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RELIAS DYSRHYTHMIA - BASIC A EXAMS

WITH ACTUAL CORRECT QUESTIONS AND

VERIFIED DETAILED ANSWERS LATEST 2023-

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1st Degree AV Block

Regular Rate: 60- P Wave: Present, upright PR interval: >0.20 sec CONSISTENTLY LONG QRS: <0.12 sec

Husband stays late till 9 consistently

2nd Degree AV Block Type I Mobitz, Wenckebach

IRREGULAR Rate: 60- P wave: Present, upright PR Interval: Progressively longer until drop (PR interval longer and longer until drop) QRS: <0.12 sec

Husband stays late till 9, then 11, then 1, then doesn't come home at all

2nd Degree AV Block Type II

Irregular or regular Rate: < P wave: Present, upright

PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop QRS: <0.12 sec

Husband stays late till 9 consistently, then wife goes out and doesn't come home

3rd Degree AV Block

Atrials and ventricles don't communicate Rate: regular atrial P wave: Present, upright No relationship between P waves and QRS PR Interval: VARIABLE QRS: variable

P-P ad R-R consistent but NO correlation

Husband and wife live separate lives and don't communicate

SA Node

1st 60-

AV Node

2nd 40-

Bundle of His

3rd 40-

Right and Left Bundle Branches

4th 40-

Purkinje Fibers

5th 20-

1 Small Box

0.04 sec

1 Big Box

0.20 sec

Junctional Rhythms

SA Node DID NOT FIRE AV Node fired NO P WAVE bc SA node didn't fire Narrow QRS

P Wave

Amplitude 0.5-2.5 mm Will be shorter than T wave Shows firing of SA node

QRS

0.06-0.10 sec SHOULD BE <0.12 sec

Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular)

Calculate Regular Rate

1500/ # boxes R-R

Calculate Irregular Rate

of Rs in 6 sec strip X 10

Unifocal PVCs

Only 1 shape PVC

Bigeminy

PVC occurs every OTHER beat

Trigeminy

PVC occurs every THIRD beat

Couplet

2 PVCs together

Triplet

3 PVCs together

Multifocal

Multiple shapes

Monomorphic V Tach

Same Shapes V Tach

Polymorphic V Tach

Different Shapes V tach

Coarse V Fib

Chopy but not as high as polymorphic V tach

Fine V Fib

Fine and fibrillatory

Idioventricular Rhythms

Only purkinje fibers firing WIDE QRS always

Atrially Paced

Spike comes before P

Ventricularly Paced

Spike comes before QRS and QRS will be wide

AV Paced

Spike before P and before QR

Failure to Capture

Spikes with no QRS

Failure to Sense

Spikes happen regardless of QRS on their own

How to determine the rhythm

Regular or irregular? Rate? P before every QRS? QRS for every P? QRS wide or narrow?

QT Interval

0.34-0.

P Wave

0.06-0.12 sec

PR Interval

0.12-0.20 sec

SA Node Firing Rhythms

Fires normally @ 60- -SR 60- -SB < -ST 100- -SVT 150-

AV Node Firing, SA Node Failed Rhythms

Fires normally @ 40- -Junctional rhythm 40- -Accelerated junctional rhythm 60- -Junctional tachycardia 100-

Only Purkinje Fibers Firing Rhythms (Everything else has failed)

Fires normally @ 20- -Idioventricular 20- -Accelerated idioventricular 50-

Normal sinus rhythm

Regular Rate: 60- P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec

Sinus Bradycardia

Regular Rate: < P Wave: Present, upright

PR Interval: 0.12-0.20 sec QRS: <0.12 sec

Sinus Tachycardia

Regular Rate: 100- P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec

Premature Atrial Contraction

IRREGULAR Rate: depends on underlying rhythm P wave: Present or hidden in T wave PR Interval: 0.12-0.20 sec QRS: <0.12 sec

Atrial Fibrillation

IRREGULAR Atrial rate: UNMEASURABLE Ventricular rate: variable P wave: unable to see PR Interval: N/A QRS: <0.12 sec

A fib RVR

IRREGULAR Ventricular rate: 100- P wave: unable to see PR Interval: N/A QRS <0.12 sec

Atrial Flutter

Usually REGULAR can be irregular Atrial rate: 250- Ventricular rate: variable BUT < atrial rate P Wave: Flutter PR Interval: N/A QRS: <0.12 sec

Supraventricular Tachycardia

Regular Rate: 150- P wave: Hidden in QRS or T wave PR: unable to determine QRS: <0.12 sec

