction
  3. “Slows down”
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6
Q

Polarization

A

Resting state
Polarized state, no current flow
+ and - are relatively equal

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7
Q

Depolarization

A

Cardiac muscle cell is stimulated
Cell membrane changes and becomes more permeable
Na+ moves into the cell
Depolarization - contraction

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8
Q

Repolarization

A

Takes place after depolarization.
Cells begin to recover and restore electrical charges to normal
Inside of the cell is restored to negatively charged state

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9
Q

Absolute refractory period

A

Portion of ventricular cardiac cycle where no stimulus, no matter how strong, can excite the cardiac tissue. Stimulus will be rejected.

“Absolutely nothing will happen.”

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10
Q

Relative Refractory Period

A

Portion of the ventricular cardiac cycle when all cardiac cells are not fully repolarized. A strong enough stimulus can excite cardiac tissue. This is referred to as the vulnerable period and if hit right can initiate arrhythmias.

“When relatives are there, something bad can happen.”

Relative refractory period is visualized in the last 1/2 of the ‘T’ wave.

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11
Q

ECG Deflections

A

Definition: any wave or complex recorded in the ECG is inscribed as positive or negative deflection.

  • A current flowing toward a (+) electrode gives a (+) deflection.
  • A current flowing away from a (+) electrode gives a (-) deflection.
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12
Q

P wave

A

Usually the 1st wave
Usually originates in the SA node
Reflects atrial depolarization

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13
Q

PR interval

A

Measured from the beginning of the P wave to beginning of QRS complex
Represents interval from time the impulse leaves the SA node, the delay at the AV node, until it arrives at the Purkinje fibers.
Normal PR interval is 0.12 to 0.20

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14
Q

QRS complex

A

Ventricular activity
Represents ventricular depolarization
Represents time required for impulse to travel through the R and L ventricles
Normal range is 0.12 or less.

Bundle branch block has QRS of 0.12 or greater

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15
Q

T wave

A

Represents ventricular Repolarization, last half of T wave is relative refractory period

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16
Q

ST segment

A

Represents time between completion of ventricular depolarization and beginning of Repolarization.

This is the segment between QRS and T wave

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17
Q

QT interval

A

Represents total ventricular activity, depolarization and Repolarization.
QT interval varies with heart rate.

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18
Q

Normal sinus rhythm characteristics

A 
HR 60 to 100
Rhythm is regular
PR interval is 0.12 to 0.20
QRS is less than 0.12
One P wave for each QRS, uniform in appearance
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19
Q

Sinus bradycardia characteristics

A 
HR less than 60
Rhythm is regular
PR interval 0.12 to 0.20
QRS less than 0.12
One P wave for every QRS, uniform appearance
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20
Q

Sinus tachycardia characteristics

A 
HR 100-160
Rhythm regular
PR interval 0.12 to 0.20
QRS less than 0.12
Uniform appearance
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21
Q

Sinus arrhythmia characteristics

A

Rate: slightly increases with inspiration, decreases with expiration
Rhythm: irregular, varies with respiration
PR interval: 0.12 to 0.20
QRS: less than 0.12

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22
Q

Sinus bradycardia Cause/Treatment

A

Cause: athlete, vegal stimulation, decreased metabolism, medications, elevated ICP, sinus node disease

Treatment: assess PT, IV/O2, atropine to increase HR, pacemaker

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23
Q

Sinus tachycardia causes/treatment

A

Cause: sympathetic stimulation (fever, stress, pain, anxiety, exercise), hyperthyroid, medications, caffeine, atropine, hypotension, shock, hypo olefin

Treatment: Treat the underlying cause!! Do not give cardiac med.

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24
Q

Sinus Arrhythmia causes/treatment

A

Cause: usually seen with deep breathing, commonly seen in the young and the elderly

Treatment: usually doesn’t require intervention - if symptomatic, IV/O2, atropine, pacemaker

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25
Q

Premature atrial contractions (PACs) characteristics

A

Rhythm is regular except for the premature beat
P wave early with premature beat, may have different configuration
PR interval with PAC may vary
QRS with PAC should be similar to regular QRS
T wave shape may change when early P wave is buried in proceeding T wave

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26
Q

Premature atrial contractions (PACs) causes/treatment

A

Cause: sympathetic stimulation, altered electrolytes, hypoxia, digoxin toxicity, HF, stress, caffeine, alcohol, may be normal for some people

Treatment: Assess patient, treat underlying cause, BB/CCB may help when idiopathic.

