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Terms in this set (154)
Arrhythmia analysis is caused by what two things?
impulse formation, impulse conduction
What are the descriptors of impulse formation (4)
site of origin, rate, regularity of ventricular or atrial response, onset
What are the descriptors of impulse conduction? (2)
direction of conduction, conduction delays or blocks
Direction of conduction. Forward
Direction of conduction. Backward
What are the 3 mechanisms of rhythms?
abnormal reentry, reentry, triggered activity
What is normal SA rate?
What kind of rhythm am I? Rate is controlled by fastest pacing site
What is the rate of a junctional escape beat?
What is the rate of a ventricular except beat?
What kind of rhythm am I? Some part of the sinus node isn't working so the atrium picks it up. What is the rate of this rhythm?
Ectopic atrial escape, varies
What kind of rhythm am I? Pauses from missed beat. Inverted p wave, normal QRS, normal rate. Then rhythm is back to normal.
atrial escape beat
What kind of rhythm am I? Pauses from missed beats, no p wave, normal QRS, rate of 40-60. Then rhythm is back to normal.
junctional escape beat
What kind of rhythm am I? Pauses from missed beats. No p wave. abnormal QRS. Rate of 20-40 bpm. Then rhythm is back to normal.
ventricular escape beat
What kind of rhythm am I? Normal p wave, QRS is less than .10 seconds, Rate is 80-100, Pr interval is .12-.20 seconds.
I can be caused by exercise, pulmonary embolism, or fever.
What kind of rhythm am I? normal P wave, QRS < .10 sec, Rate is 100-200 bpm, PR interval is .12-.20 sec
What will make sinus tachycardia stop?
heart rate going down
What is the equation for maximal heart rate?
220 bpm minus age (ie. Max of 200 bpm at age 20 or Max of 145 bpm at age 75)
What medications can cause tachycardia?
Too much Beta 2 agonists, or any beta 1 agonists
What kind of rhythm am I? Regular p wave, QRS <.10 sec, Rate is less than 60 bpm, PR interval is .12-.20 sec
What might cause sinus bradycardia?
increased parasympathetic tone, it can also be normal
What kind of rhythm am I? Normal P wave, QRS <0.10 sec, Rate varies, Longest PR interval exceeds shortest PR interval by 0.16s (or 10%)
Sinus arrhythmia (accordion effect)
In sinus arrhythmia the longest PR interval exceeds the shortest PR interval by how much?
0.16 sec or 10%
In sinus arrhythmia, what nerve mediates respiration? How?
vagus, increases heart rate during inspiration and decreased heart rate during expiration
What kind of rhythm am I? Accordion effect.
True or False: Sinus arrhythmia is common.
What kind of rhythm am I? Everything is normal except I have a pause because I was cycling normally and beating out of the SA node but I got blocked so I couldn't get out.
Sinoatrial exit block
What kind of rhythm am I? Aka dropped beat
sinoatrial exit block
What kind of rhythm am I? Normal P wave, QRS < .10 sec, Rate is 80-100 bpm, PR interval is normal but I have dropped bears that came back on the multiple of basic sinus interval
sinoatrial exit block
I may occur with increased vagal tone, IWMI, and Dig toxicity.
sinoatrial exit block
Where does the impulse form in Sinoatrial exit block?
What kind of rhythm am I? Delay of activation within the atria. Not a multiple of previous sinus interval.
What kind of rhythm am I? Normal P wave, QRS<.10 second, Rate is 80-100 bpm, normal PR interval except contains a pause with dropped beat(s) that do not come back on multiples of previous sinus interval.
Definition. =something is out of place
I occur when an out of place beat occurs when a focus stimulates an early contraction
If an ectopic beat is focused in the atria there is normal/abnormal ventricular contraction
If an ectopic beat is focused in the ventricle what does it cause?
broad QRS complex
Premature atrial contractions (PAC's) have 3 different fates depending on what?
degree of prematurity, preceding cycle length, conduction
Premature atrial contractions (PAC's) conduction: No QRS complex because AV node is still refractory.
