MEDICAL ASSISTANT CERTIFICATION
EXAM
what are ectopic rhythms? - ANSWERS-electrical impulses originate from somewhere other
than sinus node
what are conduction blocks? - ANSWERS-electrical impulses go down the usual pathway but
encounter blocks and delays
what are pre-excitation syndromes? - ANSWERS-electrical impulses bypass the normal
pathway and go down an accessory shortcut instead
what is the normal sinus rate and what is it called when its above and below this rate? -
ANSWERS-60-100 BPM
>100 tachycardia
<60 bradycardia
normal sinus rhythym - ANSWERS-(SINUS RHYTHMS) notice all PQRST waves are equal and
present. Diastolic period can be easily identified
a. HR 60-100
b. similar P in all leads in front of QRS
c. constant PR (.12-.2) sec interval
sinus bradycardia - ANSWERS-(SINUS RHYTHM) notice all waves are present and in normal
size. a very long diastolic period is easily identified
a. HR less than 60
b. diastolic pause is longer
c. bradycardia decreases the blood flow in the brain and other tissues
,sinus tachycardia - ANSWERS-(SINUS RHYTHM) diastolic period can not be seen well, P and T
waves are very close together
a. HR over 100
b. diastolic pause is small or nonexistent
c. tachycardia reduces the blood supply to the cardiac muscle
sinus arrhythmia - ANSWERS-(SINUS RHYTHM) notice that PQRST waves are equal and
normal in size, but diastolic periods are different after each heart systole
a. HR 60-100
b. different diastolic pause after each systole
supraventricular tachycardia - ANSWERS-(ATRIAL RHYTHM)
Atrial Tachycardia (AT) is caused by an irritable focus in the atria that fires electrical impulses
after normal firing of SA node pacemaker HR btw 100- 150
AV Reentry Tachcardia is caused when the electrical impulse passes a passage other than AV
node. cardiac rhythm regular but up to 250 BPM **EMERGENCY NOTIFY DOCTOR
atrial flutter - ANSWERS-(atrial rhythm) notie that there are no more "p waves" only saw-
tooth-like wave called F wave
a. characterized by rapid depolarization of a single atrial focus at a rate of 250-350 BPM
b.typically a slower ventricular rate
**EMERGENCY NOTIFY DOCTOR
atrial fibrillation - ANSWERS-(atrial rhythm) no more p waves, instead they are substituted
by small trembling waves, while QRST complex are almost normal
a. caused by multiple irritable sites all over the atria firing at rate >350
b. no identifiable P waves, fibrillatory eratic "f" waves **EMERGENCY NOTIFY DOCTOR
,Premature Ventricular Complex (PVC) - ANSWERS-(ventricular rhythm) observe difference
btw the normal QRS complexes and the wide inverted abnormal QRS of the PVC and full
compensatory pause
a. QRS and PVC greater than .12 s because ventricular depolarization is abnormal
b. T waves usu in opposite direction of QRS
ventricular tachycardia (VT) - ANSWERS-(ventricular rhythm) notice there are no more p
waves but wide, bizarre QRS complexes at a rate >100
a. 3 or more PVCs in a row
b. regular fast rhythm
c. no P waves
** EMERGENCY ND
ventricular fibrillation (VF) - ANSWERS-notice the quivering eratic waves that do not
resemble any of the normal waves or QRS complexes
a. chaotic deflection of different waves that vary in size shape and duration
b. no visible waves
EMERGENCY requires defibrillationa nd CPR
Asystole (Cardiac Arrest) - ANSWERS-just an isoelectric line, no waves are seen
patient is clinically dead EMERGENCY!!
What are the 4 types of Atrio-ventricular blocks (AV blocks) - ANSWERS-1. Type I First Degree
AV block
2. Type I Second Degree (Wenckebach, Mobitz I)
3. Type II Second Degree AV block (Mobits II)
4. Third Degree AV block
Type I First Degree AV block - ANSWERS-characterized by a delay of impulses at the level of
the AV node; PR interval prolonged and greater than 0.2s; Notice prolonged P wave
, Type I Second Degree AV block - ANSWERS-PR interval lengthens in each interval until one
QRS disapears; Notice gradual increase in PR intervene, and then sudden disapear of QRS
complex
Type II Second Degree AV Block - ANSWERS-conducted P waves have a constant PR interval;
but there is always non-conducted P waves btw cardiac cycles, usu producing a conduction
ratio btw atria and vertircles (2 P waves per QRS)
Third Degree AV block - ANSWERS-(aka complete heart block) impulses generated by the SA
node are completely blocked . atria and ventricles beat independently of one another; no
relationship btw P waves and QRS complexes
what is ischemia? - ANSWERS-insufficient blood supply to the myocardium
what is myocardial infarction (MI) - ANSWERS-sudden death of myocardial tissue due to an
abrupt cessation of blood flow
What are the 2 ischemic EKG characteristics? - ANSWERS-1. subendocardial ischemic injury is
manifest by ST segment depression
2. subepicardial and transmural injury is manifested by ST segment elevation
myocardial infarction EKG - ANSWERS-Notice ST segment depression in aVL leads on the
trace; note that changes in ST segments and T wave inversion are the early signs of
myocardial infarction
the World Health Organization (WHO) criteria for diagnosis of myocardial infarction are
presence of at least two of the following? - ANSWERS--clinical history of ischemic-type of
chest discomfort
-changes on serial EKG tracings
-rise and fall in serum cardiac markers
