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EKG PASS 573

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Question
Answer
What are the 3 layers of the heart wall?   Epicardium, Myocardium, and Endocardium  
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What are the two basic cell types of the heart?   Myocardial and Conducting cells  
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Myocardial cells are surrounded by what kind of membrane?   Sarcolemma  
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What is the name of the special contact points where myocardial cells connect?   Intercalated disks  
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What holds the myocardial cells together during contraction?   Desmosomes  
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How do myocardial cells contract when stimulated?   As a single unit  
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What is the name of the contraction phase of the cardiac cycle?   Systole  
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What is the name of the relaxation phase of the cardiac cycle?   Diastole  
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Where are the 4 locations in which receptors that monitor cardiac output are found?   Blood vessels, kidneys, brain, heart  
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What 4 methods regulate the heart?   Brain, hormones, heart tissue, and receptors monitoring cardiac output  
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What is the name and locations of receptors that detect changes in pressure in the heart and main arteries?   Baroreceptors- found in the aorta and carotid arteries  
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What is the name for the receptors that detect changes in chemical composition of the blood?   Chemoreceptors  
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Which 2 neurotransmitters are released by the sympathetic nervous system, and what are their effects on the heart when released?   Norepinephrine and epinephrine; they increase heart rate, increase force of contraction, increase conduction through the heart, and cause coronary vasodilation  
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What is the mechanism of action, neurotransmitter, and effects on the heart of the parasympathetic nervous system?   The vagus nerve releases acetylcholine, which slows the heart rate (via SA node) and electrical conduction  
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What are 4 key properties of myocardial cells?   Automaticity, excitability, conductivity, and contractility  
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The ability of certain cells to produce an electrical impulse without outside nerve stimulation is the definition of what key property of myocardial cells?   Automaticity  
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The ability to respond to an electrical stimulus is the definition of what key property of myocardial cells?   Excitability  
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The ability to transmit an electrical stimulus from cell to cell is the definition of what key property of myocardial cells?   Conductivity  
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The ability to contract when electrically stimulated is the definition of what key property of myocardial cells?   Contractility  
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What 2 types of cells are specialized to generate and transmit electrical impulses throughout the myocardium?   Pacemaker and Electrical conducting cells  
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Which cell type in the conductive pathway has the ability to spontaneously generate an impulse at a certain rate?   Pacemaker cells  
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What cell type in the conductive pathway carries the electrical impulses to the appropriate regions of the heart?   Electrical conducting cells  
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Which bundle of cells act as the heart's primary pacemaker?   Sinoatrial node  
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What is the intrinsic rate/normal sinus rhythm of the sinoatrial node?   60-100 bpm  
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Which bundle of cells in the heart act as the pathway for impulses to reach the ventricles?   Atrioventricular node  
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Where in the heart is the sinoatrial node located?   High in the posterior right atrium  
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Where in the heart is the atrioventricular node located?   Low right atrium  
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What is the intrinsic rate of the atrioventricular node?   40-60 bpm  
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Which bundle of cells in the heart act as a gatekeeper?   The atrioventricular node  
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What is the flow of electrical activity through the heart?   SA node -> AV node -> Bundle of His -> R&L Bundle branches (L. bundle branch branches into anterior and posterior fascicles) -> Purkinje fibers  
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What is the intrinsic rate of the purkinje fibers?   20-40 bpm  
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In a polarized/resting state, negatively charged ions are found where in reference to the myocardial cell?   Inside the cell  
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In a polarized/resting state, positively charged ions are found where in reference to the myocardial cell?   Outside the cell  
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What happens during depolarization of myocardial cells?   Positive Na ions enter the cell  
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What happens during repolarization of myocardial cells?   Positive Na, Ca, and K ions leave the cell  
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What is the name for the time after depolarization when the cell becomes resistant to further depolarization?   Absolute refractory period  
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What is the name for the late phase of repolarization in which a very strong electrical stimulus causes depolarization?   Relative refractory period  
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How are bipolar limb leads numbered?   I, II, III, etc.  
