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PHTH 536: Body Systems > Final Review > Flashcards

Final Review Flashcards

1
Q

What is EKG?

A

It measures the electrical activity of the heart

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2
Q

What does an EKG determine?

A

-Heart rate
-Rhythm

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3
Q

What is Phase 0 of EKG?

A

-Depolarization and rapid entry of Na+
-PR interval

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4
Q

What is Phase 1 of EKG?

A

-Early depolarization, K+ slowly enters
-QRS (ask Dr. Z)

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5
Q

What is Phase 2 of EKG?

A

-Plateau continues and slower entry of Ca2+
-ST segment

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6
Q

What is Phase 3 of EKG?

A

-K+ moves out of the cells
-T wave

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7
Q

What is Phase 4 of EKG?

A

-Resting phase
-Rest between T and P waves

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8
Q

What are the 4 main electrophysiologic principles?

A

-Automaticity: pacemaker ability
-Rhythmicity: systematic pattern
-Conductivity: spreads impulse
-Contractility: contraction ability

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9
Q

What is the function of the SA node? What is the intrinsic rate of the SA node?

A

-Activation of the atria
-Intrinsic rate: 60-100 bpm

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10
Q

What is the function of the AV node? What is the intrinsic rate of the AV node?

A

-Activation of the ventricles
-Intrinsic rate: 40-60 bpm

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11
Q

What is the intrinsic rate of the Bundle of His and Purkinje Fibers?

A

Intrinsic rate is 30-40 bpm

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12
Q

How many seconds is 1 large square on an EKG graph?

A

0.2 seconds

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13
Q

How many large boxes is 3 seconds? How many are 6 seconds?

A

-15 boxes= 3 seconds
-30 boxes= 6 seconds

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14
Q

How is heart rate calculated with an EKG graph?

A

-Uses a 6 second tracing
-Count # of QRS complexes in 6 second interval and multiply by 10

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15
Q

What is the P wave on an EKG?

A

Depolarization of the atria

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16
Q

What is the PR interval on an EKG?

A

-Onset of P wave to onset of R wave
-Measures the time between onset of atrial depolarization (SA node) and ventricular depolarization (AV node)

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17
Q

How many small squares is a normal PR interval?

A

3-5 small squares

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18
Q

What is the QRS complex?

A

-Onset of Q wave to end of S wave
-Measures the depolarization of the ventricles

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19
Q

How many small squares is a normal QRS complex?

A

1.5-3 small squares

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20
Q

What is the Q wave?

A

First downward deflection or negative deflection in the QRS complex

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21
Q

What is the R wave?

A

First upward or positive deflection in the QRS complex

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22
Q

What is the S wave?

A

Second downward or negative deflection in the QRS complex

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23
Q

What does assessment of the cardiac cycle via EKG include?

A

-Assessment of P wave
-Assessment of PR interval
-Assessment of QRS complex
-Assessment of QRS interval (duration)
-Assessment of T wave
-Evaluate R to R wave interval (is it regular)
-Evaluate HR
-Observation of pt and any symptoms

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24
Q

What is a term for a normal EKG with a normal HR?

