Cardiac Emergencies > Rhythms > Flashcards

Rhythms Flashcards

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1
Q

Red flags in ECG

A
  • Lots of jiggly bits
  • A lumpy bit on the jiggly bit
  • Big tail lumps
  • No humps, lumps or jiggles
  • Squiggly stuff you have no idea about but the patient looks bad
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2
Q

Critical part of taking ECG

A

Determining heart rate

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3
Q

Systemic approach to ECGs

A
  1. Rate
  2. Rhythm
  3. P waves
  4. PR interval
  5. QRS complex
  6. Review rate again
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4
Q

Indicated by heart rate less than 60 bpm

A

Sinus Bradycardia

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5
Q

Looks like sinus rhythm but faster, 100 bpm or more

A

Sinus Tachycardia

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6
Q

When the SA node fires slightly irregularly.
- Usually occurs at 60-100bpm

A

Sinus Arrhythmia

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7
Q

Periodically absent complex, where there is one complex missing exactly

A

Sinoatrial block

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8
Q

Disorder of impulse formation, results in absent complexes, more than one complex missing

A

Sinus Arrest

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9
Q

Reflect abnormal electrical impulse formation and conduction

A

Atrial Dysrhythmias

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10
Q

Why would an atrial dysrhythmia occur?

A
  • Altered automaticity
  • Triggered activity
  • Reentry
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11
Q

Results from abnormal electrical impulses that sometimes occur during repolarization, when cells are normally quiet

A

Triggered Activity

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12
Q

Premature beat arising from ectopic pacemaking tissue within atria

A

Premature Atrial Complexes (PACs)

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13
Q

Two premature beats in a row

A

Pairs

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14
Q

Three or more premature beats in a row

A

Runs or Bursts

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15
Q

Every other beat is a premature beat

A

Bigeminy

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16
Q

Every third beat is a premature beat

A

Trigeminy

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17
Q

Every fourth beat is a premature beat

A

Quadrigeminy

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18
Q

Associated with a ventricular rate faster than 100 bpm

A

Multifocal Atrial Tachycardia (MAT)

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19
Q

Associated with normal ventricular rate (60-100 bpm)

A

Wandering Atrial Pacemaker (WAP)

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20
Q

When would you see a drop in blood Pressure?

A

Typically occurs in SVT and is greatest in first 10-30 seconds

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21
Q

Starts or ends suddenly

A

Paroxysmal

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22
Q

Vagal Manouver

A
  • Have patient bear down as if they are taking a bowel movement, pushing through pelvic floor while tightening ab muscles
  • Have patient try to blow the plunger out of a syringe
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23
Q

PCP’S DO NOT PERFORM

A

Carotid Sinus Massage

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24
Q

Ectopic atrial rhythm in which an irritable site within the atria fires regularly at an extremely rapid rate

