Rhythm recognition

Question 1

What patients needs ECG monitoring started immediately? What are some common presentations?

Answer 1

Unexplained syncope, especially during exercise; syncope + structural heart disease, syncope + abnormal ECG (esp prolonged QT)

Question 2

In a collapsed patient, what type of cardiac rhythm technology should you use?

Answer 2

Defib (right clavicle, left mid axillary line). You are looking only for rhythm analysis - record abnormal on strip.

Then go for ECG.

Question 3

At rest, the cells of the heart are polarised with what amount of difference?

Answer 3

90mV

Question 4

The PR interval represents what?

Answer 4

AV node delay

Question 5

How do you measure the PR interval?

What is the normal interval time?

Answer 5

Start of the P wave to the first deflection of the QRS complex

0.12-.2s (3-5 small squares)

Question 6

What is the normal QRS?

Answer 6

<0.12s or <3 small squares on 25mm / s paper

Question 7

How to read the rhythm strip?

Answer 7

1) Is there electrical activity

2) What is the Ventricular rate

3) Is the QRS reg or irreg

4) Is the QRS broad or narrow

5) Is atrial activity present

6) Is the atrial activity and ventricular activity related

Question 8

What if there is doubt between asystole and fine VF?

Answer 8

Don’t defib

Question 9

What is a normal heart rate?

What is bradycardia?

What is tachycardia?

Answer 9

60-100

<60

> 100

Question 10

How do you calculate rate?

Answer 10

Count 30 squares and times by 10

Or

Count 15 squares and times by 20

Question 11

If more than three (triplet) occur in rapid succession, what is this considered?

Answer 11

tachyarrythmia

Question 12

When ectopic beats happen alternately to normal beats, what is this called?

Answer 12

bigeminy

Question 13

If you cannot see atrial activity, do you guess?

Answer 13

No

Question 14

What is the length of a normal p wave?

Answer 14

<0.12 sec

Question 15

If the monitor shows VF? what now?

Answer 15

check the patient. if the patient is conscious, this ain’t VF

Question 16

What can look like VF?

Answer 16

Polymorphic VT

Pre-excited AF

But, if the patient ain’t conscious, they are both a form of pVT and need shocking

Question 17

What is the safest rule for broad complex tachycardia?

Answer 17

Consider as VT and treat as VT

Question 18

Torsades often arises in what patient class?

Answer 18

Those with prolonged QT or low K or low Mg

Do NOT give QT prolonging medications like amiodarone

Question 19

What is PEA

What are some treatable examples?

Answer 19

A normal looking ECG that would otherwise normally lead to cardiac output but isn’t

Treatable examples: fluid / blood loss, tamponade, tension pneumo, PE

Question 20

What causes bradycardia (less than 60BPM)?

Answer 20

Drugs, normal variant, SA Node, failure of AV conduction

Question 21

What is a normal PR?

Answer 21

0.12-0.20s

Question 22

What is first degree block?

Answer 22

> 0.20s. It represents a delay through AV conduction. It can be normal like in athletes

Question 23

What is second degree block?

Answer 23

When some, but not all, P waves are conducted to the ventricles

Question 24

What is the complications of Mobitz Type 2?

Answer 24

Complete AV block

Asystole

Question 25

What causes Mobitz Type 1 AV block (also called Wenckebach AV block)?

Answer 25

Delay of AV conduction It can be caused by: Normal variant, MI, Medications (dig, ca+ blockers, amiodarone, beta blocker), myocarditis

Question 26

What is the difference between Type 1 and Type 2 second-degree HB?

Answer 26

Type 1: Progressive prolongation of P-QRS interval until P wave occurs with no QRS following Type 2: Constant PR interval but sometimes QRS does not follow P waves

Question 27

What is complete HB?

Answer 27

No relationship between P waves and QRS complex. The ventricular rate is determined by where the pacemaker orginates.

Question 28

What is an idioventricular rhythm?

Answer 28

30-40 BPM. The rhythm orginates from the ventricles

Question 29

Accelerated idioventricular rhythm is common of?

Answer 29

After succesful PCI or thrombolysis.

Question 30

What is an agonal rhythm?

Answer 30

Slow, irregular, wide complexes

Question 31

What is AF?

Answer 31

Disorganised electrical activity in atria. No recognisable P waves.

Question 32

What is atrial flutter? What are common causes?

Answer 32

Atrial activity of ~300min. (Often found in II, III, AVF) The ventricular rate is determined by AV conduction (2:2, or 3:1 block) If conduction is constant, then the HR will be regular. Atrial flutter often arises out of the right atrium and is linked to PE, COPD, CCF, Congenital heart disease

Question 33

Where does broad complex tachycardia orginate?

Answer 33

Below the bifurcation of the bundle of His or a SVT that has a bundle branch block

Question 34

What might VT degenerate to?

Answer 34

VF

Question 35

What is the safest broad complex tachycardia tx strategy?

Answer 35

Treat as VT unless good evidence of SVT

Question 36

How to measure QT interval?

Answer 36

From beginning of QRS complex to the end of the T wave