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Lecture #5 Flashcards

1
Q

What is the R-R interval?

P-P interval?

A

Ventricular Rate

Atrial Rate

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2
Q

When might you see variance between atrial and ventricular rate?

A

AV block

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3
Q

Why does asking rhythm mean?

A

Are the intervals between the waves the same?

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4
Q

What does PR Interval reflect?

A

Time of conduction through the AV Node, bundle of His, and bundle branches

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5
Q

What does a PR interval at 0.1 indicate?

A

Absolutely nothing.

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6
Q

What does a PR interval at 0.25 indicate?

A

First degree AV block

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7
Q

When might you see a short PR interval?

A

WPW and LGL syndromes

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8
Q

What does the width of QRS indicate?

What might a broadened ORS indicate?

A

Time it takes the ventricle to depolarize

WPW Syndrome and Bundle Branch Block

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9
Q

What does the QT interval reflect?

What might a longer QT indicate?

A

Time it takes the ventricle to repolarize

LQTS

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10
Q

What is indicated by downward Ps or ones without QRS?

A

2nd/3rd degree AV blocks

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11
Q

What might cause an inverted T wave?

A

Previous MI

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12
Q

What might cause changes in S-T segment?

A

Elevated or depressed in MI or ischemia

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13
Q

What might U waves indicate?

What else would you expect?

A

Hypokalemic Patient
Depressed S-T
Low amp. T waves

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14
Q

Four characteristics of normal sinus rhythm.

A

QRS after P
PR interval of .12-.2 (3-5 small squares)
RR is regular (0.6-1 second)
Beats all look like eachother

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15
Q

Five types of sinus node dysrhythmias.

A 
Sinus tachycardia
Sinus bradycardia
Sinus arrhythmia
Sinus Arrest
Wandering Pacemaker
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16
Q

Four types of atrial dysrhythmia

A

Premature atrial contraction
Paroxysmal atrial tachycardia
Atrial Flutter
Atrial fibrillation

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17
Q

Four types of ventricular dysrhythmia

A

Premature ventricular contraction
paroxysmal ventricular tachycardia
torsade de pointes
ventricular fibrillation

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18
Q

Define sinus tachycardia. Causes?

A

More than 100 beats/minute

Catecholeamines, Sympathetic Stim, Stress, Hypoxia

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19
Q

Define sinus bradycardia. Causes?

A

Less than 60 bpm (RR over 1 second)

Distance runners, sleep, PS stim,

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20
Q

Define sinus arrythmia. Cause?

A

Normal variation of sinus rhythm.
Vagal tone effect associated with breathing rates
Mostly in children

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21
Q

Define sinus arrest. Cause?

A

Failure of pacemaker cells

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22
Q

Define wandering pacemaker. Cause?

A

Varying rhythm in which P waves may vary in direction, PR interval can vary.

Inflamed/Irritated Atria or Digitalis Toxicity

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23
Q

Define premature atrial contraction (PAC). Cause?

A

Atrial ectopic focus. Different P wave morphology.

Alcohol, Smoking, Caffeine, Gastric Overload
CHF, Ischemia, COPD

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24
Q

Define paroxysmal atrial tachycardia. Cause?

A

140-220 bpm.

Ectopic Focus in Atria/AV Node or Re-entry/WPW
Caffeine, Nicotine, Alcohol, Anxiety

