"Other Rhythms" from Conduction Disorders

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22 Terms

1
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ventricular, 20-40, QRS, P, 50-100

Idioventricular Escape Rhythm

  • AKA _________ Escape Rhythm

  • Criteria

    • Ventricular rate of __-__ bpm

    • Wide ___ complex and no _ wave

      • Morphology similar to PVC

  • If rate is __-___ bpm, rhythm is accelerated idioventricular rhythm

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(accelerated) idioventricular escape rhythm

What is this?

<p>What is this?</p>
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generation, P, 40-60, narrow, 61-130

Junctional Rhythm

  • Occurs when there is failure of impulse __________ from the sinus node or atrial myocardium

  • Criteria

    • Retrograde/absent _ wave

    • Ventricular rate of __-__ bpm

    • ______ QRS complex

  • If rate is __-___ bpm, rhythm is accelerated AV junctional rhythm

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Junctional Escape Rhythm (Junctional Rhythm)

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<p>What is this?</p>
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0.47, 0.48, medications, poly, torsades, all, outpatient, holter, telemetry

Prolonged QT Interval

  • > _.__ seconds in males

  • > _.__ seconds in females

  • Can be acquired or congenital

    • Acquired is most commonly d/t __________

  • Increased risk of ____morphic v-tach and _______ de pointes

  • Treatment

    • Treat any underlying etiology of prolonged QT in ___ patients

      • Address electrolyte imbalances, d/c offending agents

    • Asymptomatic Patients

      • Closely monitor in the outpatient setting with _________ testing

    • Patient with Palpitations

      • ______ monitoring

    • Patients with Syncope

      • Admit for _________ observation

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Prolonged QT

What is this?

<p>What is this?</p>
7
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poly, QT, twisting, death, Mg, defibrillation

Torsades de Pointes

  • ____morphic VT that occurs in the setting of __ prolongation

    • Pts will usually go into v.fib then potentially die

    • Heart rate is usually 160-250 bpm

    • Characteristic “________ on a point” appearance

  • Can be short-lived/self terminating OR cause hemodynamic instability and _____

  • Treatment

    • Stable

      • IV __ (low magnesium usually the cause)

      • Address underlying etiology

    • Unstable

      • Immediate ___________

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Torsades de Pointes

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<p>What is this?</p>
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atria, sinus, sinus, no, avoid, b-blocker, catheter ablation

Premature Atrial Contractions

  • Premature beat originating anywhere in the _____

    • Except in the _____ node

    • Very common in younger and older pts

  • Criteria

    • P wave with different morphology and axis from the _____ P wave

  • Etiology

    • Idiopathic

    • Lifestyle

    • Structural Heart Disease

  • Treatment

    • Asx pts: __ therapy required

    • Symptomatic pts:

      • Patient education

        • _____ precipitants of PAC

      • _-_______

      • If patient has evidence of heart disease - further testing indicated

      • If PACs trigger a-fib - _________ _______ is indicated

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bigeminy

occurs every other beat

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trigeminy

occurs every 3rd beat

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quadrigeminy

occurs every 4th beat

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couplet

2 consecutive PACs/PVCs

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Triplet

3 consecutive PACs/PVCs

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Premature Atrial Contractions (PACs)

What is this?

<p>What is this?</p>
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Purkinje, wide, T, pattern

Premature Ventricular Contractions

  • Originates in the ventricular myocardium or terminal ________ fibers

  • Produces a ____ QRS complex

    • Secondary _ wave abnormalities directed opposite of the dominant R wave

  • Mechanism (any of these):

    • Automaticity

    • Reentry

    • Triggered activity

  • Can occur alone, grouped repetitively, or in a ________

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common, r, K, digitalis, 10-15, stimulants, b-blocker

PVCs

  • VERY ______

  • Cardiac / non-cardiac etiologies can cause / exacerbate PVC

    • Cardiac

      • LVH

      • MI

      • HF_EF

      • myocarditis

      • cardiac sarcoidosis

      • cardiomyopathy

    • Non-cardiac

      • COPD

      • Pulmonary HTN

      • Hypo_

      • HypoMg

      • _________ toxicity

  • High-risk features:

    • Frequent (>__-__%), long QRS duration, interpolated or complex PVC, highly variable coupling intervals

  • No treatment needed

    • Patient education → avoid _________ may be helpful

  • Pharmacotherapy

    • _-_______

    • CCB

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(multifocal) Premature Ventricular Contractions (PVC)

What is this?

<p>What is this?</p>
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ventricle, V1, V2, wider, ST, T, structural, pacemaker

Right Branch Bundle Block

  • Delay in depolarization of the right ________

  • Criteria

    • Rsr’, rsR’, rSR’, or M shaped pattern on __ or __

    • Secondary R' wave is usually _____ and of greater amplitude than initial r wave

    • Secondary __ segment and _ wave abnormalities in right precordial leads directed opposite of that dominant R wave

  • Etiology

    • ________ Heart Disease → cor pulmonale, MI, myocarditis

    • Iatrogenic → right heart cath

  • Treatment

    • Asx: no therapy required

    • Sx: _________

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Right Bundle Branch Block

What is this?

<p>What is this?</p>
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ventricle, R, I, 5, 6, Q, aVL, ST, T, structural, pacemaker

Left Bundle Branch Block

  • Delay in depolarization of the left ________

  • Criteria

    • Broad, notched, or slurred waves (rR’, RR’) in leads , aVL, and V_-V_

    • Absent _ waves in leads I, V5-V6

      • May be present in lead ___

    • Secondary __ segment and _ wave abnormalities in left precordial leads directed opposite to that of the dominant R wave

  • Etiology

    • ________ Heart Disease: acute anterior MI, endocarditis, myocarditis

    • Iatrogenic: septal myectomy

  • Treatment

    • Asx: no specific therapy required

    • Sx pts with AV Block: __________

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Left Bundle Branch Block

What is this?

<p>What is this?</p>