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51 Cards in this Set
- Front
- Back
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What is the first basic principle of dysrhythmias
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to identify and treat precipitating factors
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What are the 4 causes of Dysrhythmias
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-automaticity
-excitability -refractoriness -conduction |
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What are different manifestations of cardiac dysrhythmias
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-ectopic pacemakers
-heart block -re-entry (tachy dysrhythmias) -any combination of the above |
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defined as the ability to spontaneously generate an action potential and the speed that action potentials are generated
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automaticity
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What 3 things "enhance automaticity": brings the RMP closer to the TP
This will do what to HR? |
-Increased slope of phase 4
-Depolarize the RMP -Hyperpolarize the TP * Increases HR |
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What 3 things "depress automaticity": makes the RMP and TP further apart
This will do what to HR? |
-decrease in slope of phase 4
-Hyperpolarize the RMP -Depolarize the TP * Decreases HR |
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Defined as "any area of the myocardium that generates an AP other than the SA node
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Ectopic Pacemakers
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Defined as the ability of the cardiac cell to respond to stimulation by depolarization
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Excitability
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Defined as the period of time when the myocardial cell will not respond to an action potential b/c the Na or Ca inactivation gate remains closed
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Refractory Period
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rebuff
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reject (someone or something) in an abrupt or ungracious manner
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Defined as the ability to cause an adjoining cell to depolarize and the speed by which the adjoining cell is depolarized
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conduction
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What part of the refractory period occurs on the downstroke of T
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Relative
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**bold**
defined as re-excitation of the cardiac tissue from the "SAME" cardiac impulse using a circuitous pathway. |
Re-entry or circus movements
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What are the two requirements for Re-entry
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-imbalance between conduction and refractoriness
-Unidirectional block |
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What are some causes of Re-entry?
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-Elongation of the conduction pathway...i.e Afib
-Decreased velocity of conduction of the cardiac impulse (like after an MI) -shortened refractory period |
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**If you have a hyperpolarized RMP; would it increase or decrease HR?
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decrease HR
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**If you have a Hyperpolarized TP; would it increase or decrease HR?
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Increase HR
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What do you think 1st if you see a wide QRS?
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BBB
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If QRS is < 0.12 secs the complex is ___________
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supraventricular
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What leads are P waves normally upright in?
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I, II, aVF, and V4-6
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During anesthesia, p wave morphology is commonly seen in which lead?
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II
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If S-A dysrhythmia is associated with physiologic events it is called
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phasic sinus rhythm
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What is the Rx for Sick Sinus Syndrome?
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permanent pacer and antidysrhythmics
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**What is the difference between a junctional rhythm and a accelerated junctional rhythm?
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Accelerated just means rate is over 60
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**What drugs would you "NOT" use in Wolff-Parkinson-White Syndrome?
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-verapamil
-diltiazem -digoxin These drugs may put pt in V-tac |
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Review fig 4-1 pg 20
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..
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What type of heart block:
-every P wave produces a QRS complex -amt of time required to produce the QRS complex is prolonged ( exceeds_____sec) |
1st degree
> 0,20 secs |
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What type of Heart block:
the relationship between P waves and QRS complexes is altered in that some P waves conduct, and some do not |
second degree HB
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In this type of Heart Block "there will never be fixed P-R intervals
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3rd degree HB
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Type of rhythms where the "p waves are inverted" Rate is typically 40-60 bpm, but can be less
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classic junctional rhythm
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Type of rhythm where the "p waves are inverted" Rate is > 60 bpm
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junctional tachycardia
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What is very helpful in treating PVC's (stabilizes membrane)
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Magnesium
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**This rhythm is always associated with prolonged QT interval
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Torsades
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* What is the most common cause of PEA in Anesthesia
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Hypovolemia
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*In what leads would you see a RBBB
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v1-2
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*In what leads would you see a LBBB
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V5-6
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**________ makes the diagnosis of an old anterior MI impossible
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LBBB
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What Rhythm is this?
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Sinus Arrhythmia
Key Characteristic: irregular rhythm! everything else normal |
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What rhythm?
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"Sinus Arrest"
Causes: -Obstruction of RCA -Acute MI -Dig toxicity -Repeat dose of Succinylcho |
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what type of block
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right bundle branch block
"triphasic pattern" rSR in V1-2 Wide S wave in V5-V6 |
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What type of block
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left bundle branch:
Bisphasic rS in V1-2 Bisphasic rR in V5-6 |
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What rhythms are extremely common under anesthesia
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atrial and nodal rhythms
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What is the criteria for diagnosis of 1st degree A-V Block
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Fixed PR intervals
PR interval > 0.2 secs |
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What is the criteria for diagnosis of Mobitz II
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Not all P waves have QRS complexes, P to P interval is regular
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What is the criteria for diagnosis of 3rd Degree A-V Block
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* No fixed PR intervals
P to P interval is regular R to R interval is regular |
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What is the most prevalent aspect in regards to a strip that shows Torsades de Pointes
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Always associated with a prolonged QT interval
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If the ECG show BBB with a QRS 0.10-0.11, this is known as?
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incomplete BBB
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if the ECG shows BBB with a QRS >= 0.12, this is known as?
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Complete BBB
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The following diseases are common causes of which type of BBB
-PE -Pulmonary HTN -WPW |
Right BBB
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What type of block is usually an indication of organic heart disease?
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L BBB
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Pt's with acute MI who develop LBBB are at high risk for?
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complete heart block and temporary pacing is indicated
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