Mcphs Ekg Test Three

Front 1

This is an atrial impulse that is conducted with delay or fails to conduct to the ventricle at a time when the AV node should not be refractory.

Back 1

AV heart block

Front 2

What are the four types of AV heart blocks?

Back 2

1st degree heart blocks

2nd degree heart block, Mobitz Type I (Wenckebach)

2nd degree heart block, Mobitz Type II

3rd degree heart block

Front 3

The etiology of this includes increased vagal tone, drug effect, electrolyte abnormalities, ischemia or conduction system disease.

Back 3

1st degree heart block

Front 4

The symptoms of this are usually asymptomatic, but may exacerbate heart failure.

Back 4

1st degree heart block

Front 5

What do you see when you are diagnosing a 1st degree heart block

Back 5

Constantly long PR interval (> 0.2 seconds)

Front 6

What is the treatment for 1st degree heart block?

Back 6

No Tx, or if patient is symptomatic and in absence of underlying treatable causes - place dual chamber pacemaker.

Front 7

What is this displaying?

Back 7

First degree heart block

Front 8

What are two other names for 2nd degree heart block?

Back 8

Mobitz Type I / Wenckebach

Front 9

What is the etiology of 2nd degree heart block - Mobitz I / Wenckebach?

Back 9

Increased vagal tone, antiarrhythmic drugs, electrolyte abnormalities, ischemia or conduction system disease.

Front 10

What are the symptoms of 2nd degree heart block - Mobitz Type I / Wenckebach?

Back 10

Usually asymptomatic, but can see lightheadedness, dizziness, syncope

Front 11

If you see progressive PR interval prolongation (or variable PR intervals) before atrial impulse is blocked and QRS is dropped what would you diagnose?

Back 11

2nd degree heart block - Mobitz Type I / Wenckebach

Front 12

How do you treat 2nd degree heart block - Mobitz Type I / Wenckebach?

Back 12

1. Usually benign, does not develop into complete heart block.

2. If symptomatic: Initially Atropine 0.5 IV q2min to max of 0.04 mg/kg

3. For persistent Sx, permanent pacemaker

Front 13

What is this representing?

Back 13

2nd Degree Heart Block - Mobitz Type I / Wenckebach

Front 14

What is the etiology of 2nd degree heart block - Mobitz Type II?

Back 14

Includes conduction system dz, antiarrhythmic drug effect, MI (usually ant distribution), and increased vagal tone.

Front 15

What are the symptoms of 2nd Degree Heart Block - Mobitz Type II?

Back 15

Since this block often antecedes development of complete heart block, Sx include fatigue palpitations, lightheadedness and syncope.

Front 16

How do you diagnose a 2nd degree heart block - Mobitz type II?

Back 16

1. Abrupt AV conduction block without e/o conduction delay in preceding conducted impulses.

2. This type of AV block often progresses to complete (third degree) heart block!

Front 17

What is more common, Mobitz Type I or Type II?

Back 17

Benign Mobitz Type I is more common.

Front 18

What does this represent?

Back 18

2nd degree heart block - Mobitz Type II

Front 19

How do you treat 2nd degree heart block - Mobitz Type II?

Back 19

Pacemaker implantation (even in asymptomatic Pts because of risk of developing complete heart block).

Front 20

This is when all atrial impulses fail to conduct to the ventricle and the prevailing ventricular escape rhythm is slower than the atrial rate.

Back 20

3rd degree heart block

Front 21

The etiology of this is ischemia or infarction, drug toxicity, idiopathic degeneration of the conduction system, infiltrative dz (amyloidosis, sarcoidosis, mets), rheum d/o (polymyositis, scleroderma, rheumatoid nodules), infectious d/o (lyme dz), calcific AS or endocarditis.

Back 21

3rd degree heart block

Front 22

What is something that is always the case in third degree heart block?

Back 22

The QRS, or ventricular rate, is always slower than the P wave.

Front 23

What is this?

Back 23

3rd Degree Heart Block

Front 24

What is this?

Back 24

3rd Degree Heart Block

Front 25

What is this?

