Term
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Definition
| T wave inversion may indicate decreased blood supply or ischemia without MI |
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Term
| Bradycardia frequently occurs in AMI patients, particularly those with ________ wall infarctions. |
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Definition
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Term
| Bradycardic dysrhythmias include _________. |
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Definition
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Term
| 4 different types of blocks occur: |
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Definition
1st degree
2nd degree Mobitz I (Wenckebach)
2nd degree Mobitz II
3rd degree (complete heart block) |
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Term
| Management of symptomatic bradycardias and heart blocks includes... |
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Definition
| atropine, epinephrine, external pacemaker, or transvenous pacemaker |
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Term
| 2nd degree Mobitz I heart block is associated with... |
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Definition
| ...a conduction defect through the AV node and is usually benign and transient. |
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Term
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Definition
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Term
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Definition
| 2nd degree Mobitz type I heart block |
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Term
| 1st degree heart block may not... |
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Definition
| ...cause symptoms or require treatment |
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Term
| 2nd degree type I heart block is aka |
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Definition
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Term
| In this type of heart block, the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. |
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Definition
| 2nd degree heart block type I |
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Term
On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave.
Sometimes people who have this ECG change feel dizzy or have other symptoms. |
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Definition
| 2nd degree heart block type I |
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Term
When some of the electrical signals do not reach the ventricles. The pattern is slightly irregular. Some signals move between the atria and ventricles normally, while others are blocked.
On an EKG, the QRS wave follows the P wave at a normal speed. Sometimes, though, the QRS wave is missing (when a signal is blocked).
Some people need pacemakers to maintain their heart rates. |
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Definition
| 2nd degree type II heart blcok |
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Term
| In this type of heart block, none of the electrical signals reach the ventricles. |
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Definition
| 3rd degree heart block (aka complete heart block or complete AV block) |
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Term
| Supraventricular tachycardias may be indicative of... |
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Definition
| ...myocardial ischemia or anterior wall infarct. |
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Term
| often associated with chest pain |
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Definition
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Term
| systematic evaluation of cardiac rhythms |
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Definition
1. Rate
2. Rhythm (reg or irreg)
3. P-waves (present? 1 P per QRS?)
4. QRS complex (normal = .06 - .12; shape?)
5. P/QRS relationship (does QRS follow every P wave?)
6. PR interval (normal = .12 - .2) |
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Term
| Which leads are the lateral leads in this 12-lead ECG? |
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Definition
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Term
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Definition
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Term
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Definition
The T-wave in all 4 leads is upright, so T-wave inversion is not present.
Leads I and aVL have ST elevation, which is indicative of injury.
Leads V5 and V6 do not show these same changes although the T-wave may be somewhat large or hyperacute.
No Q-waves are seen. |
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Term
| Which are the inferior leads on a 12-lead ECG? |
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Definition
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Term
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Definition
II, III, and aVF are the inferior leads.
The T-waves are not inverted, but the ST segment is depressed below the baseline in all 3 leads.
ST depression could be ischemia or reciprocal changes.
No Q-waves are present. |
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Term
| Which leads are the anteroseptal leads on a 12-lead ECG? |
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Definition
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Term
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Definition
| No T-wave inversion. No ST depression. May consider T-waves hyperacute, esp in leads V2, V3, and V4. V2 may have some ST elevation. No Q-waves present. |
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Term
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Definition
| Interpretation is not always 100% clear, but we do know that this patient is having ECG changes consistent with ACS, specifically a lateral MI. |
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Term
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Definition
| Start with the lateral leads: I, aVL, V5, V6 |
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Term
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Definition
There is T-wave in version in leads V5 and V6. This may be indicative of ischemia.
There is no ST depression, ST elevation, or pathological Q-waves seen in these leads. Next, look at the inferior leads. |
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Term
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Definition
The inferior leads (II, III, aVF) all have inverted T-waves indicative of ischemia. There is also slight ST segment depression in all 3 inferior leads, also indicative of ischemia.
Neither ST elevation nor Q-waves are seen.
Next, look at the anteroseptal leads. |
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Term
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Definition
V3 and V4 show makedly inverted symmetrical T-waves of at least 2 small boxes in depth, which is consistent with ischemia.