Premature atrial contractions (PAC's) conduction: PAC makes it into the ventricles but finds one or more of the conducting fascicles or bundle branches refractory. Resulting in wide QRS. Aka Ashman beat.
Conducted with aberration
Premature atrial contractions (PAC's) conduction: Similar to other QRS complexes in the ECG
Premature atrial contractions (PAC's) contractions: Pause to rest before next depolarization. Period after premature beat is longer than baseline R-R.
Premature atrial contractions (PAC's) contractions: SA node maintains R-R interval from the ectopic beat. Beats continue as if nothing happened.
Premature atrial contractions (PAC's) contractions: Ectopic beat every other contraction
Premature atrial contractions (PAC's) contractions: Ectopic beat every third contraction
Premature atrial contractions (PAC's) contractions: Every 4th beat is a PAC.
Premature atrial contractions (PAC's) contractions: Two consecutive PACs
Premature atrial contractions (PAC's) contractions: three consecutive PACs
Definition. = conducting through abnormal pathways.
PACs that occur when ________ is partially refractory will be conducted aberrantly.
What kind of rhythm am I? Contains at least 3 different morphologies of P waves, QRS < 0.1 sec, Rate is 60-100 bpm, variable PR interval. May be an irregular rhythm.
Wandering atrial pacemaker
I am any tachyarrhythmia that requires only atrial and/or atrioventricular (AV) nodal tissue for its invitation and maintenance.
I am difficult to distinguish by rat alone. I have a narrow QRS complex (aberrated variation can result in wide-complex tachycardia though). I am usually regular.
SVt. I describe narrow complex tachycardias with sudden onset. I am no longer used.
PSVT (proxismal supraventrical tachycardia)
What are the 3 mechanisms of supra ventricular tachycardia?
physiologic, automaticity, reentry
What kind of rhythm am I? Change in p wave morphology (can be inverted), narrow QRS, Rate of 100-250 bpm, PR interval 0.12-.20 seconds
Ectopic atrial tachycardia (originates in atrial site other than SA node)
True or False: Multifocal atrial tachycardia is continuous with no periods of sinus rhythm.
false (can be intermittent, alternating with periods of normal sinus rhythm)
What kind of rhythm am I? At least 3 different p wave morphologies, narrow QRS, Rate of 100-250 bpm, varying PR interval, irregularly irregular
Multifocal atrial tachycardia
How do you distinguish multifocal atrial tachycardia from A-fib?
Multifocal atrial tachycardia has 3 different P waves with 3 different PR intervals
What kind of rhythm am I? No p waves, narrow QRS, Atrial rate of 350-600, ventricular rate is either <100 if controlled or >100 if uncontrolled. I am irregularly irregular and can be coarse or fine.
What is the ventricular rate for uncontrolled atrial fibrillation?
What is the ventricular rate for controlled atrial fibrillation?
True or False: Atrial fibrillation can be coarse or fine.
What kind of rhythm am I? no P wave, narrow QRS, atrial rate of 300 (or anywhere between 250-350). Ventricular rate is a multiple of 300. Saw tooth waves. Typical goes clockwise, atypical goes counterclockwise. Can be regular with ie. 1:1, 2:1, 3:1, 4:1 blocks or irregular with variable blocks.
What kind of rhythm am I? Sawtooth waves
Atrial flutter. Typical is clockwise/counterclockwise.
Atrial flutter. Atypical is clockwise/counterclockwise.
An atrial flutter rhythm that goes around the atria 4 times before firing would be what kind of atrial flutter?
What is the most common pre excitation syndrome?
WPW (Wolff-Parkinson-White syndrome)
2/3 of WPW occur in what population. Also what gender is WPW most common in?
otherwise healthy young, men
WPW uses what pathway?
