BASIC ARRHYTHMIAS FINAL #2
jv jv jv
QUESTIONS AND ANSWERS
jvjv jv jv
HowqsdoesqsanqsatrialqsPqswaveqsdifferqsfromqsaqssinusqsPqswave?qs-qsANSWERS-
SinusqsPqswavesqsareqsuprightqsandqsuniform.qsAtrialqsPqswavesqscanqsbeqsflattened,qsnotc
hed,qsirregularqsorqsevenqsinverted
Whatqs(2)qsbasicqsmechanismsqscanqsanqsatrialqsfocusqstoqstakeqsoverqspacemakingqsresp
onsibilities?qs-qsANSWERS-Irritabilityqsorqsescape
Whatqsisqsanqsectopicqsfocus?qs-qsANSWERS-
ItqsisqsaqssiteqsofqselectricalqsactivityqsotherqsthanqstheqsSAqsnode
Whichqsatrialqsarrhythmiaqsisqscharacterizedqsbyqsaqspacemakerqsthatqsshiftsqsbetweenqsth
eqsSAqsnodeqsandqsvariousqsfociqsinqstheqsatria,qssometimesqsevenqsdroppingqsdownqstoqsth
eqsAVqsjunction?qs-qsANSWERS-WanderingqsPacemaker
WhatqsisqsaqsPACqs(PrematureqsAtrialqsComplex)?qs-qsANSWERS-
Itqsisqsaqssingleqsbeatqsthatqsoriginatesqsinqstheqsatriumqsandqscomesqsearlyqsinqstheqscardiac
qscycle
IsqsaqsPACqsanqsectopic?qs-qsANSWERS-
Yes,qsbcqsitqsoriginatesqsoutsideqsofqstheqsSAqsnode
Ifqsanqsectopicqsisqscausedqsbyqsirritability,qswillqsitqscomeqsearlierqsthanqsexpectedqsorqslater
qsthanqsexperienced?qs-qsANSWERS-
earlier;qsifqstheqsectopicqscomesqslaterqsthanqsexpected,qsitqswasqscausedqsbyqsescapeqsme
chanism
Isqswanderingqspacemakerqsaqssingleqsectopicqsbeat?qs-qsANSWERS-
No,qsisqsitqsanqsentireqsarrhythmia
WhatqsisqstheqsmostqscharacteristicqsfeatureqsofqsWanderingqsPacemaker?qs-
qsANSWERS-
ItqsisqstheqschangingqsshapesqsofqstheqsPqswavesqsasqstheqspacemakerqssiteqsshiftsqslocatio
ns
WhatqsshouldqstheqsQRSqsmeasurementqsbeqsforqsaqsPAC?qs-qsANSWERS-
lessqsthanqs0.12sec
IfqstheqsPqswaveqsofqsaqsPACqswasqsnotqsclearlyqsvisible,qswhereqsmightqsyouqsconsiderqsloo
kingqsforqsit?qs-qsANSWERS-inqstheqsTqswaveqsofqstheqsprecedingqscomplex
WhatqswillqstheqsPqswaveqslookqslikeqsonqsaqsPAC?qs-qsANSWERS-
itqswouldqshaveqstheqscharacteristicqslookqsofqsatrialqsPqswaves.qsItqscouldqsbeqsflattened,qsn
otched,qsdiphasic,qsorqspeaked
WhatqsisqstheqsusualqsrateqsrangeqsforqsAtrialqsTachycardia?qs-qsANSWERS-150-250bpm
DoesqsAtrialqsTachycardiaqshaveqsaqsPqswaveqsinqsfrontqsofqseveryqsQRSqscomplex?qs-
qsANSWERS-
Yes,qsalthoughqsyouqsmayqshaveqssomeqstroubleqsseeingqsthemqsifqstheyqsareqssuperimpos
edqsonqstheqsTqswavesqsofqstheqsprecedingqscomplexes
WhatqsdoesqstheqsPqswaveqslookqslikeqsinqsanqsAtrialqsTachycardia?qs-qsANSWERS-
ItqslooksqsjustqslikeqstheqsPqswaveqsofqsPAC;qsinqsfact,qsATqslooksqsveryqsmuchqslikeqsaqslotqsof
qsPACsqsconnectedqstogether
Whatqshappensqsifqstheqsatriaqsbeginqsbeatingqstooqsrapidlyqsforqstheqsventriclesqstoqsrespon
