Podcast
Questions and Answers
In junctional rhythms, where do impulses originate?
In junctional rhythms, where do impulses originate?
- In the atria
- In the ventricles
- Directly within the AV node
- Close to, but not within, the AV node (correct)
What is the typical heart rate range for a junctional rhythm?
What is the typical heart rate range for a junctional rhythm?
- 40-60 bpm (correct)
- 100-120 bpm
- 60-100 bpm
- 20-40 bpm
Which of the following best describes the P waves in a junctional rhythm?
Which of the following best describes the P waves in a junctional rhythm?
- Inverted or absent (correct)
- Always upright
- Tall and peaked
- Always inverted
What is a common cause of junctional bradycardia?
What is a common cause of junctional bradycardia?
A patient is diagnosed with a premature junctional contraction (PJC). Which characteristic is most likely to be observed on their ECG?
A patient is diagnosed with a premature junctional contraction (PJC). Which characteristic is most likely to be observed on their ECG?
What defines a junctional rhythm as 'accelerated'?
What defines a junctional rhythm as 'accelerated'?
Which of the following would be the most appropriate initial treatment for symptomatic junctional bradycardia?
Which of the following would be the most appropriate initial treatment for symptomatic junctional bradycardia?
A patient presents with a heart rate of 110 bpm, regular R-R intervals, and inverted P waves following each QRS complex. What is the most likely diagnosis?
A patient presents with a heart rate of 110 bpm, regular R-R intervals, and inverted P waves following each QRS complex. What is the most likely diagnosis?
What QRS complex duration is characteristic of rhythms originating in the AV junction?
What QRS complex duration is characteristic of rhythms originating in the AV junction?
In which area of the AV junction can impulses originate?
In which area of the AV junction can impulses originate?
Which of the following is a typical cause of accelerated junctional rhythm?
Which of the following is a typical cause of accelerated junctional rhythm?
What is the first-line treatment for junctional tachycardia when pharmacological intervention is required?
What is the first-line treatment for junctional tachycardia when pharmacological intervention is required?
What adverse effect(s) are associated with junctional tachycardia?
What adverse effect(s) are associated with junctional tachycardia?
Which of the following rhythms originating in the AV junction is characterized by a heart rate less than 40 bpm?
Which of the following rhythms originating in the AV junction is characterized by a heart rate less than 40 bpm?
If P waves are present in junctional rhythms, what is the range of the PR interval?
If P waves are present in junctional rhythms, what is the range of the PR interval?
What underlying condition is considered a cause of junctional tachycardia, making careful medication review essential?
What underlying condition is considered a cause of junctional tachycardia, making careful medication review essential?
A patient’s ECG strip shows a rhythm with a rate of 52 bpm, regular R-R intervals, absent P waves, and narrow QRS complexes. The patient denies any symptoms. What is the most appropriate next step?
A patient’s ECG strip shows a rhythm with a rate of 52 bpm, regular R-R intervals, absent P waves, and narrow QRS complexes. The patient denies any symptoms. What is the most appropriate next step?
In a PJC, why does atrial activity cease during the premature beat?
In a PJC, why does atrial activity cease during the premature beat?
A patient on digoxin presents with a regular narrow-complex tachycardia at a rate of 130 bpm. P waves are absent. Vagal maneuvers are ineffective. Which of the following is the MOST appropriate next step in management?
A patient on digoxin presents with a regular narrow-complex tachycardia at a rate of 130 bpm. P waves are absent. Vagal maneuvers are ineffective. Which of the following is the MOST appropriate next step in management?
When would holding bradycardia-inducing medications be considered?
When would holding bradycardia-inducing medications be considered?
Flashcards
Junctional Rhythms
Junctional Rhythms
Impulses originate near, but not in, the AV node, with heart rates varying from slow to fast.
PJC Regularity
PJC Regularity
A premature beat that interrupts the regularity.
Junctional Bradycardia
Junctional Bradycardia
Rate: less than 40 bpm. Regularity: Regular.
Junctional Bradycardia: Adverse Effects
Junctional Bradycardia: Adverse Effects
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Junctional Bradycardia: Treatment
Junctional Bradycardia: Treatment
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Junctional Rhythm
Junctional Rhythm
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Accelerated Junctional Rhythm
Accelerated Junctional Rhythm
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Accelerated Junctional Rhythm: Causes
Accelerated Junctional Rhythm: Causes
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Junctional Tachycardia
Junctional Tachycardia
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Junctional Tachycardia: Causes
Junctional Tachycardia: Causes
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Junctional Tachycardia: Treatment
Junctional Tachycardia: Treatment
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Study Notes
Junctional Rhythms
- Impulses start close to the AV node, not actually in it.
- Heart rates can be slow to fast.
- Impulses originate in the AV junction in three areas: high, low, and mid.
Premature Junctional Contraction (PJC)
- Rate can occur at any rate.
- Regularity is regular but interrupted by a premature beat.
- P waves are inverted or absent.
- PR interval is less than 0.12 seconds if a P wave precedes the QRS complex.
- QRS complex is less than 0.12 seconds.
- Causes include stimulants, hypoxia, heart disease, and nicotine.
- Usually has no adverse effects.
- Treatment involves addressing the underlying cause.
- People often don't realize it's happening and it can go untreated.
Junctional Bradycardia
- Rate is less than 40 beats per minute.
- Regularity is regular.
- P waves are inverted or absent.
- PR interval is less than 0.12 seconds if a P wave precedes the QRS complex.
- QRS complex is less than 0.12 seconds.
- Causes include vagal stimulation, hypoxia, sinus node ischemia, and heart disease.
- Adverse effects can include decreased cardiac output.
- Treatment includes atropine, pacemaker, oxygen, and withholding bradycardia-inducing medications.
- Sinoatrial node intrinsic rate is 60-100 beats per minute.
Junctional Rhythm
- Rate is between 40-60 beats per minute.
- Regularity is regular.
- P waves are inverted or absent.
- PR interval is less than 0.12 seconds if a P wave precedes the QRS complex.
- QRS complex is less than 0.12 seconds.
- Caused by vagal stimulation, hypoxia, sinus node ischemia, and heart disease.
- Can result in decreased cardiac output at slower heart rates.
- Treat with atropine, consider oxygen, and hold any bradycardia-inducing medications.
Accelerated Junctional Rhythm
- Rate is between 60-100 beats per minute.
- Regularity is regular.
- P waves are inverted or absent.
- PR interval is less than 0.12 seconds if a P wave precedes the QRS complex.
- QRS complex is less than 0.12 seconds.
- Caused by heart disease, stimulants, and caffeine.
- Usually has no adverse effects.
- Remove the cause to treat.
Junctional Tachycardia
- Rate greater than 100 beats per minute.
- Regularity is regular.
- P waves are inverted or absent.
- PR interval is less than 0.12 seconds if a P wave precedes the QRS complex.
- QRS complex is less than 0.12 seconds.
- Digitalis toxicity, heart disease, and stimulants can cause it.
- Decreased cardiac output is an adverse effect at faster heart rates.
- Treat with beta-blockers, calcium channel blockers, and adenosine; consider oxygen.
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