Pre-wk 6 quiz studying

Question 1

What is this an example of?

Answer 1

MAT
(1P:1QRS with varying PR interval and P wave morphology)

Question 2

What is this an example of?

Answer 2

PAT

(regular rhythm, rate of 100-200, warm up and cool down, varying distances b/t p waves and QRSs)

Question 3

What is this?

Answer 3

A PVC

(premature QRS that’s wide and bizarre; no p wave)

Question 4

What is this?

Answer 4

3 PVCs (rule of malignancy says this is bad; multiple and multiform)

Question 5

What is this?

Answer 5

V-Tach

Question 6

What is this rhythm?

Answer 6

Accelerated idioventricular rhythm.

No P waves, wide QRS complex, rate abt 50-100bpm

Question 7

What is this?

Answer 7

Torsade de pointes

Question 8

What is this?

Answer 8

Mobitz type 2 second degree heart block

Randomly dropped beat; P:QRS interval is variable
On this EKG, each 3rd P wave is missing its QRS

Question 9

What is A? What is B?

Answer 9

A) PVC
B) Ventricular escape beat

Question 10

Prolonged PR interval
1:1 P:QRS
Regular rhythm

This describes what?

Answer 10

First degree AV block

Question 11

What is this?

Answer 11

First degree AV block (long PR interval)

Question 12

What is this?

Answer 12

Sinus exit block w jct escape beat

(narrow QRS, no P wave)

Question 13

What is this?

Answer 13

Complete heart block

(slow 30-45bpm, wide QRS)

Question 14

What is this?

Answer 14

Mobitz type 2 second degree heart block (Wenckebach)

Randomly dropped beat; P:QRS interval is variable

Question 15

What is this?

Answer 15

Sinus bradycardia

QRS narrow, everything else regular

Question 16

What is the general heart rate for AFIB?

Answer 16

75-175bpm ventricular; atrial rate >400

Question 17

What are two pill in the pocket drugs used for AF?

Answer 17

Flecainide or propafenone

Question 18

Take BB or CCB 30 minutes prior to _______________ to prevent atrial flutter with RVR

Answer 18

flecainide

Question 19

What is the heart rate with AVNRT?

Answer 19

150-250/ min

Question 20

What is this?

Answer 20

Sick sinus syndrome

(has a P wave)

Question 21

How fast is atrial flutter?

Answer 21

Atrial rate is ~ 250-350 bpm, ventricular rate classically 150 bpm or 2:1 conductio

Question 22

What is the go to drug for rate control for a pt in AFIB who’s unstable?

Answer 22

IV diltiazem

Question 23

QRS is wide (>3 boxes), and it appears to be a regular rhythm with a normal PR duration that we can tell, so what may you be looking at?

Answer 23

Third degree block

Question 24

What is this?

Answer 24

Mobitz type 1 second degree heart block

Question 25

How can you Dx right atrial enlargement?

Answer 25

P wave is taller than 2.5 boxes in at least one inferior lead; potential right axis deviation of P wave (think severe lung disease)

Question 26

Explain the 4 questions to assess any rhythm d/o

Answer 26

1) Are NORMAL P-waves present? i.e. normal shaped P waves and normal P wave axis (0-70 degrees therefore + in lead II, - in lead aVR.) 2) Are QRS complexes narrow (< 0.12 sec or 3 small boxes) or wide (>0.12 sec)? 3) What is the relationship between the P waves and the QRS complexes? 4) Is the rhythm regular or irregular (look at rhythm strip)?

Question 27

What 2 things indicate a dominant right ventricle (right ventricular hypertrophy)?

Answer 27

V1: R wave > S wave V6: S wave > R wave

Question 28

P wave amplitude > 2.5 mm in at least one of the inferior leads allows you to diagnose what?

Answer 28

Right atrial enlargement

Question 29

How do you diagnose left atrial enlargement?

Answer 29

1) 2nd portion of P wave incr. amplitude: In V1, terminal P wave drops > 1 mm below baseline, and no axis deviation seen OR Incr. in duration: 2) terminal portion of P wave at least 1 small box (0.04 sec) in width in lead 2

Question 30

Which tends to occur first, atrial enlargement or ventricular hypertrophy?

Answer 30

Ventricular hypertrophy

Question 31

What are the criteria for left ventricular hypertrophy (LVH)? (important)

Answer 31

1) R wave in V5 or V6 + S wave in V1 or V2 exceeds 35mm 2) R wave in aVL is 11mm 3) R wave in aVL + S wave in V3 exceeds 20mm in women and 28mm in men 4) LAD > ~15 degrees, but not useful diagnostic feature, & QRS may be slightly prolonged

Question 32

What 2 leads do you need to look at for RVH?

Answer 32

V1 and V6

Question 33

Which is normally due to afterload (pressure overload), hypertrophy or enlargement?

Answer 33

Hypertrophy

Question 34

AFIB: 1) Does AFIB have true P waves? 2) Is QRS wide or narrow?

Answer 34

1) No 2) Narrow

Question 35

1) What is the rate of MAT? 2) What is the rate of PAT? 3) Do they have P waves?

Answer 35

1) 100-200 (can be <100) (irregular) 2) 100-200 3) Yes (may not be visible in PAT)

Question 36

Differentiate between the types of premature beats

Answer 36

Question 37

1) What is the rate of Vtach? 2) Is QRS narrow or wide?

Answer 37

1) 120-200 bpm 2) Wide (mono or polymorphic)

Question 38

How can you remember first degree conduction blocks?

Answer 38

"If R is far from P, then you have a first degree"

Question 39

How can you remember Mobitz type 2 second degree AV block?

Answer 39

"If some don't get through, then you have a Mobitz 2"

Question 40

What is the usual rate of a third degree (complete) AV conduction block?

Answer 40

AV: 60-100 Ventricular: 30-45

Question 41

Describe what a normal p wave looks like

Answer 41

1) Amplitude small; normally does not exceed 2.5 mm (2.5 small boxes) or 0.25 mV 2) Usually most positive in lead 2 and most negative in lead aVR -Individual patients vary so “typical” may not apply 3) Normal range of P vector = 0 – 70 degrees