Johnston- Cardiac Rhythm Disturbances (atrial, junctional, ventricular) Flashcards by Daniel Aaron

cor pulmonale

right heart failure due to lung disease

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ecg in cor pulmonale

low voltage
tall pointed, peaked p waves
sometimes intermitent RBBB

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ECG in hypothyroidism

bradycardia
low voltage
flattening of T wave

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wpw

pre excitation syndrome, congenital from extra bypass tract

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what constitutes bradycardia

under 60 bpm

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medical conditions/situations associated with bradycardia

diseases of atrium or SA node
CAD
inflammation
invsive neoplasm
cardiomyoptahy 
muscular dystrophy
amyloidosis

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drugs associated with bradycardia

digitalis, quinidine, hyperkalemia

drugs for hypertension

beta blockers

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bradycardia and MI

acute inferior MI (RCA lesion)

-related to sinus node ischemia or to a vagal reflex initiated in the ischemic area

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sick sinus syndrome

treatment

tachy alternating with bradycardia
SA node undergoing inflamation, ischemia, hypoxia

seen in people who have vascular disease, advanced heart disease and older pts
use pacemaker to treat slow rate and meds to suppress fast

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what is the most common cause of an unexplained beat pause on ECG

nonconducted PAC

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what is a nonconducted PAC

beat not conducted to the ventricle

atrial (p wave) is abnormal from ectopic focus

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nonconducted atrial bigeminy

every other beat is from ectopic and not concducted

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what can SSS cause

syncope, dizziness, fatigue, heart failure

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treatment of sinus bradycardia

atropine .3–>.5—>1—>2mg IV

repeat 10 min
use caution in glaucoma
AE = urinary retention, abd distension

Epinephrin
isproterenol
pacemaker

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what is automaticity

property of a cardiac cell to depolarize spontaneously during phase 4 of AP and leads to generation of an impulse

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what are PAC (premature atrial contraction) associated with

stress
alcohol
tobacco
coffee
COPD
CAD

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premature atrial beat ecg

biphasic p wave and premature

or different morphology

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treatment of PAC

if symptomatic

beta bloker
metoprolol 25-50 mg BID-TID

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paroxysmal atrial tachycadria

sudden heart rate greater than 100
rate is 150-250
identify irritable focus. P’ wave

atrial tachy
junctional tachy
ventricular tachy

can have p and t waves superimposed on each other

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PAT with block (AV block)

2 P’ waves for each QRS

suspect digitalis toxicity

can have T wave superimposed on P wave

P’ waves are spiked

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multifocal atrial tachycardia

3 or more different P waves (3 or more diff morph in a row)
P-R interval varies
irregular ventricular rhythm
atrial rate over 100

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MAT associated with

copd, pneumonia, beta agonists, electrolyte abnormalties, digitalis tox, sepsis

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treatment for multifocal atrial tachycardia

CCB - nondihydropyridine

diltiazem 20 mg IV
verapamil

Magnesium sulfate
amiodarone/adenosine

caution with beta blocker (pulmonary problems)

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A fib

not well defined p wave and irregular ventricular response

continuous chaotic atrial spikes

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atrial flutter

saw tooth appearance | leads II,III, aVF, V best leads

premature junctional beat

may cause retrograde atrial depolarization - each P' is inverted in leads with an upright qrs - and p' wave can come beofre or after qrs

paroxysmal junctional tachycardia

150-250 bpm p wave may be lost, inverted before or after each qrs

SVT

T wave is high and have narrow QRS complex

svt with no p wave

AVNRT

PVC ecg

premature bizarre wide QRS no preceding p wave may produce retrograde p wave in st segment ST-T wave in opp direction of QRS usually have full compensatory pause

multifocal ventricular ectopics

each irritable focus produces its own distinctive PVC

____ PVCs in a row is start of ____

3, vtac

V tac is sutained longer than ___ seconds of fast ventricular activity

30 seconds

accelerated idioventircular rhythm

- rate is fast, qrs is wide - see this in people who have received thrombolytic therapy - fusion beat

treatment of PVCs

if stable no rx if symptomatic or in setting of ACS- metoprolol if unstable then amiodarone, lidocaine, procainamide (PAL for unstable PVCs)

ventricular tachycardia

``` 3 or more consectutive bizarre qrs complexes ventricular rate of 120-200 usually regular, wide qrs p wave often lost last longer than 30 seconds ```

ventricular fibrillation cliniclal setting

``` Acute MI IHD K+ disturbance Heart failure disorganized depolarization ```

ventricular flutter

250-350 bpm sine waves leads to v fib

torsades de pointes

``` qrs swings from positive to negative direciton may be inherited (prolonged QT) or acquired (class I, II,, antiarrhytmias, alcohol, tca, electrolyte imbalance ```

what do you always check with torsades de pointes

electrolye levels | K, Ca, Mg

treatment for torsades de pointes

MgSO4 overdrive pacing isoproternol

asystole

no rhythm | start cpr

hyper or hypokalemia widens qrs

hyperkalemia

low calcium causes

prolonged AT, triggers arrhythmias (torsades)

high calcium

shortens qt interval

low mg and qt

prolongs it

high mg and qt

shortens it

u waves, increased qt interval, flat or inverted t wavre

hypokalemia

hyperkalemia ecg

tall pointed T wave wide qrs increased pr loss p wave

treatment for hyperkalemia

``` dialysis insulin and glucose na hco3 albuterol rezin binding agents ```

hypocalcemia etiology

``` chronic renal failure vitamin D deficiency hypoparathyroidism acute pancreatitis hypomagnesium ```

hypocalcemia and ecg

prolonged QT

hypercalcemia etiology

hyperparathyroidism malignancy granulomatous disorders endocrine

ecg and hypercalcemia

short qt | short st

etiology of hypomagnesemia

alcholosim and diuretics are big ones

ecg of hypomagnesemia

prolonged PR wide QRS prolonged QT decreased T wave

hypotehemia and ecg

j wave osborne wave wide bizzarre and have a little notch in downslope of QRS

PE and ECG

S1 Q3 T3 (inverted T in V1-V4) large S in lead I ST depression in lead II large Q wave in III with T wave invesion transient RBBB

low voltage in QRS is what

lung disease until proven otherwise

cerebral hemorrhage and ecg

t waves are prominent and followed by a funny notch impressive ST-T changes Widespread giant T wave inversions

hypothyroidism ecg hallmark

widespread flattening or mild inversion of T waves without associated ST segment displacement

most other constant ECG finding in myxedema (from hypothyroidism) is

low voltage of QRS complex

brugada syndrome

people of asian decent prone to sudden death RBBB with ST elevation in V1,V2,V3 bizarre "ski slope" to QRS

wolff parkinson white syndrome

short P-R interval slurred upstroke (delta wave) of QRS complex accessory av conduction pathway (bundle of kent)

Johnston- Cardiac Rhythm Disturbances (atrial, junctional, ventricular) Flashcards

(64 cards)