ST depression, ST elevation, and Q-waves are not seen in the anteroseptal leads. |
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Term
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Definition
| This patient is suffering from angina or a non-STEMI. The only way to distinguish between these 2 entities is by evaluating the cardiac biomarkers. If elevated, then the diagnosis is non-ST elevation MI, otherwise, unstable angina would likely be diagnosed. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Which leads monitor the lateral surface of the left ventricle? |
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Definition
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Term
| Which leads monitor the inferior surface of the left ventricle? |
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Definition
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Term
| Which leads monitor the interventricular septum? |
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Definition
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Term
| Which leads monitor the anterior surface of the left ventricle? |
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Definition
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Term
| When performing a 12-lead ECG, where would you place the V1 lead? |
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Definition
| 4th ICS at the right sternal border |
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Term
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Definition
supraventricular tachycardia (SVT)
rate = 180 (above)
for SVT rate = 170-230
narrow QRS |
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Term
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Definition
normal sinus rhythm (NSR) aka regular sinus rhythm (RSR)
rate = 72 |
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Term
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Definition
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Term
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Definition
sinus tachycardia
rate = 138 (above)
sinus tach: 100-150
Most often results from increased sympathetic stimulation (i.e. pain, fever, increased oxygen demand, hypovolemia) |
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Term
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Definition
atrial fibrillation
HR 90
chaotic rhythm with recognizable QRS complexes and absence of P-waves |
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Term
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Definition
atrial flutter
sawtooth baseline |
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Term
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Definition
paced atrial rhythm
note vertical spike before p-wave
An electronic pacemaker lead repeatedly generates a small but sufficient current to begin depolarization of the atria (and the resulting P-wave). |
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Term
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Definition
NSR with 1st degree AV block
results from prolonged transmission of the electrical impulse through the AV junction (AV node and the Bundle of His)
prolonged PR interval of more than .2 sec
The underlying rhythm should be identified and named prior to claiming a 1st degree AV block. |
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Term
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Definition
2nd Degree AV Block Type I (aka Wenckebach or Mobitz Type I)
HR 48
The ECG presents with a cyclical lengthening of the PR interval followed by a dropped QRS (a p-wave not partnered with a QRS).
may be caused by enhanced vagal tone, myocardial ischemia, or the effects of drugs like calcium-channel blockers, digitalis, or beta-blockers |
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Term
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Definition
2nd Degree AV Block Type II
HR 60
1 or more QRS complexes are dropped with PR intervals that do not change (fixed PR interval)
This irregular rhythm requires close monitoring because low cardiac output is likely when multiple dropped QRS complexes occur and this rhythm can progress to complete heart block (aka 3rd degree AVB) |
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Term
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Definition
2nd Degree AV Block with 2:1
HR 38
every other p-wave is NOT paired with a QRS complex
the PR interval remains constant
Monitor closely because low cardiac output associated with a slow HR and has potential to progress to 3rd degree AVB. |
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Term
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Definition
3rd Degree AV Block (aka complete heart block)
HR 36
P's and QRS's firing without relation to one another
may progress to ventricular standstill or asystole and other lethal dysrhythmias |
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Term
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Definition
ventricular tachycardia
HR 210
tendency to transition into ventricular fibrillation
causes: myocardial ischemia, a PVC landing on a T-wave (R-on-T), cardiac drug toxicity, electrolyte imbalance
Non-sustained VT (a group of 3 or more PVCs) is a run of VT. |
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Term
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Definition
ventricular fibrillation
HR --
result = no cardiac output
There's more opportunity for a successful defibrillation if the amplitude of the rhythm is equal to or more than 3 mm (course v-fib) (signifies more electrical activity than if the amplitude of the rhythm was less than 3 mm [fine v-fib]) |
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Term
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Definition
sinus arrest (aka sinus pause)
HR 54
Occurs when the SA node fails to fire. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| accelerated idioventricular |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| wandering atrial pacemaker |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| ventricular premature beats (VPB) bigeminy |
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Term
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Definition
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Term
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Definition
normal sinus rhythm
PR interval = .12-.20 sec
