Depolarization may be considered as an advancing wave of

<b>{{c1::positive}}</b>&nbsp;charges within cardiac myocytes. <b>Myocytes</b>

<u>contract</u> as they are depolarized
<b>Conduction</b> of the depolarizing wave between myocytes occurs via
<u>fast&nbsp;{{c1::Na⁺}}&nbsp;channels</u>.
"How long after depolarization does repolarization <i style=""font-weight: bold;
"">begin</i>?<div><br /></div><div>{{c1::immediately after}}</div>" "the T wave
is just the <b>most active</b>&nbsp;phase of repolarization<div><img src=""Screen
Shot 2018-08-11 at 11.18.35 AM.png"" /></div>"
EKGs record electrical activity in the heart via <b>{{c1::electrodes}}</b>
<b>{{c2::Positive}} waves</b> of depolarization mean that the depolarizing wave is
moving <b>{{c1::towards}} </b>the <u>positive electrode</u>. "the <b>electrode
itself </b>is positive, thus&nbsp;<div>1) charges moving <u><b>towards</b></u> it
will be <b>positive</b><div>2) charges moving <u><b>away</b></u> from it will be
<b>negative</b></div><div><img src=""Screen Shot 2018-08-11 at 11.26.24 AM.png""
/></div></div>"
<b>{{c1::Sinus rhythm}}</b> refers to normal heart rate and rhythm set by the SA
node.
The <u>depolarization wave</u> from the <b>SA node</b> travels {{c1::360˚}}
outwardly analogous to a pebble dropped in a pool of water
The <b>P wave</b> corresponds to <b>{{c1::atrial depolarization
(contraction)}}.</b> "<img src=""Screen Shot 2018-08-11 at 11.32.03 AM.png"" />"
Which valves <b>electrically insulate</b>&nbsp;the atria from the ventricles?
&nbsp;<div><br
/></div><div><b>{{c1::tricuspid}}</b>&nbsp;and&nbsp;<b>{{c1::mitral}}</b></div>
"<img src=""Screen Shot 2018-08-11 at 11.35.57 AM.png"" />"
The <b>{{c1::atrioventricular node}}</b> is the only electrical connection between
the <u>atria</u> and <u>ventricles</u>. Destruction, damage or changes in
dromotropy of the AV node can lead to <b>heart block</b>
Both atria contract <b>{{c1::simultaneously}}</b>
Both ventricles contract <b>{{c1::simultaneously}}.</b>
Decreased <u>conduction velocity</u> in the <b>{{c1::AV}} node </b>allows for
{{c2::ventricular filling}}. ~100msec delay
<b>{{c1::Ca²⁺}}&nbsp;ions</b> are responsible for <u>AV node</u>
depolarization. "they move more slowly, hence the conduction velocity
decrease<div><img src=""Screen Shot 2018-08-11 at 12.32.35 PM.png"" /></div>"
{{c1::Na⁺ions}}&nbsp;are responsible for <b>depolarization</b> in the
bundle of His,&nbsp;purkinje fibers<b>, </b>and myocardium."channels allow higher
conductance leading to faster depolarization than the AV node<div><img src=""Screen
Shot 2018-08-11 at 12.32.35 PM.png"" /></div>"
Depolarization of the <b>{{c1::ventricular myocardium}}</b> records as the
{{c2::QRS complex}} on EKG. <b><u>NOT</u></b> the subendocardial conductive
network
<u>Terminal filaments</u> of purkinje fibers spread out just beneath the
<b>{{c1::endocardium}}.</b> they <b><u>do not</u>&nbsp;</b>penetrate the
myocardium or epicardium
Ventricular depolarization begins at the <b>{{c1::endocardium}}</b> and spreads
towards the <b>{{c1::epicardium}} </b>(heart layers).&nbsp;
The <b>{{c1::Q wave}}</b>, when present, always occurs at the
<b>{{c2::beginning}}</b> of the QRS complex, and is the first
<b>downward&nbsp;deflection</b> of the complex. if any <b>upward deflection</b>
occurs prior to the Q wave, it is <u><b>NOT</b></u> part of the QRS
complex.&nbsp;<div><br /></div><div>Q wave marks <b>initiation</b> of the
complex.</div>
<b>{{c1::R}} waves</b> refer to <b>{{c2::upward::up/down}}</b>&nbsp;waves in the
QRS complex, and are followed by <b>{{c2::downward::up/down}}</b>&nbsp;<b>{{c1::S}}
waves</b> "<u><b>all</b></u> upward waves are <b>R waves</b><div><b style=""text-
decoration: underline; "">all</b>&nbsp;downward waves <u>preceded</u> by upward
waves are <b>S waves</b><br /><div><img src=""Screen Shot 2018-08-11 at 11.55.10
AM.png"" /></div></div>"
"<div>1. {{c1::Q wave}}&nbsp;</div><img src=""Screen Shot 2018-08-11 at 11.57.15
AM.png"" />"
"<div>2. {{c1::R wave}}</div><img src=""Screen Shot 2018-08-11 at 11.57.15 AM.png""
/>"
"<div>3.&nbsp;{{c1::S wave}}</div><img src=""Screen Shot 2018-08-11 at 11.57.15
AM.png"" />"
"<div>4. {{c1::QS wave}}</div><img src=""Screen Shot 2018-08-11 at 11.57.15
AM.png"" />" since there is no R wave, it can't be termed Q or S - so it's
both. Thanks Obama
The <b>{{c1::PR segment}}</b> corresponds to conduction through the <b>{{c2::AV
node}}.</b> "<img src=""paste-541217418903852.jpg"" />"
The <b>{{c2::ST segment}}</b> represents
the&nbsp;<b>{{c1::plateau}}</b>&nbsp;<b>phase</b>&nbsp;of ventricular
depolarization. "<div>ventricular <b>repolarization</b>&nbsp;<b>is
<u>minimal</u></b> during this period</div><img src=""Screen Shot 2018-08-11 at
12.07.59 PM.png"" />"
The {{c2::T wave}} represents <b>{{c1::rapid ventricular repolarization}}
</b>via&nbsp;{{c3::K⁺}}ion&nbsp;efflux "<img src=""Screen Shot 2018-
08-11 at 12.10.21 PM.png"" />"
Ventricular <b>{{c2::systole}}</b> occurs from the beginning of the <b>{{c1::QRS
complex}}</b> to the end of the <b>{{c1::T wave}}</b> "<img src=""Screen Shot 2018-
08-11 at 12.10.21 PM.png"" />"
The <u>{{c2::QT interval}}</u> represents the duration of <b>{{c1::ventricular
systole}}.</b> "<div>from beginning of Q wave to end of T wave</div><img
src=""Screen Shot 2018-08-11 at 12.13.52 PM.png"" />"
Does ventricular depolarization or repolarization comprise the <u>larger
duration</u> of the QT interval?&nbsp;<div><br
/></div><div><b>{{c1::repolarization}}</b></div>
QT intervals are considered <u>normal</u> if they are {{c2::less than half}} of the
<b>{{c1::R-to-R}} interval</b>
<b>{{c3::Hereditary long QT}} syndrome</b> may result in {{c1::ventricular
tachycardia}} due to increased <u>frequency</u> of <b>{{c2::after-
depolarizations}}.&nbsp;</b>
<b>Long QT syndrome</b> has more frequent &nbsp;<u>after-depolarizations</u> that
can be propagated to neighboring cells, leading to <b>{{c1::re-entrant}}</b>
<b>{{c2::ventricular arrhythmias}}</b>. propagation can occur due to the
<b>differences in the refractory periods</b>
Between each <b>heavy, black line</b> on EKG paper, there are {{c1::5}} small
squares. "<img src=""Screen Shot 2018-08-11 at 12.38.43 PM.png"" />"
Each <u>small box</u> on EKG is <b>{{c1::1mm::size}}</b> in both height and width
"<img src=""Screen Shot 2018-08-11 at 12.38.43 PM.png"" />"
Height or depth of a wave are measures of <b>{{c1::voltage}} </b>&nbsp; "<img
src=""Screen Shot 2018-08-11 at 12.43.01 PM.png"" />"
The <u>deflection</u> of a wave on EKG is the <b>{{c1::direction}} </b>of the wave.
above or below the axis<div>corresponds to whether charge is moving towards
or away from the electrode</div>
The <u>amplitude</u>&nbsp;of a wave is the <b>{{c1::magnitude}}</b>&nbsp;of
upward/downward deflection. "<div>The height/depth measures voltage</div><img
src=""Screen Shot 2018-08-11 at 12.43.01 PM.png"" />"
<u>Depolarization</u> produces an <b>{{c1::upward}} </b>deflection on EKG when it
is moving towards a positive electrode.
<b>{{c1::0.2s::time}}</b> elapse between two&nbsp;<u>heavy, black</u> lines on EKG.
"<img src=""Screen Shot 2018-08-11 at 12.59.18 PM.png"" />"
Each <u>small square</u> on EKG represents <b>{{c1::0.4 seconds}}</b> "<img
src=""Screen Shot 2018-08-11 at 12.59.18 PM.png"" />"
There are <b>{{c1::12}}</b>&nbsp;total leads on EKG
<b>{{c1::Limb}} leads</b> include leads I - III, AVR, AVL and AVF.&nbsp; "<img
src=""Screen Shot 2018-08-11 at 1.02.43 PM (1).png"" />"
<b>{{c2::Chest}} leads</b> include leads&nbsp;<b>{{c1::V_1&nbsp;}}&nbsp;-
&nbsp;{{c1::V₆}}.</b> "<img src=""Screen Shot 2018-08-11 at 1.02.43
PM (1).png"" />"
To obtain <b>{{c2::limb}} leads,</b>&nbsp;electrodes are placed on the right and
left arms, and <b>{{c1::left}} leg.</b>
Each <i>limb lead</i> consists of a&nbsp;<b>{{c1::pair}} </b>of <u>positive</u> and
<u>negative</u> electrodes. "one positive &amp; one negative<div><img
src=""Screen Shot 2018-08-11 at 1.18.12 PM.png"" /></div>"
<b>Lead {{c1::I}}</b> is <u>horizontal</u>, and its <i>left </i>arm electrode is
<b>{{c2::positive}}</b> "<div>while the&nbsp;<i>right</i>&nbsp;arm electrode
is&nbsp;<b>negative</b></div><img src=""Screen Shot 2018-08-11 at 1.18.12
PM.png"" /><div><br /></div>"
In <b>lead {{c1::III}} </b>the&nbsp;<i>left </i>leg electrode is
<b>{{c2::positive}}</b>. "<img src=""Screen Shot 2018-08-11 at 1.18.12
PM.png"" />"
In the <b>{{c1::AVF}} lead</b>, the <i>left</i>&nbsp;foot electrode is
<b>{{c2::positive}}.</b> "<div><i>both</i>&nbsp;arm electrodes
are&nbsp;<b>negative</b></div><div><b>AVF</b> - <b>A</b>mplified <b>V</b>oltage
left <b>F</b>oot</div><img src=""Screen Shot 2018-08-11 at 1.44.33 PM.png"" />"
In the <b>AVF</b> lead, <i>both </i>right and left arms are channeled into a common
ground with a <b>{{c1::negative}} </b>charge. all <b>amplified
voltage</b>&nbsp;leads ground two leads as negative
In the <b>{{c2::AVR}} lead</b>, the right arm electrode is <b>{{c1::positive}}</b>
"<div>while the&nbsp;<i>left&nbsp;</i>arm and&nbsp;<i>left</i>&nbsp;leg
are&nbsp;<b>negative</b>.</div><img src=""Screen Shot 2018-08-11 at 1.44.33
PM.png"" />"
In the <b>{{c1::AVL}} lead</b>, the <i>left </i>arm electrode is
<b>{{c2::positive}}</b>. "<div>and the other two electrodes
are&nbsp;<b>negative</b></div><img src=""Screen Shot 2018-08-11 at 1.44.33 PM.png""
/>"
Do all EKG leads record the <u>same</u>&nbsp;cardiac activity?&nbsp;<div><br
/></div><div>{{c1::yes}}</div> "The waves simply appear difference due to the
angle at which they are recorded<div><img src=""Screen Shot 2018-08-11 at 1.58.18
PM.png"" /></div><div><img src=""Screen Shot 2018-08-11 at 1.58.31 PM.png""
/></div><div><img src=""Screen Shot 2018-08-11 at 1.58.42 PM.png""
/></div><div><img src=""Screen Shot 2018-08-11 at 2.00.14 PM.png"" /></div>"
<b>{{c1::Lateral}} leads</b> have a {{c2::positive}} <b>left</b>&nbsp;arm
electrode. "<img src=""Screen Shot 2018-08-11 at 2.13.14 PM.png"" />"
<u>Lateral</u> leads include leads <b>{{c1::I}} </b>and <b>{{c1::AVL}}.</b> "<img
src=""Screen Shot 2018-08-11 at 2.13.14 PM.png"" />"
<u>{{c4::Inferior}} leads</u> include leads<b> {{c1::II}}</b>, <b>{{c1::III}}</b>,
and <b>{{c1::AVF}}</b> because they have a <b>{{c2::positive}}</b> electrode on the
<b>{{c3::left leg}}</b> "<img src=""Screen Shot 2018-08-11 at 2.13.14 PM.png"" />"
<b>{{c1::Chest}}</b><b>&nbsp;leads</b> are placed in progressively more
<b>lateral</b> locations, starting at the <u>right base</u> of the heart. "<img
src=""Screen Shot 2018-08-11 at 2.22.49 PM.png"" />"
<u>Chest leads</u> are oriented in the <b>{{c1::transverse}}</b> anatomical plane
"<img src=""Screen Shot 2018-08-11 at 2.25.41 PM.png"" />"
Each <u>electrode</u> for each <u>chest lead</u> is always considered
<b>{{c1::positive}}</b>.
