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2) Cardiopulm > 10) EKG > Flashcards

10) EKG Flashcards

1
Q

EKG

A

Graphic representation of the electrical impulses of the heart to ID arrhythmias

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2
Q

What is the path of electrical conduction through the heart?

A

SA node–>AV node–>Bundle of HIS–>L & R Bundle Branches–>Purkinje Fibers

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3
Q

What do P waves represent?

A

Atrial depolarization

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4
Q

How should a normal P wave look?

A

Nice & rounded

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5
Q

What follows a P wave?

A

Atrial contraction

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6
Q

What does the PR interval represent?

A

Slowing of conduction through the AV node

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7
Q

What does the QRS complex represent?

A

Ventricular depolarization followed by ventricular contraction

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8
Q

What does the ST segment represent?

A

Initiation of ventricular depolarization

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9
Q

How should the ST segment look?

A

Straight line

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10
Q

On a normal EKG, how should the RR interval be?

A

Regular

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11
Q

Why is a basic understanding of single-lead EKG’s necessary?

A

It can help a PT determine the safety of certain interventions in pt’s w/abn’s

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12
Q

What is a single-lead EKG used for?

A

To detect rate & rhythm abn’s

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13
Q

Can a single-lead EKG detect ischemia?

A

No

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14
Q

Where are single-lead EKG’s most commonly done?

A

*ICU *Step-downs *CPPT rehab

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15
Q

What us a twelve-lead EKG used for?

A

To determine ischemia or infarction

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16
Q

When is a 12-lead EKG ordered?

A

When there’s a change in pt condition or suspected ischemia

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17
Q

V1 & V2

A

Septum

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18
Q

V3 & V4

A

Anterior Left Ventricle

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19
Q

V5 & V6

A

Lateral Left Ventricle

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20
Q

On an EKG, what is indicated by heightened R waves & deeper S waves?

A

Ventricular Hypertrophy

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21
Q

How can ventricular hypertrophy be ID’ed on an EKG?

A

Look for heightened R waves & deeper S waves

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22
Q

True or False:Ventricular hypertrophy can be seen in both healthy & sick pt’s.

A

True

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23
Q

W/what cardiac dysfxns can ventricular hypertrophy be present?

A

LV dysfxn & CHF

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24
Q

On an EKG, what indicates myocardial ischemia?

A

ST depression or T wave inversion w/angina

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25
Q

What is ST depression or T wave inversion indicative of?

A

Myocardial ischemia

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26
Q

On an EKG, what indicates an MI?

A

ST elevation

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27
Q

What is ST elevation indicative of?

A

MI

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28
Q

Is ST elevation a medical emergency?

A

Yes

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29
Q

What length of time is 1 small box equal to?

A

.04sec

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30
Q

What length of time is 1 big box equal to?

A

.20 seconds

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31
Q

What length of time is each tick mark equal to?

A

3 seconds

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32
Q

What is one method of calculating HR?

A

Count # of QRS complexes in 6sec & multiply by 10

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33
Q

What is the square counting method good for?

A

Regular rhythms

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34
Q

How do you do the square counting method?

A

1) 1st thick line after QRS complex is 300 2) Count backwards in the sequence at each thick line (300-150-100-75-60-50) 3) Stop when you get to the next QRS complex. The # you’re at is the HR

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35
Q

Step by step approach for interpreting EKG’s:

A

*Are the RR intervals equal? *Does each beat begin w/a P wave? *Is every P wave followed by a QRS complex? *Is each QRS complex followed by a T wave? *Are the PR intervals equal? *Do all the QRS complexes look the same?

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36
Q

Characteristics of normal sinus rhythm

A

*P waves are constant & upright *Each P wave is followed by a QRS complex *Each QRST is followed by a O wave *PR interval is constant at .12-.2 sec *HR is 60-100bpm

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37
Q

What are T-wave changes indicative of?

A

Hyperkalemia

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38
Q

What do U waves represent?

A

Purkinje repolarization

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39
Q

Are U waves normal to see?

A

Yes but they can also be indicative of hypokalemia, hypercalcemia, & MI

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40
Q

What are Q waves indicative of?

A

Absence of electrical activity so sign of previous MI

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41
Q

What is a widened QT interval indicative of?

A

Impending ventricular arrhythmia

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42
Q

What is a widened QT interval commonly misdx’ed as?

A

Seizures

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43
Q

Dysrhythmia/Arrhythmia

A

Any rhythm other than NSR

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44
Q

Sinus arrhythmia

A

SA node is intact & working

45
Q

Junctional arrhythmia

A

Premature impulses that arise from the AV node or junctional tissue

46
Q

What is the most dangerous location for arrhythmia & why?

A

Ventricle bc it can alter cardiac output

47
Q

Tachyarrythmia

A

HR >100bpm

48
Q

Bradyarrhythmia

49
Q

Ectopy

A

Electrical activity outside of the normal pathways

50
Q

Sinus Tachycardia

A

HR >100bpm

51
Q

What causes sinus tachycardia

A

*Stimulants *Stress *Fever *Hemmorrhage

52
Q

What is the tx for sinus tachycardia?

A

Eliminate the cause & beta-blockers

53
Q

Sinus Bradycardia

54
Q

What causes sinus bradycardia?

A

*Beta-blockers *Incr vagal stimulation *Being a highly trained athlete

55
Q

Sx’s of sinus bradycardia

A

*Syncope *Dizziness *Angina *Diaphoresis

56
Q

Tx for sinus bradycardia

A

Do nothing unless pt is symptomatic *Atropine or pacemaker

57
Q

Sinus Arrhythmia

A

Inconsistent RR intervals

58
Q

What can cause sinus arrhythmia?

A

Normal respiration

59
Q

True or False: Normal respiration can cause sinus arrhythmia.