QRS < .12 |
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Term
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Definition
sinus tachycardia
rate = 100-160 (or 200 minus age)
PR shortens as rate increases |
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Term
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Definition
sinus arrhythmia
rate irregular and originates in the SA node
for diagnosis: longest P-P interval must be >.12 sec longer than shortest P-P interval |
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Term
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Definition
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Term
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Definition
sinoatrial block
dropped beat, P-P interval should remain the same / timing should take-up where left-off from dropped beat, as opposed to an arrest or pause where the timing would likely be off when rhythm resumes |
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Term
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Definition
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Term
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Definition
wandering atrial pacemaker
category: accelerated automaticity
3 different P-wave configurations have to be identified |
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Term
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Definition
| PACs (premature atrial complex) |
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Term
|
Definition
atrial tachycardia
a run of six or more consecutive atrial premature beats, that results from an ectopic focus where the atria take over from the SA node
atrial tachycardia is typically a stable, narrow QRS tachycardia |
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Term
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Definition
| paroxymal atrial tachycardia |
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Term
|
Definition
multifocal atrial tachycardia
category: accelerated automaticity
rhythm: irregular
p waves: early ectopic p waves or non-conducted p waves may occur
PR interval: irregular
3 or more different P-wave configurations must be seen |
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Term
|
Definition
atrial flutter
atrial rate 220-350
rhythm: usually regular
P waves replaced by flutter
PR not discernable
normal QRS |
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Term
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Definition
atrial fibrillation
atrial rate > 400
rhythm: irregularly irregular
P waves replaced by fibrillation line
PR: not measurable |
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Term
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Definition
junctional tachycardia
rhythm: regular
P waves: inverted, absent, or may precede or follow QRS
PR: present and < 0.10 |
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Term
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Definition
accelerated junctional
rate: 61-100
rhythm: regular
P waves: inverted, absent, buried, or retrograde
PR: if present, is short or retrograde
QRS: normal |
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Term
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Definition
premature junctional complexes (PJC)
rate: dependent on underlying rhythm
rhythm: irregular
P waves: may be absent, inverted, preceding or following QRS
PR: if present, < .12
QRS: normal |
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Term
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Definition
paroxysmal junctional tachycardia
rate: 140-200
rhythm: irregular
P waves: inverted, absent, or after QRS
PR: short if present
QRS: normal
characterized by rapid rate, narrow complexes and absent or abnormal wave
S/S of decreased cardiac output or may result from the rapid rate |
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Term
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Definition
SA block junctional escape
rhythm: irregular
The escape beat may be preceded by a retrograde P wave or it may have no P wave, and will have a shortened PR interval, if seen.
Junctional escape beats are usually produced by the AV node when the SA node does not fire and a pause occurs. |
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Term
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Definition
junctional escape
rate: 40-60
rhythm: regular
P waves: inverted, absent, or after the QRS |
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Term
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Definition
SA block ventricular escape
rhythm: irregular
P waves: absent with the escape beat
QRS: usally wide and not preceded by a P wave; bizarre QRS > .12 |
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Term
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Definition
AV nodal tachycardia
rate: 150-250
P waves: buried in QRS
PR interval: usually not possible to measure
Most common regular supraventricular tachycardia and the least likely to be life-threatening. |
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Term
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Definition
ventricular tachycardia
rate: 100-220
P waves: not discernable
No PR interval.
QRS: wide QRS > .12
Consists of 3 or more PVCs in a row. Most pts are not able to sustain an adequate blood pressure at rapid rates and this condition can rapidly degenerate into ventricular fibrillation. |
|
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Term
| 6 possible causes of ventricular tachycardia |
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Definition
HIM C MD
1. hypoxemia
2. ischemia
3. MI
4. cardiomyopathy
5. mitral valve prolapse
6. digitalis toxicity |
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Term
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Definition
ventricular fibrillation
rate: undeterminable
rhythm: irregular
P waves: not discernable
PR: no PR interval
QRS: replaced by fibrillation wave
No cardiac output occurs. Pts become unconscious immediately. 1 of 3 major ECG patterns seen with cardiac arrest.
Tx:
Call for help, give CPR, provide ACLS,
defibrillate,
epinephrine,
vasopressin,
antiarrhythmics (Amiodarone, Lidocaine) |
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Term
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Definition
idioventricular rhythm
Also called ventricular escape.