Each chest lead is oriented through the <b>{{c1::AV node}}</b>. "<div>The
patient's back is the negative lead</div><img src=""Screen Shot 2018-08-11 at
2.25.41 PM.png"" />"
Which chest lead measures a direct anterior-posterior axis?&nbsp;<div><br
/></div><div><b>{{c1::V₂}}</b></div>
Moving from V_1&nbsp;to V₆, the QRS complex becomes
progressively more <b>{{c1::positive}}</b> "<img src=""Screen Shot 2018-08-11
at 2.25.41 PM.png"" /><div><img src=""Screen Shot 2018-08-11 at 2.33.49 PM.png""
/></div>"
The QRS complex in V₁&nbsp;is mainly <b>{{c1::negative}}</b> "<img
src=""Screen Shot 2018-08-11 at 2.25.41 PM.png"" /><div><img src=""Screen Shot
2018-08-11 at 2.33.49 PM.png"" /></div>"
Why does the <u>QRS complex</u> become progressively more positive as you progress
from V_1&nbsp;- V₆?&nbsp;<div><br
/></div><div>{{c1::<u>Depolarizing current</u> moves <b>left</b>, and the leads are
progressively more <b>leftward</b>}}</div> "<img src=""Screen Shot 2018-08-11
at 2.33.49 PM.png"" /><div><img src=""Screen Shot 2018-08-11 at 2.25.41 PM.png""
/></div>"
<b>{{c1::V₁&nbsp;}}&nbsp;&amp;&nbsp;
{{c1::V₂&nbsp;}}</b>&nbsp;are oriented over the <u>right</u> side of the
heart, and are consequently called <u>right</u> chest leads. "<img src=""Screen
Shot 2018-08-11 at 2.25.41 PM.png"" />"
<b>{{c1::V₅&nbsp;}}&nbsp;&amp;</b>
<b>{{c1::V₆&nbsp;}}</b>&nbsp;are oriented over the <u>left</u> side of
the heart and are consequently called <u>left</u>&nbsp;chest leads "<img
src=""Screen Shot 2018-08-11 at 2.25.41 PM.png"" />"
Leads&nbsp;{{c1::V₃&nbsp;}}&nbsp;and&nbsp;
{{c1::V₄&nbsp;}}&nbsp;are oriented over the <b>interventricular
septum.</b>
Limb leads can be recorded by placing electrodes on all four corners of the
<b>{{c1::trunk}}</b> in lieu of the standard placement. "Used in ambulances,
hospital rooms, the ED, OR, recovery, pretty much everywhere<div><img src=""Screen
Shot 2018-08-11 at 2.55.28 PM.png"" /></div>"
Severe <b>pain</b> and/or <i>seeing one's own blood</i> often initiates reflex
<b>{{c1::bradycardia}}</b> and susbequent <b>{{c2::syncope}}</b> "Syncope occurs
due to &nbsp;parasympathetic innervation and blood loss<div><img src=""Screen Shot
2018-08-11 at 3.05.30 PM.png"" /></div>"
Induced gagging and carotid sinus massage are <b>{{c1::vagal maneuvers}}</b> that
induce parasympathetic reflexes. "<div><img src=""Screen Shot 2018-08-11 at
3.11.01 PM.png"" /></div>"
Standing induces compensatory peripheral <b>{{c1::vasoconstriction}}</b> and
slightly increased <b>{{c2::heart rate}}.</b> - due to pooling of blood in
veins<div>- failure of this mechanism causes syncope (i.e. orthostatic
hypotension)</div>
Prolonged standing can lead to <b>{{c1::neurocardiogenic}} syncope</b>&nbsp;due to
a paradoxical parasympathetic response. "<img src=""Screen Shot 2018-08-11 at
3.25.20 PM.png"" /><div>-venous blood pooling induces sympathetic
response</div><div>-in older adults vasoconstriction fails, thus
V_LV&nbsp;is not increased and contractility increases</div><div>- this
induces a parasympathetic response (hypotension and bradycardia) lead to
syncope</div>"
<b>Neurocardiogenic syncope</b> can be confirmed by a {{c1::head up tilt}} test
When examining an EKG, <b>{{c1::rate}}</b> should be determined <u>first</u>.
After <u>inactivation of the SA node</u>, the order of pacemaker foci from fastest
to slowest is:<b> {{c1::</b><b>atrial</b>}}&nbsp;&gt; {{c1::AV junctional}} &gt;
{{c1::ventricular}} "<img src=""Screen Shot 2018-08-11 at 3.53.32 PM.png"" />"
The automaticity focus of the atria sets heart rate at {{c1::60-80}} bpm
individual foci have specific rates
The automaticity focus of the AV junction sets heart rate at {{c1::40-60}} bpm
individual foci have their own specific rates
The automaticity foci of the ventricles sets heart rate at {{c1::20-40}} bpm any
specific focus will have its own rate of pacing
The <b>AV {{c1::junction}}</b> is the portion of the AV node that exhibits
<b>automaticity</b>
<b>{{c2::Purkinje fibers}}</b> will control heart rate if the SA node, atria and AV
junction have failed or if there is <b>{{c1::heart block}}</b>. 20-40bpm
The <u>first six</u>&nbsp;lines following the first {{c3::R}} wave on a <b>heavy
black line</b> are <b>{{c1::300}}, {{c1::150}} </b>and<b> {{c1::100}}, </b>followed
by <b>{{c2::75}}, {{c2::60}} </b>and <b>{{c2::50}}</b> "<div>Correspond to
<b>HEART RATE</b></div><img src=""Screen Shot 2018-08-11 at 4.11.15 PM.png""
/><div><img src=""Screen Shot 2018-08-11 at 4.19.00 PM.png"" /></div>"
8019ba5d483e4e17b2268b00504789b6-ao-1 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-1-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-1-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
8019ba5d483e4e17b2268b00504789b6-ao-2 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-2-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-2-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
8019ba5d483e4e17b2268b00504789b6-ao-3 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-3-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-3-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
8019ba5d483e4e17b2268b00504789b6-ao-4 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-4-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-4-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
8019ba5d483e4e17b2268b00504789b6-ao-5 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-5-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-5-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
8019ba5d483e4e17b2268b00504789b6-ao-6 "<img src=""Screen Shot 2018-08-11
at 4.11.15 PM.png"" />" "<img src=""8019ba5d483e4e17b2268b00504789b6-ao-6-
Q.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-6-A.svg"" />" "<img
src=""8019ba5d483e4e17b2268b00504789b6-ao-O.svg"" />"
"<div>Determine the <b>heart rate</b>:</div>A. {{c1::100}} bpm<div>B. {{c2::~150}}
bpm</div><div>C. {{c3::60}} bpm</div><div>D. {{c4::75}} bpm</div><div><img
src=""Screen Shot 2018-08-11 at 4.25.17 PM.png"" /></div>"
When assessing <b>{{c2::bradycardic}}</b> EKGs, the HR = {{c1::10 x (# R waves in a
6s interval)}} "R waves can be used, or any prominent part of the QRS
complex<div><img src=""Screen Shot 2018-08-11 at 4.30.41 PM.png"" /></div><div><img
src=""Screen Shot 2018-08-11 at 4.32.53 PM.png"" /></div><div><img src=""Screen
Shot 2018-08-11 at 4.38.47 PM.png"" /></div>"
"<div>Determine the heart rate from these EKGs.&nbsp;</div><div>1. {{c1::20}}
bpm</div><div>2. {{c2::~45}} bpm</div><div>3. {{c3::50}} bpm</div><img src=""Screen
Shot 2018-08-11 at 4.39.48 PM.png"" />" <b>complete</b> cardiac cycles must be
counted
All <u>automaticity foci</u> pace with <b>{{c1::regular rhythm}}</b>, meaning there
is a consistent distance between similar waves.
<b>{{c1::Sinus arrhythmia}}</b> is a <u>normal</u>, but <i>extremely <u>minimal</u>
change</i> in heart rate with inspiration/expiration. increased rate with
inspiration<div>decreased rate with expiration</div>
{{c1::Wandering pacemakers}}, {{c2::multifocal atrial tachycardia}} and
{{c3::atrial fibrillation}} are arrhythmias due to
<b>{{c4::irregular}}&nbsp;</b><b>rhythms</b>.
Rhythms that lack <u>constant duration </u>between paced cycles are said to be
<b>{{c1::irregular}}.</b>
Structural pathology or hypoxia can lead to <b>{{c1::entrance}} block</b>&nbsp;
- <b>incoming </b>depolarizations are blocked, protecting them from passive
depolarization from other sources<div>- however, they <b>cannot be overdrive
suppressed</b></div>
When automaticity foci have an <u>entrance block</u>, they are termed
<b>{{c1::parasystolic}}</b> focus paces, but cannot be overdrive suppressed
<b>{{c1::Wandering pacemakers}}</b> are a type of arrhythmia characterized by
pacemaker activity moving from the <u>SA node</u> to <b>{{c2::atrial}} foci</b>.
"<div><img src=""Screen Shot 2018-08-11 at 6.49.58 PM.png"" /></div>"
Is <b>heart rate</b> normal in patients with wandering pacemaker arrhythmias?