A

Normal sinus rhythm

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25
What is sinus bradycardia?
Slow HR (< 60 bpm) but normal rhythm
26
What is sinus tachycardia?
Fast HR (> 100 bpm) but normal rhythm
27
What are the different types of irregular atrial rhythms?
-Premature atrial contraction (PAC) -Atrial tachycardia -Atrial fibrillation -Atrial flutter
28
What is a premature atrial contraction (PAC)? How would this look on an EKG?
-Atria contracts prematurely -Shorter distance between T and P wave of next heart beat
29
What are causes of PACs? Are they dangerous?
-Often benign and non-lethal -If underlying cardiac conditions: can be an early sign of CVD -HTN, caffeine -Pregnancy -COPD, asthma -Metabolic: hyperthyroid disease -Stress or extreme fatigue -Some medications for asthma or hayfever
30
What are symptoms of PACs?
-Patient may not have any symptoms -A skipped heart beat -Fatigue or SOB -Exercise intolerance -Chest pain (advanced)
31
What is atrial tachycardia? What will it look like on an EKG?
-Also known as supraventricular tachycardia -Atrial depolarization is happening so fast you cannot see the P wave -No P waves, it is hidden in the QRS complex
32
What are causes of atrial tachycardia?
-HTN and cardiomyopathy -Previous MI -Excessive use of alcohol, cocaine, or other stimulants -An "irritable focus" when cells outside the SA node start generating an electrical pulse -Sometimes idiopathic
33
What are symptoms of atrial tachycardia?
-Palpitations -Fainting -Chest pain -SOB -Fatigue -Exercise intolerance
34
What should a PT do if they notice atrial tachycardia?
-Tell someone!!! -Document what you were doing when this happened -Reduce intensity and monitor vitals -Alert team
35
What should a PT do if they notice a PAC?
-If it is new, report to nurse/doctor -Reduce intensity and monitor vitals -Report to team
36
What is atrial fibrillation? What does it look like on an EKG?
-Atria are rapidly beating -Absence of P wave and jagged baseline -Irregular ventricular response: irregular rhythm
37
What is atrial flutter? What does it look like on an EKG? What is the atria to ventricular contraction ratio?
-Atria are rapidly beating -Normal rhythm -Rapid ventricular response -4:1 AV conduction (4 atrial contractions to 1 ventricular contraction) -"Saw-toothed" flutter appearance, multiple P waves
38
What are causes of A-fib and A-flutter?
-Anything that interferes with electrical conductivity of SA node and associated internodal fibers/Bachman's bundle -Advanced age or genetic factors -Congenital heart disease or underlying heart disease -Increased alcohol consumption -Endocrine disorders -Neurological disorders -Hemodynamic stress -Obstructive sleep apnea -Inflammation: myocarditis, pericarditis -Any condition that leads to inflammation, stress, damage, or ischemia
39
What are symptoms of A-fib and A-flutter?
-Tachycardia -SOB -Dizziness -Syncope -Fatigue -Exercise intolerance -Chest pain or anxiety -Night sweats or waking up with palpitations
40
What should a PT do if they notice A-fib or A-flutter?
-If new onset or worsening, stop activity, call in team, and monitor patient -Pulse is irregular with a-fib -If they are on beta blockers use RPE -Deep breathing can help slow HR
41
What happens with the electrical activity during A-flutter?
Electrical impulses don't travel in a straight line, they move in a circle inside the atria which results in a regular tachycardia
42
What happens with the electrical activity in A-fib?
Electrical signals travel through the atria fast and disorderly, which makes them quiver instead of squeezing strongly causing tachycardia and irregular rhythm and a reduced atrial kick
43
What are the different types of irregular ventricular rhythms?
-Ventricular arrhythmias -Premature ventricular complex (PVC) -Ventricular tachycardia -Ventricular fibrillation
44
What is premature ventricular complex (PVC)? What does it look like on an EKG?
-Ventricles contract prematurely -Inverted QRS complex and larger amplitude -No P wave
45
When does a PT need to stop activity with PVCs?
-"PVC runs in three's, let them be" -If there are 3 or more PVCs in a row or if they are becoming more frequent with activity, STOP -Report to medical team
46
What is a burst of ventricular tachycardia?
3 or more PVCs in a row
47
What are causes of PVCs?
-Excessive caffeine intake -Electrolyte imbalances: hypokalemia, hypomagnesmia, hypercalcemia -Hyperthyroidism -Excessive alcohol, tobacco, or stimulant use -Cardiac: post MI, myopathies, MV prolapse -Anemia -Most have no etiology -Prevalent in 40-75% of patients that were on 24-48 hour Holtor Monitors
