BRTP10 Electrocardiograms Flashcards
ECG or EKG
Electrocardiogram- tracing the hearts electrical activity (depolarization and repolarization)
When is ECG needed?
Symptoms of heart disease Chest pain Shortness of breath Dyspnea with palpitations Weakness, lethargy Syncope Preoperative screening
What does an EKG measure?
Cardiac electrical activity
Depolarization and repolarization of the atria and ventricles
Conductivity pathway of the heart
SA Node AV node Bundle of HIS Bundle branches Purkinje fibers
HR range of SA NODE
60-100
HR range of AV node
40-60
HR range of bundle branches
30-40
Hr range of purkinje fibers
30-40
What happens if sympathetic nervous system is stimulated
HR speeds up
What happens if parasympathetic nervous system is stimulated?
Hr slows
What does a p wave represent
Atrial depolarization (contraction)
What does QRS complex represent?
Ventricular depolarization and atrial Repolarization
What does t wave represent?
Ventricular repolarization
What is a segment?
A portion of baseline (straight line)
What is an interval
Contains at least one WAVE
What do 3 leads and 5 leads do?
Monitor heart
What does a 12 lead do?
Diagnositics
12 different angles
Placement for a 3 lead?
RA white
LA black
LL- red
white on right, smoke over fire
5 lead placement
Same as 3 except brown is added on chest and green is added on right lobe
Remember grass is green and low
5 step approach to ECGs analysis
Heart rate Rhythm P wave Pr interval Qrs complex
How many seconds is a small box?
0.04 seconds
How many seconds is a large box?
0.2 seconds
Normal sinus rhythm (NSR)
Everything is normal
Sinus bradycardia
Rhythm is regular, but slow
Sinus tachycardia
Regular rhythm, but fast
Arrhythmia
An abnromal heart rhythm
What is the duration of a PR interval?
0.12-0.2 seconds (3-5 little boxes)
Increased heart interval indicates what?
A heart block
How long is a QRS interval
0.1 seconds (less than 2.5 little boxes)
Tall t waves
Hyperkalemia
Flat t waves
Hypokalemia
Inverted t waves
Low k, ischemia
What is artifact
Interference seen on the monitor or ECG strip
4 causes of artifact
Movement
Loose electrodes (fuzzy baseline)
Improper grounding
Faulty ecg apparatus
ST depression indicates what
Ischemia
ST elevation indicates what?
Heart attack (myocardial infarction)
5 components of ecg strip
HR Rhythm P wave Pr interval Qrs complex
How long is a PR interval
0-12-0.2 seconds
How long is a QRS complex
0.1 seconds
Normal sinus rhythm
Rate 60-100
Sinus bradycardia
Rate less than 60
Slow but regular rhythm
P, qrs, T wave all normal
Causes: physical finess, medications, heart block/ damage
Sinus tachycardia
Rate greater than 100, less than 150
Fast but regular rhythm
P, qrs, t wave all normal
Causes: exercise, smoking, anxiety, fever, acute hypoxia, pain
Premature ventricular contraction
PVC
Wide, bizarre, greater rhan .10 seconds
No p wave
Irritability of ventricles
Monomorphic
All PVC look the same and come from same site
Polymorphic
Look different, coming from two or more irritable areas in the ventricles
Ventricular tachycardia
3 or more consecutive PVCs
QRS wide and irregular
HR generally 120-200
Life threatening always check pulse
Looks like long fangs
More characteristics of ventricular tachycardia
No pwaves
No pr interval
Abnormally wide QRS ( greater than .10 secs)
Ventricular fibrillation
Quiver
Not organized, irregular
Chaotic pattern
No cardiav output/ no pulse
Treat with cpr and defibrillation
think small jagged teeth with no pattern
Asystole
Absence of any cardiac electrical activity
Treat with CPR only
Pulseless electric activity (PEA)
Pattern on monitor appears organized and regular
No pulse or cardiac output
CPR only
Atrial flutter
Sawtooth
Atria rate of 250-300 times/ min
P wave flutters and QRS regular
Atrial fibrillation
Irregularly, irregular
QRS complex will be irregular
P wave will have extremely wavy pattern
Halter monitoring
Patient wears monitor 24-48 hours
Used in cases where has irregular heart rhythm but wont show up on regular EKG
When do you use defibrillation?
When patient doesnt have a pulse and is in Ventricular fibrillation or pulseless v tach
When to use cpr
V tach without pulse
Ventrical fibrillation
Asystole
Pulseless electrical activity
What arrhytmias (dysrhytmias) are associated with acute hypoxia
Tachycardia
What arrhytmias (dysrhytmias) are associated with severe hypoxia
Bradycardia