&nbsp;<div><br /></div><div>{{c1::yes}}</div> "<img src=""Screen Shot 2018-08-11
at 6.49.58 PM.png"" />"
<b>{{c2::Wandering pacemaker}}</b> is an irregular rhythm within normal rate range,
but varying <b>{{c1::P wave}}</b> shape and irregular <b>{{c3::ventricular}}</b>
rhythm. "due to different automaticity rates in various atrial foci<div><img
src=""Screen Shot 2018-08-11 at 6.49.58 PM.png"" /></div>"
If rate in <u>{{c2::wandering pacemaker}}</u> exceeds 100 bpm, it becomes
<b>{{c1::multifocal atrial tachycardia}}.</b>
"<div>The following is an example of <b>{{c1::wandering pacemaker}}</b></div><img
src=""atrial11.gif"" />" "<img src=""Screen Shot 2018-08-11 at 7.01.50
PM.png"" />"
<u>{{c4::Multifocal atrial tachycardia}}</u> is an irregular rhythm with varying
<b>{{c1::P wave}}</b>&nbsp;shape, atrial rate <b>{{c2::&gt;100}} bpm</b> and an
irregular <b>{{c3::ventricular}}</b> rhythm. "<img src=""Screen Shot 2018-08-11
at 7.16.34 PM.png"" />"
Multifocal atrial tachycardia is associated with <b>{{c1::COPD}}</b> "<img
src=""Screen Shot 2018-08-11 at 7.16.34 PM.png"" />"
Multifocal atrial tachycardia arises due to shifting of the
<b>{{c1::pacemaker}}</b>&nbsp;from the SA node to different&nbsp;<b>atrial
foci</b>. "<img src=""Screen Shot 2018-08-11 at 7.16.34 PM.png"" />"
{{c3::Multifocal atrial tachycardia}} can be associated with <b>{{c1::digitalis}}
toxicity</b> in patients with pre-existing <b>{{c2::heart}}</b> disease. "<img
src=""Screen Shot 2018-08-11 at 7.16.34 PM.png"" />"
"<div>The following is an example of <b>{{c1::multifocal ventricular
tachycardia}}</b></div><img src=""10c.jpg"" />" look at weird P waves, tachycardia
and irregular rhythm
<b>{{c1::Atrial fibrillation}}</b> is an <u>irregular rhythm</u> characterized by
<b>{{c2::continuous rapid firing}}</b> of multiple atrial <u>automaticity
foci</u>&nbsp;due to <b>{{c3::entrance}}</b> block. "<img src=""Screen Shot 2018-
08-11 at 7.30.54 PM.png"" />"
In atrial fibrillation, does any single impulse (from the multiple foci) depolarize
the atria completely?&nbsp;<div><br /></div><div>{{c1::no}}</div> "<img
src=""Screen Shot 2018-08-11 at 7.30.54 PM.png"" />"
Atrial fibrillation is characterized by an absent <b>{{c1::P wave}}</b>. "<img
src=""Screen Shot 2018-08-11 at 7.30.54 PM.png"" />"
Depolarizations in <b>{{c2::atrial fibrillation}}</b> only occasionally reach the
AV node, resulting in <b>{{c1::irregular ventricular rhythm}}</b>. "<img
src=""Screen Shot 2018-08-11 at 7.30.54 PM.png"" />"
Atrial fibrillation more common in which demographic?&nbsp;<div><br
/></div><div>{{c1::elderly}}</div> "<img src=""Screen Shot 2018-08-11 at 7.30.54
PM.png"" />"
Atrial foci in atrial fibrillation are <b>{{c1::parasystolic}}</b>, meaning they
cannot be overdrive suppressed.
Is ventricular rhythm always irregular in atrial fibrillation?&nbsp;<div><br
/></div><div>{{c1::yes}}</div>
"The following is an example of <b>{{c1::atrial fibrillation}}.</b><div><b><img
src=""atrial15.gif"" /></b></div>"
"The following is an example of <b>{{c1::atrial fibrillation}}</b><img src=""Screen
Shot 2018-08-11 at 7.58.16 PM.png"" />"
<b>{{c1::Escape rhythm}}</b> occurs when an automaticity focus is <u>no longer
regulated</u> by overdrive suppression and paces at its <i>own inherent rate</i>.
<b>{{c1::Escape beat}}</b> is when an automaticity focus transiently escapes
overdrive suppression to emit one <b>{{c2::heart beat}}</b>
Escape rhythms/beats are due to <u>cessation</u> of <b>{{c1::SA node}}
</b>activity. loss of overdrive suppression
<b>{{c1::Sinus arrest}}</b> refers to cessation of SA node pacing.
<b>{{c1::Sinus block}}</b> is when the SA node does not participate in one pacing
cycle
<b>{{c1::Atrial escape}}</b> rhythm is when an <b>{{c2::atrial}} focus</b> assumes
pacemaker function following cessation of sinus rhythm "<img
src=""image080.png"" />"
{{c3::Junctional escape}} rhythm occurs during <b>{{c1::sinus arrest}}</b>&nbsp;and
during<b> {{c2::AV conduction block}}</b>. "<img src=""image082.png""
/><div><img src=""Screen Shot 2018-08-11 at 8.13.48 PM.png"" /></div>"
In <u>junctional escape rhythm</u>, there are no&nbsp;<b>{{c1::P&nbsp;waves}}</b>
"<div><img src=""Screen Shot 2018-08-11 at 8.13.48 PM.png"" /></div>"
{{c3::Junctional escape}} arrhythmia can lead to retrograde&nbsp;<b>{{c2::atrial
depolarization}}&nbsp;</b>with an inverted <b>{{c1::P wave}}</b> spreading of
depolarization back to atria from distal AV node
Due to <i>slow conduction velocity</i> of the AV node, <b>{{c2::junctional
escape}}</b>&nbsp;rhythm can cause <b>{{c1::delayed}}</b> <u>ventricular</u> or
<u>retrograde atrial</u> depolarization. "<b>inverted P' wave</b> can occur<div>-
immediately <u>before</u> QRS</div><div>- <u>during</u> QRS (buried
within)</div><div>- <u>after</u> QRS</div><div><img src=""Screen Shot 2018-08-11 at
8.22.38 PM.png"" /></div>"
{{c3::Ventricular escape}} rhythm occurs with <b>{{c1::complete AV conduction
block}} </b>or in {{c2::downward displacement}} of pacemaker&nbsp; "- downward
displacement of pacemaker is a grave condition characterized by <b>loss of SA node
and all other automaticity foci</b>.&nbsp;<div><br /></div><div>- last ditch
attempt by the body&nbsp;</div><div><img src=""Screen Shot 2018-08-11 at 8.25.37
PM.png"" /></div>"
<b>{{c1::Stokes-Adams}}</b> syndrome refers to syncope (unconscious) due to
{{c2::ventricular escape}} rhythm - decreased cerebral perfusion pressure<div>-
biggest concern is <b>airway maintenance</b></div>
Atrial and junctional foci may be irritated by&nbsp;increased
<b>{{c1::sympathetic}}</b> stimulation. "<div><img src=""Screen Shot 2018-08-11
at 8.33.42 PM.png"" /></div>"
Atrial and junctional foci may be irritated by&nbsp;<b>{{c1::caffeine}}</b>,
amphetamines, cocaine,&nbsp;or
other&nbsp;<b>{{c2::ß₁}}</b>&nbsp;stimulants. "<img src=""Screen Shot
2018-08-11 at 8.33.42 PM.png"" />"
<b>Hyper{{c1::thyroidism}}</b> can cause irritability of atrial and junctional foci
<b>{{c1::Premature atrial}}</b> <b>beat</b> originates from irritable atrial
automaticity foci that fire earlier than normal "<img src=""Screen Shot 2018-08-11
at 8.38.42 PM.png"" />"
<b>{{c1::Premature atrial}}</b> beat may present with an abnormally large
<b>{{c2::T}} wave</b> or one abnormal <b>{{c3::P}} wave</b>. "due to P wave
""hiding"" in the T-wave<div><img src=""Screen Shot 2018-08-11 at 8.38.42
PM.png"" /></div>"
Premature stimuli can <b>{{c1::reset}}</b>&nbsp;the SA node pacing when the
dominant (SA) automaticity center is <b>{{c2::depolarized}}</b> by the premature
beat.
A slightly widened QRS complex can be due to <b>{{c1::premature atrial beat}}.</b>
- beat depolarizes one ventricle more rapidly (it's more receptive to
premature depolarization)<div>- delayed depolarization of the other ventricle
causes widened QRS</div>
<b>Atrial {{c1::bigeminy}}</b> occurs when an irritable atrial focus repeatedly
couples a <i>premature atrial beat</i> to the end of <b>{{c2::each cycle}}.</b>
"<img src=""Screen Shot 2018-08-11 at 8.55.32 PM.png"" />"
<b>Atrial {{c2::trigeminy}} </b>occurs when an irritable atrial focus adds a
<i>premature atrial beat</i> to fire after <b>{{c1::two}}</b> normal cycles "<img
src=""Screen Shot 2018-08-11 at 8.55.32 PM.png"" />"
<u>Ventricular foci</u> are most commonly made irritable via <b>low {{c1::oxygen}}
or&nbsp;{{c2::K⁺}}, </b>or&nbsp;by some pathology<b>.</b>
<b>Premature {{c1::ventricular}} beats</b> can be caused by {{c2::hypoxia}} due to
<u>irritable ventricular foci</u>
Premature {{c3::ventricular}} beats are characterized by a <b>{{c2::widened}}
{{c1::QRS complex}}.</b>
Amplitude of the {{c2::QRS}} complex is <b>{{c1::inverted}}</b> relative to normal
sinus rhythm.&nbsp; "<img src=""Screen Shot 2018-08-11 at 9.03.52 PM.png"" />"
Premature ventricular contraction is most often caused by <b>{{c1::hypoxia}}</b>
<u>&gt;</u>&nbsp;{{c1::6}} premature ventricular contractions are considered
<u>pathologic</u>.
Premature ventricular contractions have a significantly <b>{{c1::larger}}</b>
amplitude than normal sinus rhythm. "<img src=""ill_rhythm_strip_-
_premature_ventricular_contraction.jpg"" />"
<b>{{c1::Ventricular bigeminy}}</b> occurs when a PVC is coupled to every cycle
"<img src=""Screen Shot 2018-08-11 at 9.10.08 PM.png"" />"
<b>{{c1::Ventricular trigeminy}}</b>&nbsp;occurs when a PVC is coupled to every
<b>{{c2::two}}</b> cycles "<img src=""Screen Shot 2018-08-11 at 9.10.08
PM.png"" />"
<b>Ventricular {{c1::parasystole}}</b> is produced by ventricular automaticity from
{{c2::entrance block}} <b><u>without</u></b> irritability
Lack of overdrive suppression in ventricular <b>{{c2::parasystole}}</b> results
in&nbsp;<b>{{c1::</b><b>dual</b> <b>ventricular</b>}}&nbsp;rhythm. "causing a
dual ventricular rhythm<div><img src=""Screen Shot 2018-08-11 at 9.12.34
PM.png"" /></div>"
{{c2::Premature ventricular}} contractions appear as interspersed <b>{{c1::QRS
complexes}}</b> within normal sinus rhythm. "<u><img src=""Screen Shot 2018-08-
11 at 9.12.34 PM.png"" /></u>"
<b>{{c2::Ventricular tachycardia}}</b> refers
to&nbsp;<b>{{c1::<u>&gt;</u>&nbsp;3}}</b>&nbsp;premature ventricular contractions
in rapid succession. "<img src=""Screen Shot 2018-08-11 at 9.17.33 PM.png"" />"
If a run of ventricular tachycardia lasts {{c2::&gt; 30s}} it is termed
<b>{{c1::sustained VT}}</b> "<img src=""Screen Shot 2018-08-11 at 9.17.33
PM.png"" />"
<b>{{c2::Multifocal premature ventricular}}</b> contractions are caused by
<u>severe</u> <b>cardiac {{c1::hypoxia}}</b> increased likelihood of developing
<b>ventricular fibrillation</b>
Paroxysmal tachycardia, flutter and fibrillation are
<b>{{c1::tachy}}arrhythmias</b>
<b>{{c2::Paroxysmal tachycardia}}</b> results in a rate range of <b>{{c1::150-
250}}</b> bpm
<b>{{c2::Flutter}}</b>&nbsp;results in a rate range of&nbsp;<b>{{c1::250-
350}}</b>&nbsp;bpm
<b>{{c2::Fibrillation}}</b>&nbsp;results in a rate range of&nbsp;<b>{{c1::350-
450}}</b>&nbsp;bpm
<b>Paroxysmal tachycardia</b> can originate from an irritable <b>{{c1::automaticity
focus}}</b> in the <u>atria</u>, <u>junctional</u> area, or <u>ventricles</u>.
