CARDIAC RHYTHMS Flashcards
What does the P wave on an ECG represent?
Atrial Depolarization _ When the Atria are ready to pump blood into the ventricles as the SA node sends its charge to AV node
What does the QRS Waves Represent on an ECG?
Ventricular Depolarization three distinct waves created by the passage of the cardiac electrical impulse through the ventricles and occurs at the beginning of each ventricular contraction.
What occurs during the P-R Interval?
Ventricles are filling with blood prior to pumping Should be shown as a “flat line” on ECG
How would a decreased perfusion be shown on an ECG?
Prolonged QRS Complexes
What does the T wave on an ECG represent?
Ventricular repolarization
An Inverted T Wave could be indicative of: A/ Hypocalcemia B/ Hypokalemia C/ Hyponatremia D/ Hypoxia
B/ Hypokalemia Low K+ levels
What does and Elevated ST segment on an ECG mean?
Myocardial infarction
What does and depressed ST segment on an ECG mean? How do you treat this?
Ischemia or decreased workload Apply O2
This occurs during sleep, in fine-tuned athletes and is common in MIs.
Sinus Bradycardia
What are treatment options for Sinus Bradycardia?
Pulse Oximeter Give O2 if needed IV access Obtain 12-lead ECG Atropine
How does Atropine treat sinus Bradycardia?
Blocks the vagus nerve which stops the heart from slowing down. It also increases sympathetic NS activity
What is Sinus Tachycardia?
When the SA Node in the atria are firing at abnormally fast rate for patient age. typically 100-180 bpm
What is Sinus Arrhythmia?
SA Node fires irregularly
Differentiate between Respiratory Sinus Arrhythmia and Non-Respiratory Sinus Arrhythmia.
Respiratory - Associated with the phases of breathing in intrathoracic Non-respiratory - *Typically common in heart disease *Common after inferior wall MI *May be seen with increased intracranial pressure *May be result f meds
What does Supraventricular Tachycardia mean?
Increased rhythms in the Atria (Above the Ventricles Can begin in the: *SA Node *Atrial Tissue *AV Junction
What does Ectopic Atrial Tachycardia mean?
Increased Atrial Rhythm that does NOT Originate in the SA node.
What are some symptoms of Atrial Tachycardia?
*SOB *Altered LOC *Syncope *Weakness *Chest pain *Hypotension
What treatment would you provide a stable patient with atrial tachycardia?
*O2/Oximeter *Vitals *Establish IV *Apply Cardiac Monitor *Obtain 12-lead ECG *Vagal Maneuvers *Adenosine
What does Adenosine Do to Atrial Tachycardia?
Interrupts reentry pathways that involve the AV node. Slows conduction of heart.
What are Vagal Maneuvers?
Slows HR by: Gagging Holding Breath Bearing Down Coughing
How would you Treat a patient with unstable Atrial Tachycardia?
*Apply O2/oximeter *Establish IV access *Administer sedation *Synchronized cardioversion
What is Synchronized Cardioversion?
Delivery of electric shock to the heart timed at the QRS complex
This appears as a swa-tooth pattern on an ECG and is typically 250-450bpm
Atrial Flutter
what is Atrial Fibrillation? How does it increase the risk of Stroke?
Failure of Atria to properly/effectively contract, resulting in a decreased ventricular rate. Stroke risk increases as blood pools in the atria forming clots which can travel to the brain via the Aorta.
The assessment acronym for assess A-fib is A.T.R.I.A. What does it stand for?
A - Asymptomatic? T - Trend in HR? R - Reported Syncope? I - Incidents of Chest pain? A - Altered LOC?
What is the pace of the ventricular system if you SA and AV node cease firing?
20-40 bpm
What is the pace of the AV node if the SA node stops firing?
40-60 bpm
What is the difference between a complete and partial heart block?
Partial - All impulses are slowed and take longer or are intermittent were some impulses are not conducted Complete - No impulses are conducted through affected area
Looking at a patient’s ECG, you notice their PR interval is 0.29 seconds, and 2.3mm tall and is followed by a QRS complex that is 0.09 seconds long. Which of the following would be a concern?
PR interval is longer than usual. Should be between 0.12-0.20 seconds. NOT 0.29 seconds. *All other values are normal
Ventricular contraction = ______. A/ Repolarization B/ Depolarization C/ Unpolarization D/ Butt Cancer
B/ Depolarization
What does a Peaked T wave mean? What does an inverted T wave mean?