Back 25

3rd Degree Heart Block

Front 26

What is this?

Back 26

3rd Degree Heart Block

Front 27

What is this?

Back 27

3rd degree heart block

Front 28

What are the symptoms of third degree heart block?

Back 28

1. Depend on degree of bradycardia

2. May include lightheadedness, dyspnea, CHF, angina, syncope

Front 29

What is the TX of 3rd degree heart block?

Back 29

Permanent pacemaker

Front 30

This is when there is a rhythm in which atrial and ventricular activation occurs from different pacemakers. Atrial rhythm can be of sinus origin or from any atrial arrhythmia. Ventricular activation may be from either junctional or lower pacemakers.

Back 30

Atrioventricular dissociation

Front 31

In this, the atrial and ventricular rate are usually the same.

Back 31

In AV Dissociation

Front 32

3rd degree heart block is a special form of what?

Back 32

AV dissociation

Front 33

When you see PR Interval > 0.20 sec and constant.

Back 33

1st degree heart block

Front 34

If the PR is getting longer and longer (or varies) until the QRS is completely dropped.

Back 34

2nd degree heart block, Mobitz Type I, Wenckebach.

Front 35

If there is no PR prolongation, QRS just suddenly dropped.

Back 35

2nd degree heart block, Mobitz Type II

Front 36

P and QRS are completely asynchronous, ventricular rate is much slower.

Back 36

3rd degree heart block.

Front 37

This is when there are blocks within ventricular bundles, normally consist of a L or R bundle branch block. Can effect entire ventricular bundle or a fascicle of the L bundle.

Back 37

Bundle branch blocks

Front 38

What is not serious in itself, but it may indicate significant heart damage due to something such as a previous MI?

Back 38

Right BBB

Front 39

this is more serious, in older people, it often indicates heart dz due to HTN or atherosclerosis.

Back 39

Left BBB

Front 40

What is more common, RBBB or LBBB?

Back 40

Left BBB

Front 41

What are the Sx of bundle branch blocks?

Back 41

Usually asymptomatic, possibly syncope or presyncope (if both bundles effected)

Front 42

Bundle branch blocks have what kind of feature?

Back 42

"Bunny Ears"

Front 43

How do you diagnose RBBB and LBBB?

Back 43

R-R' wave

QRS wider than 0.12 seconds

Front 44

This represents 2 superimposed QRS complexes from each ventricle, spiking separately but very close in time to each other. In LBBB, the LV firing is delayed. In RBBB, the RV firing is delayed.

Back 44

R-R' wave

Front 45

In RBBB, the R wave represents the LV depolarization, while the R' wave represents the delayed RV response. In LBBB, the R wave represents the RV and the R' represents the LV depolarization.

Back 45

QRS wider than 0.12 seconds (3 small boxes)

Front 46

What leads does RBBB usually show up in?

Back 46

V1 and V2

Front 47

What is this?

Back 47

Right bundle branch block

Front 48

What is this?

Back 48

Right Bundle Branch Block

Front 49

How do you diagnose a RBBB?

Back 49

1. Secondary R wave in lead V1

2. Wide QRS >0.12 sec (3 small boxes)

Front 50

What is this?

Back 50

LBBB

Front 51

What is this?

Back 51

LBBB

Front 52

How do you diagnose a LBBB?

Back 52

Secondary R wave in a LBBB is best appreciated in leads V5-V6

Wide QRS, more than 0.12 sec (3 small boxes)

Front 53

How do you treat BBB?

Back 53

1. Often no tx needed in RBBB, reevaluate periodically

2. Treat underlying disorder (ie. HTN)

3. Packemaker (if brady after MI)

4. Cardiac resynchronization treatment (CRT) - paces both ventricles at the same time (in dilated cardiomyopathy)

Front 54

BBB increases mortality with Pt with?

Back 54

MI

Front 55

This makes diagnoses of other cardiac disease more complicated?

Back 55

BBB

Front 56

With this, there is a greater risk of CHF and sudden death?