Stimulants typically affect <b>{{c1::higher}} level</b> foci, while hypoxia or low
potassium typically irritate <b>{{c2::ventricular}}</b> foci
Is <b>sinus tachycardia</b> a paroxysmal tachycardia?<div><br
/></div><div>{{c1::no}}</div> - It is a response to exercise, excitement,
etc.&nbsp;<div>- It does not originate from an automaticity focus</div>
Paroxysmal <b>{{c3::atrial}}</b> tachycardia is characterized by abnormal
<b>{{c1::P}}</b> waves and accelerated <b>{{c2::heart rate}}.</b> <!--anki--
>Paroxysmal atrial tachycardia originates from
<b>irritable&nbsp;atrial&nbsp;automaticity foci&nbsp;</b>
Paroxysmal atrial tachycardia is characterized by <b>{{c1::normal}}</b> P-QRS-T
cycles
<b>{{c1::Supraventricular}}&nbsp;</b><b>tachycardia</b>&nbsp;is a term
that&nbsp;includes paroxysmal<u> {{c2::atrial}}</u> and <u>{{c2::junctional}}</u>
tachycardias
"<div>This as an example of <b>{{c1::supraventricular
tachycardia}}.&nbsp;</b></div><div><b><br /></b></div><div><b>How do you know?
&nbsp;</b></div><div>{{c1::P and T waves are fused and there's tachycardia
~250bpm}}</div><img src=""j114.gif"" />"
Supraventricular tachycardia is characterized by merging of <b>{{c1::P}} &amp;
{{c1::T}} waves</b>
<b>{{c2::Ventricular tachycardia}}</b> is characterized by <b>dramatic
{{c1::ventricular complexes}}</b> that <u>hide P waves</u> (which can be seen
occasionally). "<!--anki-->Ventricular tachycardia is produced by irritable
ventricular automaticity foci&nbsp;<div><img src=""paste-93548682674433.jpg""
/></div>"
In ventricular tachycardia, the <u>atria</u> are paced by the<b> {{c1::SA
node}}</b>
In ventricular tachycardia, the <u>ventricles</u>&nbsp;are paced
by&nbsp;<b>{{c1::irritated ventricular automaticity foci}}</b>
"<div>The following is an example of <b>{{c1::ventricular
tachycardia}}</b></div><div><b><br /></b></div><img src=""Screen Shot 2018-08-12 at
2.27.55 PM.png"" />"
Runs of <b>{{c3::ventricular tachycardia}}</b> may be associated with
<b>{{c1::coronary insufficiency}}</b>&nbsp;or <b>cardiac {{c2::hypoxia}}</b> "<img
src=""Screen Shot 2018-08-12 at 2.33.05 PM.png"" />"
The difference in pacing between foci during VT produces <b>{{c1::AV
dissociation}}</b>
Coronary artery disease common in <b>{{c1::ventricular}} tachycardia</b>
<b><u>not</u> SVT</b>
QRS width <b>{{c2::&lt; 0.14s}}</b> is characteristic
of&nbsp;<b>{{c1::supraventricular</b>}} tachycardia widened QRS
QRS width&nbsp;<b>{{c2::&gt; 0.14s}}</b>&nbsp;is characteristic
of&nbsp;<b>{{c1::ventricular}} tachycardia</b>
AV dissociation is {{c2::common}} in <b>{{c1::ventricular}} tachycardia</b>&nbsp;
rare in SVT
Extreme right axis dissociation is <b>{{c1::common}}</b> in <b>{{c2::ventricular}}
tachycardia</b>
Extreme right axis dissociation is <b>{{c1::rare}}</b> in <b>supraventricular
(widened QRS type) tachycardia</b>
AV dissociation is <b>{{c1::rare}}</b> in <u>supraventricular</u> tachycardia
<b>{{c2::Torsades de Pointes}}</b> is a type of <u>{{c1::ventricular}}
tachycardia</u> caused by <b>{{c3::hypokalemia}}</b> or <b>{{c4::congenital}}</b>
abnormalities. "hypokalemia due to metabolic abnormalities <b>or drug induced
K⁺channel blockage</b><div><b><img src=""Screen Shot 2018-08-12 at
3.23.24 PM.png"" /></b></div>"
<b>{{c2::Torsades de pointes}}</b> is characterized by a series of ventricular
complexes with cyclically increasing and then decreasing <b>{{c1::amplitudes}}</b>
"so when viewed as a whole, it looks like an end-end spindle shape or
ribbon<div><img src=""Screen Shot 2018-08-12 at 3.23.24 PM.png"" /></div>"
The rate of torsades de pointes is between <b>{{c1::250-350}} bpm</b>
Is torsades de pointes continuous?&nbsp;<div><br /></div><div><b>{{c1::no -
intermittent}}</b></div> "can be fatal if untreated<div><img src=""Screen Shot
2018-08-12 at 3.23.24 PM.png"" /></div>"
<b>Atrial {{c2::flutter}}</b> occurs due to an irritable atrial focus producing a
pace of <b>{{c1::250-350}}</b> bpm "<img src=""Screen Shot 2018-08-12 at 3.36.00
PM.png"" />"
Atrial <b>{{c1::flutter}}</b> is characterized by identical flutter waves that
occur in <u>rapid succession</u>. "<img src=""Screen Shot 2018-08-12 at 3.36.00
PM.png"" />"
"<div>The following is an example of <b>{{c1::atrial
flutter}}.</b></div><div><b><br /></b></div><div>How do you know?
&nbsp;</div><div><br /></div><div>{{c1::several identical depolarizations of atria
preceding ventricular depolarization}}</div><img src=""1200px-
Atrial_flutter34.svg.png"" />" vs. premature atrial contractions which are
<b>irregular in P wave shape</b>
"<div>The following are examples of&nbsp;<b>{{c1::atrial
flutter}}.</b></div><div><b><br /></b></div><div><b>How do you know?
&nbsp;</b></div><div><br /></div><div>{{c1::several identical depolarizations of
atria preceding ventricular depolarization}}<img src=""paste-
100708393157118.jpg"" /></div><div><img src=""paste-100893076751416.jpg"" /></div>"
vs. premature atrial contraction which has varying P wave shape/size
Atrial flutter does not induce <u>ventricular tachycardia</u> due to the long
<b>{{c1::refractory period}} </b>of the <b>{{c2::AV node}}</b> "AV node only
transmits every 2^nd- 3^rd&nbsp;flutter&nbsp;<img src=""paste-
100871601914936.jpg"" />"
In atrial flutter, atrial depolarizations may be <b>{{c1::masked}}</b> by a rapid
<b>{{c2::QRS}}</b> response rate. "<div>2:1 P' flutter:QRS complex
ratio</div><div>P waves can be prolonged via <b>vagal maneuvers&nbsp;</b>due to
vagal parasympathetic innervation of the atria and AV node, <u><b>but not
ventricles</b></u></div><img src=""Screen Shot 2018-08-12 at 3.48.21 PM.png"" />"
Ventricular flutter is characterized by a pace of <b>{{c1::250-350}}</b> bpm
"usually rapidly deteriorates into a deadly arrhythmia (no ventricular
filling)<div><img src=""Screen Shot 2018-08-12 at 4.03.47 PM.png"" /></div>"
Ventricular <b>{{c2::flutter}}</b> is characterized by a <b>{{c1::smooth
sinusoidal}}</b>&nbsp;wave pattern on ECG "<img src=""Screen Shot 2018-08-12 at
4.03.47 PM.png"" />"
Sinusoidal waves in ventricular <b>{{c1::flutter}}</b> are typically of
<b>{{c2::similar}}</b> amplitude. "<div>Versus sinusoidal waves
in&nbsp;<u>torsades de pointes</u>&nbsp;which&nbsp;cycle up and down in
amplitude</div><img src=""Screen Shot 2018-08-12 at 4.03.47 PM.png"" />"
Ventricular flutter <u>almost invariably</u> rapidly deteriorates into ventricular
<b>{{c1::fibrillation}}</b> "<div>requires <b>defibrillation</b></div><img
src=""Screen Shot 2018-08-12 at 4.06.50 PM.png"" />"
"<div>This is an example of <b>{{c1::atrial tachycardia}}</b></div><img
src=""Screen Shot 2018-08-12 at 4.09.19 PM.png"" />" QRS complexes are normal -
not ventricular origin<div>P waves not inverted - not junctional retrograde
depolarization&nbsp;</div><div>P waves abnormal</div><div>HR elevated (250+)</div>
<b>{{c1::Fibrillation}}</b>&nbsp;is an <b>erratic</b>&nbsp;rhythm caused by
<b>{{c2::continous}}</b>&nbsp;rapid rate discharges from <u>numerous</u>
automaticity foci "<div>Can be atrial or ventricular</div><img src=""Screen Shot
2018-08-12 at 4.16.01 PM.png"" />"
Both atrial and ventricular fibrillation are <b>{{c1::parasystolic}} rhythms</b>,
meaning they cannot be overdrive suppressed due to <b>{{c2::AV block}}</b> "<img
src=""Screen Shot 2018-08-12 at 4.16.01 PM.png"" />"
The theoretical pace rate in fibrillation is between <b>{{c1::350-450}}</b> bpm
"<div>The following is an example of <b>{{c1::atrial
fibrillation}}</b></div><div><b><br /></b></div><div><b>How do you know?
&nbsp;</b></div><div><b><br /></b></div><div>{{c2::ventricular rate is irregular,
not every atrial depolarization is coupled to ventricular contraction, and there
are numerous small depolarizations of the atria (p waves)}}</div><img src=""paste-
104745662415103.jpg"" />" irregular ventricular rhythm<div>numerous small
depolarizations of atria with no apparent pattern in rhythm</div><div>not all
atrial depolarizations reach ventricles (P waves do not always couple to QRS
complex)</div>
Atrial {{c2::fibrillation}} is often characterized by a <b>{{c1::wavy}}
baseline</b>&nbsp;prior the QRS complex "<!--anki--><img src=""Atrial fib strip-
1.jpg"" /><div><img src=""Screen Shot 2018-08-12 at 4.26.31 PM.png"" /></div>"
"<div>The following are examples of <b>{{c1::atrial fibrillation}}</b></div><img
src=""Atrial fib strip-1.jpg"" /><div><br /><div><img src=""Screen Shot 2018-08-12
at 4.26.31 PM.png"" /></div></div>"
In <b>{{c1::atrial fibrillation}}</b>, ventricular rate is usually within
relatively <b>{{c2::normal}}</b> ranges due to the duration of the <u>AV node</u>
{{c3::refractory}} period
<div>Each automaticity center in&nbsp;<b>ventricular</b>&nbsp;fibrillation
depolarizes a&nbsp;<b>{{c1::small}}</b>&nbsp;portion of the ventricle.</div>
"<div>Ventricular fibrillation is the result of numerous irritated
parasystolic ventricular automaticity centers.</div><img src=""5.gif"" />"
<div>Ventricular <b>{{c3::fibrillation}}</b> results in rapid,
ineffective&nbsp;<b>{{c1::twitching}}</b>&nbsp;of the ventricles due to
<b>{{c2::partial}} ventricular&nbsp;depolarization</b> by each focus.</div>
"<div>Ventricular fibrillation is the result of numerous irritated
parasystolic ventricular automaticity centers.</div><img src=""5.gif"" /><div><img
src=""Screen Shot 2018-08-12 at 4.34.39 PM.png"" /></div>"
Ventricular <b>{{c1::fibrillation}}</b> typically has erratic, unidentifiable wave
forms on EKG.