rate: < 40
P waves: absent
PR: no PR interval
QRS: wide, > .12
consists of 6 or more consecutive ventricular escape beats
occurs when the AV & SA node fail to fire |
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Term
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Definition
accelerated idioventricular
rate: 40-100
P waves: not discernable
PR: no
QRS: wide, > .12
higher rate than idioventricular and may only last for a few seconds to a few minutes |
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Term
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Definition
torsades de pointes
rate: 250-350
v-tach waveforms
antiarrhythmic drugs can often cause this dysrhythmia |
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Term
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Definition
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Term
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Definition
premature ventricular complexes (PVCs)
rate: dependent on underlying rhythm
rhythm: irregular
P wave: lost with each PVC
PR: no PR interval with PVC
QRS: wide, > .12
EArly ectopic beats which originate in the ventricles and are conducted through the myocardium instead of the normal conduction system. The T waves are in the opposite direction of the QRS and has an obscured ST segment. These beats are usually followed by a pause before the next beat appears. |
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Term
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Definition
| ...repolarization of the ventricles. |
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Term
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Definition
right PVC
beat originates in the right ventricle causing a negative deflection in Lead V1 |
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Term
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Definition
left PVC
Early ectopic beat that originates in the left ventricle causing a positive deflection in Lead V1. |
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Term
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Definition
PVC - bigeminy
rhythm: irregular
P waves: lost with each PVC
PR: no PR with PVC
QRS: wide, > .12
A repeating pattern of PVCs. One normal beat followed by one uniform PVC. PVCs that originate from the same location in the ventricles will have identical QRS complexes and are called "unifocal." They are premature and occur before the next normal beat is expected. |
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Term
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Definition
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Term
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Definition
PVC - couplet
PVCs which occur as two consecutive beats |
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Term
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Definition
1st degree block
rate: may occur with any sinus rhythm or seen in sinus brady or tachy
rhythm: regular
P waves: normal
PR: > .20
QRS: normal, < .12
most common disturbance of the conduction system
caused by an increased delay at the level of the AV node
This is more of a prolongation of conduction rather than a true block of conduction. |
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Term
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Definition
2nd degree AV block Mobitz I (aka Wenckebach)
Characterized by a progressive lengthening of PR interval until an impulse is blocked and the QRS is dropped in a repeating pattern.
Generally a benign rhythm. |
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Term
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Definition
2nd degree AV block Mobitz II
rate: atrial rate faster than ventricular rate
rhythm: irregular
P waves: intermittent conduction
PR: consistent PR interval for conducted beats / PR interval never changes as compared to Mobitz I
QRS: usually wider than normal
often progresses to 3rd degree (complete) heart block |
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Term
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Definition
3rd degree (complete) heart block
rhythm: atrial and ventricular rhythm are independently regular but dissociated
P waves: normal, but not related to the QRS
PR: no PR interval due to dissociation
This is a complete conduction failure between the atria and the ventricles, characterized by a consistent P-P interval and a separate but constant R-R interval. |
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Term
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Definition
infranodal block
an uncommon type of block |
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Term
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Definition
right bundle branch block
- variant 1 - Lead V1
QRS: wide, > .12 |
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Term
|
Definition
right bundle branch block
variant 2 - Lead V1
QRS: wide, > .12 |
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Term
|
Definition
right bundle branch block
- variant 3 - Lead V1
QRS: wide, > .12 |
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Term
|
Definition
left bundle branch block - Lead V1
QRS: wide, > .12 |
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Term
|
Definition
| left anterior fascicular block - Lead V1 |
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Term
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Definition
single chamber atrial pacemaker
evidenced by the single pacer spike just prior to the P wave
This is non-problematic. |
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Term
|
Definition
ventricular pacemaker
PR: no PR interval
QRS: wide, > .12
evidenced by the single pacer spike just prior to the QRS and is followed by a wide QRS complex > .12 sec
This is non-problematic. |
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Term
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Definition
dual chamber pacemaker
evidenced by a spike produced just prior to the P wave and the QRS complex
QRS typically wider than .12
This is non-problematic. |
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Term
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Definition
biventricular pacemaker
cardiac resynchronization therapy (CRT) to correct the ineffective pumping action caused by heart failure
This is non-problematic. |
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Term
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Definition
failure to sense - undersense
rhythm: irregular due to spike occurring too close to previous beat |
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Term
|
Definition
| failure to sense - oversense |
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Term
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Definition
failure to capture
the pacemaker fires but depolarization does not occur |
|
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Term
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Definition
| ...the ability of the pacing stimulus to depolarize the chamber being paced. Pacemaker spikes are immediately followed by a P wave or QRS complex. |
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Term
| Failure to capture is when... |
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Definition
| ...the pacemaker fires, but depolarization does not occur. |
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Term
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Definition
failure to fire
The pacemaker fails to deliver a stimulus and a spike or captured beat is not visible when expected. |
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Term
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Definition
Wolff-Parkinson-White
short PR interval
slurred initial upstroke of QRS complex called a "delta wave" |
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Term
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Definition
Lown-Ganong-Levine
short PR interval |
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Term
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Definition
artifact - loose electrodes
can be caused by influences other than the heart's electrical activity |
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Term
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Definition
asystole
must always be confirmed by checking the ECG in at least 2 different leads
one of the 3 major ECG patterns of cardiac arrest |
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