ECG Analysis and Arrhythmias
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Questions and Answers

What is defined as a slow arrhythmia?

  • Bradyarrhythmia (correct)
  • Tachyarrhythmia
  • Dysrhythmia
  • Artifact

    • Which of the following is NOT a common cause of artifact in ECG monitoring?

  • Muscle contractions
  • Respiratory artifact
  • Loose electrode
  • Re-entry mechanism (correct)

    • Which symptoms are associated with bradyarrhythmias?

  • Rapid heart rate and anxiety
  • Increased perspiration and headache
  • Dizziness and lightheadedness (correct)
  • Chest pain and palpitations

    • What is the first step in analyzing a 12-lead ECG?

    <p>Orient yourself</p> Signup and view all the answers

    What distinguishes sinus tachycardia from other forms of tachyarrhythmia?

    <p>Rate exceeds 100 bpm</p> Signup and view all the answers

    Which of the following describes the mechanism of triggered activity in arrhythmias?

    <p>Abnormal impulse generation following a normal impulse</p> Signup and view all the answers

    Which option is a treatment approach for sinus tachycardia?

    <p>Identify and correct the underlying cause</p> Signup and view all the answers

    Which of the following statements about arrhythmias is true?

    <p>Arrhythmia signifies a lack of normal rhythm</p> Signup and view all the answers

    What is a key characteristic of Premature Ventricular Contractions (PVCs)?

    <p>Impulse generated below the branching point of the Bundle of His</p> Signup and view all the answers

    Which treatment is appropriate for symptomatic Monomorphic Ventricular Tachycardia?

    <p>Electrical cardioversion</p> Signup and view all the answers

    What is the most critical action for Ventricular Fibrillation (V fib)?

    <p>Immediate defibrillation and ACLS protocols</p> Signup and view all the answers

    What defines Torsades de Pointes on an EKG?

    <p>Wide, bizarre morphology of QRS complexes fluctuating around the baseline</p> Signup and view all the answers

    When is it necessary to treat Premature Ventricular Contractions (PVCs)?

    <p>When they are frequent (&gt;6/min) or symptomatic</p> Signup and view all the answers

    What is the primary feature that distinguishes supraventricular tachycardia from ventricular tachycardia?

    <p>It originates from parts above the ventricles.</p> Signup and view all the answers

    Which of the following statements about premature atrial contractions (PACs) is true?

    <p>PACs can occur more frequently in patients with coronary heart failure.</p> Signup and view all the answers

    What is the usual rate range for focal atrial tachycardia (FAT)?

    <p>150-250 bpm</p> Signup and view all the answers

    What treatment options can help 'break' AV nodal reentrant tachycardia (AVNRT)?

    <p>Adenosine and vagal maneuvers.</p> Signup and view all the answers

    In which part of the heart does focal atrial tachycardia most commonly originate?

    <p>Left atrium</p> Signup and view all the answers

    What mechanism is primarily involved in AV reentrant tachycardia (AVRT)?

    <p>A reentrant circuit involving an accessory pathway.</p> Signup and view all the answers

    What characteristic of the P-waves can typically be observed in AV nodal reentrant tachycardia?

    <p>P-waves may be buried or retrograde.</p> Signup and view all the answers

    What is the primary reason for performing ablation in patients with AVNRT?

    <p>To eliminate the reentrant circuit at the AV node.</p> Signup and view all the answers

    Which of the following characterizes Wolff-Parkinson-White Syndrome in terms of ECG findings?

    <p>Presence of delta waves</p> Signup and view all the answers

    What is the typical atrial rate in Atrial Flutter?

    <p>200-350 bpm</p> Signup and view all the answers

    Which treatment is commonly used for Atrial Fibrillation to control heart rate?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the mechanism of Atrial Fibrillation?

    <p>Firing from multiple ectopic pacemakers</p> Signup and view all the answers

    In Atrial Flutter, what pattern is typically observed on an ECG?

    <p>Saw-tooth pattern of flutter waves</p> Signup and view all the answers

    What is likely the treatment for pre-excitation in Wolff-Parkinson-White Syndrome?

    <p>Catheter ablation</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with Atrial Fibrillation?

    <p>Hypertension</p> Signup and view all the answers

    In Multifocal Atrial Tachycardia (MAT), what distinguishes it from Atrial Fibrillation?

    <p>Variable PR interval and multiple P-wave shapes</p> Signup and view all the answers

    What defines the AV conduction ratio in Atrial Flutter?

    <p>Typically a 2:1 ratio</p> Signup and view all the answers

    Which medication is considered for rhythm control in Atrial Fibrillation?

    <p>Sotalol</p> Signup and view all the answers

    What is the primary treatment for Torsades de Pointes?

    <p>IV Magnesium</p> Signup and view all the answers

    Which arrhythmia is characterized by multiple distinct P-waves?