Ventricular fibrillation is a type of cardiac <b>{{c1::arrest}}</b> no effective
cardiac output (only ventricular twitching)
The <b>{{c1::bundle of kent}}</b> is an abberant <b>{{c2::atrioventricular}}
conduction pathway</b> that {{c3::shortens}} the typical AV nodal conduction delay.
"<img src=""Screen Shot 2018-08-12 at 4.48.21 PM.png"" />"
Circumvention of typical AV node <u>delay</u> &nbsp; in <b>{{c1::wolf-parkinson-
white}}</b>&nbsp;<b>syndrome</b>&nbsp;leads to premature {{c2::ventricular
depolarization}}.&nbsp; "<img src=""Screen Shot 2018-08-12 at 4.48.21 PM.png"" />"
Premature <u>ventricular depolarization</u> in <b>{{c3::wolf parkinson
white}}</b>&nbsp;syndrome appears as a shortened
<b>{{c1::PR}}&nbsp;</b><b>segment&nbsp;</b>and widened <b>{{c2::QRS}} wave</b>.
"<b><img src=""Screen Shot 2018-08-12 at 4.48.21 PM.png"" /></b>"
Ventricular <u>pre-excitation</u> in wolf-parkinson-white syndrome creates a
characteristic <b>{{c1::delta}}</b> wave that appears as a widened QRS complex.
Patients with wolf-parkinson white syndrome can have <b>{{c1::tachycardia}}</b>
<div>Via three mechanisms:</div><div><br /></div>- <b>supraventricular</b>
tachycardia (including atrial flutter &amp; fibrillation) transmitted via bundles
of kent<div>- bundles of kent may have their own <b>automaticity
foci</b></div><div>- ventricular depolarization can immediately cause <b>retrograde
re-stimulation</b> of the <u>atria</u></div>
Patients with <b>{{c1::Lown-ganlong-levine (LGL) syndrome}}</b> have an aberrant
extension of the <b>{{c2::anterior internodal}} tract </b>known as the
<b>{{c3::James}} tract</b> "bypasses the AV node, <b>directly to the bundle of
His</b><div><b><img src=""Screen Shot 2018-08-12 at 5.13.56 PM.png"" /></b></div>"
Electrical conduction in <b>{{c1::LGL}} syndrome</b> bypasses the <b>{{c3::AV
node}}</b>, connecting the {{c2::SA node}} directly to the {{c2::AV bundle of His}}
via the James tract "<div>via a direct electrical connection from the SA
node</div><img src=""Screen Shot 2018-08-12 at 5.13.56 PM.png"" />"
Patients with <b>{{c2::LGL}} syndrome</b> may conduct rapid atrial paces, leading
to rapid<b>&nbsp;{{c1::ventricular}} contractions</b>
<b>{{c1::Sinus block}}</b> occurs when the <u>SA node</u> temporarily fails to pace
for at least <b>{{c2::one cycle}}</b> "<img src=""Screen Shot 2018-08-12 at
5.35.54 PM.png"" />"
<u>Sinus block</u> may induce an <b>{{c1::escape beat}}</b> from an <i>automaticity
focus</i>
Does the SA node resume normal pacing after SA block?&nbsp;<div><br
/></div><div><b>{{c1::yes}}</b></div> may allow escape beat during arrest
<b>{{c1::Sick sinus}} syndrome</b> is characterized by<b>
{{c3::</b><b>SA</b>}}&nbsp;node failure <u>in association with</u> dysfunctional
<b>{{c2::supraventricular}}</b> automaticity foci "<img src=""Screen Shot 2018-
08-12 at 5.41.23 PM.png"" />"
Sick sinus syndrome typically presents with <b>{{c3::sinus bradycardia}}</b> in
<b>{{c1::elderly::age}}</b> individuals with pre-existing <b>{{c2::heart}}</b>
disease
<i>{{c2::Sick sinus}} syndrome</i> is characterized by <b>{{c3::sinus
bradycardia}}</b> <u>without</u>&nbsp;normal escape mechanisms of
<b>{{c1::atrial}}</b> <b>&amp; {{c1::junctional}}</b> foci
<b>{{c2::Pseudo-sick sinus syndrome}}</b>&nbsp;can present in healthy young adults
due to <b>{{c1::parasympathetic hyperactivity}}</b> at rest. i.e. marathon
runners, conditioned athletes
<b>{{c1::Bradycardia-Tachycardia}}</b> syndrome is characterized by {{c2::sick
sinus}} syndrome with intermittent episodes of <b>{{c3::SVT}}</b> or atrial
<b>{{c3::fibrillation}} or {{c3::flutter}}</b>
<b>{{c2::AV blocks}}</b> slow down or eliminate <u>conduction</u> from the
<b>{{c1::atria}}</b> to the <b>{{c1::ventricles}}</b> "<img src=""Screen Shot 2018-
08-12 at 6.07.59 PM.png"" />"
<b>{{c2::1^st}}&nbsp;degree</b> <u>AV blocks</u> prolong the <b>{{c1::PR
interval}}</b> "- due to <b>slowed conduction</b> through <u>AV
node</u>&nbsp;<div>- prolongs time from <b>atrial</b> depolarization to
<b>ventricular</b> depolarization<div>- prolonged to <b>&gt; 0.2 sec (1 big
square)</b></div></div><div><b><img src=""Screen Shot 2018-08-12 at 6.07.59
PM.png"" /></b></div>"
1st degree AV blocks prolong the <u>PR interval</u> to <b>{{c1::&gt; 0.2s (1 large
square)}}</b> "- normally less than 0.2 seconds<div>- there is AV block if
<b>any PR interval</b>&nbsp;on the <b>entire EKG </b>is &gt; 0.2 sec</div><div><img
src=""Screen Shot 2018-08-12 at 6.07.59 PM.png"" /></div>"
<b>{{c2::1^st}}&nbsp;degree</b> AV block is present when the <b>{{c1::PR
interval}}</b> is <u>consistently</u> prolonged by the {{c3::same}} amount in every
cycle "<div>1˚ block = 1˚ AV block</div><div>PQRST complex should be the same for
every cycle as well</div><img src=""Screen Shot 2018-08-12 at 6.07.59 PM.png"" />"
<b>{{c1::2^nd}}&nbsp;degree</b> <u>AV blocks</u>
<b>{{c2::intermittently}}</b> permit conduction of atrial depolarization to the
ventricles. "<img src=""Screen Shot 2018-08-12 at 6.11.41 PM.png"" />"
Intermittent transmission in&nbsp;<b>{{c2::2^nd}}&nbsp;degree</b> AV
block results in lone <b>{{c1::P}} waves</b> with no associated <b>{{c1::QRS
complexes}}&nbsp;</b> "<img src=""Screen Shot 2018-08-12 at 6.11.41 PM.png"" />"
<b>{{c1::Wenckebach}}</b> 2˚ AV node blocks produce a series of cycles with
<b>{{c3::progressive}}</b> blocking of AV node until there is no <b>{{c3::QRS
complex}}</b> results in consistent P:QRS ratios<div>3:2, 4:3, 5:4 (one less
QRS than P waves)</div>
<b>{{c3::Wenckeback}}</b> 2˚ AV block is characterized by <b>{{c2::cycles}}</b>
of&nbsp;<u>progressive</u> lengthening of the <b>{{c1::PR}} interval</b>&nbsp;until
there is no subsequent&nbsp;<b>{{c1::QRS complex}}</b> "<div>can last anywhere
from 2-8 cycles</div><img src=""Screen Shot 2018-08-12 at 6.24.45 PM.png"" />"
<b>Wenckebach</b> AV block can be caused by <b>{{c1::parasympathetic}}</b> excess
or <u>drugs that mimic/induce</u> <b>{{c1::parasympathetic}}</b> effects. "<img
src=""Screen Shot 2018-08-12 at 6.24.45 PM.png"" />"
<b>{{c1::Mobitz}} 2˚ AV blocks</b> are blocks of bundle of his,&nbsp;purkinje
fibers or branch bundles.
<b>{{c2::Mobitz}}</b> <b>blocks</b> induce a <u>series</u> of <b>{{c3::paced P}}
waves</b> that fail to generate a QRS complex followed by one <b>{{c1::normal
cycle}}</b> "typically resuts in 3:1, 4:1, 5:1 P:QRS ratio<div><img src=""Screen
Shot 2018-08-12 at 6.31.11 PM.png"" /></div>"
<b>{{c1::Mobitz}} blocks</b> can cause&nbsp;<b>{{c2::syncope}}</b> due to
dramatically reduced <u>ventricular contraction rate</u> due to blockage of
conduction from AV node
3:1 block refers to <b>{{c1::mobitz 2˚ AV}} block </b>where sinus rhythm is
achieved after<b> {{c2::</b><b>3</b>}}&nbsp;failed P waves.
<u>P waves</u> in <i>mobitz blocks</i> are <b>{{c1::regularly}}</b> timed&nbsp;
"unlike <b>premature atrial contractions</b><div><b><img src=""Screen Shot
2018-08-12 at 6.31.11 PM.png"" /></b></div>"
<b>2:1 {{c2::wenckebach}} block</b> is characterized by <b>{{c1::lengthened}}</b>
<u>PR interval</u> and <b>{{c1::normal}}</b> <u>QRS complex</u>. "<img src=""Screen
Shot 2018-08-12 at 6.35.16 PM.png"" />"
<b>2:1 {{c2::mobitz}} block</b>&nbsp;is characterized
by&nbsp;<b>{{c1::normal}}</b>&nbsp;<u>PR
interval</u>&nbsp;and&nbsp;<b>{{c1::widened}}</b>&nbsp;<u>QRS complex</u>. "<img
src=""Screen Shot 2018-08-12 at 6.35.16 PM.png"" />"
<u>Wenckebach</u> block is considered <b>{{c1::normal}}</b>, while <u>mobitz</u>
block is considered <b>{{c1::pathologic}}</b>.
