Flashcards in Leahs VERY BASIC Cards for Wehner the Weiner Deck (18)
What is UAT?
-3+ pre-mature atrial beats of the SAME shape.
-Pacemaker is present but it is NOT the SA node, so the rate isn't 60-100. It's higher.
*NOTE: you can "lose" a P wave within the QRS complex, lose a QRS wave in the case of a block, or see wide QRS waves. However, these are the exceptions and NOT THE RULE.
What is a PAC?
What is its general cause?
One or two early beats followed by an abnormal P wave.
Sinus rhythm, meaning the AV node is the pacemaker (= rate of 60-100 BPM)
Can be normal, caused by something simple like caffeine, OR a sign of organic disease. Wide range of causes, not always pathogenic.
What is MAT? How is it any different from PAC? What causes it?
-MAT is kind of like 3+ PACs in a row, but all three with different shapes.
-MAT has no pacemaker, so the rate is not a normal 60-100 BPM
-It is always pathogenic.
-It always has an isoelectric P line.
Caused most generally by pulmonary/cardiac pathologies, or may be observed in sepsis.
What is the difference between PAC, MAT, UAT, and sinus tachycardia with PACs?
1. PAC- 2 or less early P waves of a consistent shape, SA pacemaker
2. MAT- 3+ early P waves, all DIFFERENT shapes, NO pacemaker.
3. UAT- 3+ early P waves all of the SAME shape, pacemaker IS NOT the SA node.
4. Sinus Tach with PACs- 3+ early P waves of the SAME shape with an SA NODE pacemaker.
Note: SA pacemaker = rate of 60-100 BPM
What does it mean if there is a not a QRS wave for every P wave present?
This is called a conduction BLOCK.
Describe it as a ratio.
Ex 3:1 means there are 3 P waves for every 1 QRS wave.
What is AFIB?
What causes it?
Pattern of ABSENT p waves, constant quivering on the trace (NO baseline), and v rate of 100-180.
It has a very wide range of causes but it is important to note that AFIB is NEVER NORMAL. Most benign causes include post op status, alcohol, and hypertension.
What is atrial flutter? (3)
What causes it?
-"Saw tooth pattern", loss of isoelectric baseline.
-Usually Assc with conduction block MEANING there is not a QRS for every P wave. Our homework example was a 4:1 block, meaning there were four P waves for every 1 QRS.
-Atrial rate of 240-340.
Same pathologies as AFIB, wide range of causes but important to note this is always always pathogenic.
Quick and easy way to distinguish AFIB/FLUTT from MAT or UAT?
Is there an isoelectric baseline?
If so, it cannot be A fib or flutter.
Definition of a fib and flutter includes loss of baseline/constant quivering on the trace!!
What is one general difference between atrial arrhythmias and ventricular arrhythmias?
-Atrial arrythmias have THIN/NARROW QRS waves.
-Ventricular arrythmias have WIDE QRS waves.
*Note: yes, atrial arrythmias occasionally hVe wide QRS waves during a condition called aberrant conduction, but this is the exception and NOT the rule.
#1 cause of UAT with block?
What might it be mistaken for?
How do you NOT fall for this trap?
-UAT with block is caused by digitalis toxicity in 75% of cases
-It may look a lot like atrial flutter.
-You will know it is NOT a-flutter because you will be a smart student and notice the ISOELECTIC baseline which is NEVER EVER present in a flutter or a fib!!!!
What is a pre-mature junctional complex? Is it pathologic?
What is a junctional rhythm? Is it pathologic?
-early narrow QRS wave w/inverted P waves in II, III, and aVF. (yes, QRS may be wide if there is a block or another complication, but this is not the rule)
-Like PAC, PJC can be normal.
-Junctional rhythm is like several PJCs in a row. HR is 40-60.
P waves are gone or inverted at II, III, and aVF. It is pathologic always.
What's the difference between a premature junctional complex and a junctional escape rhythm?
They're essentially the same but you call it an "escape beat" if it follows a long pause.
Atrial flutter or atrial fibrillation with a REGULAR R:R interval:
-what is happening?
The regular R:R rhythm is often actually a full heart block compensated for with a junctional rhythm!
Three EKG patterns that could be caused by digitalis toxicity?
1. A fib or flutter with regular R-R interval.
2. Junctional rhythm.
3. UAT with block.
Technically, because Wehner is a Weiner, where could the P wave be in junctional rhythm?
-could be before the QRS, after the QRS or buried/hidden.
-commonly inverted in leads II, III, and aVF.
What does left ventricular hypertrophy look like? Right?
-Left: heart normally depolarizes to the left first, so making this side bigger exaggerates normal findings. Look for huge S waves in V2-3.
-Right: this will invert normal findings. Look for inverted S waves in I, upright waves in V1.
Common EKG finding in hypothermia?