dqstoqsthem?qs-qsANSWERS-
, TheqsAVqsnodeqsmayqsblockqssomeqsofqstheqsimpulsesqssoqsthatqstheyqsaren'tqsconductedqst
oqstheqsventricles;qsthisqsresultsqsinqsmoreqsPqswavesqsthanqsQRSqscomplexes
Whichqs(2)qsatrialqsarrhythmiasqsdoqsyouqsknowqsthatqsinvolveqstheqsphenomenonqsdescrib
esqsinqstheqsprecedingqsquestion?qs-qsANSWERS-Atrialqsflutterqs&qsatrialqsfibrillation
What'sqstheqsatrialqsrateqsinqsAtrialqsFlutter?qs-qsANSWERS-250-350bpm
IsqstheqsventricularqsrhythmqsregularqsorqsirregularqsinqsAtrialqsFlutter?qs-qsANSWERS-
ThisqsdependsqsonqshowqstheqsAVqsnodeqsisqsblockingqsimpulses;qsifqsatrialqsimpulsesqsareq
sbeingqsconductedqsinqsaqsregularqspattern,qstheqsventricularqsrhythmqswouldqsbeqsregular,q
sbutqsifqstheqsconductionqsratioqsvaried,qstheqsventricularqsrhythmqswouldqsbeqsirregular
Inqsatrialqsflutter,qswouldqstheqsventricularqsrateqsbeqsfasterqsorqsslowerqsthanqstheqsatrialqsrat
e?qs-qsANSWERS-
Theqsventricularqsrateqswouldqsalwaysqsbeqsslower,qsunlessqstheqsconductionqsrationqswasq
s1:1;qsthisqsisqsbcqsnotqsallqsofqstheqsPqswavesqsareqsableqstoqsproduceqsQRSqscomplexes
WhatqsdoesqstheqsatrialqsactivityqslookqslikeqsinqsanqsAtrialqsFlutter?qs-qsANSWERS-
Theqsflutterqswavesqsusuallyqstakeqsonqsaqscharacteristicsqssawtoothqsappearance,qsaltho
ughqsnotqsalways
HowqswouldqsyouqsdescribeqstheqsatrialqsactivityqsinqsAtrialqsFibrillation?qs-qsANSWERS-
Theqsatriaqsnotqscontracting;qsinstead,qstheyqsareqsquiveringqschaotically;qsthisqscausesqsth
eqsisoelectricqslineqstoqsundulateqsinqsaqsveryqsirregularqsfashion;qsthereqsareqsnoqsvisibleqsPq
swaves,qsonlyqsfibrillaryqswavesqs(fqswaves)
WhatqsisqstheqsatrialqsrateqsinqsAtrialqsFibrillation?qs-qsANSWERS-overqs350bpm
WhatqsisqstheqsventricularqsrateqsforqsAtrialqsFibrillation?qs-qsANSWERS-
Thatqsdependsqsonqshowqsmanyqsofqstheqsimpulsesqsareqsconductedqsthroughqstoqstheqsven
tricles;qsifqstheqsventricularqsrateqsisqs100bpmqsorqsless,qstheqsrhythmqsisqscalledqsAtrialqsFibr
illationqswithqs"controlledqsventricularqsresponse"qsorqs"AtrialqsFibrillation,qscontrolled";qsifqs
theqsrateqsisqsoverqs100bpm,qsitqsisqscalledqsaqs"rapidqsventricularqsresponse"qsorqs"AtrialqsFi
brillation,qsuncontrolled"
Whatqsareqstheqs(2)qsmostqscharacteristicsqsfeaturesqsofqsAtrialqsFibrillation?qs-
qsANSWERS-ItqshasqsnoqsdiscernibleqsPqswavesqsandqstheqsR-
Rqsintervalsqsisqsgrosslyqsirregular
WhatqsdoesqstheqsPqswaveqslookqslikeqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
TheqsPqsisqsalwaysqsinverted,qsevenqsthoughqsitqsisqsoftenqshiddenqsinqstheqsQRSqscomplex