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How are unipolar limb leads numbered?   V1-V6 for chest/precordial leads; aVR, aVL, or aVF for augmented limb leads  
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Electrical impulses moving in what direction cause an upright wave/tracing on the EKG?   Toward a positive electrode  
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Electrical impulses moving in what direction cause a negative deflection/below baseline on the EKG?   Toward a negative electrode  
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Many small electrical currents in various directions is the definition of what?   Vectors  
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The overall direction of the sum of the currents (vectors) is the definition of what?   Axis  
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Which leads are in the frontal plane?   Limb leads I, II, and III, and aVR, aVF  
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Which leads are in the horizontal plane?   Precordial chest leads V1-V6  
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The P wave represents what electrical activity in the heart?   Atrial depolarization  
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The QRS complex represents what electrical activity in the heart?   Ventricular depolarization  
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The T wave represents what electrical activity in the heart?   Ventricular repolarization  
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Which electrical activity in the heart is hidden and by what wave?   Atrial repolarization is hidden by the QRS complex  
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What length of time does each small square on an EKG paper represent?   0.04 seconds  
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What length of time does 5 small squares on EKG paper represent?   0.20 seconds  
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What is the name of the flat line that occurs either when no electrical activity is occurring, or when electrical impulses are too weak to be detected?   Isoelectric line  
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What is the normal duration of the P wave?   0.06-0.10 seconds  
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What is the starting and ending point for measuring the PR interval?   Start measuring at the beginning of the P wave, end measuring at the end of the QRS complex  
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What is the normal duration of the PR Interval?   0.12-0.20 seconds  
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What is the starting and ending point for measuring the PR segment?   The PR segment is the isoelectric line between the end of the P wave and the beginning of the QRS complex  
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What is the normal duration of the QRS complex?   0.06-0.11 seconds  
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What is the starting and ending point of the ST segment?   The ST segment is the isoelectric line that begins at the end of the QRS complex, and ends at the beginning of the T wave  
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What is the name given for the point where the QRS complex meets the ST segment?   The J point  
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What is the starting and ending point of the QT Interval?   The QT Interval begins at the beginning of the QRS complex and ends at the end of the T wave  
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What electrical activity of the heart is represented by the QT Interval?   The time of ventricular depolarization and repolarization  
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What is the normal duration of the QT Interval?   0.36-0.44 seconds  
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What is the term given for markings on an EKG that are not a product of the heart's electrical activity?   Artifact  
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Where are the positive and negative electrode placings in the bipolar lead I?   Positive on the left arm, negative on the right arm  
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Where are the positive and negative electrode placings in the bipolar lead II?   Positive on the left leg, negative on the right arm  
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Where are the positive and negative electrode placings in the bipolar lead III?   Positive on the left leg, negative on the left arm  
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Which limb has two negative bipolar electrodes?   The right arm  
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Which limb has two positive bipolar electrodes?   The left leg  
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Which limb does the positive electrode of aVR attach to?   The right arm  
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Which view of the heart does the aVR lead represent?   The base of the heart: the atria and great vessels  
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Which lead gives a base view of the heart: the atria and great vessels?   aVR  
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Which limb does the positive electrode of aVL attach to?   Left arm  
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Which view of the heart does the aVL lead represent?   The lateral wall of the left ventricle  
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Which lead gives a view of the lateral wall of the left ventricle?   aVL  
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Which limb does the positive electrode of aVF attach to?   Left leg  
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Which view of the heart does the aVF lead represent?   The inferior wall of the left ventricle  
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Which lead gives a view of the inferior wall of the left ventricle?   aVF  
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Where is the precordial V1 lead placed on the chest?   In the 4th ICS on the right of the sternum  
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Where is the precordial V2 lead placed on the chest?   In the 4th ICS on the left of the sternum  
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Where is the precordial V3 lead placed on the chest?   Halfway between V2 and V4  
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Where is the precordial V4 lead placed on the chest?   In the 5th ICS in Mid-clavicular line  
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Where is the precordial V5 lead placed on the chest?   At the anterior axillary line  
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Where is the precordial V6 lead placed on the chest?   Mid-axillary line  
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Which leads provide anterior and lateral views of the heart?   Precordial leads V1-V6  
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Which leads provide information about the anterior surface of the heart?   V1-V4  
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Which leads provide information about the lateral surface of the heart?   I, aVL, and V5-V6  
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Which leads provide information about the inferior surface of the heart?   II, III, and aVF  
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What characteristics of a P wave constitute normal sinus rhythm?   P waves are upright, round, and one is present before each QRS complex  
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What characteristics of a QRS complex constitute a normal sinus rhythm?   QRS complexes are narrow, and are 0.06-0.11 seconds in duration  
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What are the 3 methods available for determining heart rate?   Multiply the number of QRS complexes in a 6-second interval by 10; start 300 150 100 75 60 50 large boxes between R waves; 1500/the number of small squares between 2 consecutive R waves  
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When is a person considered to have bradycardia?   Heart rate <60 bpm  
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When is a person considered to have tachycardia?   Heart rate >100 bpm  
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What constitutes a regular rhythm?   The distance between RR-intervals is the same, and the distance between P-P intervals is the same  
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What 7 types of irregular rhythm are there?   Occasionally irregular, very irregular, slightly irregular, sudden heart rate acceleration, patterned irregularity, total irregularity (irregularly irregular), and variable conduction ratio  
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What is an explanation of occasionally irregular heart rhythm?   Rhythm is mostly regular, but can be irregular from time to time  
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What is an explanation of very irregular heart rhythm?   There are many areas of irregularity  
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What is an explanation of a slightly irregular heart rhythm?   Pacemaker changes locations = wandering atrial pacemaker. P waves look different (some are smaller, some are inverted, etc.)  