Since <b>{{c1::mobitz}} blocks</b> originate <b>{{c2::below}}</b> the AV node, the
block is either&nbsp;<b>{{c3::not impacted}}</b>&nbsp;or is
<b>{{c3::eliminated}}</b> by <b>{{c2::vagal}} maneuvers</b>"<img src=""Screen Shot
2018-08-12 at 7.08.21 PM.png"" />"
<b>Increased</b> <b>{{c1::parasympathetic}}</b> stimulation of the <u>AV node</u>
makes it more refractory to <b>{{c2::depolarization}}.</b> "- thus, <u>vagal
maneuvers</u> increase the P:QRS ratio (2:1 --&gt; 3:2 or 4:3)&nbsp;<div>-
refractory means <b>less P waves will induce depolarization</b></div><div><div>-
whereas vagal maneuvers in <b>mobitz block</b> will have <b>no effect</b> or
<b>eliminate</b> the block (maintain <b>2:1</b> or drop to
<b>1:1</b>)</div><div><img src=""Screen Shot 2018-08-12 at 7.08.21 PM.png""
/></div></div>"
EKGs with P waves <u>lacking</u> a QRS response indicate a <b>{{c1::2˚}} or
{{c1::3˚}} block</b> 1˚ always has a QRS response, it's just delayed
"<div>The following is an example of a <b>{{c1::1˚ AV}}</b> heart
block&nbsp;</div><div><br /></div><div><b>How can you tell?&nbsp;</b></div><div><br
/></div><div>{{c1::PR interval is <b>prolonged</b> &gt; 0.2s (1 big square);&nbsp;P
wave&nbsp;<b>always </b>followed by QRS}}</div><img src=""Screen Shot 2018-08-12 at
7.19.56 PM.png"" />"
"The following is an example of a <b>{{c1::2˚ wenckebach AV}}</b> heart
block<div><br /></div><div><b>How do you know?&nbsp;</b></div><div><div><br
/></div><div>{{c2::There is progressive lengthening of the PR interval followed by
P wave with no QRS complex after; this cycle repeats}}</div><div><img src=""37)
SECOND DEGREE AV BLOCK - TYPE 1.jpg"" /></div></div>"
"The following is an example of <b>{{c1::mobitz 2˚ AV}} </b>heart
block<div><b><br /></b></div><div><b>How do you know?&nbsp;</b></div><div><b><br
/></b></div><div>{{c1::No PR interval lengthening, widened QRS complex and P wave
not followed by QRS; cycle repeats}}</div><div><b><img src=""Screen Shot 2018-08-12
at 7.25.42 PM (1).png"" /></b></div>" 3:2 (3 P waves: 2 QRS)
<b>{{c3::3^rd}}&nbsp;degree</b> heart block is characterized by
<b>{{c1::complete}} block</b> of <b>{{c2::supraventricular}}</b> foci some
automaticity focus below the block takes over<div><br /></div>
In <b>{{c1::complete (3˚)}}</b> heart block, a <b>{{c2::junctional}}</b> or
<b>{{c2::ventricular}}</b> focus paces the {{c3::ventricles}}, while the
{{c3::atria}} are in <b>{{c2::sinus}} rhythm</b>. this is what is known as
<b>AV dissociation</b>
<b>{{c1::Complete (3˚)}}</b> heart block causes <u>AV dissociation</u>
<b>3˚ block</b> with <b>{{c3::junctional}} focus</b> results in ventricle pacing
at&nbsp;<b>{{c1::40-60}} bpm</b>&nbsp;by the<b> {{c2::</b><b>AV
junctional</b>}}&nbsp;automaticity foci&nbsp; "<img src=""Screen Shot 2018-08-12
at 7.35.20 PM.png"" />"
in <b>3˚ heart block</b>, {{c2::QRS}} complexes appear
<b>{{c1::normal}}</b>&nbsp;in <u>shape</u>, but
<b>{{c1::slower}}</b>&nbsp;<u>pace</u> "<img src=""Screen Shot 2018-08-12 at
7.35.20 PM.png"" />"
<b>3˚ AV block</b> with <b>{{c1::ventricular}} focus </b>results in
<b>{{c3::sinus}} </b>generated <u>P waves</u> with <b>{{c2::ventricular}} foci</b>
controlling ventricular contraction. "<img src=""Screen Shot 2018-08-12 at
7.39.08 PM.png"" />"
3˚ heart block with ventricular focus presents with <b>{{c1::widened}}</b> <u>QRS
complexes</u> &nbsp;and <b>{{c2::AV}} dissociation</b>. "<img src=""Screen Shot
2018-08-12 at 7.39.08 PM.png"" />"
Severely decreased <u>cardiac output</u> in <b>{{c1::3˚}}</b> heart block with
<b>{{c1::ventricular}}</b> focus can cause <b>{{c2::syncope}} </b>({{c3::stokes-
adams}} syndrome) due to ventricular focus rhythm of 20-40 bpm
If there is a <u>bradycardic</u><b> </b>EKG with a widened<b> </b><u>QRS
complex</u> <b>without</b>&nbsp;{{c1::atrioventricular}} dissociation it is more
likely to be a <b>{{c2::downward displacement of the pacemaker}}</b> than 3˚ block
"<div><img src=""Screen Shot 2018-08-12 at 7.45.40 PM.png"" /></div>"
<div>If there is a&nbsp;<u>bradycardic</u><b>&nbsp;</b>EKG with a
widened<b>&nbsp;</b><u>QRS complex</u>&nbsp;<b>with</b>&nbsp;
{{c1::atrioventricular}} dissociation it is more likely to be a&nbsp;<b>{{c2::3˚ AV
heart block}}</b>&nbsp;than downward displacement of the pacemaker</div> "<!--
anki--><img src=""Screen Shot 2018-08-12 at 7.45.40 PM.png"" />"
Extremely high <b>serum&nbsp;{{c1::[K⁺]}}</b>&nbsp;can severely depress
the <b>{{c2::SA}} </b>node<b> </b>&amp; <b>{{c2::supraventricular}} </b>foci
leading to {{c3::asystole (cardiac arrest)}}. kyperkalemia is bad
Blockage of a <b>{{c1::bundle branch (R/L)}}</b> delays depolarization of the
<b>{{c2::ventricle}}</b> it supplies "<img src=""Screen Shot 2018-08-12 at
8.10.42 PM.png"" />"
<b>{{c3::Bundle branch}} block</b> leads to&nbsp;<b>{{c2::widened}}</b> <u>QRS
complex</u>&nbsp;with <b>{{c1::two peaks}}</b> on EKG from delayed depolarization
of the blocked ventricle "<div>since it is blocked, depolarization spreads
from the surrounding myocardium (of the other ventricle)&nbsp;</div><img
src=""Screen Shot 2018-08-12 at 8.14.36 PM.png"" />"
{{c2::Bundle branch}} block is characterized by <b>{{c1::joined QRS's}}</b> "<img
src=""Screen Shot 2018-08-12 at 8.14.36 PM.png"" />"
Ventricular depolarization has&nbsp;<b>{{c1::normal}} </b><u>duration</u>&nbsp;in
bundle branch blocks "<img src=""Screen Shot 2018-08-12 at 8.14.36 PM.png"" />"
In bundle branch block, delayed depolarization leads to a QRS complex <u>wider</u>
than <b>{{c1::3 blocks}}</b> or <u>&gt;</u>&nbsp;<b>{{c1::0.12}} seconds</b>
"<div>diagnosis is primarily based on the widening of the QRS with dual
peaks</div><img src=""Screen Shot 2018-08-12 at 8.20.26 PM.png"" />"
Diagnosis of bundle branch block cannot be made without QRS
widening&nbsp;<b>{{c1::<u>&gt;</u>&nbsp;0.12s}}</b>
<b>{{c1::Supraventricular}} tachycardia</b> superimposed on <u>bundle branch
block</u> may imitate <b>{{c2::ventricular}} tachycardia</b> due to rapid
succession of widened QRS
89f90cbc3f5d44a48f60fe654819a9d9-ao-1 "<img src=""Screen Shot 2018-08-12
at 8.23.41 PM.png"" />" "<img src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-1-
Q.svg"" />" "<img
src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-1-A.svg"" />" "<img
src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-O.svg"" />"
89f90cbc3f5d44a48f60fe654819a9d9-ao-2 "<img src=""Screen Shot 2018-08-12
at 8.23.41 PM.png"" />" "<img src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-2-
Q.svg"" />" "<img
src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-2-A.svg"" />" "<img
src=""89f90cbc3f5d44a48f60fe654819a9d9-ao-O.svg"" />"
If there is a bundle branch block, look at
leads&nbsp;<b>{{c1::V₁&nbsp;}}&nbsp;&amp;&nbsp;
{{c1::V₂}}</b>, as well as
leads&nbsp;<b>{{c2::V₅}}&nbsp;&amp;&nbsp;{{c2::V₆}}</b>
If QRS <u>&gt;</u> <b>{{c2::0.12sec}}</b>, look at right and left chest lead for
<b>{{c1::R, R'}}</b>&nbsp;configuration to diagnose <b>{{c3::bundle branch
block}}</b> "<div><img src=""Screen Shot 2018-08-12 at 8.23.41 PM.png"" /></div>"
At critically rapid rates, <b>{{c1::bundle branch}}</b> blocks may imitate
<b>{{c2::ventricular}} tachycardia</b> due to different refractory period
timing,&nbsp;there is non-simultaneous ventricular depolarization, leading to
tachycardia with widened QRS complexes&nbsp;
If there is an R, R' configuration in leads&nbsp;{{c1::V₁&nbsp;or
V₂}}&nbsp;it is most likely a&nbsp;<b>{{c2::right}}
bundle</b>&nbsp;<b>branch</b>&nbsp;block "<img src=""Screen Shot 2018-08-12 at
8.32.42 PM.png"" />"
If there is an R, R' configuration in leads&nbsp;{{c1::V₅ or
V₆}}&nbsp;it is most likely a&nbsp;<b>{{c2::left}}
bundle</b>&nbsp;<b>branch</b>&nbsp;block "<img src=""Screen Shot 2018-08-12 at
8.32.32 PM.png"" />"
d12c371bc28c40908a725ac188754912-ao-1 "<img src=""Screen Shot 2018-08-12
at 8.33.33 PM.png"" />" "<img src=""d12c371bc28c40908a725ac188754912-ao-1-
Q.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-1-A.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-O.svg"" />"
d12c371bc28c40908a725ac188754912-ao-2 "<img src=""Screen Shot 2018-08-12
at 8.33.33 PM.png"" />" "<img src=""d12c371bc28c40908a725ac188754912-ao-2-
Q.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-2-A.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-O.svg"" />"
d12c371bc28c40908a725ac188754912-ao-3 "<img src=""Screen Shot 2018-08-12
at 8.33.33 PM.png"" />" "<img src=""d12c371bc28c40908a725ac188754912-ao-3-
Q.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-3-A.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-O.svg"" />"
d12c371bc28c40908a725ac188754912-ao-4 "<img src=""Screen Shot 2018-08-12
at 8.33.33 PM.png"" />" "<img src=""d12c371bc28c40908a725ac188754912-ao-4-
Q.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-4-A.svg"" />" "<img
src=""d12c371bc28c40908a725ac188754912-ao-O.svg"" />"
<b>{{c2::Intermittent mobitz}} block</b> occurs due to <b>{{c1::permanent}}</b> BBB
of one branch with <b>{{c1::intermittent}}</b> BBB of the other branch.