HowqsdoqsyouqsexplainqstheqsunusualqsconfigurationqsofqstheqsPqswaveqsinqsjunctionalqsrhyt
hm?qs-qsANSWERS-
Theqsatriaqsareqsdepolarizedqsviaqsretrogradeqsconduction;qssinceqstheqselectricalqsflowqswi
llqsbeqstravelingqsawayqsfromqstheqspositiveqselectrodeqsinqsLeadqsII,qstheqswaveqsformqswillqs
beqsnegative
WillqstheqsQRSqscomplexqsbeqsnormalqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
Yes,qsevenqsthoughqsatrialqsdepolarizationqsisqsretrograde,qsventricularqsdepolarizationqsw
illqsbeqsnormal;qstheqsQRSqscomplexqsshouldqsmeasureqslessqsthanqs0.12sec
DoesqsanqsinvertedqsPqswaveqsalwaysqsindicateqsaqsjunctionalqsrhythm?qs-qsANSWERS-
No,qsatrialqsrhythmsqscanqsalsoqshaveqsinvertedqsPqswavesqsifqstheqsimpulseqsoriginatedqslo
wqsenoughqsinqstheqsatria;qsyouqscanqsdifferentiateqsbetweenqstheqs(2)qsbyqslookingqsatqstheq
sPRI;qsinqsaqsjunctionalqsrhythmqsitqswillqsbeqslessqsthanqs0.12sec
WhereqswillqstheqsPqswaveqsbeqslocatedqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
ItqscanqsfallqsbeforeqsorqsafterqstheqsQRSqscomplex,qsorqsitqscanqsbeqshiddenqswithinqstheqsQ
RSqscomplex;qsinqstheqslatter,qsitqswillqsappearqsasqsifqstheqsrhythmsqshasqsnoqsPqswaveqsatqs
all
Whatqsisqstheqsbiggestqsclueqstoqsaqsjunctionalqsrhythm?qs-qsANSWERS-
theqsinvertedqsPqswave
jv jv jv
QUESTIONS AND ANSWERS
jvjv jv jv
HowqsdoesqsanqsatrialqsPqswaveqsdifferqsfromqsaqssinusqsPqswave?qs-qsANSWERS-
SinusqsPqswavesqsareqsuprightqsandqsuniform.qsAtrialqsPqswavesqscanqsbeqsflattened,qsnotc
hed,qsirregularqsorqsevenqsinverted
Whatqs(2)qsbasicqsmechanismsqscanqsanqsatrialqsfocusqstoqstakeqsoverqspacemakingqsresp
onsibilities?qs-qsANSWERS-Irritabilityqsorqsescape
Whatqsisqsanqsectopicqsfocus?qs-qsANSWERS-
ItqsisqsaqssiteqsofqselectricalqsactivityqsotherqsthanqstheqsSAqsnode
Whichqsatrialqsarrhythmiaqsisqscharacterizedqsbyqsaqspacemakerqsthatqsshiftsqsbetweenqsth
eqsSAqsnodeqsandqsvariousqsfociqsinqstheqsatria,qssometimesqsevenqsdroppingqsdownqstoqsth
eqsAVqsjunction?qs-qsANSWERS-WanderingqsPacemaker
WhatqsisqsaqsPACqs(PrematureqsAtrialqsComplex)?qs-qsANSWERS-
Itqsisqsaqssingleqsbeatqsthatqsoriginatesqsinqstheqsatriumqsandqscomesqsearlyqsinqstheqscardiac
qscycle
IsqsaqsPACqsanqsectopic?qs-qsANSWERS-
Yes,qsbcqsitqsoriginatesqsoutsideqsofqstheqsSAqsnode
Ifqsanqsectopicqsisqscausedqsbyqsirritability,qswillqsitqscomeqsearlierqsthanqsexpectedqsorqslater
qsthanqsexperienced?qs-qsANSWERS-
earlier;qsifqstheqsectopicqscomesqslaterqsthanqsexpected,qsitqswasqscausedqsbyqsescapeqsme
chanism
Isqswanderingqspacemakerqsaqssingleqsectopicqsbeat?qs-qsANSWERS-