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27
Q

Atrial tachycardia characteristic

A

Rate usually 160 to 250, classic rate is 180, may be precipitated by PAC
P waves “should be seen”, but may be lost in preceding T wave
PR interval may be different than normal PR interval, may not be measurable
QRS less than 0.12

  • *Sinus tachycardia 100-160 (slow onset)
  • *Atrial tachycardia 160-250 (sudden onset)
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28
Q

Atrial tachycardia causes/treatment

A

Cause: dig toxicity, hypoxia, ischemia, electrolyte imbalance, CAD

Treatment: if stable - vagle maneuver, adenosine, CCB, BB, amiodarone
If unstable - synchronized cardio version

29
Q

Paroxysmal Atrial Tachycardia (PAT) characteristics

A

Same as atrial tachycardia, but has a sudden onset/cessation

**Causes/treatment same as atrial tachycardia

30
Q

Atrial flutter characteristics

A

Saw tooth pattern - flutter waves
Atrial rate (use exact method) is 250 to 400
PR interval is not measurable
Ventricular rate depends on amount of blocking occurring at AV node; may be regular or irregular
QRS less than 0.12
QT is usually immeasurable in flutter

31
Q

Atrial flutter causes/treatment

A

Causes: rheumatic heart disease, valve disease, ischemia, hypoxia, pericarditis, sick sinus syndrome

Treatment: Control rate (BB, CCB, dig, amiodarone), convert the rhythm (rate > 48 hrs then anticoagulate first) use amiodarone, synchronized electrical cardioversion, ablation

32
Q

Atrial fibrillation characteristics

A

Absence of P waves *zero coordinated electrical activity, atrial just quiver.
Atrial rate is 400+ (known from research, this cannot actually be measured
Rhythm is irregular
Ventricular rate depends on amount of blocking by the AV node
If ventricular rate is greater than 100 then it is called a fib with RVR
QRS is less than 0.12

33
Q

Atrial fibrillation causes/treatment

A

Cause: rheumatic heart disease, hypertension, MI/ischemia, COPD, frequent PAC’s, post cardiac surgery

Treatment: control rate, convert rhythm, concerns for clot formation (this is the same as atrial flutter)

34
Q

Supra ventricular tachycardia (SVT) characteristics

A

Broad term
Any tachycardia originating from somewhere above the ventricles
Cannot see P waves
Skinny QRS

35
Q

Junctional rhythm characteristics

A 
Rate is 40 to 60
P wave may be inverted, absent, or after the QRS
PR interval less than 0.12
QRS less than 0.12
R-R interval is regular
36
Q

Junctional rhythm causes/treatment

A

Cause: digoxin, hypokalemia, ischemia, SA node disease, electrolyte imbalances, cardiomyopathy

Treatment: determine underlying cause, withold medications, potassium replacement, is s/s give atropine to stimulate SA node, may need to pace temporarily.

37
Q

Accelerated junctional rhythm characteristics

A

Rate is 61 to 100
P wave is inverted, absent, or after QRS
QRS less than 0.12

38
Q

Accelerated junctional rhythm causes/treatment

A

Causes: dig toxicity, MI, HF, valvular disease

Treatment: treat the underlying cause

39
Q

Junctional tachycardia characteristics

A

Rate 101 to 200
P wave absent, inverted, or after QRS
QRS 0.12 or less

40
Q

Junctional tachycardia causes/treatment

A

Causes: #1 cause is dig toxicity

Treatment: Treat underlying cause, O2/IV, BB, CCB, amiodarone, cardioversion

41
Q

Premature ventricular contractions (PVCs) characteristics

A

Rhythm is irregular due to premature beat
QRS is wide and ugly; greater than 0.12
ST & T wave slope in opposite direction of the ectopic QRS

42
Q

PVC causes/treament

A

Causes: sympathetic stimulation, dig toxicity, ischemia, MI, HF, electrolyte imbalance, hypoxia, stimulants

Treatment: assess PT, O2/IV, replace electrolytes, amiodarone, lidocaine

43
Q

Ventricular tachycardia characteristics

A

Rate 100 to 250 - use exact method
Rhythm R-R is regular
Usually no visible P waves
QRS is wide, >0.12

44
Q

V tach causes/treatment

A

Causes: same as PVCs

Treatment: Assess Pt, check pulse, O2/IV, amiodarone, cardioversion, if no pulse, call code, CPR, defibrillation, epi/amiodarone.