    <p>Multifocal Atrial Tachycardia</p> Signup and view all the answers

    What distinguishes AV nodal reentrant tachycardia (AVNRT) from AV reentrant tachycardia (AVRT)?

    <p>Reentrant circuit located at the AV node</p> Signup and view all the answers

    Which arrhythmia is characterized by a 'saw-tooth' pattern on an ECG?

    <p>Atrial Flutter</p> Signup and view all the answers

    Which arrhythmia may manifest with no P-waves on an ECG?

    <p>Atrial Fibrillation</p> Signup and view all the answers

    In what scenario would synchronized cardioversion be applied?

    <p>Unstable Atrial Flutter</p> Signup and view all the answers

    What is a key feature of Premature Ventricular Contractions (PVCs)?

    <p>Generated below the bifurcation of the His bundle</p> Signup and view all the answers

    What condition is closely associated with minimal cardiac output?

    <p>Ventricular Fibrillation</p> Signup and view all the answers

    Study Notes

    Arrhythmia Definitions

    • Arrhythmia = lack of normal rhythm
    • Dysrhythmia = rhythm doesn't work properly
    • Tachyarrhythmia = fast arrhythmia
    • Bradyarrhythmia = slow arrhythmia

    Why Do We Care about Arrhythmias?

    • Cardiac output (CO) = Stroke Volume x Heart Rate
    • Bradyarrhythmias reduce heart rate, lowering cardiac output
    • Tachyarrhythmias increase heart rate, increasing oxygen demand

    Artifact

    • Disruption in monitoring caused by external factors
    • Common causes:
      • AC interference: 60 Hz artifact
      • Muscle contractions and tremors
      • Respiratory artifact: patient movement, wandering baseline
      • Loose electrode
      • Broken lead wire

    Steps in Analyzing a 12-Lead ECG

    • Orient yourself: Identify the leads and their positions
    • Calculate Rate: Determine the heart rate per minute
    • Determine Rhythm: Identify the regularity and origin of the rhythm
    • Determine the Axis: Analyze the electrical direction of the heart
    • Intervals and QRS Duration: Measure durations of PR, QRS, and QT intervals
    • "Others": Assess ST segment and T wave morphology

    Mechanisms of Arrhythmias

    • Re-entry: A circuit where an impulse travels back on itself in the heart, creating a continuous loop, causing a rapid rhythm.
    • Automaticity: An area within the heart that fires spontaneously, independent of the normal pacemaker (SA node).
    • Triggered Activity: A heart cell is stimulated to fire repeatedly by delayed afterdepolarizations (DADs) and early afterdepolarizations (EADs).

    Bradyarrhythmias

    • Heart rate < 60 bpm
    • Symptoms:
      • Dizziness, lightheadedness
      • Palpitations, pre-syncope
      • Syncope

    Sinus Bradycardia (SB)

    • Rate: < 60 bpm
    • Symptoms:
      • Asymptomatic
      • Palpitations
      • Shortness of breath, fatigue
      • Syncope, lightheadedness

    Sinus Tachycardia

    • Rate: > 100 bpm
    • Rhythm: Normal P waves precede every QRS complex
    • Intervals: QRS normal, PR interval normal
    • Causes:
      • Normal physiologic response to pain, exercise, stress, infection, anemia, hyperthyroidism, dehydration, pulmonary embolism
    • Treatment: Identify and correct the underlying cause

    Supraventricular Tachycardia (SVT)

    • A rapid heart rhythm that originates above the ventricles
    • Includes:
      • Atrial Flutter
      • Atrial Fibrillation
      • AVNRT
      • AVRT

    Premature Atrial Contractions (PACs)

    • Premature activation of the atria from an ectopic pacemaker
    • Rate: Normal or accelerated
    • Rhythm: Irregular
    • Intervals:
      • P-R: Ectopic beats may have a different P-R interval
      • QRS: Usually normal
    • Causes:
      • Occasional PACs are normal
      • More frequent in CHF, myocardial ischemia, COPD

    Focal Atrial Tachycardia (FAT)

    • Regular atrial rhythm originating from a site other than the SA node, with a rate > 100 bpm
    • Rate: 150 - 250 bpm
    • Rhythm: Regular
    • Intervals: Narrow QRS, normal PR
    • Treatment: Adenosine can reveal underlying atrial activity

    AV Nodal Reentrant Tachycardia (AVNRT)

    • Most common type of paroxysmal SVT
    • Reentrant circuit at the AV node, causing simultaneous atrial and ventricular depolarization
    • Rate: 150 - 250 bpm
    • Rhythm: Regular
    • Treatment:
      • Vagal maneuvers: Carotid sinus massage, coughing, Valsalva
      • Adenosine
      • Long-term: Ablation

    AV Reentrant Tachycardia (AVRT)

