Ekg

Front 1

5 Types of Arrhythmias

Back 1

Irregular Rhythms
Escape
Premature Beats
Tachy-arrythmias

Front 2

3 Types of Irregular Rhythms

Back 2

Wandering Pacemaker
Multifocal Atrial Tachycardia
Atrial Fibrilation

Front 3

Wandering Pacemaker

Back 3

Paced by SA Node and other atrial automaticity foci
Irregularly Irregular
Different shaped P waves
Normal Rate

Front 4

Multifocal Atrial Tachycardia

Back 4

Same as wandering pacemaker but tachy-arrhythmia because atrial foci have entrance block (not overdrive suppressed).
COPD, digitalis toxicity

Front 5

Atrial Fibrilation

Back 5

Rapid firing multiple atrial automaticity foci
No impulse depolarizes atria completely (no P waves).
Irregularly Irregular
May be fast or slow ventricular rate

Front 6

Escape Rhythms / Beats

Back 6

SA node stops pacing for a beat or all together and another foci starts pacing
Atrial Escape Rhythm / Beat
Junctional Escape Rhythm / Beat
Ventricular Escape Rhythm / Beat

Front 7

Atrial Escape Rhythm

Back 7

Rate: 60-80
P waves not identical to SA P waves
May see an arrest of SA pacing followed by escape rhythm

Front 8

Junctional Escape Rhythm

Back 8

Rate: 40-60 (may become accelerated)
Failure of SA node and atrial foci OR complete AV conduction block
No P waves but may get retrograde depolarization leading to inverted P waves before, after or within QRS complex.

Front 9

Ventricular Escape Rhythm

Back 9

Rate: 20-40 (may become accelerated)
Complete AV conduction block or downward displacement of pacemaker
Leads to Stokes-Adams Syndrome
Ventricular escape beat may occur with burst of parasympathetic activity as blocks all other foci

Front 10

Premature Beats

Back 10

Premature Atrial Beat
Premature Junctional Beat
Premature Ventricular Beat

Front 11

Cause of Atrial and Junctional Premature Beats

Back 11

Adrenaline
Increased sympathetic stimulation
Caffeine, amphetamines, cocaine, Beta 1 receptor agonists
Digitalis, ethanol
Hyperthyroidism

Front 12

Premature Atrial Beat

Back 12

Early P prime wave that resets SA node so next cycle is at regular interval.
Abberant condution: early depolarization down one bundle branch causing widened QRS for that cycle.
Non-Conducted PAB: AV node still repolarizing so no QRS but resets SA node for next cycle. Looks like a block because missing QRS.

Front 13

Atrial Bigeminy/Trigeminy

Back 13

PAB coupled to the end of a normal cycle leading to two successive QRS depolarizations with a stretch in between.
Trigeminy: PAB after every second QRS.

Front 14

Premature Junctional Beat

Back 14

Premature irritable focus from AV junction.
Aberrant Ventricular Conduction: widened QRS if one BBB depolarizes before the other
Retrograde Atrial Depolarization: inverted P wave before, during or after. This will reset SA node pacing.

Front 15

(AV) Junctional Bigeminy / Trigeminy

Back 15

Premature junctional beat coupled with normal cycle or after every second normal cycle. May see retrograde P waves.

Front 16

Causes of Irritable Ventricular Focus

Back 16

Hypoxia: airway obstruction, air with poor O2, minimal blood oxygenation (PE, pneumothorax), reduced CO, poor coronary blood supply
Hyokalemia
Pathology: mitral valve prolapse, myocarditis

Front 17

Premature Ventricular Contraction

Back 17

Produces a Premature Ventricular Complex (PVC)
QRS: wide, large amplitude, inverse
Pause afterwards caused by repolarization of ventricles, not resetting of SA node
>6/min = pathological
>2 in a row = V tach, if >30seconds = sustained V tach

Front 18

Ventricular Bigeminy / Trigeminy

Back 18

Quickly exceeds 6 PVCs/min so hypoxia likely

Front 19

Ventricular Parasystole

Back 19

Ventricular automaticity focus with entrance block.
Paces at its own rate regardless of SA node pacing.