Peaked = Hyperkalemia Inverted = Hypokalemia
Explain what the large box method is in determining Heart Rate.
Counting the number of “large” boxes between R-R intervals and then take 300 and divide it by the number of boxes.
ex. 5 boxes… 300/5= 60 bpm
Which type of heart condition is common among athletes?
Sinus Bradycardia (<60bpm)
A 63 year old patient with a history of Anemia and narcolepsy comes for a routine check-up with the following vitals:
B/P: 134/95
Pulse: 51
Resp.: 16
SaO2: 98%
Temp: 37.1
What should you do?
Nothing.
Although Bradycardic, he is asymptomatic and feeling fine. Monitor and ask if normal HR is low.
A patient comes into the ER with the following vitals:
BP: 194/100
Pulse: 48
SaO2: 94%
Resp. 18
Temp 37.7
What should you do?
*BRADYCARDIC with symptoms
Pulse Oximeter
Give O2 if needed
IV access
Obtain 12-lead ECG
Give Atropine as ordered
What does Atropine do?
Is a Vagolytic drug that increases sympathetic NS activity -> Increasing Heart Rate
A patient comes into the ER in the early stages of shock. Which type of Heart rate/rhythm would you expect to see on an ECG?
Sinus Tachycardia
What may be some causative factors for sinus Tachycardia?
Acute MI
Caffienated beverages
Dehydration/hypovolemia
Drugs
Exercise
Fear/anxiety
Hyperthyroidism
Hypoxia
Infection
Nicotine use
Pain
Pulmonary Embolism
Shock
Sympathetic NS stimulation
How do you treat Sinus Tachycardia?
Treat underlying cause of Sinus Tach.
Ex. Fluid replacement if hypovolemic, Relief of pain, Removal offending substance, reduction of fear.
What are the two types of sinus arrhythmias? Define each
Respiratory Sinus Arrhythmia - Associated with phases of breathing and changes in intrathoracic pressure
Non-Respiratory Sinus Arrhythmia - Not related to ventilation.
If a Patient has a Sinus arrhythmia and is symptomatic, what should to nurse consider doing?
Placing the patient as a Falls risk
What is Supraventricular Tachycardia?
A rhythm that begins the in Atria and is significantly accelerated. P waves are still present, but look different than P waves originating from SA node.
What is Atrial Tachycardia? Where does the impulse originate from?
A series of rapid beats that originate from an Atrial Ectopic focus. This rapid rate overrides the SA nodes and becomes pacemaker.
What is a common presenting symptom of Atrial Tachycardia?
Syncope - due to decreased cardiac output.
Why would you give Adenosine to a patient with Atrial Tachycardia?
Adenosine is an antiarrhythmic that slows the conduction activity in the heart = decreasing HR
What is one treatment option that you would only perform on an unstable patient with Atrial tachycardia?
Synchronized cardioversion
What is this rhythm? How would you treat your patient if they have signs of hemodynamic compromise?
Atrial Flutter
Tx: Cardioversion
What is happening on this ECG? What is this patient at an increased risk for? Why?
A-Fib
Increased risk of stroke due to poor emptying of blood from Atria that causes pooling -> increased risk of clot formation which could travel to the brain.
A patient comes to the ER feeling “sick”. Upon further investigation, you find the following results:
HR: 67 -*Irregular
BP: 115/69
SaO2: 92%
Resp.: 18
Temp: 36.8
pH: 7.24
K+: 6.9 mmol/L
Preventricular Contraction.
- Normal HR, but with an irregular beat (QRS mis-fire)
- Electrolyte imbalance is a common indicator of PVCs
- Patient is relatively “stable” (no hyperventilation, injury, chest pain, fever, etc.)
What does the assessment Acronym for A-Fib mean?
A.T.R.I.A
A - Asymptomatic?
T - Trend in HR? - may vary in rate/regularity
R - Report syncope, especially orthostatic
I - Incidents of chest pain?
A - Altered LOC?
What is the next course of action if your A-Fib-ing patient has been cardioverted but doesn’t respond to the treatment?
If Cardioversion fails, the next course of action would be to control their HR and keep it below 100 bpm
What is occuring on this ECG?
Normal Sinus Rhythm with Preventricular Contraction
*Specifically a Uniform PVC because the QRS complexes appear the same and therefor original from the same area.
What are some potential complications for NSR PVCs?
If the PVC occurance increases, a risk of V-Tach or V-Fib can occur
A spanish midget comes onto your Cardiac floor with a PVC. What would you expect to find on her MAR?
