ADVANCED ARRHYTHMIA EXAM PREP WITH 100% CORRECT ANSWERS ALREADY GRADED A+.

Conduction System SA Node AV Node Bundle of His Right and Left bundle branches Purkinje Fibers SA Node primary pacemaker rate 60-100 Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:15 Full screen AV Node slightly delays impulse from atria to ventricles Bundle of His conducts impulses to left and right bundle branches Purkinje Fibers relay impulses to ventricular myocardium Depolarization contraction Repolarization relaxation Primary Lead lead 2 (red) positive camera/eye Small box 0.04 P Wave atrial depolarization spread of impulse through atria QRS Complex ventricular depolarization <0.12 seconds T Wave ventricular repolarization Inverted T wave myocardial ischemia Peaked T wave hyperkalemia (K>5.5) Flat T wave hypokalemia (low K) U Wave repolarization of purkinje fibers more prominent in hypokalemia ST normally flat may be elevated/depressed ST Elevation acute MI ST Depression ischemia narrowed arteries/decreased CO PR 0.12-0.2 QT ventricular depolarization to repolarization begining of QRS to end of T <_0.44 varies w/HR QTc QT divided by square root of R-R adjusted based on HR more accurate men<_0.44 women<_0.45 Prolonged QT increases risk for life threatening ventricular arrhythmias d/t meds new onset bradydysrhythmias (pauses/blocks) hypokalemia hypomagnesemia Ventricular rate R-R Atrial rate P-P 6 second method QRS/Pwave x10 Small box method (for busts of tachycardia) R-R/P-P in small boxes and divide by 1500 Artifact Causes improper skin prep loose electrodes broken cables/wires muscle tremor movement chest compressions 60 cycle interference Analyzing Strips ventricular/atrial rate rhythmicity left to right P waves (size/shape/position) PR interval (0.12-0.2) QRS (duration/narrow/wide) ST (elevation/depression) T waves (upright/inverted/peaked/flat) QT <0.44 (calc QTc) Sinus Rhythm at 75 3 Sinus Brady at 51 in a 68y/o male 2 Sinus Brady at 51 in 1 month old infant 1 Sinus Brady at 27 1 Sinus Tach at 110 (pt has fever ad and PNA) 3 expected w/fever and rhythm isn't problem Sinus Brady at 55 (well conditioned athlete) 3 Sinus Arrhythmia (19y/o phasic w/resp) 3 Sinus Rhythm with 4 seconds episode of sinus arrest 1 SR with 2-3 episodes AV block per min 2 Normal Sinus Rhythm 60-100 regular 1 upright p wave before QRS constant PR 0.12-0.2 QRS<0.12 Sinus Bradycardia <60 same as NSR but slower As HR slows QT interval increases As HR speeds up QT interval decreases Sinus Brady Causes could be normal especially in athletes during sleep vagal stimulation -coughing -vomiting -straining -sudden exposure of face to cold water -carotid sinus pressure Sinus Tachycardia 101-180 same as NSR but faster P/T waves may run together gradual increase/decrease Sinus Arrhythmia 60-100 may be faster/slower same as NSR but irregular only 1 type of p wave Respiratory -phasic w/respirations Nonrespiratory -elderly -heart disease -after MI -inc ICP -Digoxin/Morphine SA Block 1 missed beat blocked as they exit SA node not common Caused by -meds CAD/CHF/Myocarditis Sinus Arrest longer than 1 missed beat SA node fails to generate impulse backup pacemaker should kick in measure in seconds (5 big boxes=1 sec) Atrial Dysrhythmias abnormal electrical impulse generally not life threatening Premature Atrial Complexes early beats that originate outside SA node very common upright and at least one unusual p wave 2 different p waves Normally Conducted PAC normal narrow QRS after p wave normal conduction through ventricles Aberrantly Conducted PAC Wide QRS after p wave abnormal conduction through ventricles first one then the other Non-conducted PAC blocked very early p wave with no QRS not conducted through ventricles at all Coupled beats 2 in a row Runs/Bursts more than 3 in a row Bigeminal every other beat Trigeminal every 3rd beat Quadrigeminal every 4th beat Multifocal Atrial Rhythm shifting of dominant pacemaker usually irregular size/shape/direction of p waves varies beat to beat at least 3 different p waves no s/s usually resolves on own Multifocal Atrial Tach same as MAR but >101