Lecture 8

Question 1

inflammation of pericardium

Answer 1

pericarditis

Question 2

EKG changes in pericarditis

Answer 2

• T wave initially upright and elevated but inverts during recovery phase
• elevated ST segment (flat or concave)
• ST changes diffuse

Question 3

low voltage seen in all leads

Answer 3

pericardial effusions

Question 4

electrical alterans

Answer 4

manifested by changing aamplitude of the QRS complex (seen with large pericardial effusions because the heart may rotate freely)

Question 5

acute occlusions of the pulmonary artery

Answer 5

pulmonary embolism

Question 6

what rhythm is commonly seen with pulmonary embolism?

Answer 6

sinus tachycardia (esp. if embolism is small)

Question 7

EKG pattern seen with massive PE

Answer 7

S1 Q3 T3

Question 8

axis deviation with PE

Answer 8

right axis

Question 9

other EKG changes with PE

Answer 9

signs of RAE, RBBB, inverted T waves in precordial leads

Question 10

congenital condition with delayed repolarization following depolarization

Answer 10

long QT syndrome

Question 11

long QT syndrome is a/w which ventricular dysrhthmias

Answer 11

V. fib and torsafes

-usually a/w exercise

Question 12

short QT syndrome is a/w?

Answer 12

syncope, ventricular arrhythmias, risk of sudden cardiac death

Question 13

represents depolarization and repolarization but it is corrected for the heart rate

Answer 13

QTc interval

Question 14

signs of hyperkalemia

Answer 14

• tall, peaked T waves
• flattened p waves
• 1st degree AV block
• wide QRS complexes
• sine wave pattern (K>7.0)

Question 15

signs of hypokalemia

Answer 15

• flattened T waves
• appearance of U waves**
• ST segment depression

Question 16

hypercalcemia will result in ____ (increased, decreased) automaticity with _____(faster, slowed) conduction

Answer 16

decreased; slowed

Question 17

QT interval for hypercalcemia

Answer 17

shorter!

-short refractory period

Question 18

QT interval for hypocalcemia

Answer 18

longer!

Question 19

hypocalcemia can precipitate what?

Answer 19

V. tach or torsades

Question 20

what ions does digoxin affect the movement of?

Answer 20

sodium and calcium

• slows influx of sodium
• increases influx of calcium

Question 21

what is the primary biomechanical mechanism of action of digoxin?

Answer 21

inhibition of the Na/K ATPase of the cell membrane

Question 22

effect of digoxin on contractility and heart rate?

Answer 22

increases contractility and slows heart rate/AV conduction

Question 23

digoxin effect

Answer 23

expected EKG changes and do not indicate a need to d/c the drug

• seen in therapeutic drug levels
• slows SA node and conduction through the AV node

Question 24

digoxin therapeutic drug levels

Answer 24

0.8-2.0 ng/ml

Question 25

toxic blood levels of digoxin

Answer 25

>2.4 ng/ml

Question 26

EKG findings a/w toxic blood levels of digoxin

Answer 26

conduction blocks or tachy-dysrhythmias

Question 27

increased risks a/w toxic blood levels

Answer 27

renal disease, hypokalemia, and aging(?)

Question 28

Specific EKG changes with therapeutic digoxin levels

Answer 28

- shortened QT interval - flattened T waves - asymmetric ST depression and T wave inversion in leads with tall R waves (gradual downslope of ST segment)

Question 29

most characteristic rhythm disturbance of toxic digoxin levels

Answer 29

PAT (paroxysmal atrial tachycardia)

Question 30

drugs that put pt at risk for V. tach and torsades

Answer 30

anti-arrhythmics, TCA, phenothiazines, erythromycin

Question 31

effect of quinidine

Answer 31

prolonged QT interval | -also widened QRS

Question 32

when should you d/c quinidine

Answer 32

QTI >25% prolongation

Question 33

where do you seen osborne waves

Answer 33

hypothermia

Question 34

all intervals with hypothermia are _____ (prolonged or shortened)

Answer 34

prolonged

Question 35

what is an osborne wave

Answer 35

ST segment elevation with an abrupt ascent at the J point, then plunge back to baseline

Question 36

most common arrhythmias a/w hypothermia

Answer 36

sinus bradycardia and slow a fib

Question 37

what is brugade syndrome

Answer 37

EKG abnormalities which cause sudden death due to V. fib | -3 different EKG patterns with variable ST segment elevation abnl.

Question 38

treatment for brugade syndrome

Answer 38

ICD (implantable cardioverter-defibrillator)