BASIC ARRHYTHMIA exam Questions and Answers

BASIC ARRHYTHMIAS FINAL #2 jv jv jv




QUESTIONS AND ANSWERS
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How does an atrial P wave differ from a sinus P wave? - ANSWERS-
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Sinus P waves are upright and uniform. Atrial P waves can be flattened, notched, irre
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gular or even inverted jv jv jv


What (2) basic mechanisms can an atrial focus to take over pacemaking responsibiliti
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es? - ANSWERS-Irritability or escape
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What is an ectopic focus? - ANSWERS-
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It is a site of electrical activity other than the SA node
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Which atrial arrhythmia is characterized by a pacemaker that shifts between the SA n
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ode and various foci in the atria, sometimes even dropping down to the AV junction? -
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ANSWERS-Wandering Pacemaker
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What is a PAC (Premature Atrial Complex)? - ANSWERS-
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It is a single beat that originates in the atrium and comes early in the cardiac cycle
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Is a PAC an ectopic? - ANSWERS-Yes, bc it originates outside of the SA node
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If an ectopic is caused by irritability, will it come earlier than expected or later than exp
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erienced? - ANSWERS- jv jv


earlier; if the ectopic comes later than expected, it was caused by escape mechanism
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Is wandering pacemaker a single ectopic beat? - ANSWERS-
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No, is it an entire arrhythmia
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What is the most characteristic feature of Wandering Pacemaker? - ANSWERS-
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It is the changing shapes of the P waves as the pacemaker site shifts locations
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What should the QRS measurement be for a PAC? - ANSWERS-less than 0.12sec
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If the P wave of a PAC was not clearly visible, where might you consider looking for it?
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- ANSWERS-in the T wave of the preceding complex
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What will the P wave look like on a PAC? - ANSWERS-
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it would have the characteristic look of atrial P waves. It could be flattened, notched, di
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phasic, or peaked jv jv


What is the usual rate range for Atrial Tachycardia? - ANSWERS-150-250bpm
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Does Atrial Tachycardia have a P wave in front of every QRS complex? - ANSWERS-
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Yes, although you may have some trouble seeing them if they are superimposed on t
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he T waves of the preceding complexes
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What does the P wave look like in an Atrial Tachycardia? - ANSWERS-
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It looks just like the P wave of PAC; in fact, AT looks very much like a lot of PACs conn
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ected together jv


What happens if the atria begin beating too rapidly for the ventricles to respond to the
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m? - ANSWERS- jv jv


The AV node may block some of the impulses so that they aren't conducted to the ven
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tricles; this results in more P waves than QRS complexes
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Which (2) atrial arrhythmias do you know that involve the phenomenon describes in th
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e preceding question? - ANSWERS-Atrial flutter & atrial fibrillation
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What's the atrial rate in Atrial Flutter? - ANSWERS-250-350bpm
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Is the ventricular rhythm regular or irregular in Atrial Flutter? - ANSWERS-
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This depends on how the AV node is blocking impulses; if atrial impulses are being co
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nducted in a regular pattern, the ventricular rhythm would be regular, but if the conduc
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tion ratio varied, the ventricular rhythm would be irregular
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, In atrial flutter, would the ventricular rate be faster or slower than the atrial rate? -
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ANSWERS-
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The ventricular rate would always be slower, unless the conduction ration was 1:1; thi
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s is bc not all of the P waves are able to produce QRS complexes
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What does the atrial activity look like in an Atrial Flutter? - ANSWERS-
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The flutter waves usually take on a characteristics sawtooth appearance, although not
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always
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How would you describe the atrial activity in Atrial Fibrillation? - ANSWERS-
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The atria not contracting; instead, they are quivering chaotically; this causes the isoel
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ectric line to undulate in a very irregular fashion; there are no visible P waves, only fibr
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illary waves (f waves) jv jv jv


What is the atrial rate in Atrial Fibrillation? - ANSWERS-over 350bpm
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What is the ventricular rate for Atrial Fibrillation? - ANSWERS-
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That depends on how many of the impulses are conducted through to the ventricles; if
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vthe ventricular rate is 100bpm or less, the rhythm is called Atrial Fibrillation with "contr
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olled ventricular response" or "Atrial Fibrillation, controlled"; if the rate is over 100bpm,
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it is called a "rapid ventricular response" or "Atrial Fibrillation, uncontrolled"
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What are the (2) most characteristics features of Atrial Fibrillation? - ANSWERS-
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It has no discernible P waves and the R-R intervals is grossly irregular
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What does the P wave look like in a junctional rhythm? - ANSWERS-
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The P is always inverted, even though it is often hidden in the QRS complex
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How do you explain the unusual configuration of the P wave in junctional rhythm? -
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ANSWERS-
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The atria are depolarized via retrograde conduction; since the electrical flow will be tra
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veling away from the positive electrode in Lead II, the wave form will be negative
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Will the QRS complex be normal in a junctional rhythm? - ANSWERS-
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Yes, even though atrial depolarization is retrograde, ventricular depolarization will be
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normal; the QRS complex should measure less than 0.12sec
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Does an inverted P wave always indicate a junctional rhythm? - ANSWERS-
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No, atrial rhythms can also have inverted P waves if the impulse originated low enoug
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h in the atria; you can differentiate between the (2) by looking at the PRI; in a junction
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al rhythm it will be less than 0.12sec
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Where will the P wave be located in a junctional rhythm? - ANSWERS-
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It can fall before or after the QRS complex, or it can be hidden within the QRS comple
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x; in the latter, it will appear as if the rhythms has no P wave at all
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What is the biggest clue to a junctional rhythm? - ANSWERS-the inverted P wave
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What is a PJC? - ANSWERS- jv jv jv jv jv


A premature junctional complex is a single beat that originates from an irritable focus i
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n the AV junction
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Will a PJC have a P wave? - ANSWERS-
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Yes, the P wave will be inverted, either before or after the QRS complex or it can be hi
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dden within the QRS complexjv jv jv jv


What will the PRI be for a PJC? - ANSWERS-
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If the P wave is in front of the QRS complex, the PRI will be less than 0.12sec; otherwi
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se, there will be no PRI
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Does a PJC come earlier or later than expected in the cardiac cycle? - ANSWERS-
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earlier
What will the QRS measurement be for a PJC? - ANSWERS-
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Since conduction through the ventricles is normal, the QRS measurement should be l
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ess than 0.12secjv jv