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49 Cards in this Set

  • Front
  • Back
3 mechs for bradycardia
1. SA disease
2. AV disease
3. his-purkinje disease
2 reasons for bradycardia due to SA node disease
1. sick sinus syndrome
2. hi vagal activity
causes of vagal activity
1. coughing
2. vomiting
3. sudden exposure of cold water to face
4. defecation
5. valsalva manoever
6. carotid pressure (press on it)
7. drugs
Sick sinus syndrome refers to
Any disease that affects SA:
e.g. fibrosis, inflammation, infiltration, circ. problem
where is AV node located
interatrial septum
etiology of AV node dysfunction
fibrosis, ischemia, calcification, drugs, trauma
what are chars of type 1 AV block?
slowed conduction (PR > 200 ms)

all impulses from atria are conducted to ventricle
what are features of type 2 AV block (general)
slowed conduction (PR > 200 ms)

some impulses from atria are not conducted to ventricles

mobitz I, mobitz II
Difference b/w mobitz I (wenckebach) and mobitz II
mobitz I: progressive prolongation of PR interval, followed by a non-conducted atrial beat

mobitz II: PR interval is fixed; sudden non-conduction of atrial activity
which is more dangerous, mobitz I or II?
mobitz II...
its usually a/w BBB and can lead to 3rd degree heart block
3rd degree AV block
no communication b/w atria and ventricles
what is an escape rhythm?
anything that 'escapes' the SA node (failure of SA node)

inherent rate of depol becomes that of AV or purkinje fibers
when is a pacemaker indicated for bradycardia?
when bradycardia is
(i) not reversible AND
(ii) pt is symptomatic
3 general mechs of tachycardia
1. automaticity
2. re-entry
3. triggered activity
a myocyte's property of automaticity has to do with what aspect of its AP?
rate of Phase 4 depol.
what is the most common mech of clinical tachycardias?
reentry
in atrial fibrillation, how fast can the atrial depolarization rate be?
350-600 bpm
what is the mech of a.fib?
multiple micro re-entry circuits
management of A. fib: what is the major long-term decision that needs to be made?
rhythm control or rate control
management of a. fib: what are 2 ways that you can control rhythm?
ablative techniques (surgically, through catheter ablation techniques)

Drug therapy
when do you consider implantation of a AICD (automated implantable cardiac device)
ventricular tachycardia
on an ECG, how much time does 1 little square equal?
0.04 sec
Sinus arrhythmia - is it normal or abnormal? why?
normal - its just that your rhythm is irregular with a pattern (HR is faster on inspiration than expiration) due to increase in preload with inspiration due to negative intrathoracic pressures
As a general rule, rates faster than _____ are not sinus (except in babies)
200 bpm
abnormality in 1st degree Heart block
increased PR interval (greater than 5 lil' squares)
how do you describe the rhythm for wenckeback heart block?
regular with a pattern (prolongation of the PR, then one missed QRS complex)
how do you describe rhythm for type II second degree heart block?
regular with random missing QRS complexes
what is the sawtooth pattern characteristic of
atrial flutter
what is the atrial rate usually in atrial flutter
about 300
is the block in atrial flutter physiological or pathological
physiological
what is the rate in atrial fibrillation?
usually greater than 80 (not req'd for Dx tho)
what does PSVT or SVT refer to?
any narrow QRS complex tachycardia in which teh P waves are not obvious
what is the rate of PSVT or SVT usually?
>150
for junctional rhythm, what do the p waves look like?
1. burried in teh QRS
2. inverted before QRS
3. occur after QRS in ST segment
what happens to the PR interval in jucntional rhythm?
PR interval is short or non existant. (b/c the AV node conducts - therefore atria contract just before, simultaneously or just after ventricles)
PVC rhythm
regular with an early beat
Ventricular tachycardia rate?
100-250
no rate, no rhythm, no p waves, no CO, no pulse, no BP is characteristic of...
v. fib
torsades de pointes is a deadly form of
ventricular tachycardia
waht changes with each heartbeat in torsade de pointes?
the QRS complexes change in amplitude adn direction
why does torsade occur?
path of conduction changes with each heart beat
what is the rate in T de P?
>100
rate >100, no p waves, no PR, wide QRS, no BP, no pulse, no CO is characteristic of
t de p
3 things to check for in a pt with asystole?
1. rule out fine v. big by checking amplitude of ECG
2. leads are connected properly
3. check other leads in case one lead isn't reading very well
absolute refractory period for working myocardium occurs in what part of the AP?
from phase 0 to the middle of phase 3
the relative refractory period for working myocardium will occur in which part of the AP?
from phase 0 to the end of phase 3
why is re-entry often triggered by a pre-mature beat?
a premature beat occurs when the working myocardium is still partly in refractory period. Some of the tissue will be refractory, while other tissue is ready to accept a new signal. Because we have tissue in 2 different electrical states, this sets us up perfectly for re-entry.
afterdepolarizations are more common with long QT syndrome why?
b/c prolonged repolarization gives time for calcium to be pumped back into the SR, and therefore causing small depolarizations during the repolarization phase
if you have 2 pathways that have different electrical properties, will a reentry circuit always result?
nope. 99.9% of time time, the signal will just terminate