A

Atrial Flutter

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25
Intrinsic Rate for sinus rhythms
60-100 bpm
26
Intrinsic Rate for Junctional Rhythms
40-60 bpm
27
What does it mean when P wave is inverted?
Junctional Rhythm
28
Specialized cells located in the lower portion of the right atrium. Delays the electrical impulse and allows atria to contract and complete filling of ventricles before next ventricular contraction.
AV Node
29
Connects AV node with bundle branches
Bundle of His
30
- QRS will usually measure 0.12 sec or less - Often followed by a noncompensatory (incomplete) pause - P wave may or may not be present - If a P wave is present, it is inverted (retrograde) and may precede or follow the QRS - NOT AN ENTIRE RHYTHM, SINGLE BEAT
Premature Junctional Complex (PJC)
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Originates in the AV junction and appears late (after next expected sinus beat)
Junctional Escape Beat
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Several sequential escape beats
Junctional Escape Rhythm
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- An ectopic rhythm caused by enhanced automaticity of the bundle of His - Results in a regular ventricular response at a rate of 61 to 100 bpm
Accelerated Junctional Rhythm
34
Typically characterized by QRS complexes that are abnormally shaped and prolonged (>0.12)
Ventricular Depolarization
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T waves are usually in a direction opposite that of the QRS complex
Ventricular Repolarization
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- Occurs earlier than the next expected sinus beat - QRS is typically 0.12sec or greater - T wave is usually in the opposite direction of the QRS complex - Full compensatory pause often follows
Premature Ventricular Complex (PVC)
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Every other beat is a PVC
Ventricular Bigeminy
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Every 3rd beat is a PVC
Ventricular Trigeminy
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Every 4th beat is a PVC
Ventricular Quadrigeminy
40
Premature ventricular beats that look the same in the same lead and originate from the same anatomical site (focus)
Uniform (Unifocal/monomorphic) PVS
41
- PVCs that appear different from one another in the same lead - Often (but not always) arise from different anatomical sites
Multiform (Multifocal/polymorphic) PVCs
42
- Occur when the R wave of a PVC falls on the T wave of the preceding beat - PVC occurring during this period of the cardiac cycle can cause ventricular tachycardia or ventricular fibrilation
R-on-T PVC
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- Three or more ventricular escape beats occurring in a row at a rate of 20-40 bpm - Agonal rhythm (P waves only, no ventricular activity, rate <20 bpm)
Idioventricular Rhythm (IRV)
44
Exists when three or more ventricular beats occur in a row at a rate of 41-100 bpm
Accelerated Idioventricular Rhythm (AIVR)
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Exists when three or ore PVCs occur in a row at a rate of more than 100 bpm
Ventricular Tachycardia (VT)
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A short run lasting less than 30 seconds
Non-sustained VT
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Persists for more than 30 seconds
Sustained VT
48
QRS complexes vary in shape and amplitude from beat to beat and appear to twist from upright to negative or negative to upright and back, resembling a spindle
Polymorphic VT
49
- Chaotic rhythm that begins in the ventricles - No organized depolarization of the ventricles
Ventricular Fibrillation (V-Fib)
50
Total absence of ventricular electrical activity
Asystole
51
Organized electrical activity is observed in the cardiac monitor but the patient is unresponsive, is not breathing, and has no pulse
Pulseless Electrical Activity (PEA)
52
A delay or interruption in impulse conduction from the atria to the ventricles occurs as a result of a temporary or permanent anatomic or functional impairment
Atrioventricular Block
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Delayed impulse conduction
First-degree AV Block
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Intermittent impulse conduction
Second-degree AV block (types I and II)
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Absent impulse conduction
Third-degree AV Block
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When some, but not all, atrial impulses are blocked from reaching the ventricles. Not every P wave will be followed by QRS.
Second-Degree AV Block
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- PR interval prolonged (>0.20 sec) but constant
First Degree Heart Block
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A progressive lengthening of the P wave from the corresponding QRS that eventually results in the dropping of a beat
Second-Degree AV Block Type 1 (Wenckebach)
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Generally progressive increase increase in the length of the PR intervals until P wave occurs that is not followed by QRS cpmplex
"Classic" Wenckebach Phenomenon
60
Conduction delay occurs below the AV node, within the His-Purkinje system
Second-Degree AV Block Type II (Mobitz II AV Block)
61
- P to QRS relation not present before every QRS - PR interval lgenerally progressively lengthens until P wave is completely blocked at the AV node - "longer-longer-longer-dropped QRS"
Winckebach AV Block
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- More P waves than QRS complexes - PR interval can be normal or prolonged - PR intervals before and after a blocked sinus impulse are constant - QRS complex may be narrow or wide
Second-Degree AV Block Type II
63
Complete block in conduction of impulses between the atria and the ventricles
Third-Degree AV Block
64
- P waves upright and rounded more than QRS - No correlation P to QRS - AV completely blocks impulses
3rd Degree AV Block
65
A battery-powered device that delivers an electrical current to the hear to stimulate depolarization
Pacemaker
66
Cardiac Emergencies
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