60
Q

What population is sinus arrhythmia common in?

A

Young/elderly at rest

61
Q

What is sinus arrhythmia associated w/?

A

*Morphine or digoxin toxicity *Infection *Fever

62
Q

Atrial Flutter

A

No true P waves, but rather flutter waves so there will be multiple P waves before every QRS

63
Q

What can cause atrial flutter?

A

*Rheumatic heart disease *Mitral valve disease *Hypoxemia

64
Q

Tx for atrial flutter

A

*Meds (digoxin, verapamil, & beta blockers) *Cardioversion

65
Q

Does atrial flutter effect ventricular rate?

A

Usually not

66
Q

Atrial Fibrillation

A

No true P wave leaving a flat/wavy baseline between QRS complexes & SA node is no longer doing its job so AV node takes over

67
Q

Describe the RR interval seen w/A-fib

A

Regularly irregular

68
Q

What causes A-fib?

A

*Age *Ischemia/Infarction *Stress *CHF *Renal failure

69
Q

Why is A-fib a problem?

A

Bc it can decr CO by 15-30%

70
Q

What is A-fib very dangerous & why?

A

Tachycardia bc it can cause stagnant blood–>Excess coagulation–>Clot

71
Q

Until what point can a pt w/a-fib exercise until?

A

Ventricular rate >120bpm at rest

72
Q

Tx for a-fib?

A

Blood thinners, anticoags, & ablation

73
Q

Heart Block

A

Occurs when cardiac electrical impulse is delayed/blocked w/in the AV node, bundle of HIS. or purkinje system

74
Q

1° Heart Block

A

Delay caused by conduction at the AV node or bundle of HIS so PR interval becomes longer by .2 sec

75
Q

2° (Mobitz 1/Wenckebach) Heart Block

A

Progressive elongation of PR interval followed by a dropped (missing) QRS complex

76
Q

What part of the heart has a problem during 2° (Mobitz 1) heart block?

77
Q

Tx for 2° (Mobitz 1) heart block

A

Nothing unless pt is symptomatic

78
Q

2° (Mobitz 2) Heart Block

A

Normal PR interval but beats are dropped–>Intermittent non-conducted P waves so there’s 2 P waves for every 1 QRS

79
Q

What part of the heart has a problem during 2° (Mobitz 2) heart block?

A

Bundle of HIS or Purkinje Fibers

80
Q

What can 2° (Mobitz 2) heart block progress to?

A

Complete heart block or cardiac arrest

81
Q

Tx for 2° (Mobitz 2) heart block

82
Q

3° (Complete) Heart Block

A

SA node generates impulse, but its not conducted to the ventricles

83
Q

What will 3° heart block look like on an EKG?

A

*Complete lack of relationship between P waves & QRS complexes *Escape rhythms–>2 independent rhythms on EKG *Regular P waves & QRS complex, but variable PR interval

84
Q

What can cause 3° heart block?

A

Ischemia or MI

85
Q

Sx of 3° heart block

A

*Severe bradycardia *Hypotension *Hemodynamic instability

86
Q

Tx for 3° heart block

A

*Electrical pacing by dual chamber artificial pacemaker

87
Q

Premature Ventricular Contractions

A

Ectopic focus generating an impulse from somewhere in the ventricles

88
Q

Regarding PVC’s, when should you be concerned?

A

When a pt has 3 PVC’s in a row or 6 in a minute

89
Q

What can PVC lead to?

90
Q

What can cause PVC’s?

A

*Stress *Caffeine *Nicotine Sensitivity *Electrolyte imbalance *Ischemia *Myocardial Irritation *Cardiac disease

91
Q

Sx’s of PVC’s

A

*Feeling of skipped beat *Anxiety *SOB *Dizziness

92
Q

Tx for PVC’s

A

*Tx underlying cause *Meds *Supplemental O2 for pt’s w/lung disease

93
Q

In pt’s lung disease, what can PVC indicate?

94
Q

Ventricular Tachycardia

A

3+ PVC’s in a row w/HR >120bpm

95
Q

Why does V-tach occur?

A

Rapid firing from a single ventricular focus

96
Q

How can you ID v-tach on an EKG?

A

No P waves & will look like a bunch of PVC’s in a row

97
Q

Non-sustained V-tach

A

Self-termination in <30sec

98
Q

Sustained V-tach

A

V-tach lasts >30sec

99
Q

Causes of V-tach

A

*Ischemia *Acute infarction *CAD *Heart disease *Med rxn to digoxin or qunidine *Athletes w/electrolyte imbalance

100
Q

Sx’s of V-tach

A

*Weak thready pulse *Dizziness *Syncope *Disorientation

101
Q

Tx for V-tach

A

*Immediate pharmacologic intervention *Cardioversion *Defibrillation

102
Q

Torsade de Pointes

A

Unique configuration of V-tach; Twisting of the points around the isoelectric line

103
Q

What is Torsade de Pointes associated w/?

A

Prolonged QT interval

104
Q

Tx for Torsade de Pointes

A

Cardioversion

105
Q

V-Fib

A

Erratic quivering of ventricular musculature–>Multiple ectopic foci firing simultaneously, so there’s no CO

106
Q

On an EKG, what does a vertical spike indicate?

A

Pacemaker activity (V-fib)

107
Q

How does a pacemaker fxn during V-fib & what will it look like on an EKG?

A

1) It emits a pulse when a native P wave or QRS complex isn’t sense w/in a certain amount of time 2)Atrial pacer spikes are seen right before the P wave 3)Ventricular pacing is seen right before the QRS complex

108
Q

What is V-fib almost always associated w/?

A

Cardiac Arrest

109
Q

Tx for V-fib

A

*Always de-fib V-fib *CPR *O2

2) Cardiopulm (16 decks)

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