EXAM
what are ectopic rhythms? - ANSWERS-electrical impulses originate from somewhere other
than sinus node
what are conduction blocks? - ANSWERS-electrical impulses go down the usual pathway but
encounter blocks and delays
what are pre-excitation syndromes? - ANSWERS-electrical impulses bypass the normal
pathway and go down an accessory shortcut instead
what is the normal sinus rate and what is it called when its above and below this rate? -
ANSWERS-60-100 BPM
>100 tachycardia
<60 bradycardia
normal sinus rhythym - ANSWERS-(SINUS RHYTHMS) notice all PQRST waves are equal and
present. Diastolic period can be easily identified
a. HR 60-100
b. similar P in all leads in front of QRS
c. constant PR (.12-.2) sec interval
sinus bradycardia - ANSWERS-(SINUS RHYTHM) notice all waves are present and in normal
size. a very long diastolic period is easily identified
a. HR less than 60
b. diastolic pause is longer
c. bradycardia decreases the blood flow in the brain and other tissues
,sinus tachycardia - ANSWERS-(SINUS RHYTHM) diastolic period can not be seen well, P and T
waves are very close together
a. HR over 100
b. diastolic pause is small or nonexistent
c. tachycardia reduces the blood supply to the cardiac muscle
sinus arrhythmia - ANSWERS-(SINUS RHYTHM) notice that PQRST waves are equal and
normal in size, but diastolic periods are different after each heart systole
a. HR 60-100
b. different diastolic pause after each systole
supraventricular tachycardia - ANSWERS-(ATRIAL RHYTHM)
Atrial Tachycardia (AT) is caused by an irritable focus in the atria that fires electrical impulses
after normal firing of SA node pacemaker HR btw 100- 150
AV Reentry Tachcardia is caused when the electrical impulse passes a passage other than AV
node. cardiac rhythm regular but up to 250 BPM **EMERGENCY NOTIFY DOCTOR
atrial flutter - ANSWERS-(atrial rhythm) notie that there are no more "p waves" only saw-
tooth-like wave called F wave
a. characterized by rapid depolarization of a single atrial focus at a rate of 250-350 BPM
b.typically a slower ventricular rate
**EMERGENCY NOTIFY DOCTOR
atrial fibrillation - ANSWERS-(atrial rhythm) no more p waves, instead they are substituted
by small trembling waves, while QRST complex are almost normal
a. caused by multiple irritable sites all over the atria firing at rate >350
b. no identifiable P waves, fibrillatory eratic "f" waves **EMERGENCY NOTIFY DOCTOR
,Premature Ventricular Complex (PVC) - ANSWERS-(ventricular rhythm) observe difference
btw the normal QRS complexes and the wide inverted abnormal QRS of the PVC and full
compensatory pause
a. QRS and PVC greater than .12 s because ventricular depolarization is abnormal
b. T waves usu in opposite direction of QRS
ventricular tachycardia (VT) - ANSWERS-(ventricular rhythm) notice there are no more p
waves but wide, bizarre QRS complexes at a rate >100
a. 3 or more PVCs in a row
b. regular fast rhythm
c. no P waves
** EMERGENCY ND
ventricular fibrillation (VF) - ANSWERS-notice the quivering eratic waves that do not
resemble any of the normal waves or QRS complexes
a. chaotic deflection of different waves that vary in size shape and duration
b. no visible waves
EMERGENCY requires defibrillationa nd CPR
Asystole (Cardiac Arrest) - ANSWERS-just an isoelectric line, no waves are seen
patient is clinically dead EMERGENCY!!
What are the 4 types of Atrio-ventricular blocks (AV blocks) - ANSWERS-1. Type I First Degree
AV block
2. Type I Second Degree (Wenckebach, Mobitz I)
3. Type II Second Degree AV block (Mobits II)
4. Third Degree AV block
Type I First Degree AV block - ANSWERS-characterized by a delay of impulses at the level of
the AV node; PR interval prolonged and greater than 0.2s; Notice prolonged P wave
, Type I Second Degree AV block - ANSWERS-PR interval lengthens in each interval until one
QRS disapears; Notice gradual increase in PR intervene, and then sudden disapear of QRS
complex
Type II Second Degree AV Block - ANSWERS-conducted P waves have a constant PR interval;
but there is always non-conducted P waves btw cardiac cycles, usu producing a conduction
ratio btw atria and vertircles (2 P waves per QRS)
Third Degree AV block - ANSWERS-(aka complete heart block) impulses generated by the SA
node are completely blocked . atria and ventricles beat independently of one another; no
relationship btw P waves and QRS complexes
what is ischemia? - ANSWERS-insufficient blood supply to the myocardium
what is myocardial infarction (MI) - ANSWERS-sudden death of myocardial tissue due to an
abrupt cessation of blood flow
What are the 2 ischemic EKG characteristics? - ANSWERS-1. subendocardial ischemic injury is
manifest by ST segment depression
2. subepicardial and transmural injury is manifested by ST segment elevation
myocardial infarction EKG - ANSWERS-Notice ST segment depression in aVL leads on the
trace; note that changes in ST segments and T wave inversion are the early signs of
myocardial infarction
the World Health Organization (WHO) criteria for diagnosis of myocardial infarction are
presence of at least two of the following? - ANSWERS--clinical history of ischemic-type of
chest discomfort
-changes on serial EKG tracings
-rise and fall in serum cardiac markers
