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46 Cards in this Set

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What does "irregularly irregular" mean on an ECG?
Irregular RR intervals
Irregularly irregular rhythm without p-waves prior to each QRS
Atrial fibrillation
Etiologies of A-Fib (10)
PIRATES:
Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;
Ischemic heart dz, HTN;
Rheumatic heart dz;
Anemia;
Thyrotoxicosis;
Ethanol (& cocaine), Endocarditis;
Sepsis
Signs/symptoms of A-Fib (5)
A FL PT:
Asymptomatic patient;
Fatigue (most common);
Light headedness, syncope;
Palpitations, skipped beats;
Tachypnea, dyspnea
Complication of A-Fib
diffuse Embolization (often to brain, leading to TIA or stroke)
One of two possible Drugs given to A-Fib to control rate in an emergent situation
IV Calcium channel blocker: Diltiazem
(or)
IV Beta-blocker: Metoprolol
Drugs given to A-Fib to control rate in a non-emergent situation (2)
oral Beta-blocker:
Atenolol
(and)
oral Calcium channel blockers:
Verapamil or Diltiazem
what are the (2) ways to cardiovert an A-Fib rhythm?
when should you not cardiovert?
what would the Tx be then?
Medical: Amiodarone

Electrical: start at 100 J Do not cardiovert if patient is in A-Fib > 24 hours.

Tx: Warfarin for 3-4 weeks before cardioversion
If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?
Long-term anticoagulants DOC:
Warfarin (1st)
Aspirin (2nd)
how many seconds and boxes is a normal PR interval?
0.2 ms 5 small boxes
define:
Q-wave

When is it pathologic?
when initial part of ventricular depolarization is downward

Pathologic: greater then 1 small box
normal time and boxes for QRS interval?
< 0.12 ms 3 small boxes
normal sinus rate
60 - 100 bpm
define:
Junctional rhythm
rhythm originating in the AV node and causing narrow QRS w/o P-waves
Dx:
no p-waves; all complexes are wide; no changes in height (amplitude) w/ each complex; > 100bpm
Ventricular tachycardia
Dx:
wide QRS complexes that vary in amplitude
(2 names)
Ventricular Fibrillation

Torsades de Pointes
Dx:
normal sinus rhythm w/ PR interval > 0.2 ms (> 5 small boxes)
First-degree AV block
Dx:
PR interval elongates from beat to beat until it becomes so long that a beat drops
Second-degree AV block, type 1 (Wenckebach)
Dx:
PR interval is fixed but every so often there is a P-wave w/o a QRS
Second-degree AV block, type 2 (Mobitz)
Dx:
no relationship b/t P-waves and QRS complexes
Third-degree AV block
Dx:
QRS > 0.12 (> 3 small boxes) RSR' in V1 + V2;
deep S-wave in lateral leads (I, aVL, V5 + V6)
RBBB
Dx:
QRS > 0.12 (> 3 small boxes);
RSR' in V5 + V6; diffuse ST elevation
LBBB
Dx:
Different shapes to 3 or more P-waves; normal rhythm
(what is it called if it is tachycardic?)
Wandering pacemaker

MFAT: Multifocal Atrial Tachycardia
Dx:
short PR interval; slurring delta wave connecting P-wave to QRS complex
Wolff-Parkinson-White syndrome
Dx:
diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
Pericarditis
drug Tx of wandering pacemaker and MFAT?
Verapamil (Ca channel block)
what Tx breaks SVT (superventricular tachy) in > 90%?
Adenosine (failure to break r/o SVT)
Tx for V-tach w/ hypotension or no pulse
Emergency defibrillation @ 200 - 360 J
Tx of asymptomatic V-tach
(2 meds)
Amiodarone

or

Lidocaine
Tx of V-Fib
Emergent electroshock @ 200 - 360 J
how do you distinguish Paroxysmal Noctournal Dyspnea from asthma?
no improvement w/ bronchodilators
Dx:
SVT w/ AV block + yellow skin
Digoxin toxicity
How do you diagnose LVH from a ECG? (2)
1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small)
2. R-wave in V5 or V6 > 25 small boxes
OR
R-wave in lead aVL > 11 small boxes
Causes of prolonged QT (8)
QT WIDTH:
QT: Prolonged QT syndrome
W: WPW
I: Infarction
D: Drugs
T: Torsades de pointes
H: HypoK, HypoC, Hypomagnesium
What electrolyte disorder causes short QT segments?
HyperC
Causes of Torsades de Pointes (7)*
POINTES:
Phenothiazines
Other meds (TCAs)
Intracranial bleed
No known cause (idiopathic)
Type 1 Anti-arrhthymics
Electrolyte abnormalities
Syndrome of prolonged QT
POINTES
What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?
Adenosine
What drugs should not be given to someone w/ Wolff-Parkinson-White syndrome?
(4)
What is the DOC?
ABCD:
Adenosine
Beta-blockers
Calcium channel blockers
Digoxin

DOC: Procainamide
Causes of Mobitz I (3)

Causes of Mobitz II (2)
Mobitz I:
Inferior wall MI;
Digitalis toxicity;
Inc Vagal tone

Mobitz II:
Inferior or septal wall MI;
Conduction system disease
Tx for Mobitz I & II
(2)
Both:
Atropine & temporary pacing

(Mobitz II should have pacemaker)
Causes of third-degree heart block (3)
Digitalis toxicity;
Inferior wall MI;
Conduction system disease
Causes of Bradycardia (6)
if R-R is longer then "One INCH":
Overmedication;
Inferior MI / Inc intracranial Pressure;
Normal variant (athletes);
Carotid sinus hypersensitivity;
Hypoparathyroidism
Tx for bradycardia (3)
1. Atropine
2. pacing
3. pressors for hypotension
a 24-yo woman w/ preclampsia Tx w/ IV drip of magnesium complains of difficulty breathing and has diminished reflexes.
Next step? (2 together)
1. Stop magnesium

2. give IV calcium
equation for Mean Arterial Pressure
MAP = (2dBP + sBP)/3
Dilation of which heart chamber is a major cause of A-fib?
Left atrium