Cardiology: Atrial and Sinus Rhythms

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Questions and Answers

What is the diagnosis when there are retrograde P-waves in Lead 2 and an atrial rate of 160?

Atrial Tachycardia (correct)

Atrial Flutter

Atrial Fibrillation

Sinus Bradycardia

Which diagnosis is indicated by a narrow complex and irregularly irregular rhythm with no discernable P-waves?

Sinus Tachycardia

Atrial Flutter

Sinus Arrhythmia

Atrial Fibrillation (correct)

What is the diagnosis associated with a 'saw-tooth' pattern of atrial depolarization in Lead 2?

First Degree AV Block

Complete Heart Block

Atrial Bradycardia

Atrial Flutter (correct)

Sinus arrhythmia reflects a changing sinus node rate with the respiratory cycle.

True Signup and view all the answers

What characterizes sinus bradycardia in an ECG?

Normal upright P wave in Lead II preceding every QRS complex with a ventricular rate of less than 60 bpm Signup and view all the answers

What is indicated by an upright P wave in Lead II preceding every QRS complex with an atrial rate greater than 100 bpm?

Sinus Tachycardia Signup and view all the answers

What does a large amplitude of the P wave in Lead 2 suggest?

Right Atrial Enlargement Signup and view all the answers

What does a QRS complex that is upright in lead I and downward in lead aVF indicate?

Left Axis Deviation Signup and view all the answers

Which diagnosis is characterized by a QRS that is predominantly negative in lead I and positive in lead aVF?

Right Axis Deviation Signup and view all the answers

What happens in a patient with left ventricular hypertrophy?

Increased amplitude of the QRS complex Signup and view all the answers

What is indicated by strain pattern with ST segment depression in leads V1 to V3?

Right Ventricular Hypertrophy Signup and view all the answers

What signifies a prolonged PR interval greater than 300 ms in Lead 2?

First Degree AV Block Signup and view all the answers

Which condition is characterized by grouped beats with a progressively lengthening PR interval followed by a dropped beat?

Second Degree AV Block Mobitz I Wenckebach Signup and view all the answers

What diagnosis should be considered when there is no evidence of conduction from the atria to the ventricles?

Complete Heart Block Signup and view all the answers

What is indicated by a broad negative S wave in leads V1,2 and a QRS duration greater than 120 ms?

Left Bundle Branch Block Signup and view all the answers

What does an rsR' 'bunny ear' pattern in the anterior precordial leads indicate?

Right Bundle Branch Block Signup and view all the answers

What ECG patterns indicate hyperkalemia?

Peaked T waves, shortened QT interval, and widened QRS complex Signup and view all the answers

What diagnosis is characterized by a prolonged QT interval and a lengthened ST segment?

Hypocalcemia Signup and view all the answers

What is indicated by a U wave that occurs just after the T wave and is usually of smaller amplitude than the T wave?

Hypokalemia Signup and view all the answers

What term describes a heart condition characterized by premature, ectopic impulses from the ventricles?

Premature Ventricular Contraction Signup and view all the answers

Study Notes

Atrial Rhythms

Atrial Tachycardia: Characterized by retrograde P-waves in Lead 2, with an atrial rate of 160 and a ventricular rate of 80. Indicates two P waves for every QRS complex.
Atrial Fibrillation: Identified by narrow complex and irregularly irregular rhythm, with no discernible P-waves present.
Atrial Flutter: Recognized by a "saw-tooth" pattern of atrial depolarization in Lead 2, with variable A-V conduction.

Sinus Rhythms

Sinus Arrhythmia: Associated with a changing sinus node rate during the respiratory cycle, featuring a P-P interval variation of at least 0.12 seconds.
Sinus Bradycardia: Identified by a normal upright P wave in Lead II preceding every QRS complex, with a ventricular rate less than 60 beats per minute.
Sinus Tachycardia: Defined by a normal upright P wave in Lead II preceding every QRS complex, indicating a sinus node pacemaker, with an atrial rate exceeding 100 beats per minute.

Atrial Enlargement

Right Atrial Enlargement: Indicated by large amplitude of the P wave in Lead 2, resulting from hypertrophic right atrial myocardium close to the SA node.

Axis Deviations

Left Axis Deviation: Characterized by an upright QRS in lead I (positive) and a downward QRS in lead aVF (negative).
Right Axis Deviation: Predominantly negative QRS in lead I and positive in lead aVF.

Ventricular Hypertrophy

Left Ventricular Hypertrophy (LVH): Defined by increased amplitude of QRS complex, potential widening of QRS, and ST segment discordance. Typical T wave inversions in Leads V1-V6 are also noted.
Right Ventricular Hypertrophy: Identified by strain causing ST segment depression and asymmetric T wave inversions in leads V1-V3.

Heart Blocks

First Degree AV Block: Identified in Lead 2 by a long PR interval, marked as >300 ms, indicating slowed conduction through the His-Purkinje system.
Second Degree AV Block (Mobitz I/Wenckebach): Characterized by grouped beats with progressively lengthening PR intervals followed by a dropped beat.
Complete Heart Block: Occurs with a faster atrial rate and a slower ventricular escape rate, showing no conduction from atria to ventricles.

Bundle Branch Blocks

Left Bundle Branch Block (LBBB): Noted by broad negative S waves in leads V1, V2, and weak R waves in V5, V6, with QRS duration >120 ms.
Right Bundle Branch Block (RBBB): Identified by QRS duration >120 ms, rsR' "bunny ear" pattern in leads V1-V3, and slurred S waves in leads I, aVL, V5, and V6.

Electrolyte Disturbances

Hyperkalemia: Characterized by peaked T waves, shortened QT intervals, and sometimes ST segment depression, with QRS widening and changes in P wave amplitude and PR interval.
Hypocalcemia: Defined by a prolonged QT interval and lengthened ST segment.
Hypokalemia: Noted for U waves appearing after the T wave, potentially flattening T waves, and ST segment depression.

Additional Conditions

Prolonged QT Interval: Indicates an underlying issue that could predispose the individual to arrhythmias.
Premature Ventricular Contraction (PVC): Characterized by premature occurrence, ectopic origin outside the SA node (different QRS morphology), wide QRS complexes, and a compensatory pause following the contraction.

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Description

Test your knowledge on atrial and sinus rhythms including atrial tachycardia, fibrillation, flutter, and various forms of sinus arrhythmias. This quiz covers characteristics, rates, and conduction patterns essential for understanding cardiac rhythms. Perfect for students and professionals in cardiology or medical fields.