Week 3 Flashcards
(74 cards)
1
Q
Label
A
2
Q
Label
A
3
Q
Why is the ECG used?
A
4
Q
Define: aberrant, arrhythmia, dysrhythmia, ectopic, sinus
A
5
Q
What are the properties of cardiac muscle?
A
6
Q
Where do impulses originate from? Travel pathway?
A
7
Q
Explain the function of: SA node, internodal tracts, AV node
A
8
Q
Explain the function of: AV bundle, R & L bundle branches, Purkinje fibers
A
9
Q
Explain depolarization and repolarization
A
10
Q
Do cardiac cells have a stable resting potential?
A
11
Q
Explain
A
12
Q
Explain
A
13
Q
What does a wave of depolarization moving towards positive electrode cause? Away from electrode?
A
14
Q
What are the functions of the 12 lead ECG? Single lead?
A
15
Q
What is the 12 lead placement?
A
16
Q
What is the electrode movement and view for leadI, II, II, aVR, aVL, and aVF?
A
17
Q
What are the angels of limb leads?
A
18
Q
What are the precordial leads?
A
19
Q
What is the amount of passed time between every tick on the ECG strip? Each small box? Large box?
A
20
Q
What happens in: P wave, QRS, ST wave
A
21
Q
Explain atrial depolarization
A
22
Q
Explain ventricular depolarization
A
23
Q
What does the R, Q, and S mean?
A
24
Q
Is there an atrial repolarization? What does the ST segment mean?
A
25
Explain (in order) the steps of the cardiac cycle
26
What does the 12 lead assess vs the single lead?
27
How do you take a systematic approach in assessing ECG?
Alternate: 1. Observe the pt 2. Evaluate the rhythm (regular or irregular)? 3. Estimate the HR 4. Determine the axis (12-lead only) 5. Evaluate the waves (P, QRS, T) 6. Evaluate the intervals (P-R, QRS)
28
How do you observe the pt?
29
How do you evaluate rhythm?
bottom image: it is not irregular, pt can be taking a seat after a walk
30
Estimate the HR
31
Estimate the HR
32
Estimate the HR
33
What are the time intervals for each wave component in a normal ECG?
34
Explain the issue
35
Explain the issue
36
Explain the issue
37
Explain the issue
38
What are the components of normal sinus rhythm (NSR)?
39
What is this?
40
What is this?
41
What is the issue?
42
What is the issue?
43
What is the issue?
44
what is the issue?
45
What is the issue?
46
What is the issue?
47
What is the issue?
48
Explain premature ventricular arrhythmias. When do they become life threatening?
49
What is the issue?
In this strip, each PVC arises from the same ectopic ventricular focus, as evidenced by their identical wide and bizarre QRS complexes (labeled “PVC site 1”). These PVCs interrupt the normal sinus rhythm, but the underlying rhythm resumes normally after each one. Because all abnormal beats look the same, this is classified as unifocal.
The beats labeled “Atria” are normal P-QRS-T cycles initiated by the sinoatrial (SA) node. PVCs, on the other hand, lack preceding P waves, have a prolonged QRS duration, and occur prematurely within the cardiac cycle. Unifocal PVCs are often benign, especially if infrequent and asymptomatic.
50
What is the issue?
This ECG image shows a multifocal premature ventricular complex (PVC) pattern, a more serious form of ventricular arrhythmia. Unlike unifocal PVCs, which originate from a single ectopic site and appear identical, multifocal PVCs arise from multiple ectopic foci within the ventricles. This is evident in the strip where the two PVCs—labeled “PVC site 1” and “PVC site 2”—have distinctly different morphologies, indicating that they originate from different locations in the ventricular myocardium.
Multifocal PVCs suggest greater irritability or dysfunction of the ventricular tissue and are considered more clinically concerning than unifocal PVCs. They may signal underlying myocardial pathology and warrant closer monitoring or intervention depending on frequency, symptoms, and associated conditions.
51
What is the issue?
This ECG strip shows a ventricular trigeminy pattern—a type of recurring premature ventricular complex (PVC) that occurs every third beat. The PVCs are indicated by wide, early, and abnormally shaped QRS complexes without preceding P waves, interrupting an otherwise normal sinus rhythm.
In this pattern:
* Two normal atrial-driven beats (with normal P-QRS-T complexes) are followed by one PVC.
* The PVCs are uniform in shape, suggesting a unifocal origin.
* This repeating cycle of “normal-normal-PVC” defines trigeminy.
Ventricular trigeminy may be benign in healthy individuals but can also signal increased ventricular irritability, especially if frequent, symptomatic, or associated with structural heart disease. It often requires further evaluation depending on the clinical context.
52
What is the issue?
This ECG illustrates a serious ventricular arrhythmia pattern known as “R on T” phenomenon, which can precipitate ventricular fibrillation (VF)—a life-threatening emergency.
* The rhythm begins in normal sinus rhythm at a heart rate of 100 bpm.
* A premature ventricular contraction (PVC) occurs early, and its R wave lands directly on the preceding T wave—a vulnerable phase in ventricular repolarization.
* This R-on-T event interrupts the normal repolarization process and triggers ventricular fibrillation, shown by the chaotic, irregular waveform with no discernible P waves, QRS complexes, or T waves. At this point, the heart rate becomes unmeasurable, and effective cardiac output ceases.
The R on T phenomenon is dangerous because it strikes during the relative refractory period—when myocardial cells are partially repolarized and more susceptible to disorganized depolarization. Prompt recognition and defibrillation are critical to prevent cardiac arrest.