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What rhythm is seen with a wandering atrial pacemaker?   Slightly irregular rhythm  
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What is an explanation of a sudden heart rate acceleration rhythm irregularity?   A normal heart rate suddenly accelerates to tachycardia = paroxysmal tachycardia  
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What rhythm irregularity is seen with paroxysmal tachycardia?   Sudden heart rate acceleration  
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What is an explanation of a patterned irregularity heart rhythm?   Irregularity is repeated in a cyclic fashion  
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Which rhythm irregularity is seen with sinus dysrhythmia, breathing, or 2nd degree A-V heart block?   Patterned irregularity  
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What is an explanation of a totally irregular/irregularly irregular rhythm?   No pattern to the irregularity  
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Which rhythm irregularity is seen with atrial fibrillation?   Irregularly irregular  
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What is the normal duration and amplitude of a P wave?   Duration 0.06-0.10 seconds, Amplitude 0.5-2.5 mm/small boxes  
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What is the name for a tall P wave (greater than 2.5 mm/small boxes high), and what might it indicate?   P pulmonale suggests RAE  
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What 2 possible heart conditions might be represented by a notched, wide, or biphasic P wave?   Increased left atrial pressure or left atrial dilation  
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What is the name for a wide P wave (greater than 0.10 seconds), and what condition might it indicate?   P mitrale suggests LAE  
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What might the P wave look like in atial tachycardia?   It might be buried in the T wave  
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A saw-toothed pattern between QRS complexes could indicate what condition?   Atrial flutter- an ectopic site in the atria fires at 250-300 times per minute  
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When does atrial fibrillation occur?   When ectopic sites in the atria fire faster than 350 times per minute  
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What is the physiological explanation behind an inverted P wave?   Results when a P wave arises from the lower right atrium near the AV node, in the left atrium, or the AV junction  
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What condition is associated with inverted P waves?   Dysrrhythmias originating from the AV junction  
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What is the explanation for the presence of more P waves than QRS complexes?   The pulse was initiated in the SA node or atria, but was blocked before reaching the ventricles  
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Tall QRS complexes indicate what 3 possible heart conditions?   Ventricle(s) hypertrophy, abnormal pacemaker, or aberrant conduction  
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Short/Low-voltage QRS complexes indicate what 3 possible conditions?   Obesity, hypothyroidism, pericardial effusion  
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Wide, bizarre QRS complexes may be explained by what condition?   Right or left bundle branch block resulting from a defect in ventricular conduction  
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What is the explanation for the wide QRS complex seen in aberrant conduction?   An electrical impulse reaches the bundle branch while it is still in a refractory period after a previous impulse. The new impulse travels down  
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When does atrial fibrillation occur?   When ectopic sites in the atria fire faster than 350 times per minute  
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What is the physiological explanation behind an inverted P wave?   Results when a P wave arises from the lower right atrium near the AV node, in the left atrium, or the AV junction  
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What condition is associated with inverted P waves?   Dysrrhythmias originating from the AV junction  
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What is the explanation for the presence of more P waves than QRS complexes?   The pulse was initiated in the SA node or atria, but was blocked before reaching the ventricles  
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Tall QRS complexes indicate what 3 possible heart conditions?   Ventricle(s) hypertrophy, abnormal pacemaker, or aberrant conduction  
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Short/Low-voltage QRS complexes indicate what 3 possible conditions?   Obesity, hypothyroidism, pericardial effusion  
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Wide, bizarre QRS complexes may be explained by what condition?   Right or left bundle branch block resulting from a defect in ventricular conduction  
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What is the explanation for the wide QRS complex seen in aberrant conduction?   An electrical impulse reaches the bundle branch while it is still in a refractory period after a previous impulse. The new impulse travels down the non-refractory bundle branch, and then down the other bundle branch. Separate impulses = wide QRS complex  
