1. Chapter 4 Supraventricular Rythms II

2. Abnormal conduction Initiation of the heart beat occurs in the ventricles. Impulse is spread through the myocardial cells via gap junctions.

3. PVC (pg. 43) Early Wide (>100 ms) 1mm = 40 ms >2.5 boxes Different morphology

4. Uniform and “Multiform” (pg.44) PVCs that look different in the same ECG lead. Multifocal vs. Multiform.

5. Compensatory Pause Vs. Interpolated PVC (pg.44-45)

6. Bigeminy, Trigeminy, Quadregiminy (pg. 46)

7. Couplets, Triplets, VTach (pg.46-47)

8. Short, non-sustained, or self terminating (pg.47) Sustained V-Tach (> 30 seconds) Sustained=MI. Shock treatment, meds. Patient may be awake or no pulse.

9. Torsades de pointes “Twisting of the Points” Looping or shifting of the ectopic beat. Differing appearance than VTach – not as lethal. Cause is electrolyte abnormalities (K+) or medication. Usually begins with a prolonged QT, usually is not sustained for long periods.

10. R on T PVC (pg. 48) Why is this a big deal?

11. Accelerated and Escape Ideoventricular Rythms Wide QRS but rate <100. Pacemakers above AV Node have failed. Not PVCs. Not early beats but escape beats. Very slow HR. Poor Q.

12. Ventricular Fibrillation (Pg. 50-51) Numerous, unorganized, chaotic, rapid depolarizing of the ventricles. No Pulse, no Q. Coarse vs. Fine

13. Agonal Vs. Asystole (pg. 50-51) Agonal – very slow rhythm that proceeds death. Differing pacemakers. Asystole – The absence of electrical activity. No pulse, no Q. Flat line. –Be aware of leads coming off.