48
What are symptoms of PVCs?
-Very often asymptomatic or benign palpitation -Lightheadedness, chest pain, chest discomfort, dyspnea, and anxiety -Rarely syncope -May possibly palpate or auscultate a missed beat
49
What are treatments for PVCs?
-Rarely need treatments -Anti-arrhythmics -Cardiac ablation to treat aberrant SA node cells
50
What should the PT do if they notice a PVC?
-If it is 1 or 2, monitor and keep going -Increasing in frequency, reduce intensity or stop
51
What is burst ventricular tachycardia (V-tach)?
5-6 PVCs in a row, fast rhythm
52
What should the PT do if they notice a burst V-tach?
-Stop exercise -Notify team -Monitor patient
53
What is sustained V-tach?
-Bizarre widened QRS complexes, no P waves -Rate over 100 bpm
54
What should someone do if they notice sustained V-tach?
-Call someone ASAP because this can quickly turn into ventricular fibrillation or death -Stop all activity immediately
55
What are causes of V-tach? How dangerous is it?
-Potentially life threatening if sustained > 30 seconds -Ischemia or MI -Acute coronary syndrome
56
What are symptoms of V-tach?
-Syncope -SOB due to pulmonary edema -Cardiac arrest and even sudden cardiac death -This is a RAPID RESPONSE or CODE situation
57
What is Torsade de Pointes?
V-tach with increasing and decreasing amplitude
58
What is ventricular fibrillation (V-fib)?
-Chaotic wave pattern and no pulse -Irregularly shaped wave forms that reflect multiple ventricular foci firing randomly in v-fib -This lack of organization prevents measurement of HR
59
What are the causes and symptoms of V-fib?
-MI or other damage to heart wall or conduction system -Severe & sustained electrolyte imbalances, especially hypokalemia -Syncope or near syncope -Significant SOB -Cardiac arrest
60
What should a PT do if they notice V-fib?
Call a code and start CPR!!!
61
What are the different types of atrioventricular heart blocks?
-1st degree AV heart block -2nd degree AV heart block -3rd degree AV heart block
62
What are the two types of 2nd degree AV blocks?
-2nd degree Mobitz Type I/ Wenkebach -2nd degree Mobitz Type II
63
What is a 1st degree AV block? What does it look like on an EKG?
-Delay in conduction -"If the R is far from P, then you have a 1st degree"
64
What is a 2nd degree AV Mobitz Type I/Wenkebach? What does it look like on an EKG?
-Partially blocked conduction -"Longer, longer, longer, drop! Then you have a Wenkebach" -Gradual elongation of PR interval then a QRS complex is dropped -Regularly irregular
65
What is a 2nd degree AV Mobitz Type II? What does it look like on an EKG?
-Partially blocked conduction -"If some P's don't get through then you have a Mobitz II" -Intermittent dropped QRS complex that is not in a type I pattern -P waves are consistent even if there is no QRS complex following it
66
What is a 3rd degree AV block? What would it look like on an EKG?
-Complete block in conduction -"If P's and Q's don't agree, then you have a 3rd degree" -Fixed P-P interval -No relationship between P and QRS waves
67
What are the causes of heart blocks?
-CAD with and without MI -Cardiomyopathy -Autoimmune disorders such as Lupus and Sarcoidosis -Infections, cancers, or inflammation -Congenital -Hyperkalemia
68
What are symptoms of 1st degree heart blocks?
Will likely be asymptomatic
69
What are symptoms of 2nd degree heart blocks?
-Dizziness or syncope -Palpitations or chest pain -SOB -Fatigue -Exercise intolerance
70
What are symptoms of 3rd degree heart blocks?
-Intense tiredness -Irregular rhythm -Dizziness or syncope -Cardiac arrest
71
What should a PT do if they notice a 1st degree heart block?
-If asymptomatic, continue to monitor -Notify team if it is not yet known
72
What should a PT do if they notice a 2nd degree heart block?
-Notify team -Reduce intensity and monitor -May get a pacemaker
73
What should a PT do if they notice a 3rd degree heart block?
-Notify team!!! -Do not treat until a pacemaker has been placed!
74
What is a NSTEMI? What might this look like on an EKG?
-Non-ST segment elevation myocardial infarction -T wave inverted
75
What is a STEMI? What might this look like on an EKG?
-ST-segment elevation myocardial infarction -ST segment is elevated and above the isoelectric line
76
Is a STEMI or NSTEMI more dangerous? Why?
-STEMI is more dangerous -It indicates acute injury -If ST-segment elevation is present with acute onset of chest pain (hours), this is a cardiac emergency!

PHTH 536: Body Systems (3 decks)

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