Junctional Rhythms of the Heart

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Questions and Answers

Where do junctional rhythms originate?

  • The Purkinje fibers
  • The atrioventricular (AV) junction (correct)
  • The bundle branches
  • The sinoatrial (SA) node

What happens when the AV node becomes the dominant pacemaker?

  • The QRS complex widens
  • A junctional rhythm occurs (correct)
  • The P waves become more prominent
  • The heart rate slows down

What is the typical shape of the QRS complex in junctional rhythms?

  • Absent
  • Normal (correct)
  • Inverted
  • Prolonged

What is the rate range for a normal junctional rhythm?

<p>40-60 bpm (C)</p> Signup and view all the answers

What is the intrinsic function of the AV junction?

<p>Secondary pacemaker (D)</p> Signup and view all the answers

What is the rate of Accelerated Junctional rhythm?

<p>61-100 bpm (A)</p> Signup and view all the answers

What is the rate of Junctional Tachycardia?

<blockquote> <p>100 bpm (B)</p> </blockquote> Signup and view all the answers

What best describes the rhythm of junctional rhythms?

<p>Regular (C)</p> Signup and view all the answers

What best describes P waves in junctional rhythms?

<p>May be absent, inverted, or retrograde (B)</p> Signup and view all the answers

What is the usual length of the PR interval in Junctional rhythms?

<p>Short or absent (B)</p> Signup and view all the answers

Why do P waves in junctional rhythms differ from sinus P waves?

<p>They originate near the AV node (B)</p> Signup and view all the answers

In which leads are inverted P waves typically seen in retrograde conduction?

<p>II, III, and aVF (C)</p> Signup and view all the answers

When do P waves appear after the QRS complex?

<p>When atrial depolarization is delayed (A)</p> Signup and view all the answers

What is the origin of a premature junctional complex (PJC)?

<p>The AV junction (A)</p> Signup and view all the answers

What is the typical rhythm of a PJC?

<p>Irregular (D)</p> Signup and view all the answers

What can cause PJCs?

<p>All of the above (D)</p> Signup and view all the answers

What is a common cause of accelerated junctional rhythm?

<p>Digoxin toxicity (B)</p> Signup and view all the answers

What is the first step in treating symptomatic bradycardia caused by Junctional Escape Rhythm?

<p>Administer atropine (A)</p> Signup and view all the answers

What treatment is indicated for unstable junctional tachycardia?

<p>Perform cardioversion (A)</p> Signup and view all the answers

What could decreased cardiac output due to junctional tachycardia lead to?

<p>Dizziness (B)</p> Signup and view all the answers

Flashcards

Junctional Rhythms

Rhythms originating in the AV junction, occurring when the SA node fails or the AV node becomes the dominant pacemaker.

Junctional Pacemaker

The AV junction serves as a backup when the SA node fails or conduction is delayed.

Normal Junctional Rate

40-60 bpm; also known as escape rhythm.

Accelerated Junctional Rate

61-100 bpm

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Junctional Tachycardia

Greater than 100 bpm

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Junctional P Waves

Originate near the AV node, not the SA node.

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Absent P Waves

Atrial depolarization is buried in the QRS complex.

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Inverted P Waves

Seen in leads II, III, and aVF, indicating retrograde conduction.

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P Waves After QRS

A rare event when atrial depolarization is delayed

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Premature Junctional Complex (PJC)

An early ectopic beat originating from the AV junction, interrupting the underlying rhythm.

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P Wave in PJC

Absent, inverted, or retrograde.

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PR Interval in PJC

Short (<0.12 sec) or absent.

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Causes of PJCs

Stimulants, electrolyte imbalances, hypoxia, myocardial infarction.

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Junctional Escape Rhythm

A slow rhythm from the AV junction when the SA node fails or conduction is blocked.

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Rate of Junctional Escape

40-60 bpm.

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P Waves in Escape Rhythm

Absent, inverted, or retrograde.

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Accelerated Junctional Rhythm

A junctional rhythm faster than 60 bpm but slower than 100 bpm due to increased automaticity.

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Causes of Accelerated Junctional Rhythm

Digoxin toxicity, myocardial infarction, hypoxia, electrolyte imbalances.

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Junctional Tachycardia

A rapid junctional rhythm (>100 bpm) due to enhanced automaticity or reentry in the AV junction.

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Causes of Junctional Tachycardia

Digoxin toxicity, sympathetic stimulation, hypoxia, electrolyte imbalances, heart disease.

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Study Notes

  • Junctional rhythms start in the atrioventricular (AV) junction.
  • The AV junction includes the AV node and the Bundle of His.
  • These rhythms are present when the SA node malfunctions.
  • They also occur when the AV node takes over as the primary pacemaker.
  • This happens because of increased automaticity or reentry mechanisms.
  • The rate of junctional rhythms is variable based on the specific type.
  • The rhythm in junctional rhythms is regular.
  • P waves in junctional rhythms can be absent.
  • P waves can be inverted.
  • P waves can be retrograde, showing up after the QRS complex.
  • The PR interval is either short or absent, less than 0.12 seconds.
  • QRS complex is typically normal and less than 0.12 seconds.

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