No,qsisqsitqsanqsentireqsarrhythmia
WhatqsisqstheqsmostqscharacteristicqsfeatureqsofqsWanderingqsPacemaker?qs-
qsANSWERS-
ItqsisqstheqschangingqsshapesqsofqstheqsPqswavesqsasqstheqspacemakerqssiteqsshiftsqslocatio
ns
WhatqsshouldqstheqsQRSqsmeasurementqsbeqsforqsaqsPAC?qs-qsANSWERS-
lessqsthanqs0.12sec
IfqstheqsPqswaveqsofqsaqsPACqswasqsnotqsclearlyqsvisible,qswhereqsmightqsyouqsconsiderqsloo
kingqsforqsit?qs-qsANSWERS-inqstheqsTqswaveqsofqstheqsprecedingqscomplex
WhatqswillqstheqsPqswaveqslookqslikeqsonqsaqsPAC?qs-qsANSWERS-
itqswouldqshaveqstheqscharacteristicqslookqsofqsatrialqsPqswaves.qsItqscouldqsbeqsflattened,qsn
otched,qsdiphasic,qsorqspeaked
WhatqsisqstheqsusualqsrateqsrangeqsforqsAtrialqsTachycardia?qs-qsANSWERS-150-250bpm
DoesqsAtrialqsTachycardiaqshaveqsaqsPqswaveqsinqsfrontqsofqseveryqsQRSqscomplex?qs-
qsANSWERS-
Yes,qsalthoughqsyouqsmayqshaveqssomeqstroubleqsseeingqsthemqsifqstheyqsareqssuperimpos
edqsonqstheqsTqswavesqsofqstheqsprecedingqscomplexes
WhatqsdoesqstheqsPqswaveqslookqslikeqsinqsanqsAtrialqsTachycardia?qs-qsANSWERS-
ItqslooksqsjustqslikeqstheqsPqswaveqsofqsPAC;qsinqsfact,qsATqslooksqsveryqsmuchqslikeqsaqslotqsof
qsPACsqsconnectedqstogether
Whatqshappensqsifqstheqsatriaqsbeginqsbeatingqstooqsrapidlyqsforqstheqsventriclesqstoqsrespon
dqstoqsthem?qs-qsANSWERS-
, TheqsAVqsnodeqsmayqsblockqssomeqsofqstheqsimpulsesqssoqsthatqstheyqsaren'tqsconductedqst
oqstheqsventricles;qsthisqsresultsqsinqsmoreqsPqswavesqsthanqsQRSqscomplexes
Whichqs(2)qsatrialqsarrhythmiasqsdoqsyouqsknowqsthatqsinvolveqstheqsphenomenonqsdescrib
esqsinqstheqsprecedingqsquestion?qs-qsANSWERS-Atrialqsflutterqs&qsatrialqsfibrillation
What'sqstheqsatrialqsrateqsinqsAtrialqsFlutter?qs-qsANSWERS-250-350bpm
IsqstheqsventricularqsrhythmqsregularqsorqsirregularqsinqsAtrialqsFlutter?qs-qsANSWERS-
ThisqsdependsqsonqshowqstheqsAVqsnodeqsisqsblockingqsimpulses;qsifqsatrialqsimpulsesqsareq
sbeingqsconductedqsinqsaqsregularqspattern,qstheqsventricularqsrhythmqswouldqsbeqsregular,q
sbutqsifqstheqsconductionqsratioqsvaried,qstheqsventricularqsrhythmqswouldqsbeqsirregular
Inqsatrialqsflutter,qswouldqstheqsventricularqsrateqsbeqsfasterqsorqsslowerqsthanqstheqsatrialqsrat
e?qs-qsANSWERS-
Theqsventricularqsrateqswouldqsalwaysqsbeqsslower,qsunlessqstheqsconductionqsrationqswasq
s1:1;qsthisqsisqsbcqsnotqsallqsofqstheqsPqswavesqsareqsableqstoqsproduceqsQRSqscomplexes
WhatqsdoesqstheqsatrialqsactivityqslookqslikeqsinqsanqsAtrialqsFlutter?qs-qsANSWERS-
Theqsflutterqswavesqsusuallyqstakeqsonqsaqscharacteristicsqssawtoothqsappearance,qsaltho