    • Involves a reentrant circuit via an accessory pathway (abnormal connection between atria and ventricles)
    • Two conduction pathways: AV node (normal) and accessory pathway
    • Retrograde P wave seen after the QRS
    • QRS may be normal (orthodromic) or prolonged (antidromic)
    • Treatment: Similar to AVNRT

    Wolff-Parkinson-White Syndrome (WPW)

    • Pre-excitation: Early ventricle activation due to impulses bypassing the AV node via an accessory pathway
    • ECG Findings:
      • Shortened PR interval
      • Delta wave: Slurring slow rise of the initial portion of the QRS
      • QRS > 120 ms (when pre-excited)
      • ST Segment and T wave discordant changes
      • Treatment:
        • Catheter ablation
        • Vagal maneuvers
        • Medications: Adenosine, Verapamil, Procainamide

    Atrial Fibrillation (A-Fib)

    • Multiple atrial foci fire chaotically, causing rapid, irregular atrial activity
    • Rate: Atria firing ~300 - 650 bpm
    • Rhythm: Irregularly Irregular
    • Intervals: PR unmeasurable, narrow QRS
    • Causes:
      • Hypertension (most common)
      • COPD, CHF, underlying heart disease, aging, stress, infection, alcohol, thyrotoxicosis, caffeine

    Atrial Fibrillation Management

    • Rate control: Medications slow the ventricular rate:
      • Beta-blockers (Metoprolol)
      • Calcium Channel Blockers (Diltiazem)
      • Digoxin
    • Rhythm control: Medications restore sinus rhythm:
      • Amiodarone, Sotalol, Flecainide
    • Anticoagulation: Prevent cerebrovascular accident:
      • Warfarin, Enoxaparin, Rivaroxaban, Apixaban, Dabigatran
    • Emergency: Electrical cardioversion (DCCV)
    • Ablation: Pulmonary vein isolation

    Atrial Flutter

    • A rapid heart rhythm caused by a re-entry circuit in the right atrium, traversing the cavo-tricuspid isthmus
    • Rate: Atrial rate ~ 300 bpm (range 200 - 350 bpm)
    • Ventricular rate determined by the AV block ratio
    • Rhythm: "Saw-tooth" pattern (flutter waves) in leads II, III, and aVF
    • Intervals: PR unmeasurable, narrow QRS
    • Treatment:
      • Difficult to control rate with medications
      • Anticoagulation
      • Cardioversion if unstable
      • Ablation of the cavo-tricuspid isthmus

    Multifocal Atrial Tachycardia (MAT)

    • Multiple atrial foci fire intermittently
    • Rate: 100 - 250 bpm
    • Rhythm: Irregular, ≥ 3 different p-wave shapes
    • Intervals: QRS narrow, PR interval variable
    • Causes: Most common in COPD, hypoxemia, hypomagnesemia, hypokalemia
    • Treatment: Verapamil; treat the underlying cause

    Premature Ventricular Contractions (PVCs)

    • Ectopic beats originating below the bifurcation of the Bundle of His
    • Wide QRS, usually without a preceding P wave
    • Causes:
      • Electrolyte abnormalities, hypoxia, hyperthyroidism, catecholamines, drug toxicities
      • Can occur in normal or abnormal hearts
    • Treatment:
      • If associated with acute MI, couplets, bigeminy, trigeminy, multifocal, frequent, or symptomatic

    Monomorphic Ventricular Tachycardia

    • Usually occurs in diseased hearts
    • Rhythm: P-waves obscured or absent, unrelated to QRS complex
    • Causes: CAD, acute MI, digitalis toxicity, CHF, ventricular aneurysms, cardiomyopathy, electrolyte abnormalities
    • Treatment:
      • Symptomatic/Unstable: Electrical cardioversion
      • Medications: Amiodarone, Lidocaine

    Ventricular Fibrillation (V Fib)

    • Chaotic electrical activity from the ventricles, causing absence of cardiac output
    • Treatment: Immediate defibrillation and ACLS protocols

    Torsades de Pointes

    • Upward and downward deflection of QRS complexes around the baseline
    • P wave usually obscured, wide and bizarre QRS complex
    • Causes: Drugs that prolong QT interval, MI, electrolyte imbalances (hypo-Mg, hypo-K, hypo-Ca)
    • Treatment:
      • Synchronized cardioversion if unstable
      • IV Magnesium, IV Potassium
      • Overdrive pacing

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    Clinical ECG: Atrial/Ventricular Arrhythmias Lecture PDF

    Description

    This quiz covers essential definitions and implications of various arrhythmias, including tachyarrhythmias and bradyarrhythmias. Learn about the importance of cardiac output and the artifacts that can affect ECG monitoring. Additionally, familiarize yourself with the steps required to analyze a 12-lead ECG effectively.

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