Back 56

LBBB

Front 57

This occurs when you have a normal QRS width (or just slightly prolonged)

QRS morphology is significant

Back 57

Hemiblocks

Front 58

With this you see an EKG with a Tall R in 1 plus a deep S in aVf (left axis deviation)

additional criteria for this is a Q wave in lead 1, an S wave in lead 3 or aVf

Back 58

Left Anterior Hemiblock

Front 59

With this you see a Deep S in lead 1 plus a tall R in aVf (R axis deviation), Additional criteria includes an S wave in lead 1, a Q wave in lead 3 or aVf.

Back 59

L Posterior Hemiblock

Front 60

What is this showing?

Back 60

Left Anterior Hemiblock

Front 61

What is this showing?

Back 61

Left anterior hemiblock

Front 62

What is this showing?

Back 62

Left posterior hemiblock

Front 63

A bifasicular block is present if?

Back 63

RBBB +

L ant BBB or L post BBB

Front 64

What does it mean when there is only 1 fasicle conducting properly, and if that fasicle is intermittently blocked it leads to what?

Back 64

Mobitz type II which leads to AV dissociation.

Front 65

What is this?

Back 65

Bifascicular block

Front 66

This is present if you have prolonged PR (1st degree AV block) + RBBB + Either L ant or L post BBB

Back 66

Trifascicular block

Front 67

If you see alternating LBBB and RBBB it can mean what?

Back 67

Trifascicular block

Front 68

What is this?

Back 68

Trifascicular block

Front 69

This originates from the right side of the aorta, divides into the marginal artery and the posterior interventricular artery, supplies RA and RV, inf and posterior wall of LV and post 1/3 of interventricular septum, as well as SA and AV nodes.

Back 69

Right main coronary artery

Front 70

This originates from the left side of the aorta, divided into the anterior descending and circumflex, the anterior descending artery supplies the anterior surface and lateral surface of LV and anterior 2/3 of interventricular septum as well as RBB and LBB, the circumflex A supplies LA, anterolateral, posterolateral, and post. wall of left ventrical, as well as SA and AV nodes.

Back 70

Left main coronary artery

Front 71

This is caused by atherosclerosis in 90% of cases.

Back 71

Coronary artery disease

Front 72

This is a progressive process of obstruction and hardening of the artery wall.

Back 72

atherosclerosis

Front 73

This is a deprivation of 02 and nutrients to the myocardium.

Back 73

Myocardial ischemia

Front 74

What are the causes of myocardial ischemia?

Back 74

Atherosclerosis, vasospasm, thrombosis, embolism, decreased ventricular filling time (in tachycardia), and decreased filling pressure in coronary arteries (in severe hypotension or aortic valve disease).

Front 75

What is a symptom of ischemia?

Back 75

Pain - Angina

Front 76

Tissue damage is ________ in ischemia?

Back 76

Reversible

Front 77

This is the degree of cellular damage beyond ischemia.

Back 77

Myocardial injury

Front 78

This occurs if blood flow is not restored within a few minutes, and/or if blood flow is not restored tissue death ultimately occurs.

Back 78

Myocardial injury

Front 79

This is when there is a death of injured myocardial cells?

Back 79

Myocardial infarction.

Front 80

When you have myocardial infarction tissue damage is _________ ?

Back 80

Not reversible

Front 81

What EKG changes do you see with an MI?

Back 81

T wave peaking or inversion

ST elevation or depression

Significant Q waves (> .04 sec and 1/2 of QRS), new Q waves

Front 82

How can you tell if an MI is an anterior MI?

Back 82

changes will be seen in leads V1-V4 (LAD occluded)

Front 83

How can you tell if an MI is a septal MI?

Back 83

changes will be seen in leads V1-V3

Front 84

How can you tell if an MI is a lateral MI?

Back 84

Changes in I, aVL (and V5, V6) (LAD occluded)

Front 85

How can you tell if an MI is a inferior MI?

Back 85

Changes in II, III, and aVf (right coronary artery occluded)

Front 86

What is seen with a posterior MI?

Back 86

Large R wave and upright T wave, ST depression will be seen in V1 or V2 - (right coronary artery occluded)