Front 20

R on T

Back 20

PVC falls on T wave which can cause dangerous rhythm

Front 21

Tachyarrhythia Rate

Back 21

150-250: Paroxysmal Tachycardia
250-350: Flutter
350-450: Fibrillation

Front 22

Paroxysmal Tachycardia

Back 22

Types: Atrial, Junctional, Ventricular
Irritable focus suddenly paces rapidly 150-250

Front 23

Paroxysmal Atrial Tachycardia with AV block

Back 23

150-250
Spiked P prime waves
2:1 P:QRS
Digitalis Toxicity (excites atrial foci but causes depression of AV node)

Front 24

Paroxysmal Junctional Tachycardia

Back 24

150-250
May see retrograde P prime waves
May have aberrant ventricular conduction wtih widened QRS
AVNRT - AV nodal re-entry

Front 25

Ventricular Tachycardia

Back 25

150-250
SA still paces atria but hidden by huge QRS
Looks like consecutive PVCs
Usually from hypoxia

Front 26

SVT with aberancy vs. V tach

Back 26

V tach: coronary artery disease, QRS > .14s, AV dissociation, extreme R axis deviation

Front 27

Torsades de Pointes

Back 27

From long QT segment
1. hypokalemia
2. Long QT syndrome

Front 28

Atrial Flutter

Back 28

250-350
Saw tooth pattern
2:1 or 3:1 P:QRS
Vagal maneuvers slow AV node so possible to see difference between P and QRS

Front 29

Ventricular Flutter

Back 29

250-350 - smooth sine waves
Usually decompensates into v fib which requires defib
No good CO

Front 30

Fibrillation

Back 30

Multiple irritable foci.
Parasystolic: no overdrive suppression
Atrial: irregular ventricular rhythm; QRS rate depends on AV refractoriness
Ventricular: type of cardiac arrest; defibrillation required

Front 31

Wolff-Parkinson-White Syndrome

Back 31

Bundle of Kent accessory pathway conducts before normal delay through AV node producing pre-excitation and delta waves. Shortened PR interval.
May get paroxysmal tachycardia in 3 ways
1. rapid conduction: supraventricular tachycardia conducted 1:1 causing high ventricular rate
2. may contain automaticity foci that initiate tachycardia
3. Re-entry: ventricular depolarization may restimulate atria retrograde causing re-entry loop.

Front 32

Lown-Ganong-Levine Syndrome

Back 32

AV node bypassed by extension of Anterior Internodal Tract (James tract).
Conducts tachy atrial rate 1:1 to ventricles
P adjacent to QRS (no PR interval)

Front 33

Sinus Block

Back 33

SA node does not pace for one cycle. May start next cycle or may be an escape beat in between.

Front 34

Sick Sinus Syndrome

Back 34

SA node dysfunction with unresponsive atrial and junctional automaticity foci so no escape beats.
Sinus bradycardia
Bradycardia-Tachycardia Syndrome: Sinus brady with intermittent SVT

Front 35

1st Degree AV Block

Back 35

Prolonged PR interval > .2s (1 large square) - measured from beginning of P wave to start of QRS.
Seen in every cycle the same amount.

Front 36

Second Degree AV Block

Back 36

Wenkebach (Type I): progressive PR interval lenghtening until 1 P wave is not transmitted. Consistent P:QRS ratio (3:2, 4:3, 5:4). Increased parasympathetic activity (not harmful). Originates in AV node so vagal maneuvers increase P:QRS ratio.
Mobitz (type II): several P waves that don't conduct followed by normal cycle with consistent P:QRS ratio (3:1, 4:1). Pathological. May see widened QRS (originates in His Bundle).

Front 37

Third Degree Heart Block

Back 37

Independent atrial and ventricular rates (AV dissociation)
Block high in AV node - junctional escape rhythm (40-60).
Block lower - Ventricular escape rhythm (20-40).
May lead to Stokes Adams Syndrome (not enough CO).

Front 38

Bundle Branch Block

Back 38

1. wide QRS >.12s (3 small boxess)
2. Check V1/V2 (RBBB), V4/V5 (LBB) for R/R prime

Front 39

Axis (normal and abnormal causes)

Back 39

0 to 90
1. Body habitus: R = obese, L = slim
2. Hypertrophy: toward
3. Infarction: away

Front 40

Lateral Leads
Inferior Leads

Back 40

1. I, AVL
2. II, III, AVF

Front 41

Axis

Back 41

Front 42

Left Axis Deviation in Degrees

Front 43

Left Axis Deviation in Degrees

Back 43

Front 44

Right Axis Deviation in Degrees

Back 44

Front 45

+ / - QRS in chest leads

Back 45

1. negative
2. negative - through AV node and over anterior and posterior LV wall
3. isoelectric
4. slightly positive
5/6. positive
Heart rotates in horizontal plane toward hypertrophy and away from infarct.