ughqsnotqsalways
HowqswouldqsyouqsdescribeqstheqsatrialqsactivityqsinqsAtrialqsFibrillation?qs-qsANSWERS-
Theqsatriaqsnotqscontracting;qsinstead,qstheyqsareqsquiveringqschaotically;qsthisqscausesqsth
eqsisoelectricqslineqstoqsundulateqsinqsaqsveryqsirregularqsfashion;qsthereqsareqsnoqsvisibleqsPq
swaves,qsonlyqsfibrillaryqswavesqs(fqswaves)
WhatqsisqstheqsatrialqsrateqsinqsAtrialqsFibrillation?qs-qsANSWERS-overqs350bpm
WhatqsisqstheqsventricularqsrateqsforqsAtrialqsFibrillation?qs-qsANSWERS-
Thatqsdependsqsonqshowqsmanyqsofqstheqsimpulsesqsareqsconductedqsthroughqstoqstheqsven
tricles;qsifqstheqsventricularqsrateqsisqs100bpmqsorqsless,qstheqsrhythmqsisqscalledqsAtrialqsFibr
illationqswithqs"controlledqsventricularqsresponse"qsorqs"AtrialqsFibrillation,qscontrolled";qsifqs
theqsrateqsisqsoverqs100bpm,qsitqsisqscalledqsaqs"rapidqsventricularqsresponse"qsorqs"AtrialqsFi
brillation,qsuncontrolled"
Whatqsareqstheqs(2)qsmostqscharacteristicsqsfeaturesqsofqsAtrialqsFibrillation?qs-
qsANSWERS-ItqshasqsnoqsdiscernibleqsPqswavesqsandqstheqsR-
Rqsintervalsqsisqsgrosslyqsirregular
WhatqsdoesqstheqsPqswaveqslookqslikeqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
TheqsPqsisqsalwaysqsinverted,qsevenqsthoughqsitqsisqsoftenqshiddenqsinqstheqsQRSqscomplex
HowqsdoqsyouqsexplainqstheqsunusualqsconfigurationqsofqstheqsPqswaveqsinqsjunctionalqsrhyt
hm?qs-qsANSWERS-
Theqsatriaqsareqsdepolarizedqsviaqsretrogradeqsconduction;qssinceqstheqselectricalqsflowqswi
llqsbeqstravelingqsawayqsfromqstheqspositiveqselectrodeqsinqsLeadqsII,qstheqswaveqsformqswillqs
beqsnegative
WillqstheqsQRSqscomplexqsbeqsnormalqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
Yes,qsevenqsthoughqsatrialqsdepolarizationqsisqsretrograde,qsventricularqsdepolarizationqsw
illqsbeqsnormal;qstheqsQRSqscomplexqsshouldqsmeasureqslessqsthanqs0.12sec
DoesqsanqsinvertedqsPqswaveqsalwaysqsindicateqsaqsjunctionalqsrhythm?qs-qsANSWERS-
No,qsatrialqsrhythmsqscanqsalsoqshaveqsinvertedqsPqswavesqsifqstheqsimpulseqsoriginatedqslo
wqsenoughqsinqstheqsatria;qsyouqscanqsdifferentiateqsbetweenqstheqs(2)qsbyqslookingqsatqstheq
sPRI;qsinqsaqsjunctionalqsrhythmqsitqswillqsbeqslessqsthanqs0.12sec
WhereqswillqstheqsPqswaveqsbeqslocatedqsinqsaqsjunctionalqsrhythm?qs-qsANSWERS-
ItqscanqsfallqsbeforeqsorqsafterqstheqsQRSqscomplex,qsorqsitqscanqsbeqshiddenqswithinqstheqsQ
RSqscomplex;qsinqstheqslatter,qsitqswillqsappearqsasqsifqstheqsrhythmsqshasqsnoqsPqswaveqsatqs
all
Whatqsisqstheqsbiggestqsclueqstoqsaqsjunctionalqsrhythm?qs-qsANSWERS-
theqsinvertedqsPqswave