Ekg 2

Front 1

Sinus arrythmias result fro disturbances in

Back 1

impulse discharge or conduction. The SA node retains its role as pacemaker, but discharges impulses too slow or too fast, irregularly

Front 2

In sinus tach the SA node discharge impulses

Back 2

regularly

Front 3

Cuases of sinus tach:

Back 3

excitement, exxertion, exercise, fever, infection, septic shock, hpoxia, hypovolemia, hypotension, heart failur, hypothyroidism, pain, anxiety, myocardial ischemia, infart, EPI, NOR EPI, dopamine, dobutamine, antidepressant, stimulants

Front 4

Causes of sinus Brady:

Back 4

-Acute inferior wall MI involving the RCA which usually supplies the SA nore
-VAgal stimulation fro vomiting, pain, fright, or sudden stressful situations
-hypothermia, hypothyroidism, hyperkalemia
-Increased ICP due to cerebral edema or subdural hematoma
-Drugs such as Digoxin (>2 toxic), CALCIUM CHANNEL BLOCKERS (cardizam, dilitazem), and Beta blockers (-olols, Lung Pt)
-Degenrative disease of the SA node

Front 5

Sinus arrythmia originates in the

Back 5

sinud node and discharges impulses irregularaly (irregular R wave)

Front 6

Sinus arrythmia is a normal finding and thought to be the result of

Back 6

autonomic tone

Front 7

Sinus arrythmias are associated with

Back 7

phases of respiration

Front 8

Sinus arrythmia is a common finding in

Back 8

children and young adults

Front 9

sinus arrythmis is sometimes a precursor to:

Back 9

skick sinus syndrome

Front 10

Sinus arrest is caused by:

Back 10

a failure of the SA node to discharge an impulse (misses a beat)

Front 11

After sinus arrest the underlying rhythm will:

Back 11

not resume on time after the pause. The length of the pause will not be a multiple of the R-R interval

Front 12

In sinus exit block the impulse is generated by the SA node but:

Back 12

is blocked as it exits the SA node

Front 13

In sinus exit block the underlying rhythm will:

Back 13

resume on time, because the discharge is just blocked, not interuppted. The length of the pause will be a multiple of the R-R interval.

Front 14

Causes of sinus arrest/exit block:

Back 14

-increased vagal tone due to nausea, carotid sinus massage
-Damage to the SA node from an inferior wall MI, myocarditis, or degenerative fibrosis
-sick sinus syndrome
-hyperkalemia, hypoxia,
-Drugs such as digoxin, beta blockers, and calcium channel blockere

Front 15

Atrial arrythmias originate from:

Back 15

eptopic sites in the atria

Front 16

When the Atrial rate is extremely rapid, as in A-Fib or Flutter the AV node

Back 16

Blocks some of the atrial impulses from getting through

Front 17

Wandering atrial pace maker occurs when the

Back 17

pacemaker site shifts back and forth between the SA node and other atrial sites

Front 18

In wandering atrial pacemakerth P waves :

Back 18

change their shape as the pacemaker "wanders" between the multiple sites

Front 19

In wandering atrial pacemaker the P waves vary in

Back 19

size, shape, and direction

Front 20

Wandering Atrial pacemaker is caused by

Back 20

an increase in vagal tone that slows that SA node
-enhanced automaticity of the atria or junctional pacemaker cells that compete with the SA node for control

Front 21

A non conducted PAC occurs when:

Back 21

ectopic atrial focus occurs so early that eh av node is refractory and the impulse is not conducted

Front 22

In nonconducted PAC

Back 22

-P waves will be premature
-P waves will have an abnormal shape, size or direction (you know it is not a U wave because it is a single isolated event, if one has a U wave, all will have a U wave)
-P waves may also be hidden in the preceeding T wave

Front 23

Paroxymal Atrial tachycardia (PAT) is caused by a

Back 23

rapid firing of an ectopic atrial focus

Front 24

PAT usually starts and ends

Back 24

abruptly

Front 25

In PAT ventricular rate will be:

Back 25

the same at Atrial rate because all beats are conducted

Front 26

Pat t wave is

Back 26

mIA

Front 27

Paroxysmal atrial tach is caused by:

Back 27

-stress, mitral valve disease, COPD, Dig toxicity, alcohol, caffiene, nicotine

Front 28

PAT is treated with

Back 28

adenosine, cardioversion, and in extreme cases ablation

Front 29

Atrial flutter is caused by:

Back 29

rapid firing of the atria

Front 30

In atrial flutter atrial impulses are conducted:

Back 30

at a regular rate by the AV node

Front 31

In atrial flutter the atrial rate is:

Back 31

faster than the ventricular rate. (250-400)

Front 32

Treatment for A. FLutter:

Back 32

Anticoagulants for 3 weeks, the cardioverted with anticoagulants for another month. Chronic conditions may require ablation

Front 33

A. Fib is caused by:

Back 33

multiple atrial ectopic sites firing at a rate of 400 or more

Front 34

In A. Fib the ventricles are refractory to most impulses and the AV node :

Back 34

keeps most impulses from reaching the ventricles

Front 35

A. Fib causes:

Back 35

are similar to A. Flutter. Most important is the loss of "atrial kick" (last 25-30% of blood gets kicked into the ventricle) becuas the atria are quivering, not contracting synchonously, further compromising cardiac output.

Front 36

Treatment for A Fib involves

Back 36

Treating the heart rate with calcium channel blockers, Dig, or amioderone
Provide prophylaxis for thromboemboli
cardioversion
some people will remain in chronic a fib

Front 37

Coumadin

Back 37

A Fib

Front 38

AV junctional arrythmias originate in the

Back 38

area around the AV node. The AV node is sunctioning as the pacemaker

Front 39

AV junctional rhythms
P wave in front is

Back 39

the impulse from the AV junction depolarizes the atria first

Front 40

AV junctional rhythms
P wave after the QRS if

Back 40

the impulse from the AV node repolarizes the ventricles first

Front 41

AV junctional rhythms
P wave hidden is

Back 41

the atria and ventricles are depolarized simulatneously

Front 42

Premature Junctional Contractions (PJC) are

Back 42

early beats that originate from an eptopic pacemaker site in the AV node

Front 43

The PR interval in PJCs is short as compared to an

Back 43

PAC where the interval is normal

Front 44

PJCs may occur in the same pattern of

Back 44

PACs. Many of the causes are similar to PAC's though they may also occur with no apparent cause

Front 45

Occasionally an ectopic junctional beat will come late instead of early this is called a

Back 45

Junctional escape beat

Front 46

Escape beats are more liekly to occur due to

Back 46

increased vagal tone

Front 47

Junctional rhythm orriginates in the

Back 47

AV junction with a rate between 40-60 per minute. Junctional rhythm is a continous rhythm but may be transient in nature

Front 48

Junctional rhythm is caused by drugs such as

Back 48

calcium channel blockers, DIG, and beta blockers, valvular heart disease, MI and cardiomyopathy. The slow rate may cause a decrease in cardiac ouput and may require pacing.

Front 49

An accelerated junctional rhythm rate is

Back 49

60-100 beats per minute and is usually caused by increased automaticity of the AV tissue

Front 50

Paroxysmal Junctional tachycardia originates in the

Back 50

AV node and has a rate that exceeds 100 beats per minute. It usually starts and ends abruptly

Front 51

AV heart blocks as described as a

Back 51

delayed or failed conduction of impulses through the AV node to the ventricles

They may be transient or permanent
They are classified as first degree, second degree, or complete heart block.

Front 52

First degree heart block is caused by

Back 52

delayed conduction through the AV node causing a prolonged PR interval.

It usually requires no treatment.
It may be caused by degeneration of the conduction pathways or drugs.

Front 53

Second degree heart block type 1 is caused by

Back 53

a failure of some of the sinus impulses to be conducted to the ventricles. Each successive interval gets longer and longer until finally one is dropped.

Front 54

Second degree heart block type 2 is caused by

Back 54

a failure of the sinus impulses to be conducted.
It is usually the result of extensive damage to teh bundle branches after an anterior wall MI

Front 55

Second degree heartblock type 2 treatment

Back 55

-may requie transvenous pacing
-atropine is not always a successful treatment especially with wide QRS complexes becuase the atropine does not improve conduction through the AV node
-There may be significant hypotension that requires dopamine or epinephrine infusions
May also require permant pacing

Front 56

Thrid degree or complete heart block is

Back 56

a complete abscence of conduction between the atria and the ventricles.
The atria and ventricles are beating independantly of each other.

Front 57

Complete heart block may be transient or permenant. may be caused by

Back 57

Inferior wall MI, Dig toxicity, following carciad surgery, in older aptietns with degenerative changes to the electrical conduction system.