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25
Define atrial flutter. Cause?
Atrial Rate = 250-250 bpm Typically fixed ratio w/ ventricular Macro-Reentry -- movement around openings of VC or Tricuspid Prevalent in enlarged atria
26
In atrial flutter, what is seen instead of P wave?
Saw-tooth pattern
27
What is atrial fibrillation. Cause?
``` Rapid depolarization (only in A), no discernable P IRREGULARLY IRREGULAR ``` Inc. Atrial size, decreased conduction velocity, decreased refractory period -- MICROREENTRY LOOPS
28
What do you see in AV nodal rhythm?
SA has failed. AV takes over. Inverted P Wave preceding QRS
29
How to distinguish Atrial Fib and Junctional Rhythm if no Ps around?
Junctional -- Regular | Fib -- Irregularly Irregular
30
What are cannon A-Waves
When atria contract during/after onset of ventricular contraction Caused by RA contracting against closed Tri. Valve
31
What do you see with idioventricular rhythm?
Wide QRS, Always same shape | 20-40 bpm
32
Define premature ventricular contraction. Cause?
Wide QRS, No P | Ectopic Foci in ventricles
33
What may premature ventricular contraction lead to?
Ventricular Tachycardia
34
What is an "R on T" Event. Why do we care?
Premature ventricular contraction during T Wave Depolarizing pulse may take a cirtuitous route around refractory regions, causing reentry rhythm Causes Tachycardia or Fibrillation
35
What is paroxysomal ventricular tachycardia? Cause?
Sudden, Rapid ventricular beat Often caused by PVC creating reentry
36
Define torsade de pointes. Cause?
Polymorphic ventricular tachycardia Hypokalemia and LQTS
37
Define ventricular fibrillation. Cause?
Ventricles quiver several hundred times/minute CO drops to zero "Electrical Storm" Micro-reentry circuits
38
How does a defibrillator work?
Depolarizes all parts of ventricular myocardium simultaneously, 3-5 seconds later heartbeat restarts
39
What is asystole?
Ventricular Standstill
40
Define commotio cordis.
Vfib + blow to chest = Death
41
What part of the waves do you need to watch for in commotio cordis?
Just before T Wave
42
What do tall P waves in II, III, and aVF mean?
R Atrial Hypertrophy
43
What do two-peaked P waves in I mean?
L atrial hypertrophy
44
Five causes of R Ventricular Hypertrophy?
``` Valve Stenosis Tricuspid Insufficiency Pulm. Hypertension Septal defect Fallot ```
45
How do you diagnose Left Ventricular Hypertrophy?
Echocardiography
46
Difference in observations of 1st, 2nd, and 3rd degree AV block
1 -- Slowing 2 --- Some Dropped 3 -- Atrial and Ventricular contraction are unrelated
47
Mobitz I, II, and 2:1 II.
M1 -- PR increases till beat drops M2 -- PR normal, QRS sometimes dropped 2:1M2 -- 2 Ps per QRS
48
Causes of AV block?
Ischemia, Compression, Inflammation, diptheria/rheumatic fever, Vagus
49
Why is Mobitz type II dangerous?
It can progress to complete heart block
50
Describe L Bundle branch block.
Heart Disease Wide Rs in I, aVL, or V6 Deep Ss in V1-4
51
Describe R Bundle branch Block
Wide S in I, | R'>R, but switches as you go from V1-V6
52
What is LQTS?
Slowed repolarization of cardiac muscle Leads to Early Afterdepolarizations Slowed Repolarization allows Ca Channels to reactivate, causing serious tachycardia/fibrillation via torsade de pointes
53
What is hERG?
A gene forming a major portion of I-Kr ion channels | Mutations delay repolarization, cause LQTS
54
How can LQTS be acquired?
Anti-arrhythmics, anti-psycholics, antibiotics | Alcoholism, Pericarditis, LV hypertrophy, cocaine
55
Coronary Artery Disease is the result of....
Atherosclerosis (development of arterial lesions that can lead to narrowing of lumen)
56
Heart pain that goes away when exertion is over?
Stable Angina
57
Cause of Acute Coronary syndrome
Disruption of previously non-severe lesion. | Stenosis/Blockage of vessel + myocardial ischemia
58
What are STEMI and NSTEMI?
STEMI -- ACS -- ST-Elevated myocardial infarction | NSTEMI -- ACS -- Non-ST Elevated myocardial infarction
59
What damage is typically seen in STEMI? NSTEMI?
STEMI -- Full Thickness Damage, Prolonged Anginal Pain | NSTEMI -- Stenosis, Sub-endocardial ischemia, Unstable Angina
60
What is Prinzmetal's variant angina?
Transient coronary vasospasm triggered by atherosclerotic plaque Ischemia only with anginal pain
61
Leads associated with Lateral heart (Left Circumflex and LAD arteries)
I, aVL, v5, V6
62
Leads associated with Inf/Right Coronary?
II, III, aVF
63
Waves seen within 5 minutes, within 20 minutes, and within an hour of MI
within 5 -- Hyperacute T from hyperkalemia within 20 -- ST Elevation Within 1 hour -- QRS elevation
64
Nickname for ST elevations seen in MIs
Tombstones
65
What wave difference is often seen long term following MI?
Permanent pathologic Q-wave

Cardio (10 decks)

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