Exam 2 Content

What’ the word for a regular heart rate?

rhythmic

Whats the word for an irregular heart rate?

arrhythmic

What is NSR and what is the pace?

normal sinus rhythm, 60-100 bpm

How do you tell on an ECG if the SAN is the pacemaker?

upright (+) P in lead I/II

Identify this rythm?

sinus arrhythmia: because the SAN node is pacemaker (normal upright P), irregular HR

ID this rythm?

Sinus bradycardia: SAN pacemaker (normal upright P), regular HR, rate <60 bpm

ID this rhythm?

sinus tachycardia: SAN pacemaker (normal upright P), regular rhythm, rate >100 bpm

ID this rythm?

NSR: SAN pacemaker (normal upright P), regular rhythm, rate 60-100

Name the 3 regular sinus rhythms?

sinus tachycardia, NSR, sinus bradycardia

What are the traits of a wandering atrial pacemaker (WAP)?

multiple atrial AC’s, variable P wave morph., irregular, HR <100 bpm

ID this rythm?

WAP

Name the traits of multifocal atrial tachycardia (MAT)?

multiple atrial AC’s, different P wave morphology, irregular, HR >100 bpm

ID this rhythm?

MAT

Name the traits of Atrial fibrillation?

multiple rapid AC’s, parasystolic (no overdrive suppression), no P waves (no contraction), irregular, normal QRS morph

ID this rythm?

AFib: no visible p waves, irregular R-R, vent rate variable

Name the irregular rhythms?

atrial fibrillation (AFib), wandering atrial pacemaker (WAP), multifocal atrial tachycardia (MAT), sinus arrhythmia

What does escape mean in ECG?

normal response to pause

What’s an escape rhythm?

an automaticity focus escapes ODS to pace PACE at its inherent rate

What’s an escape beat?

an automaticity focus TRANSIENTLY escapes ODS to emit ONE BEAT

What two things are these ECG showing?

A: escape beat (P’ after pause, lower rate but only one).

B: Escape rhythm: (multiple P’ after pause, lower rate)

Inherent rate of an atrial escape ryhtm?

60-80 bpm

Inherent rate of junctional escape rythm?

40-60 bpm

Inherent rate of ventricular escape rhythm?

20-40 bpm

What’s characteristic of a junctional escape rythm?

no Ps

What’s characteristic of a ventricular escape rhythm?

no Ps and a wide QRS

What is a sinus block?

a missed/dropped beat, pause…ODS lost, then allows for an escape

What does this ECG show?

atrial escape beat: sinus block/pause, then an atrial escape beat (P’) then a return back to NSR

What’s a junctional escape beat?

sinus block, missed/dropped beat, pause, escape beat with no P and narrow QRS

What’s a ventricular escape beat?

sinus block, missed/dropped beat, pause, escape beat with no P/P’ and a wide QRS

What’s a premature beat?

An irritable focus spontaneously fires a single stimulus

What does irritability mean in ECG?

increased inherent rate

What causes atrial and junctional foci irritability?

SNS outflow (NE), hormones (E), Exog subst (caffeine, drugs, toxins, etc)

What makes this a PAB?

early P’ then back to a normal SAN cycle

What’s PAB/PAC with aberrant vent conduction?

incomplete repol of BB (one still refractory), wide QRS

What’s a non-conducted PAB/PAC?

incomplete repol of 2 BBs (AVN still refractory), no QRS

What are the repeating patterns of PAB’s?

bigeminy (1 normal/1 PAB), trigeminy (2 normal/1 PAB)

What makes this a PJB?

early beat with narrow QRS complex

What causes premature ventricular beats?

↓PO2 → ↑ vent irritability

↓K+ / Mitral Valve Prolapse → ↑ vent irritability

What makes this a PVC?

wide QRS early in the cycle with no SAN reset

What are the dotted lines showing?

compensatory pause, result of nl refractory period

What is ,multiple PVCs >6.im indicative of?

pathological, stop a stress test (low PO₂)

What is the name for 3+ consecutive PVCs? What about when they last >30 sec?

3+ = run of PVC = VT.

>30 sec = sustained VT

What are multifocal PVC’s?

each focus produces a unique PVC

Why do multifocal PVCs indicate a global/systemic problem rather than a local one?

multiple different ectopic foci across the ventricles are firing simultaneously, can't be explained by one irritable spot

What are the two main causes of multifocal hypoxia?

very low K+ and diffuse cardiac hypoxia

What are the three categories of tachy-arrhythmias?

paroxysmal tachycardia, flutter, fibrillation

What are tachy-arrythmias?

rapid rhythms originating in very irritable automaticity foci

What is paroxysmal tachy?

sudden onset of very irritable automaticity focus at a rate of 150-250

What defines PAT?

sudden/irritable/150-250, P’ (alt atrial AC), normal QRS

What is different about a PAT with block?

2:1 conduction ratio of P’ to QRS

What defines PJT?

sudden/ irritable/ 150-250, no P/P’, normal (narrow) QRS

What defines PSVT/SVT?

sudden/ irritable/ 150-250, “narrow complex tachy”, originates above ventricles (normal QRS), umbrulla term thate ncompasses PAT and PJT

What defines PVTs?

sudden/irritable, 150-250, wide QRS, runs of PVCs,

What defines ventricular tachy (VT)?

sudden, irritable, 150-250, wide QRS

What defines torsades de pointes?

rapid VT (250-350) and polymorphic (difference in amplitude)

What rate do tachy-arrhythmia flutters occur at?

250-350

What defines an atrial flutter?

rate 250-350, “saw-tooth P waves), normal QRS, regular, 3/2:1 conduction (atria to ventricles)

What does this ECG depict?

Atrial Flutter: rate 250-350, saw tooth, 3:1 conduction

What defines a ventricular flutter?

rate 250-350, “sine wave” (smooth), stable amplitude

ID this rhythm?

ventricular flutter

What’s ventricular flutter deterioration?