Accessory (not all conduction from atria to ventricles through the AV node. Results in premature activation of ventricular myocardial tissue)
A slurred transition PR to QRS in WPW is called a what?
delta wave (represents an early excitation of ventricle)
What is the 2nd most common tachycardia episodes in WPW?
What is the most frequent tachycardic episodes in WPW?
narrow complex tachycardia
WPW with anterograde over AV node and retrograde over the accessory
WPW with retrograde over AV node and antrograde over the accessory.
What kind of rhythm am I? normal p wave, narrow QRS, Ventricular rate of >250 in Afib, PR interval <.12 sec. I have delta waves. I can be orthodromic or antidromic
True or False: Delta waves are present in tachycardia WPW.
True or False: Afib with WPW has dangerously fast heart rates and you can't fill the heart.
Atrial reentry tachycardias depend on what?
reentry circuit locations
Atrial Reentry tachycardia: Utilizes Av node as part of reentry pathway. AV node functionally divided into 2 pathways. Fast alpha pathway is antegrade conduction over ventricle. Slow beta pathway is retrograde conduction.
In AVNRT, the ______ pathway has a long refractory period.
Alpha (fast pathway)
In AVNRT the _______ pathway has a short refractory period.
AVNRT is initiated when ________ finds ______ pathway that is still refractory. Impulse then conducts to ventricle over _______ pathway. By the time the impulse races the ________ of the circuit, the fast pathway has recovered so the impulse can conduct _________ up the fast pathway and go around and around and around.
PAC (aka APC), fast, slow, bottom, retrograde
What is the most common form of AVRT (atrioventricular reentrant tachycardia)?
What is the route of conduction for orthodromic AVRT (atrioventricular reentrant tachycardia)?
integrate from atrium to ventricle over the AV node. Retrograde up an accessory pathway.
What usually initiates an orthodromic AVRT?
PAC or PVC
AVRT stands for
Atrioventricular reentry tachycardia
AVNRT stands for
AV nodal reentrant tachycardia
What is the route of conduction in antidromic AVRT?
anterograde through the accessory tract. Retrograde up aV node.
True or False: P waves may be seen in antidromic AVRT
True (they may or may not be seen. Sometimes buried in the QRS)
Generally, t waves are _________ with ___ amplitude while p waves are ______ with ______ amplitude that is usually lower than a t wave.
broad, low, short, low
What kind of rhythm am I? P waves varies (either buried, inverted before QRS or inverted after QRS) because the activation of the atria occurs retrograde. Narrow QRS. Rate of 40-60 bpm
Junctional Rhythm. What does the morphology of the P wave depend on for junctional rhythm?
site of origin in junction
Junctional rhythm. If the atria depolarize before the ventricles the p wave will be what?
inverted before QRS
Junctional Rhythm. If the atria and ventricles depolarize at the same time, the p wave will be what?
Junctional rhythm if the atria depolarize after the ventricles the p wave will be what?
inverted after the QRS
What kind of rhythm am I? No p wave, narrow QRS, Rate higher than 60 but less than 100 bpm
Accelerated junctional rhythm
What kind of rhythm am I? No p wave, narrow QRS, Rate higher Rate is higher than 100 bpm
What kind of rhythm am I? Early beat. inverted P wave. Not very common.
Premature Junctional Complex
What kind of rhythm am I? Sinus fails to continue. Escape beat with introverted p-wave.
Junctional escape beat
IN ventricular arrhythmias, depolarization spreads directly through what?
ventricular myocardium (QRS is wide and abnormal and t waves have unusual morphology because depolarization pathways are also different)
True or False: Premature ventricular Contractions use special conducting tissue.
What kind of rhythm am I? Premature ectopic beat arising from ventricle. Wide QRS complex. Either initially high-energy negative or positive deflection that depends on exact location of the focus.
PVC (premature ventricular contractions)
In a premature ventricular contraction, if the focus is further down in the apex then the deflection is negative/positive.
In premature ventricular contraction, if the focus is superior then the deflection is negative/positive.
