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1

inflammation of pericardium

pericarditis

2

EKG changes in pericarditis

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

3

low voltage seen in all leads

pericardial effusions

4

electrical alterans

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

5

acute occlusions of the pulmonary artery

pulmonary embolism

6

what rhythm is commonly seen with pulmonary embolism?

sinus tachycardia (esp. if embolism is small)

7

EKG pattern seen with massive PE

S1 Q3 T3

8

axis deviation with PE

right axis

9

other EKG changes with PE

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

10

congenital condition with delayed repolarization following depolarization

long QT syndrome

11

long QT syndrome is a/w which ventricular dysrhthmias

V. fib and torsafes
-usually a/w exercise

12

short QT syndrome is a/w?

syncope, ventricular arrhythmias, risk of sudden cardiac death

13

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

QTc interval

14

signs of hyperkalemia

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

15

signs of hypokalemia

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

16

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

decreased; slowed

17

QT interval for hypercalcemia

shorter!
-short refractory period

18

QT interval for hypocalcemia

longer!

19

hypocalcemia can precipitate what?

V. tach or torsades

20

what ions does digoxin affect the movement of?

sodium and calcium
-slows influx of sodium
-increases influx of calcium

21

what is the primary biomechanical mechanism of action of digoxin?

inhibition of the Na/K ATPase of the cell membrane

22

effect of digoxin on contractility and heart rate?

increases contractility and slows heart rate/AV conduction

23

digoxin effect

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

24

digoxin therapeutic drug levels

0.8-2.0 ng/ml

25

toxic blood levels of digoxin

>2.4 ng/ml

26

EKG findings a/w toxic blood levels of digoxin

conduction blocks or tachy-dysrhythmias

27

increased risks a/w toxic blood levels

renal disease, hypokalemia, and aging(?)

28

Specific EKG changes with therapeutic digoxin levels

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

29

most characteristic rhythm disturbance of toxic digoxin levels

PAT (paroxysmal atrial tachycardia)

30

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

anti-arrhythmics, TCA, phenothiazines, erythromycin