Junctional Rhythm

Regular Rate: 40- P Wave: ABSENT or INVERTED PR Interval: None or <0. QRS: <0.12 sec

Accelerated Junctional Rhythm

Regular Rate: 60- P Wave: NONE or INVERTED PR Interval: None or <0. QRS: <0.12 sec

Junctional Tachycardia

Regular Rate: > P Wave: NONE or INVERTED PR Interval: None or <0. QRS: <0.12 sec

Premature Ventricular Contraction

IRREGULAR Rate: refer to underlying rhythm P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE , >0.12 sec

Ventricular Tachycardia

Regular Rate: > P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE, >0.12 sec

Ventricular Fibrillation

Chaotic Coarse: big waves Fine: small waves Rate: unmeasurable P Wave: NONE PR Interval: N/A QRS: N/A

Idioventricular

Regular Rate: 20-

P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec

Accelerated Idoventricular Rhythm

Regular Rate: 50- P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec

normal sinus rhythm

heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute

Sinus Arrhythmia

Appearance is ALMOST NORMAL: Respiratory - Circulatory interaction Rate INCREASES with INSPIRATION (IN=IN)

Sinus Bradycardia

< normal sinus rhythm

Sinus Tachycardia

100 (100-150) normal sinus rhythm

Premature Atrial Contraction (PAC)

Heart Rate: Depends on underlying rhythm Regularity: Interrupts the regularity of underlying rhythm P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes QRS: <.12 seconds

Sinus Arrest/Pause

• SA node doesn't fire
• notice absence of P-wave for a complete cycle (a missed cycle) length of pause ≠ multiple of normal rate (block)

Atrial Fibrillation (A-Fib)

an irregular and often very fast heart rate originating from abnormal conduction in the atria

Atrial Flutter

irregular beating of the atria; often described as "a-flutter with 2 to 1 block or 3 to 1 block"

Junctional Rhythm

40-60 Regular! -impulse from AV node w/ retro/antegrade transmission

• P wave often inverted/buried/follow QRS
• slow rate
• narrow QRS (not wide like ventricular)

Junctional Tachycardia

60 bpm (ms. K; 150-250)

• KEY: will be regular (consistent)
• AV junction produces a rapid sequence of QRS-T cycles
• p-wave often inverted/buried/follow QRS

Premature Junctional Contraction

Inverted p wave or hidden p wave PRI<0.12 or none Normal QRS

Supraventricular Tachycardia (SVT)

an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node

First degree heart block

atrioventricular (AV) block in which the atrial electrical impulses are delayed by a fraction of a second before being conducted to the ventricles

2nd degree heart block type 1 (Wenkebach)

Progressively longer PR interval until the P wave is not followed by a QPR

2nd Degree Heart Block (Mobitz II)

Rare, but more serious Sudden appearance of a nonconducted P-wave P-waves are nl, but some aren't followed by a QRS complex PR & RR intervals are constant

3rd degree heart block

no obvious correlation between p and qrs, need pace maker

premature ventricular contraction (PVC)

a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)

Bigeminy PVC

every other beat is a PVC

PVC couplets

PVC occurring in pairs, no adequate C.O. when this occurs

monomorphic ventricular tachycardia

presents with wide QRS complexes of a common shape.

Torsades de pointes

Rate: 120 - 200 usually P wave: Obscured by ventricular waves QRS: Wide QRS - "Twisting of the Points" Conduction: Ventricular only Rhythm: Slightly irregular

Ventricular fibrillation (V-fib)

abnormal heart rhythm which results in quivering of ventricles

Idioventricular Rhythm

< looks like vtach but slow

• no P waves (from vent foci)
• Wide QRS (serious, death like rhythm)
• called "dying heart" rhythm...occasional ventric beat b4 death (asystole)

Accelerated Idioventricular Rhythm

Rate: 50 - 100 usually (usually slow) P wave: Obscured by ventricular waves (occur during ventricular contraction) - SA node slower than faster ventricular pacing than should be QRS: Wide QRS Conduction: Ventricular only Rhythm: Regular

• benign rhythm that is sometimes seen during acute MI or early after reperfusion. - Rarely sustained, does not progress to vfib, rarely requires treatment

asystole

absence of contractions of the heart

Failure to capture (pacemaker)

failure to sense (pacemaker)

Atrial paced rhythm

spike before P wave

Ventricular paced rhythm

ventricular contractions which occur in cases of complete heart block.