In PVC there is usually a what?
compensatory pause (interval > baseline R-R)
PVC with more than one potential focus which gives you more than one morphology.
PVC every other beat
PVC every third beat
PVC every fourth beat
Two consecutive PVCs
Occur when higher pacing sites (SA, AVN) fail and ventricle taks over pacing
True or False: you can live with idoventricular rhythm.
false (Increased vagal tone. pretty catastrophic. Can be a terminal rhythm especially in person with really bad heart failure or in advanced heart disease who has had it for a long time)
What kind of rhythm am I? No p wave. Wide QRS. Rate of 20-40 bpm.
What kind of rhythm am I? No p wave, wide QRS, Rate of 40-100 bpm.
Accelerated idioventricular Rhythm
You see me following thrombolytic repercussion therapy actor MI
accelerated idioventricular rhythm
What kind of rhythm am I? Sinus mechanism fails, junctional focus does not respond so ventricle beats.
ventricular escape beat
What kind of rhythm am I? No p wave. Wide QRS that is delayed from prior R-R. Followed by return to sinus rhythm.
Ventricular escape beat
There are 2 things that cause ventricular tachycardia. What are they?
irritable area in ventricle acting as a rapid pacemaker, reentry (most common)
What kind of rhythm am I? No P wave, Wide QRS, Rate of >100 bpm. Can by monomorphic or polymorphic.
= One site.
= Multiple different sites.
How long is sustained ventricular tachycardia?
greater than 30 seconds
How long is non sustained tachycardia?
3 beats in a row or less than 30 seconds
What are the 3 criteria for ventricular tachycardia?
is there concordance?, onset of R to nadir of S>100 ms?, Av dissociation?
What is concordance?
No RS complex in V1-V6
If there is concordance do you have ventricular tachycardia?
If the onset of R to the nadir of S is > 100 ms is there ventricular tachycardia?
If there is AV dissociation do you have ventricular tachycardia?
What is AV dissociation?
buried p waves that surface on the R of the QRS
What kind of rhythm am I? no p waves unless there is AV dissociation, wide QRS, Rate is >200 bpm.
Polymorphic ventricular tachycardia
I am often associated with acute ischemia/infarct
Polymorphic ventricular tachycardia
What can polymorphic tachycardia deregulate to very quickly?
What kind of rhythm am I? Special type of polymorphic VT. Repeated alteration of axis over 5-20 beats. No usually sustained (<90 seconds) but reoccurs and possible to degenerate into VF. Due to prolonged QT from drug induced, congenital, or electrolyte factors.
Torsades de Pointes
Torsades de Pointes is caused by what?
True or False: Torsades de Pointes is usually sustained.
False (usually not sustained <90 seconds but recurs)
What fixes Torsades de Pointes?
Torsades de Pointes. ____________ migrates back and forth resulting in a continuous change in axis.
What often predisposed by prolonged _________. Typically after early complex that follows a long pause also known as what?
I happen with cardiac arrest
What kind of rhythm am I? No P wave, QRS is continuous sine wave ventricular rate is greater than 200, usually about 300 or faster.
True or False: Ventricular flutter is faster than ventricular tachycardia
R on T phenomenon. If onset of ventricular tachycardia or premature ventricular contraction occurs when ____ wave of a premature beat overlaps with a __ wave of previous be at, it can precipitate what two rhythms?
R, T, ventricular flutter, ventricular tachycardia
Ex. Kid gets hit with a baseball and goes into Vfib
R on T phenomenon
Get this before you get cardiac arrest
During Vfib what should be administered while you wait of the arrival of a defibrillator?
What kind of rhythm am I? Undetectable P, QRS, or T wave.
Multifocal ventricular contractions are rapid, irregular, and ineffective in what rhythm?
AKa ventricular stand still
What kind of rhythm am I? Terminal rhythm
What does asystole mark?
cessation of ventricular activity
What kind of rhythm am I? Straight line
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