53
What is the issue?
This ECG strip shows a triplet or 3-beat run of ventricular tachycardia (v-tach)—a short burst of three consecutive premature ventricular contractions (PVCs). This is considered a nonsustained ventricular tachycardia (NSVT).
* The first portion of the strip shows a normal sinus rhythm with regular P-QRS-T complexes.
* Suddenly, three wide, abnormal QRS complexes appear in rapid succession—this is the triplet, indicating a short run of v-tach.
* The QRS complexes during this run are broad, tall, and bizarre, with no preceding P waves, confirming their ventricular origin.
* The rhythm returns to baseline sinus rhythm after the triplet.
This pattern is significant because a triplet of PVCs may indicate increased ventricular irritability and is a warning sign for more dangerous arrhythmias like sustained ventricular tachycardia or fibrillation. While not an emergency by itself, it typically warrants further evaluation and monitoring.
54
Explain ventricular tachycardia
55
What is the issue?
56
Explain ventricular fibrillation
57
State which is: ST depression, normal, T inversion, ST elevation, and the condition associated with each
58
What is the function of dual chamber (DDD) pacemaker?
59
Is this normal?
yes, it is a pacemaker
60
Explain
This image illustrates tiered therapy delivered by an implantable cardioverter defibrillator (ICD) in response to life-threatening ventricular arrhythmias. ICDs are sophisticated devices that detect abnormal heart rhythms and automatically administer appropriate therapy to restore normal sinus rhythm.
* In Panel A, the ICD detects ventricular tachycardia (VT) and initially responds with antitachycardia pacing (ATP)—a rapid series of low-energy pulses intended to interrupt the arrhythmia. This successfully restores sinus rhythm without the need for a shock.
* In Panel B, another episode of VT occurs, but ATP is ineffective. The ICD delivers a cardioversion shock (moderate energy synchronized with the QRS complex), successfully terminating the arrhythmia and restoring sinus rhythm.
* In Panel C, the ICD detects ventricular fibrillation (VF)—a chaotic, disorganized rhythm with no effective cardiac output. The device responds with a high-energy defibrillation shock, restoring a normal rhythm.
This image demonstrates the ICD’s ability to escalate treatment—from pacing to shock—based on the severity and type of arrhythmia, potentially preventing sudden cardiac death.
61
What are the ions involved in depolarization and repolarization? Movement of depolarization and repolarization?
62
What do these represent: P wave, QRS complex, T wave
63
If given a 6 second strip, how can you estimate HR? Define Rhythm
64
What does the PR interval represent? What is occurring physiologically at this time and what’s the significance of it? What is the significance of a prolonged PR interval? Define QT interval
65
How would you differentiate a-fib vs a-flutter? What is occurring in the heart in each of those events?
66
How would you differentiate 1st, 2nd, and 3rd degree heart (AV) block?
67
What is a PVC and what is occurring in the heart when this happens?
68
Which rhythms are considered a medical emergency?
69
What is the condition, HR, rhythm, and is it a medical emergency?
Bradycardia, 50 bpm. Does not require medical attention or emergeny (depends), it depends if that is normal for them, are they feeling fatigued or SOB?
RHYTHM: regular, slow
70
What is the condition, HR, rhythm, and is it a medical emergency?
SVT supraventricular tachycardia (top of the QRS presents the issue), around 190 bpm. Medical attention (not emergency, because pt still gets CO) needed because patients with SVT often need urgent attention, especially if symptomatic (palpitations, hypotension).
RHYTHM: Regular, narrow QRS, no visible P waves. Not all signals may be originating from the SA node, some may be from the AV node.
71
What is the condition, HR, rhythm, and is it a medical emergency?
Atrial flutter, around 110-120 bpm, “saw tooth” like pattern, the pattern as clear ups and downs. Medical attention needed (not emergency) because atrial flutter can lead to poor cardiac output and thromboembolic risk.
RHYTHM: Regular, sawtooth pattern of flutter waves (“F-waves”) best seen between QRS.
72
What is the condition, HR, rhythm, and is it a medical emergency?
Multifocal PVC, around 70-80 bpm. Medical attention if there is 6 PVCs in a minute, otherwise no. multifocal PVCs are more concerning than unifocal PVCs because they suggest multiple irritable foci in the ventricles. It could be benign, but if frequent, symptomatic, or if the patient has underlying cardiac disease, this needs further evaluation.
RHYTHM: P waves are present, but some beats are missing a QRS. When a QRS does appear, it’s wide and bizarre, they look different shapes (morphology changes beat-to-beat). No consistent PR prolongation before dropouts (rules out Wenckebach). Multiple different-looking wide QRS complexes.
Key Observations: Wide QRS early → PVC. Different morphologies → Multifocal PVCs. Irregular rhythm due to ectopic beats.
73
What is the condition, HR, rhythm, and is it a medical emergency?
Sinus tachycardia, around 140 bpm. Medical attention depends (for example: medication, stress, exercise).
RHYTHM: No irregularity, Narrow QRS complexes (not wide like PVCs). P waves present
74
What is the condition, HR, rhythm, and is it a medical emergency?
2nd degree AV block, type I, 70-80 bpm. Conduction issue, medical attention (not emergency for now), assess if its addressed.
RHYTHM: P waves are visible. PR interval progressively lengthens with each beat. Then a QRS complex is dropped (P wave without a QRS). After the dropped beat, PR interval shortens again, and the cycle repeats.