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What 4 conditions would label the PR interval as abnormal?   Shorter than 0.12 seconds, longer than 0.20 seconds, absent interval, or interval duration varies  
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What is the explanation for a short PR Interval?   Electrical impulses start from a supraventricular site, but travels to the ventricles via abnormal accessory pathways and causes premature ventricular depolarization = preexcitation  
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What is the explanation for a long PR interval?   Conduction of electrical impulse through the AV node is delayed = 1st degree AV heart block  
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What 2 conditions may cause varying PR intervals?   Wandering atrial pacemaker or 2nd degree AV heart block  
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What is the varying PR interval pattern seen with 2nd degree AV heart block?   PR intervals are progressively longer until a QRS complex is dropped. Repeat.  
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In what 4 conditions are PR intervals absent?   Atrial flutter, atrial fibrillation, 3rd degree AV heart block, and ventricular dysrhythmias  
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What is the explanation for absent PR intervals in 3rd degree AV heart block?   Atria and ventricles are beating independently of each other  
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What is the characteristic of sinus bradycardia?   Normal sinus rhythm with heart rate <60 bpm  
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What is the characteristic of sinus tachycardia?   Normal sinus rhythm with heart rate >100 bpm  
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What problem with oxygen is associated with tachycardia?   Tachycardia can increase oxygen requirements = worsen ischemia, induce infarction  
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Describe the pattern seen with sinus dysrhythmia.   Dysrhythmia is cyclic: slows down, then speeds up with breathing  
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What 3 conditions might sinus dysrhythmia be normal in?   Athletes, children, or older adults  
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Describe the pattern seen with sinus arrest.   A pause in EKG rhythm occurs (isoelectric), normal rhythm resumes  
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What 3 mechanisms can cause atrial dysrhythmias?   Automaticity, triggered activity, and reentry  
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What key characteristics are seen with atrial dysrhythmias?   Abnormal P waves that differ in appearance with each beat, varying PR intervals, narrow-normal QRS complexes  
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What pattern is seen with premature atrial contraction?   Abnormal P-waves, followed by a non-compensatory pause, and wide QRS complexes  
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What characteristics are seen with atrial tachycardia?   Abnormal, consistent P waves with a heart rate of 150-250 bpm  
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What is the term for short bursts of atrial tachycardia?   Paroxysmal atrial tachycardia  
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What characteristics are seen with multifocal atrial tachycardia?   Changing P wave morphology, irregular rhythm, and a heart rate of 120-150 bpm  
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What characteristics are seen with supraventricular tachycardia?   Tachycardia with no P waves  
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What is the heart rate seen with atrial flutter?   250-350 bpm  
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What are 2 potential side effects of atrial fibrillation?   Decreased cardiac output by 25%, clots form in the atria due to blood stagnating from inefficient atrial contraction... predispose pt. to a systemic emboli  
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What characteristics are seen with junctional dysrhythmias?   Inverted or absent P waves, short PR interval if P waves present, P wave after QRS complex  
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What characteristics are seen with premature junctional complex?   An early electrical impulse and an inverted P wave  
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Where does the electrical impulse come from with premature junctional complex?   AV junction  
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What characteristics are seen with junctional escape rhythm?   Inverted P wave before, during, or after QRS complexes, heart rate of 40-60 bpm, short PR interval  
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What characteristics are seen with accelerated junctional rhythm?   Inverted P waves before, during, or after QRS complexes, short PR interval, heart rate of 60-100 bpm  
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What characteristics are seen with junctional tachycardia?   Inverted P waves before, during, or after QRS complexes, short PR interval, heart rate of 100-180 bpm  
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