ECG Tutorial Part 1 - Dr. Johnston

Question 1

Treat sinus tachy

Answer 1

Find the cause and tx THAT

Question 2

21yo otherwise healthy with 120bpm tachy most likely EKG finding

Answer 2

Supraventricular tachycardia

Question 3

Normal sinus arrhythmia

Answer 3

Some beats are a little closer then others since you increase HR a little in inhalation and decrease a little in exhalation

Question 4

Causes of sinus tachy 8

Answer 4

1. Emotions (anxiety, fear)
2. fever
3. Preg
4. Drugs
5. Hyperthyroidism
6. Anemia
7. CHF
8. Hypovolemia

Question 5

Bradycardia causes 8

Answer 5

1. Normal healthy people
2. Athletes, yoga
3. Sleep
4. Fright
5. Carotid sinus massage , carotid hypersensitivity = avoid tight collars
6. Obstructive jaundice
7. Sliding hiatal hernia
8. Valsalva maneuver
   9**. DRUGS : B-blocker, or hyperkalemia, HTN drugs

Question 6

Biological conditions that can cause bradycardia

Answer 6

1. acute Inferiror MI : you have more Vagal tone leading to N/V also
2. Low pO2
3. Low pH
4. High BP
5. High pCO2
6. Sick Sinus Syndrome = going fast then going slow HR
7. Ischemia

Question 7

Tx bradycardia

Answer 7

** think of cause first** then ATROPINE
1. Atropine ——> repeat as needed, 2mg IV to 2mg IV
= can cause IOP (precipitate narrow angle) in glaucoma
= side effects : ABD distention, urinary retention

Question 8

Automaticity

Answer 8

Cardiac cell that can spontaneously depolarize on its own during phase 4 of action potential ——> impulse

Question 9

Premature Atrial Contraction causes

Answer 9

= normal heart pts

1. Coffee
2. Alcohol
3. Stress
4. Smoking
5. COPD, CAD

Question 10

Premature Atrial Contraction is what

Answer 10

Spontaneous fire in the SA node causing a smaller or different looking P wave and and the entire P, QRS,T complex to come sooner then expected, the next one takes longer then expected to come

Question 11

Non-conductive Premature Atrial Contraction

Answer 11

P wave right after the T wave that is earlier then expected in the bpm, only with NO QRS following it , the next beat is farther then expected

Question 12

Aberrant Premature Atrial Contraction

Answer 12

Premature p wave that causes the entire P,QRS,T to look different then normal

Question 13

Premature Atrial Contraction TX

Answer 13

Nothing (reverse cause) unless symptomatic :

1. Small does B-blocker = Metoprolol

Question 14

Paroxysmal Atrial Tachycardia (PAT)

Answer 14

= sudden unset HR greater then 100

1. Rate 150- 250bpm
2. From irritable foci someplace ——> P’ wave

Question 15

Paroxysmal Atrial Tachycardia (PAT) causes

Answer 15

1. Ischemia or hypoxia in atrium

Question 16

Paroxysmal Atrial Tachycardia (PAT) looks like on ECG

Answer 16

Normal HR then premature P wave comes

1. Then all beats after are that rhythm
2. Only premature P wave is in place of the T normal wave and that happens every time in every beat

Question 17

2:1 P’:QRS and you cant see T wave is what

Answer 17

2 spiked p waves for every QRS
= Paroxysmal Atrial Tachycardia (PAT) (you cant really see the T wave) + AV BLOCK
= suspect digitalis excess or toxicity

Question 18

Multifocal Atrial Tachycardia (MAT)

Answer 18

1. 3 or more P waves (meaning at least 3 p waves that look different)
2. Irregular V rhythm
3. Beats over 100bpm

Question 19

Multifocal Atrial Tachycardia (MAT) associated with

Answer 19

1. COPD ** = LUNG
2. Pneumonia ** = LUNG
3. Ventilator theophylline ** = LUNG
4. B agonist
5. Low K or low Mg
6. digitalis toxicity ** which is drug for CHF or arrhythmia
7. Sepsis

