ARC Preliminary Review Set #4 EDIT

Sinus Exit Block and __________  are commonly mistaken for each other.  The main difference between the two is that in ___________ the SA node does not demonstrate a regular cadence.  In Sinus Exit Block the SA node does demonstrate a regular cadence.

The characteristic of the ______ 12-Lead is as follows:  1…ST elevation (concave down) in Leads V1,V2,V3 , 2…RBBB-like pattern (pseudo-Right Bundle), 3…Biphasic T-waves in Leads V1,V2,V3.  This pattern is frequently INCORRECTLY interpreted as an acute Anteroseptal MI (STEMI).  This pattern is indeed not an acute MI, but these patients should all be urgently referred to the cardiologist for workup and consideration for AID.

The two qualities which define a vector are magnitude and ________.  The magnitude is determined by the net area under the curve of the QRS complex. In the frontal plane, the directions are indicated by the Hexaxial system vectors.

You have been asked by the Emergency Dept. physician to interpret a Rhythm Strip.  Your analysis reveals the following characteristics: 1…P-wave rhythm is regular, 2…QRS complex is narrow, 3…QRS rhythm is irregular 4…Progressive lengthening of the PR interval til one P-wave dropped (ratio of 5:4 of P to QRS).  The pattern then repeats itself.  The interpretation is ______.

You have been asked by the hospital General Surgeon to interpret a Rhythm Strip. Your analysis reveals the following: 1…P-wave rhythm regular, 2…QRS complex rhythm regular, 3…Ratio of P:QRS is 4:1, 4…The PR intervals are equal when the P-wave is conducted (otherwise the other 3 P-waves are not conducted including one hidden in the QRS-ST complex).  The interpretation is ______________ .

The class “know-it-all” has asked you to interpret a rhythm strip.  Your analysis reveals the following: A long time frame of normal sinus rhythm disrupted by a long pause (a 2 second flatline) followed by an inverted P-wave, then a normal appearing QRS-T complex then a resumption of normal sinus rhythm. Your astute observation is that the P-wave cadence has been disrupted.  Your interpretation is ______________.

The class “know-it-all” challenges you to interpret another rhythm strip. Your analysis reveals the following:   an area of normal sinus rhythm is followed by a long pause ( 2.5 second flatline) followed by a resumption of normal sinus rhythm.  After careful analysis you note that the P-waves fall on a pattern grid (the cadence has not been disrupted).  The inference is that the SA node is discharging regularly but during the long pause is unable to escape and activate the atrial myocardium.  Your interpretation would be ___________________ .

The PAC is an extremely common cause for an irregular rhythm.  If the PAC strikes the AV node during it refractory period, it will not conduct. The rhythm strip will then simply reveal a P-wave (often hidden in the T-wave) with no QRS following.  This is called the /a ___________.  This dysrhythmia does not need treatment.

The following is an electrical/physiological description of the ____________:  Initially the P-QRS waveform is generated in the normal manner (the P-wave will be normal appearing and on time).  The signal travels down the HIS Bundle and to the ventricles, but somewhere during this propagation, an ectopic area in the ventricles discharges.  This ectopic signal will radiate in a wavefront manner…..occurring simultaneously with that of the normal conducting signal. These two signals merge to form this ectopic beat. The PR interval may be normal or short.

If tachycardia is noted on a rhythm strip and of note is that the shape of each P-wave is different, this is best described as _________________ and is frequently associated with COPD.  The treatment will depend on the clinical findings-sometimes requiring no treatment (especially if it is a chronic pattern as revealed by comparison with the old tracing).