45
Q

Torsades de Pointes

Torsades V Tach

Characteristics

A

Variation of v tach in which the QRS appears to twist around baseline

QRS complex changes shape, size, amplitude, width

46
Q

Torsades V tach cause/treatment

A

Cause: any drug that may prolong QT interval, inherited prolonged QT interval, low K, low mag, low Ca, acute MI

Treatment: Call code, CPR, defibrillation, magnesium, Epi

47
Q

Ventricular Fibrillation Characteristics

A 
No measurable rate
No identifiable ECG waveform
No contraction, no cardiac output
Wavy baseline
Rhythm is fine or coarse
48
Q

V fib cause/treatment

A

Cause: CAD/CHF, ACS, MI, drug toxicities, electrical shock, post cardioversion, antiarrhythmics

Treatment: Call code, CPR, defibrillation, epi, amiodarone

49
Q

Idioventricular rhythm characteristics

A

Rate 20 to 40
P wave absent, sometimes retrograde
QRS wide, greater than 0.12, look alike

50
Q

Idioventricular causes/treatment

A

Cause: ischemia, MI, dying heart, hypoxia, dig toxicity, SA node/AV junction have failed

Treatment: avoid antiarrhythmics, correct underlying cause, atropine, temporary pacing

51
Q

Accelerated idioventricular rhythm (AIVR) characteristics

A

Rate 41 to 100

QRS > 0.12

52
Q

AIVR cause/treament

A

Cause: ischemia, reperfusion, dig toxicity, cocaine, cardiomyopathy

Treatment: do not give antiarrhythmics, give atropine if rate is slow

53
Q

Asystole

A

Complete absence of electrical activity in the heart
May resemble fine v fib
Confirm in 2 leads

Check PT
Call code
CPR
Epi
Fix the cause

Cause: hypovolemia, hypoxia, acidosis, hypokalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis

54
Q

Agonal rhythm

A

Dying heart
Rate is less than 20

Tx: transcutaneous pacing, call code, CPR, epinephrine, atropine

55
Q

Beta Blockers

A

Decreases HR, BP, strength of contractions
Used with MI and unstable angina
Examples: metoprolol, labetalol, atenolol, carvedilol

56
Q

Calcium channel blockers

A

Decreases myocardial contractility, decreases conduction of SA and AV nodes.
Used to control atrial tach
Ex: diltiazem, amylodipine

57
Q

Digoxin

A

Cardiac glycoside
Used to control a fib with RVR and a flutter
Very narrow therapeutic window

58
Q

Amiodarone

A

Antiarrhythmics used to control atrial and v tach dysrhythmias.

59
Q

Adenosine

A

Push fast

Depresses AV and SA node activity

60
Q

Amiodarone

A

Treat v-tach

61
Q

Lidocaine

A

Grate ventricular arrhythmias.

62
Q

Epinephrine

A

Only IVP when doing CPR
Vasopressor
Increases HR, BP, perfusion pressure to the brain and heart

63
Q

Magnesium

A

Shortens QT interval

Used to treat or prevent recurrence of torsades de Pointes v tach.

64
Q

1st degree heart block

A

Rhythm regular, originates in the SA node
P wave is present, appears normal
PR is greater than 0.20 consistently
QRS less than 0.12

Cause: seen in aging, may be normal, may be a forerunner to further AV block

Tx: usually no tx, hold medication, continue to monitor

65
Q

2nd degree heart block type I

A

Atrial rate is greater than ventricular rate
P-P is constant, originates in SA node (P-P always regular)
Some P waves not conducted, more P waves than QRSs
PR interval progressively lengthens until QRS is dropped
Ventricular rhythm is irregular (R-R irregular)
QRS less than 0.12
Has a consistent pattern

Cause: increased parasympathetic tone, medications, MI

Tx: usually none required, hold medications, monitor for further block, atropine if bardycardic, may need to externally pace if atropine doesn’t work.

66
Q

2nd degree heart block type II

A

Atrial rate is regular, P to P is constant (exact method)
More P waves than QRS’s (P waves all on time)
Ventricular rate varies, R-R is usually irregular
PR interval constant where present, may be greater than 0.12
QRS less than 0.12

Cause: MI, drugs, degeneration of the conduction system

Tx: hold meds, atropine if symptomatic, temporary pacemaker

67
Q

3rd degree heart block

Complete heart block

A

A/V rates unrelated, complete a sense of conduction between atria and ventricle
Atrial rate regular, P to P constant, P waves normal (exact method)
Ventricular rate regular (R to R constant)
PR interval varies and has no pattern
QRS may be wise or narrow - depends on where impulse originates

Cause: ischemia or injury, CCP, BB, trauma

Tx: hold meds, pacing, epi drip, atropine (maybe)

68
Q

Conduction system electrical pathway

Name the components

A

Sinus node –> Bachmann’s bundle

Internodal pathways –>AV node –> Bundle of His –>

Left bundle branch –> Purkinje fibers
Right bundle branch –> Purkinje fibers

SSM Dysrhythmia Course (1 decks)

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