Question 20

Multifocal Atrial Tachycardia (MAT) TX

Answer 20

1. Ca Channel Blocker : CCB, be careful can make worse
2. MgSO2 + Amiodarone / Adenosine
3. Diliazem
4. Verapamil

Question 21

Multifocal Atrial Tachycardia (MAT) dont give

Answer 21

1. B -Blocker

2. Digitalis

Question 22

Atrial Fibrillation wha happens

Answer 22

1. 350bpm - 600bpm, quivering P waves = undulation of baseline cant see what some P waves are
2. Irregularly Irregular ** ventricular rhythm = QRS is not regular
3. Causes blood to pool ——> clots form ——> travel to brain, kidney, foot other places

Question 23

Atrial Flutter looks like what and seen in what leads

Answer 23

1. “ Saw tooth appearance”

2. Leads 2,3,AVF, V

Question 24

Atrial Flutter bpm

Answer 24

250-350bpm

Question 25

Atrial Flutter with 2:1 AV Block

Answer 25

2 atrial saw tooth looking waves for each QRS

Question 26

Proximal Junctional Tachycardia looks like

Answer 26

1. Inverted P wave since ectopic impulse firing up is from junction above AV node 2. Upright QRS wave 3. P wave can come before QRS, after QRS, or after T wave

Question 27

Proximal Junctional Tachycardia what happens no bpm

Answer 27

1. Sudden ,Narrow QRS 2. Cant see P wave is probably is buried ——> supraventricular tachycardia contraction (PSVT) = 150-250bpm

Question 28

Supraventricular tachycardia contraction (PSVT)

Answer 28

A type of Proximal Junctional tachy + proximal atrial tachy | = you cant see P wave or really know for sure you see T wave

Question 29

Premature Ventricular Contraction (PVC, VPC) causes

Answer 29

1. Normal heart 2. CAD, MI, HF, myocardial ischemia, hypoxia 3. Cardiomyopathy 4. Acid base problem, electrolyte problem 5. Hyperthyroidism 6. Drugs

Question 30

Things to order for abnormal EKG

Answer 30

1. Toxicity panel 2. CBC : ischemia or bleeding, hypoxia can be seen in vitals 3. Electrolytes CMP 4. ABG acid base 5. Thyroid hormones hyperthyroidism

Question 31

Premature Ventricular Contraction (PVC, VPC) looks like what on EKG

Answer 31

1. Premature not normal looking QRS 2. No P wave or small inverse P wave in ST segment 3. ST-T wave opposite of QRS

Question 32

More then 3 Premature Ventricular contractions

Answer 32

For longer then 30 sec = V tach with hemodynamics significance

Question 33

Multifocal Premature Ventricular Contraction

Answer 33

More then 2 foci = more then 2 different looking QRS waves from different places in V = they are hemodynamicaly unstable

Question 34

Ventricular Premature contraction with R on T phenomenon

Answer 34

Means premature beat happens during repolarization of normal beat = notch in the bottom part of QRS ( S wave)

Question 35

Accelerated idioventricular rhythm

Answer 35

Looks like very bad V tach = huge upward wide R and narrow S = you dont see P or T = this is GOOD = after thrombolysis is done ( clot buster is working)

Question 36

Premature Ventricular Contraction (PVC, VPC) TX

Answer 36

1. Stable = nothing 2. Symptomatic or acute coronary syndrome = give B-blocker small dose ( Metoprolol) 3. Unstable : Amiodarone, Lidocaine , Procainamide

Question 37

Monomorphic Ventricular tachycardia

Answer 37

All the same looking V Tach

Question 38

Sustained V Tach

Answer 38

Goes on and on until something is done

Question 39

Torsades de Pointes what is it

Answer 39

“ twisting of the points” 1. QRS goes from + to - direction 2. Looks like a party streamer like a twisting flat streamer

Question 40

Causes of Torsades de Pointes

Answer 40

1. Anti-psychotic , anti- arrhythmia 2. Alcohol 3. TCA 4. Inherited prolonged QT 5. Electrolytes imbalanced

Question 41

Torsades de Pointes TX

Answer 41

1. Pacemaker put in 2. MgSO4 IV 3. Isoproterenol 4. Remove the drug and reverse it if they were taking something

Question 42

When will you most likely be asked to do CPR

Answer 42

Ventricular Fibrillation

Question 43

Ventricular Fibrillation is what

Answer 43

No pumping, quivering Disorganized depolarization of V = usually no pulse and not conscious

Question 44

Ventricular Fibrillation causes

Answer 44

1. AMI 2. HF 3. IHD (ischemic heart disease) 4. K+ low or high

Question 45

Asystole

Answer 45

No rhythm , goes away downward line