"results in 2˚ AV block with intermittent absence of QRS
complex&nbsp;<div><img src=""Screen Shot 2018-08-12 at 8.38.59 PM.png"" /></div>"
Simultaneous <b>complete</b> RBBB &amp; LBBB results in <b>{{c1::3˚ (complete)
AV}}</b> <b>block</b>
EKGs with a <u>bundle branch block</u> pattern with intermittently <b>{{c2::absent
QRS}}</b> indicates <b>{{c1::intermittent mobitz}} block</b> - widened QRS
<u>&gt;</u> 0.12s , distinctive peaks&nbsp;<div>- <b>warning sign</b> for need for
<b>pacemaker</b></div>
<b>{{c2::Axis}}</b> refers to the <b>{{c1::direction}} </b>of depolarization as it
moves through the heart
<b>{{c1::Depolarization}}</b> of the ventricular endocardium occurs in&nbsp;<b>all
areas</b>&nbsp;of the ventricle at nearly the <b>{{c2::same time}}</b>
The <b>{{c1::mean QRS}} vector</b> is the sum of all of the <u>smaller ventricular
depolarization</u> vectors "<div>tail is always the <b><u>AV
node</u></b></div><img src=""Screen Shot 2018-08-12 at 8.57.56 PM.png"" />"
Why does the mean QRS vector point<b> left</b>?&nbsp;<div><br
/></div><div>{{c1::the small depolarizations in the left are larger than the right
due to thicker myocardial wall}}</div> "<img src=""Screen Shot 2018-08-12 at
8.57.56 PM.png"" />"
Vectors represent both <b>{{c1::direction}} </b>and <b>{{c1::magnitude}}&nbsp;</b>
<b>{{c3::Limb}} leads</b> are used to determine the position or
<b>{{c1::axis}}</b>&nbsp;of the {{c2::mean QRS}} vector in the <b>{{c1::fronal}}
plane</b> "<div>- center of circle is <b>AV node</b></div><div><b>- </b>note that
the positive axis is on the <b>inferior aspect</b> of the circle</div><img
src=""Screen Shot 2018-08-12 at 9.43.55 PM.png"" />"
Normally the <b>mean QRS vector</b> points downward and between {{c1::0˚}} and
{{c1::+90˚}} "<img src=""Screen Shot 2018-08-12 at 9.43.55 PM.png"" />"
In tall, skinny people the heart may be rotated toward the patient's
<b>{{c1::right}} side</b>
In obese individuals, the diaphragm is pushed up, so the mean vector will point
directly to the patients <b>{{c1::left}}</b>
Vector points <b>{{c1::towards}}</b> the <u>hypertrophied</u>&nbsp;side of the
heart "<img src=""Screen Shot 2018-08-12 at 9.52.49 PM.png"" />"
In <b>{{c1::myocardial infarction}}</b>, there is a portion of the ventricle that
does not depolarize. "<img src=""Screen Shot 2018-08-12 at 9.54.36 PM.png"" />"
In <b>MI</b>, the depolarization vector points <b>{{c1::away from}}</b> the side
<u>with</u> the lesion. "<img src=""Screen Shot 2018-08-12 at 9.54.36 PM.png"" />"
If the QRS complex is <b>{{c3::positive}}</b> in <b>lead {{c1::I}}</b>&nbsp;the
mean QRS vector is pointing towards the <b>{{c2::left}}</b>"<img src=""Screen Shot
2018-08-12 at 9.58.32 PM.png"" />"
If the QRS is {{c2::negative}} in lead I, it is termed <b>{{c1::right axis}}
deviation</b> "because depolarization wave is negative it means the wave is
pointing right/away from lead I + charge<div><img src=""Screen Shot 2018-08-12 at
10.00.02 PM.png"" /></div>"
Right axis deviation is best detected in <b>lead {{c1::I}}</b>
In <b>lead {{c3::AVF}}</b>, the <b>{{c2::positive}}</b> charge is on the
<b>{{c1::left foot}}</b> "<img src=""Screen Shot 2018-08-12 at 10.02.33
PM.png"" />"
QRS is <b>{{c2::positive}}</b> in the <b>{{c3::AVF}}</b> <b>lead</b> because QRS
vector points <b>{{c1::down}} </b>&amp; <b>left</b> "<img src=""Screen Shot 2018-
08-12 at 10.04.41 PM.png"" />"
If the QRS is <b>{{c2::negative}}</b> in the <b>{{c3::AVF}} lead</b>, the
depolarization wave is moving&nbsp;{{c1::<b>upwards</b>&nbsp;(cephalic)}} "<img
src=""Screen Shot 2018-08-12 at 10.05.38 PM.png"" />"
If the QRS is <b>{{c2::positive}}</b> in <b>leads {{c1::I}} </b>&amp;
<b>{{c1::AVF}}</b>, the axis is considered normal
If the QRS vector is <u>negative</u> on <b>{{c2::AVF}}</b> and <u>positive</u> on
lead I, it is a <b>{{c1::left axis}} deviation</b> "<img src=""Screen Shot 2018-
08-12 at 10.07.51 PM.png"" /><div><img src=""Screen Shot 2018-08-12 at 10.08.24
PM.png"" /></div>"
Negative QRS in <b>AVF</b> and negative QRS in <b>lead I</b> indicate
<b>{{c1::extreme right axis}}</b> deviation "<img src=""Screen Shot 2018-08-12
at 10.08.59 PM.png"" />"
When depolarization moves <b>{{c2::perpendicularly}} </b>to a lead, the QRS complex
is <b>{{c1::isoelectric}}</b> "<img src=""Screen Shot 2018-08-12 at 10.43.59
PM.png"" />"
<b>{{c2::Isoelectric}}</b> <u>QRS complexes</u> indicate that depolarization moves
as much <b>{{c1::toward}} </b>the lead as much as it moves <b>{{c1::away from}}
</b>the lead
The <b>{{c5::P wave}}</b> generally points <b>{{c6::downward}}</b>, towards the
positive <b>{{c1::inferior}}</b> electrodes - leads <b>{{c2::AVF}}, {{c3::II}} and
{{c4::III}}</b> "<img src=""Screen Shot 2018-08-12 at 10.54.37 PM.png"" />"
The <b>{{c2::P}} wave</b> generally points left, meaning it will be positive in
<b>{{c1::AVF}}</b>&nbsp;and&nbsp;<b>&nbsp;{{c1::lead I}}</b>
Inverted <b>P waves</b> in leads I or AVF generally indicate P' depolarization from
a <b>{{c1::low atrial}} focus</b> or <b>{{c2::retrograde}}</b> from the<b>&nbsp;
{{c2::</b><b>AV</b>}}&nbsp;node
Most premature <b>{{c2::ventricular}}</b> contractions induce depolarization in a
general <b>{{c1::bottom-upward}}</b>&nbsp;direction Most premature ventricular
contractions originate from a peripheral focus in the ventricles
<b>{{c2::Chest}} leads</b> measure vectors in the <b>{{c1::transverse
(horizontal)}} plane</b> "<img src=""Screen Shot 2018-08-13 at 11.36.59
AM.png"" />"
The axis <b>deviates</b>&nbsp;in the {{c1::frontal}} plane, but
<b>rotates</b>&nbsp;in the {{c1::horizontal}} plane
The positive electrode in V₂&nbsp;is located on the <b>{{c1::anterior}}
</b>chest "at the <b>left sternal border</b><div><b><img src=""Screen Shot 2018-
08-13 at 11.49.33 AM.png"" /></b></div>"
The QRS complex in <b>lead II</b> is normally {{c1::negative}}&nbsp; "<div>left
ventricle is pointed posteriorly - so depolarization points towards
the...back</div><img src=""Screen Shot 2018-08-13 at 12.18.36 PM.png"" /><img
src=""Screen Shot 2018-08-13 at 12.16.11 PM.png"" /><div><br /></div>"
<b>Lead {{c2::V₂}}</b>&nbsp;projects directly through the <u>anterior
and posterior</u>&nbsp;walls of the <b>{{c1::left}} ventricle</b> "<div>Thus,
V₂&nbsp;is the best lead to determine anterior and posterior infarctions
of the left ventricle</div><img src=""Screen Shot 2018-08-13 at 12.18.36
PM.png"" />"
Which lead is best for detecting <u>anterior/posterior</u> <b>infarctions</b> of
the left ventricle?&nbsp;<div><br /></div><div><b>{{c1::V₂}}</b></div>
infarctions should be inspected on <b>right chest leads</b>&nbsp;because they
can reveal subtle LV infarcts
The <u>QRS complex</u> is&nbsp;most<b> {{c2::isoelectric}}</b>&nbsp;in
lead&nbsp;<b>{{c1::V₃}}&nbsp;&amp;&nbsp;{{c1::V₄}}</b> known
as the <b><i>transitional zone</i></b>
<b>Rightward</b> rotation occurs when the net <u>{{c1::QRS vector}}</u> rotates to
the <b>right</b> "<div>conversely is leftward rotation</div><img src=""Screen Shot
2018-08-13 at 12.48.55 PM.png"" />"
Lead&nbsp;{{c1::V₁&nbsp;}}&nbsp;is directly over the
<b>{{c2::atria::part of heart}}</b> <!--anki-->Atrial hypertrophy is typically due
to&nbsp;<b>dilation&nbsp;</b>of the atrium, so the term atrial enlargement is used
Which lead is most useful when assessing <u>atrial enlargement</u>?
&nbsp;<div><br /></div><div>{{c1::V₁}}</div>
In atrial {{c3::enlargement}}, the<b> {{c2::</b><b>P</b>}}&nbsp;wave is typically
<b>{{c1::diphasic}}</b> "<img src=""Screen Shot 2018-08-13 at 1.00.20 PM.png"" />"
If the&nbsp;<b>{{c1::1^st}}&nbsp;part</b>&nbsp;of a <u>diphasic P
wave</u> is larger, the <b>{{c2::right}} atrium</b>&nbsp;is enlarged. "<img
src=""Screen Shot 2018-08-13 at 1.02.17 PM.png"" />"
If the&nbsp;<b>{{c1::2^nd}}&nbsp;part</b>&nbsp;of a&nbsp;<u>diphasic P
wave</u>&nbsp;is larger, the&nbsp;<b>{{c2::left}} atrium</b>&nbsp;is enlarged.
