Rhythm lecture 2 -ECG

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1

what does a reentrant rhythm usually produce?

tachycardia

2

what is an example of a supra ventricular rhythm with abnormal conduction (wide QRS)?

wolfe parkinson white

3

what is an example of a supra ventricular rhythm (narrow QRS) that is regular?

PSVT, and atrial flutter

4

what is an example of a supra ventricular rhythm (narrow QRS) that is irregular?

atrial fibrillation

5

what is an example of a ventricular rhythm (wide QRS)? (2)

ventricular tachycardia and ventricular fibrillation

6

what is the rate for PSVT (paroxysmal supra ventricular tachycardia)

150-220 bpm

7

what does the ECG look like for a PSVT?

regular, no p wave, narrow QRS

8

what is the hallmark for PSVT?

begins and ends abruptly

9

what is the most common paroxysmal tachycardia?

PSVT

10

PSVT is generally due to a reentrant mechanism. Where is the reentrant mechanism from?

AV node

impulse circulates in the AV node until terminated
no P wave seen-retrograde atrial depolarization

11

what is supraventricular tachycardia?

general term for narrow complex tachycardia

12

where does atrial flutter originate?

right atrium

13

describe the rates in atrial flutter

regular, fast atrial activity (250-350bpm)

ventricular rate depends on conduction through AV node (often 150bpm)

14

rate for atrial flutter

250-350 (often over 300)

15

in atrial flutter the ventricular rate depends on AV node conduction. What is the most common ratio?

2:1 --> 150bpm ventricular rate

16

what is the rhythm for atrial flutter look like?

-regular
-P wave present and at times buried-SAW TOOTH PATTERN!!!!
-narrow QRS

17

when the rate is close to 150 bpm in atrial flutter what should look for?

buried P waves with 2:1 conduction ratio

18

when I say "SAW TOOTH PATTERN", you say??????

ATRIAL FLUTTER!!!!

19

where does atrial fibrillation most commonly originate?

around the pulmonary veins

20

what is atrial fibrillation?

chaotic atrial activity-no atrial contraction

irregular ventricular contraction

21

what does the ECG look like for atrial fibrillation?

-irregularly irregular
-no P wave
-narrow QRS

22

rate for A-fib?

rate varies-usually fast

23

how is A-fib classified?

by the ventricular rate

-Afib w/ rapid ventricular response-->RVR
-Afib w/ controlled ventricular response
-Afib w/ slow ventricular response-->generally due to meds or sick sinus syndrome

24

what is WPW (Wolfe Parkinson White) syndrome?

reentrant rhythm due to an accessory pathway b/w atrium and ventricle- Bundle of Kent

25

what is WPW syndrome also called?

preexcitation syndrome

26

what is WPW syndrome associated with?

tachycardias

27

what does the ECG look like for WPW syndrome?

-normal P wave
-PR interval is short (<0.12 seconds)
-wide QRS
-delta wave
-ST-T wave changes

28

rate for ventricular tachycardia

>120 bpm (usually 150-300)

29

what does the ECG look like for ventricular tachycardia?

-regular
-wide QRS
-no marriage of P and QRS= AV dissociation
-P wave (representing sinus beats) hidden in QRS

30

what is a fusion beat?

complex caused by combo of both SA and ventricular pacemaker

31

what is a capture beat?

normally conducted sinus beat

32

what is wide complex tachycardia until proven otherwise?

ventricular tachycardia!!!!!!!

**get a cardiologist involved!!**

33

what is the rate for Torsades de Pointes?

200-250 bpm

34

what does the ECG look like for Torsades de Pointes?

-QRS morphology twists around like streamer
-PROLONGED QT INTERVAL!!!!

35

how do you treat Torsades de Pointes?

(ACLS)= IV Mag

36

what does Torsades de Pointes often degenerate to?

Vfib (VERY SERIOUS DYSRHYTHMIA!!)

37

what 3 things may cause Torsades de Pointes?

-congenital
-drugs
-e'lyte disturbances

38

what does the ECG look like in V-fib?

-No P wave or QRS

CARDIAC ARREST!!!!!!!!

39

rate for V-fib

no discernable rate

40

what is asystole?

-no heart beat
-flatline
-death

-make sure the lead is not off

41

what is PEA (pulseless electrical activity)?

any rhythm w/o a pulse


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