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Critical Care Cardiac Exam–Questions & Solutions
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Critical Care Cardiac Exam–Questions & SolutionsName the main waves noted on an ECG ✔️Ans - P wave, QRS Complex, T
Wave, PR interval, QT interval
What does the P Wave Represent ✔️Ans - Atrial Depolarization
What could cause P Wave abnormalities ✔️Ans - Atrial Flutter, Atrial
Fibrillation, SA node not firing, Ventricular ectopic beats firing over SA node
What would you expect if you noted P-wave inversions? ✔️Ans - ectopic
atrial beats, junctional rhythms
What would you expect if you noted tall, peaked p-waves? ✔️Ans - Atrial
enlargement, pulmonary hyperension
What would you expect if you noted rapid, squiggly "p-waves" before each
QRS complex? ✔️Ans - Atrial fibrillation - the atria are not fully depolarizing
and are "quivering" as a result of rapid ectopic beats
What would you expect if you not 1-4 sawtooth type p'waves before each QRS
complex? ✔️Ans - Atrial flutter - the atria are depolarizing repeatedly and
rapidly and the AV node is only allowing every few depolarizations through
What would you expect if you saw no p-waves, or p-waves that were inverted
before or after the QRS ✔️Ans - Junctional rhythms - the junctional bundles
are producing contractions OVER the SA node or in place of the SA node
What is the PR interval? ✔️Ans - The amount of time from the beginning of
atrial depolarization through the beginning of ventricular depolarization
What may cause a lengthened PR interval? ✔️Ans - Heart blocks, which
mean that the conduction from the SA node to the AV node is either going very
slow or being blocked completely
What is the QRS complex? ✔️Ans - Ventricular depolarization, beginning at
the septum and then moving from the inside of the heart to the outer muscle
,What sort of QRS abnormalities may occur? ✔️Ans - Narrowing, widening,
inversion
What would you expect if you noted a very narrow QRS complex? ✔️Ans -
Atrial Flutter, Junctional Tachycardia (Beats are supraventricular in origin)
What would you expect if you noted a very wide QRS complex? ✔️Ans -
Ventricular Tachycardia, bundle branch block
What would you expect if you noted a very tall "R" within the QRS? ✔️Ans -
Left ventricular hypertrophy
What would you expect if you noted an inverted QRS wave? ✔️Ans -
Premature Ventricular Contraction (originates from ectopic beat within the
ventricle)
What is a normal heart rate? ✔️Ans - 60-100 BPM
What is sinus bradycardia? ✔️Ans - A regular rhythm that occurs at a rate of
<60 BPM
First line treatment: Atropine (Anticholinergic) 0.5 mg q3-5 min up to 3mg
Causes: Heart tissue damage (MI), HTN, Sinus node firing slowly, AV block
What is sinus tachycardia? ✔️Ans - A regular rhythm that occurs at a rate of
>100 BPM
First line treatment: Adenosine 6mg, then 20mL NS, then 12 mg, IVP FAST
Causes: Rapid firing of SA node, fever, hypoxia, stimulant drugs, heart failure,
valvular disorders
What is ventricular tachycardia? ✔️Ans - A fast, regular heart rhythm that
results from ectopic beats in the ventricles.
ECG: Rapid, wide QRX with no notable p waves, >100BPM
,Causes: Heart disease (MI, cardiomyopathy, ventricular hypertrophy)
Electrolyte imbalances (hypokalemia), stimulant drugs
Treatment (if stable): If patient has pulse: Oxygen supplementation, vagal
maneuvers, adenosine, beta-blockers if rate is irregular
What is ventricular fibrillation? ✔️Ans - A rapid, irregular heart rhythm that
results from ectopic beats in the ventricles. This rhythm is life threatening,
ventricles are NOT contracting, no cardiac output or pulse.
Causes: Heart attack (heart not getting enough blood), cardiomyopathies,
heart surgery, narrowed coronary arteries
ECG: Rapid squiggles with little formation, irregular
Treatment: ACLS is necessary. Shock should be administered as soon as
possible. Epinephrine is given first, Vasopressin may be given as a second
dose of epinephrine. CPR is preformed, only stopping for shocks. Amiodarone
is given if Vasopressors and shocks do not convert rhythm.
What is Atrial Flutter? ✔️Ans - An SA node arrhythmia occurring when the
Atria contract faster than the ventricles
ECG: "Sawtooth" P-waves will proceed each QRS at a regular rate. There may
be 1, 2, 3 or 4 P waves proceeding each QRS, as the AV node blocks some
depolarizations
Causes: Heart attack, valvular abnormalities (mitral valve stenosis may cause
stretching of the L Atria, leading to flutter or fibrillation), heart failure (as
blood accumulates in the heart)
Treatment: Atrial flutter can cause blood clots and increase the strain on the
heart as it is beating at a fast rate. Treatment to return to normal sinus rhythm
is indicated. IV Calcium Channel Blockers or Beta Blockers will slow the rate of
depolarization and help return to normal sinus. Cardioversion may be
indicated if drugs are unsuccessful. Anticoagulation therapy will be necessary
for atrial flutter lasting > 48 hours.
, What is atrial fibrillation? ✔️Ans - Atrial fibrillation is a rapid, irregular
rhythm caused by ectopic beats in the atria
ECG: An irregular, rapid rhythm with no identifiable P-Waves. The p-wave is
replaced with a squiggly wave, representing the rapid and ineffective
electrical activity in the atria. QRS waves will be narrow and will exist
intermittently along the atrial fibrillation line.
Causes: Hypertension, MI, coronary artery disease, valvular disease (mitral
valve stenosis especially), sick sinus syndrome, stimulants
Treatment: Treatment includes preventing blood clots and slowing the
conduction and rate of the heart. Beta blockers, calcium channel blockers, and
digoxin may be used to control the heart rate. Cardioversion may be indicated.
What is a Premature Ventricular Contraction (PVC)? ✔️Ans - A heart beat
that originates in the ventricles due to an ectopic stimulation, occurs out of
sync with regular heart heart rhythm.
Causes: Heart disease, heart injury, chemical imbalances, stimulant drugs
ECG: PVCs will not be preceded by a p-wave, and will be irregular in
appearance, and wide. They may be inverted. There is usually a compensatory
pause after the PVC.
Treatment: Solitary PVCs are common and do not require treatment. If more
than 3 PVCs occur in a row, it is a run of tachycardia. This will likely be treated
with the use of a beta-blocker or possibly an anti arrhythmic such as
amiodarone.
What is a junctional rhythm? ✔️Ans - A heart rhythm originating from the
tissue surrounding the AV node. These may occur randomly and cause
tachycardia, or may occur in response to SA node failure.
ECG: The p wave will be missing or will be inverted before or after the QRS.
The QRS will be narrow, rate will be SLOW 40-60 BPM. If the rhythm is fast, it
may be an accelerated junctional rhythm (a common symptom of digitalis
toxicity).
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