A/ Amiodarone
B/ Amlodipine
C/ Digoxin
D/ Lidocaine
E/ Coumadin
F/ Adenosine
A/ and D/ are correct
(AMIODARONE and LIDOCAINE for PVCs)
What does this ECG reading represent? What do you do if your patient is stable BUT symptomatic?
Ventricular Tachycardia
Tx:
O2
IV access - ventricular anti-arrhythmics (Amiodarone)
Closely monitor and ready to Shock if unstable (prn)
What are your treatment options for this patient? What do they suffer from?
V-Fib
Tx:
CPR -> until Defibrillator available
Epinephrine, Amiodarone
Hank is a Jew who came into your ER with Asystole. What up with Hank?
Hank is Dead.
Ø Ventricular activity or impulses
Tx: Defibrillation (Possibly), Epinephrine.
But he gone. He dead.
What occurs during 1st degree Heart block?
A delay occurs between impulse condutions and contraction of ventricules.
*Note the distance between the P wave and the QRS complex
Differentiate between Type I and II 2nd Degree heart block.
Type I: Intermittent pulse condution with a gradually lengthening P wave - QRS complex
Type II: Occaisonally the SA Node fires (P wave)and no QRS complex occurs.
OR
SA Node fires and produces Ø QRS complex, fires against and produces QRS. 2:1 ratio of firing (QRS occurs every other P wave)
What occurs during 3rd Degree Heart Block?
Complete Disinct between SA Node and Ventricles. Both Firing on their own terms.
NO DISCERNABLE RELATIONSHIP BETWEEN P WAVE AND QRS COMPLEX
What is the common treatment of 3rd degree Heart block?
PACE MAKER
Name this rhythm and what is going on.
Idioventricular Rhythm (IVR)
Occurs when either SA or AV nodes are not firing so the Ventricular act as pacemaker and fire at the ventricular rate (20-40 bpm)
EMTs coming rushing into the ER with Mrs. Cockgobbler who is lying on a stretcher. You see this on her ECG…. WHAT DO YOU DO?
FIRE Your EMTs because this is a Normal SInus rhythm.
What is happening on this ECG?
Sinus Arrest
The SA node fails to fire and causes a pause in activity. NOT to be confused with a Heart block, because there is an absense of P waves.
Mr. Dickleson comes into the ER and you hook his fat ass up to an ECG and find the following results. What’s going on?
Sinus Arrhythmia
*Note all the Waves are present, but the rate changes. Rate changes are typically synched with respirations.
Kevin, a third year basket-weaving student from York University comes onto your floor and you notice this peculiar rhythm on his ECG. What up wit Kev?
Kevin has an Atrial Pacemaker
*Pacemakers provide a noticeable “Spike” on ECGs, and depending on spike location can give away where it is located.
Llyod Vagini, is a bread-making Italian immigrant, who came to the floor with some minor aches. His ECG shows this… What is going on?
Wandering Pacemaker
*Note the changing P Wave. Sometimes they are upright and normal (SA node), sometimes they are zig-zaged, and sometimes they are inverted. P Wave shape signifies it’s location on the heart. The higher up on the heart the more elevated the P wave. If the P wave is inverted, the signal may be coming from well below the SA node.
Madame Helen Bitchler is a French Teacher for primates at the Toronto Zoo. She is admitted to the ER with significant findings on her ECG. What is going on with Helen?
Junctional Tachycardia
Junctional means that the impulse conducting the Ventricles is coming from the AV node (Junction of the heart). It is tachycardic because… well… it’s tachycardic.
To tell it is junctional, look where the P wave should be and you will not find it, or find an inverted P wave (Suggesting the signal came from elsewhere).
Lars Von Lhabian is a Danish mormon who came to the ER with this Presenting on his ECG. What is wrong with Lars?
Idioventricular Rhythm
Both SA and AV nodes are NOT firing, so the Ventricles take over and conduct themselves because the SA and AV nodes are deadbeat bastards…
Note the rhythm is not considered Bradycardic because Ventricles naturally fire at 20-40bpm
Motti Anafi is an avid Macintosh computer user/dillhole who felt “funny” when looking at old-school egyptian pornography on his computer and decided to go to the ER. He presented this on his ECG. What is his issue aside from being a total Knob-job?
PVC (Preventricular Contraction)
Sinus rhythm is normal, but the Ventricle fires out of sync without a P Wave. QRS typically looks weird in a PVC