"<img src=""Screen Shot 2018-08-13 at 1.03.16 PM.png"" />"
Left atrial<b> {{c2::enlargement}}</b> is most commonly due to <b>{{c1::systemic
hypertension}}</b>, but can be caused by <b>{{c3::mitral valve}} stenosis</b>
"<img src=""Screen Shot 2018-08-13 at 1.03.16 PM.png"" />"
Why is the <b>S wave</b> large in V₁?&nbsp;<div><br
/></div><div>{{c1::QRS depolarization points posteriorly and leftward --&gt; the
wave is pointing away from V₁}}</div>
In <u>{{c3::right}}</u> ventricular hypertrophy, there is a large <b>{{c1::R}}
wave</b>&nbsp;in&nbsp;{{c2::V₁}} "<div>there's more depolarization
in the R ventricle due to increased mass --&gt; positive QRS complex</div><img
src=""Screen Shot 2018-08-13 at 1.17.10 PM.png"" />"
With {{c2::right ventricular}} hypertrophy, there is a large R wave in
lead&nbsp;<b>{{c3::V₁}}, </b>that becomes progressively smaller in chest
leads&nbsp;<b>{{c1::V_2&nbsp;- V₄}}</b> "<div>enlarged RV
adds more vectors towards the right side --&gt;&nbsp;</div><div>- right axis
deviation in frontal plane&nbsp;</div><div>- rightward rotation of the QRS vector
in the transverse plane</div><img src=""Screen Shot 2018-08-13 at 1.23.59
PM.png"" />"
In {{c1::left ventricular hypertrophy}}, there is a steep <b>{{c2::R}} wave</b> in
lead&nbsp;{{c3::V₅&nbsp;}}and a steep <b>{{c2::S}} wave</b> in
lead&nbsp;{{c3::V₁}} "<div>there is left axis deviation as well as
leftward displacement in the horizontal plane<img src=""Screen Shot 2018-08-13 at
1.36.25 PM.png"" /></div>"
If S wave in V₁+ R wave in V₅&nbsp;<b>&gt; {{c2::35mm}}
</b>there is {{c1::left ventricular hypertrophy}}_&nbsp; "<img
src=""Screen Shot 2018-08-13 at 1.48.51 PM.png"" />"
{{c4::Left ventricular}} hypertrophy often presents with <b>{{c1::asymmetric}}</b>
{{c2::T}} wave <b>{{c3::inversion}}</b>&nbsp; "<div>T wave has a <u>gradual
downslope</u>&nbsp;with a very steep <b>return to baseline</b>.</div><img
src=""Screen Shot 2018-08-13 at 1.51.10 PM.png"" />"
Depression of the <b>{{c2::ST segment}}</b> is characteristic of
<b>{{c1::ventricular}} strain</b>&nbsp; "- generally a curve or ""hump"" is found
in the middle of the segment<div>- usually associated with
hypertrophy</div><div><br /></div><div><img src=""Screen Shot 2018-08-13 at 2.00.19
PM.png"" /></div>"
e2682416d33b4c389f9487d13d5a9dbf-ao-1 "<img src=""Screen Shot 2018-08-13
at 2.01.11 PM.png"" />" "<img src=""e2682416d33b4c389f9487d13d5a9dbf-ao-1-
Q.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-1-A.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-O.svg"" />"
e2682416d33b4c389f9487d13d5a9dbf-ao-2 "<img src=""Screen Shot 2018-08-13
at 2.01.11 PM.png"" />" "<img src=""e2682416d33b4c389f9487d13d5a9dbf-ao-2-
Q.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-2-A.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-O.svg"" />"
e2682416d33b4c389f9487d13d5a9dbf-ao-3 "<img src=""Screen Shot 2018-08-13
at 2.01.11 PM.png"" />" "<img src=""e2682416d33b4c389f9487d13d5a9dbf-ao-3-
Q.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-3-A.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-O.svg"" />"
e2682416d33b4c389f9487d13d5a9dbf-ao-4 "<img src=""Screen Shot 2018-08-13
at 2.01.11 PM.png"" />" "<img src=""e2682416d33b4c389f9487d13d5a9dbf-ao-4-
Q.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-4-A.svg"" />" "<img
src=""e2682416d33b4c389f9487d13d5a9dbf-ao-O.svg"" />"
<b>{{c1::Infarction}}</b> of ventricular tissue can produce <b>fatal
{{c2::arrhythmias}}</b> due to irritation of nearby automaticity foci in the
ventricles.
<b>Necrotic, infarcted</b> areas of the heart are unable to {{c1::depolarize}}
produces an electrical void
Cardiac {{c2::ischemia}} is characterized by <b>inverted {{c1::T}} waves</b> "<img
src=""Screen Shot 2018-08-13 at 2.20.21 PM.png"" /><div><img src=""Screen Shot
2018-08-13 at 2.21.35 PM.png"" /></div>"
T wave <b>{{c2::inversion}} </b>is characteristic of cardiac {{c1::ischemia}}
"<img src=""Screen Shot 2018-08-13 at 2.21.35 PM.png"" />"
What clinical finding is often associated with transient T wave inversion?
<div><br /></div><div>{{c1::angina}}</div> "<img src=""Screen Shot 2018-08-13
at 2.21.35 PM.png"" />"
T wave inversion in <u>infarction</u> is <b>{{c1::symmetric}}</b> "on
V₁&nbsp;- V₆&nbsp;<div><img src=""Screen Shot 2018-08-13 at
2.21.35 PM.png"" /></div>"
T wave inversion in leads&nbsp;<b>{{c1::V₂&nbsp;}}-&nbsp;
{{c1::V₆&nbsp;}}</b>&nbsp;is <u>always</u> <i>pathologic</i> -
indicative of infarction<div>- normal variants in limb leads have non-existent T
waves or minmal inverison</div>
Marked T wave inversion in&nbsp;{{c2::V₂}}&nbsp;or
{{c2::V₃}}&nbsp;is hallmark of <b>{{c1::wellens}}
syndrome</b>&nbsp;which is stenosis of the {{c3::LAD}} "<img src=""Screen Shot
2018-08-13 at 2.21.35 PM.png"" />"
<b>{{c2::ST segment}}</b> <u>elevation</u> indicates myocardial {{c1::injury}}
"<img src=""Screen Shot 2018-08-13 at 2.28.45 PM.png"" />"
{{c1::ST elevation}} is the earliest sign of <b>{{c2::acute MI}}</b> on EKG
<b>{{c1::Prinzmetal's angina}}</b> can cause transient <u>ST elevation</u> in the
absence of <b>{{c2::infarction}}</b>
<u>ST elevation</u> <b>{{c2::without}}</b> associated Q waves may indicate
<b>{{c1::non-Q-wave}}</b>&nbsp;infarction usually a small infarction that precedes
an impending larger infarct
<b>{{c1::Brugada}} syndrome</b> is a hereditary condition caused by dysfunctional
cardiac&nbsp;<b>{{c2::Na⁺}}&nbsp;channels</b> leading to sudden cardiac
death. "<img src=""Screen Shot 2018-08-13 at 2.39.32 PM.png"" />"
{{c2::Brugada}} syndrome is characterized by <b>{{c3::right bundle branch
block}}</b> <u>with</u> {{c4::ST}} elevation in leads&nbsp;<b>{{c1::V₁-
V_3&nbsp;}}</b> "<img src=""Screen Shot 2018-08-13 at 2.39.32
PM.png"" />"
Elevated <b>ST segments</b> in {{c2::brugada}} syndrome have a characteristic
<b>{{c1::peaked downslope}}</b>&nbsp;shape
<b>{{c1::Flat}} or slightly {{c1::concave}}</b> ST segment elevations are
associated with <b>{{c2::pericarditis}}</b> "- resolves with time<div>-
typically baseline returns gradually down</div><div><br /></div><div><img
src=""Screen Shot 2018-08-13 at 2.54.14 PM.png"" /></div>"
"<img src=""Screen Shot 2018-08-13 at 2.54.14 PM.png"" /><div>The EKG on the
<u>left</u> was taken from <b>{{c2::right chest}} leads</b>, whereas the EKG on the
<u>right</u> was taken from <b>{{c1::inferior/lateral limb}} leads</b></div>"
<b>{{c1::Subendocardial}}</b> infarcts do not extend through the full thickness of
the left ventricular wall
<b>ST {{c3::depression}}</b> can be caused by {{c1::subendocardial}} infarcts,
{{c2::positive}} stress test or digitalis toxicity. positive stress test
indicates CAD
{{c1::Subendocardial}} infarction causes <b>{{c2::flat}} </b>{{c3::ST}} segment<b>
depression</b> "<img src=""Screen Shot 2018-08-13 at 3.05.14 PM.png"" />"
Presence of a significant<b> {{c2::</b><b>Q</b>}}&nbsp;wave indicates
<b>{{c1::necrosis}}</b> of cardiac tissue "<img src=""Screen Shot 2018-08-13 at
3.07.36 PM.png"" />"
"Are the following Q waves significant?&nbsp;<div><br /></div><div><img
src=""Screen Shot 2018-08-13 at 3.07.56 PM.png"" /></div><div><br
/></div><div>{{c1::no}}</div>" insignificant is by definition &lt; 0.04sec
The <b>{{c1::right}} bundle branch</b> travels the entire length of the septum
vertically <u>without</u> branching.
The <b>{{c1::left}} bundle branch</b> gives off terminal purkinje fibers at the
<u>mid-septal</u> level
If a <b>{{c1::Q}} wave</b> is at least {{c2::1 small square}} wide, it is
significant and indicates myocardial <b>{{c3::necrosis}}</b>. "<div><img
src=""Screen Shot 2018-08-13 at 3.10.42 PM.png"" /></div>"
Significant <u>Q waves</u> will be found in <b>{{c2::anterior}} infarction</b> on
leads&nbsp;<b>{{c1::V₁-V₄}}</b>
<b>{{c2::Lateral}} infarctions</b> present with significant <u>Q waves</u> on leads
<b>{{c1::I}}</b> and <b>{{c1::AVL}}</b>
<b>{{c2::Inferior}} infarcts</b> present with significant Q waves on leads
<b>{{c1::AVF}}</b>, <b>{{c1::II}}</b> and <b>{{c1::III}}</b>
Q waves in&nbsp;<b>{{c2::V₁}}&nbsp;-&nbsp;
{{c2::V₄}}</b>&nbsp;indicate <b>{{c1::anterior}}</b> infarction "<img
src=""Screen Shot 2018-08-13 at 3.16.50 PM.png"" />"
<b>{{c1::Insignificant}}</b> Q waves are seen normally in V₅&nbsp;&amp;
V₆
<u>Lateral infarction</u> refers to infarction of the <b>lateral {{c1::left}}
ventricle</b>
"<div>The following is an example of an <b>{{c1::anterior
infarction}}</b></div><div><b><br /></b></div><div><b>How do you know?
&nbsp;</b></div><div><b><br /></b></div><div>{{c2::depolarization cannot pass
through ant. ventricle so net vector is negative (away) from leads
V₁&nbsp;and V₂}}</div><img src=""Screen Shot 2018-08-13 at
3.22.53 PM.png"" /><div><br /></div>"
In acute {{c3::posterior}} infarction, there is a large<u>
{{c2::</u><u>R</u>}}&nbsp;wave in
leads&nbsp;<b>{{c1::V₁}}</b>&nbsp;and&nbsp;<b>{{c1::V₂}}</b>
"<img src=""Screen Shot 2018-08-13 at 3.25.03 PM.png"" />"
In acute <u>{{c2::posterior}}</u> infarctions, there
is&nbsp;ST&nbsp;<b>{{c1::depression}}</b>&nbsp;with {{c3::R}} waves on leads
V₁&nbsp;and V₂
In acute&nbsp;<u>{{c2::anterior}}</u>&nbsp;infarctions, there is
ST&nbsp;<b>{{c1::elevation}}</b>&nbsp;with {{c3::Q}} waves on leads
V₁&nbsp;and V₂
When looking for signs of <u>{{c2::infarction}}</u>, pay special attention to
leads&nbsp;<b>{{c1::V₁}} </b>&amp;&nbsp;<b>{{c1::V₂}}</b>
<u>Infarction</u> cannot be appropriately diagnosed in the setting of <b>{{c1::left
bundle branch}} block</b> -&nbsp;In&nbsp;<b>left bundle branch block</b>, the
left ventricle depolarizes after the right<div>- masks any Q waves that would be
present&nbsp;<div>- why infarction can't really be diagnosed in the setting of
LBBB</div><div>- exception IV septum infarction would produce Q waves at the
beginning of the wide QRS</div></div>
<b>{{c1::Hemiblocks}}</b> are due to loss of blood supply to either the
<u>anterior</u> or <u>posterior</u> division of the
<b>{{c2::left}}&nbsp;</b><b>bundle branch</b>
<b>{{c1::LAD}}</b> occlusion can cause <b>{{c2::right}}</b> bundle branch block
with <b>{{c3::anterior}}</b> hemiblock&nbsp; "anterior hemiblock - block of
anterior division of the L bundle branch<div><img src=""Screen Shot 2018-08-13 at
3.37.03 PM.png"" /></div>"
{{c2::Anterior}} hemiblock is due to {{c1::LAD}} occlusion "block of the Ant branch
of left bundle<div><img src=""Screen Shot 2018-08-13 at 3.40.36 PM.png"" /></div>"
{{c3::Anterior}} hemiblock is associated with a Q wave in lead
<b>{{c1::I}}</b>&nbsp;and a prominent S wave in lead<b> {{c2::III}}</b> "<img
src=""Screen Shot 2018-08-13 at 3.40.36 PM.png"" />"