Cardiac Rhythms

Question 1

An irregularity or disturbance of the normal electrical activity of the heart
abnormal rhythm

Answer 1

dysrhythmia

Question 2

taking a breath causes what type of pressure

Answer 2

negative

Question 3

steps in the cardiac conduction system

Answer 3

1) SA node initiates rate
2) AV node relays atrial impulse to ventricles
3) bundles of His
4) Purkinje fibers- ventricular myocardium

Question 4

one square on EKG paper is how many seconds

Answer 4

0.04 sec and 1 mm

Question 5

needed for the diagnosis of heart muscle damage, enlargement of a cardiac chamber, and interruption of some portions of the cardiac conduction system

Answer 5

12 Lead EKG

Question 6

describe a 12 lead EKG

Answer 6

looks at heart from 12 different angles

Question 7

a print-out of a single lead or view

Answer 7

rhythm strip

Question 8

single lead usually is sufficient for identifying basic

Answer 8

dysrhythmias

Question 9

used for constant 24-hour monitoring in intensive care situations

Answer 9

single leads

Question 10

how do you calculate the rate on an EKG

Answer 10

count R complex in 6 sec strip and multiply by 10

Question 11

easy way to remember telemetry

Answer 11

White on Right, Clouds over Grass; Smoke over Fire and Christmas Tree on the bottom

Question 12

every 15 large blocks is how many seconds

Answer 12

3 sec

Question 13

simple way to estimate rate

Answer 13

from one R to the next how far apart? Each large square

300, 150, 75, 60, 50, 43

Question 14

are small pauses in heart rate normal

Answer 14

yes

Question 15

Dubin’s method can only be used if

Answer 15

the rhythm is regular

Question 16

depolarization of the chambers _____ their contraction

Answer 16

provokes

Question 17

When the heart is resting between “beats”, the EKG machine draws a straight line on the paper

Answer 17

isoelectric line

Question 18

first deflection in the normal cardiac cycle

Answer 18

p wave

Question 19

what does the p wave represent

Answer 19

depolarization of the atria

Question 20

why does the depolarization of the SA node appear on EKG

Answer 20

does not generate enough voltage to be seen on the EKG, we assume it occurred to initiate the cycle

Question 21

After the p wave…

Answer 21

there is a brief return to the isoelectric line, then the QRS complex

Question 22

what does QRS complex represent

Answer 22

depolarization of ventricles

Question 23

does the QRS normally point upwards or downwards

Answer 23

could be either, but all the QRS complexes should be pointed in the same direction

Question 24

what is the duration of the QRS complex

Answer 24

0.04- 0.12 sec or about 1-3 blocks

Question 25

what does the T wave represent

Answer 25

reploarization of ventricles

Question 26

is atrial repolarization seen on an EKG

Answer 26

no because the voltage is so low, however it occurd during the QRS complex

Question 27

what occurs during the PR interval

Answer 27

atria contract/depolarization | (0.12-0.20) or about 3-5 blocks

Question 28

what organs are nourished by blood first in circulation

Answer 28

heart and brain

Question 29

what three things do you look at when diagnosing heart dysrthythmias

Answer 29

rate, rhythm, complex

Question 30

a small increase in what electrolyte will cause the heart to stop

Answer 30

potassium (K)

Question 31

what are some typical causes of dysrhythmias

Answer 31

Hypoxia Ischemia Sympathetic stimulation- stress, trauma, CHF, hyperthyroidism Medications-antiarrhythmics, bronchodilators, cardiac glycosides, etc. Electrolyte disturbances- K, Ca and Mg Stretch or hypertrophy

Question 32

describe a normal sinus rhythm

Answer 32

rate: 60-100 or about 75 rhythm: regular PR: upright (0.16) QRS: 0.06

Question 33

describe sinus bradycardia

Answer 33

``` SLOW rate: 23 or < 60 rhythm: regular PR: 0.24 QRS: 0.12 ```

Question 34

how do you treat sinus bradycardia

Answer 34

atropine or pacemaker

Question 35

describe sinus tachycardia

Answer 35

``` FAST, poor fill time rate: 150 rhythm: regular PR: 0.16 QRS: 0.04 ```

Question 36

describe premature atrial contraction (PACs)

Answer 36

not super concerning, just keep an eye on *they are usually evident in atrial dysrthymias P wave comes early rhythm is irregular PR: 0.16 QRS: 0.06

Question 37

describe atrial tachycardia

Answer 37

eventually if left untreated, lungs will fill with fluid fast rate, cells are overriding the AV node rate: 150-300 *P wave: differs in shape* PR: short, < 0.12

Question 38

treatment for atrial tachycardia

Answer 38

beta blockers and calcium channel blockers

Question 39

describe supraventricular tachycardia (SVT)

Answer 39

rate: rapid about 160 cause SOB, chest pain coming from atria

Question 40

what is SVT treated with

Answer 40

Metoprolol or *adenosine (slows heart)

Question 41

describe atrial flutter

Answer 41

hypertrophy of the heart *all blood is not emptied out of heart atrial rate: 250-300 *P waves look like FLUTTERS or SAW TOOTH

Question 42

what is used as treatment for many dysrhthmias if other measures don't work

Answer 42

cardioversion therapy

Question 43

describe atrial fibrillation

Answer 43

``` *most common dysrhythmia* low blood pressure, SOB "quivering", not kicking heart beat no discernible Ps rhythm: always IRREGULAR rate: about 70 wavy baseline ```

Question 44

initial drug treatment for atrial fibrillation

Answer 44

Amiodarone | Dilitiazem

Question 45

broadly describe what heart block is

Answer 45

longer period from SV to AV | ALL types are slow (brady)

Question 46

describe first degree AV block

Answer 46

don't do anything, just monitor PR interval is prolonged (0.36) rate is regular bradycardic: 60

Question 47

another name for second degree Heart Block Mobitz type 1

Answer 47

Wenkebach

Question 48

describe 2nd degree Wenkebach

Answer 48

rate is slow, progressive* rhythm is irregular *PR gets longer then drops a beat* (0.2 then 0.24 then 0.26 then drops beat)

Question 49

describe 2nd degree mobitz type 2

Answer 49

bundle branch delay | *drops every other beat*

Question 50

treatment for 2nd degree heart block

Answer 50

atropine: to speed up heart and trigger nerves | ONLY give 3 doses max

Question 51

treatment for dysrhythmias if pt has pulse

Answer 51

MEDICATION

Question 52

treatment for dysrhythmias if pt has NO pulse

Answer 52

*dead | compressions (30:2) THEN defib.

Question 53

describe 3rd degree heart block

Answer 53

* NO coordination between atria and ventricles (INDEPENDENT of eachother) rhythm: 40-60 * BAD: SOB, chest pain, dizziness

Question 54

treatment for 3rd degree heart block

Answer 54

pacemaker or atropine(sometimes)

Question 55

describe premature ventricular contraction (PVC)

Answer 55

``` no P wave preceding PVC feels like a skipped beat not very concerning unless couplet weird looking beat occur due to pain, fever or low O2 ```

Question 56

describe couplet PVC

Answer 56

PVC occurring in pairs due to inadequate CO2 | this is a problem when they occur in pairs

Question 57

describe ventricular tachycardia

Answer 57

rapid rate: 150 no Ps or QRS cardiac output is decreased heart is irritated

Question 58

treatment for ventricular tachycardia

Answer 58

if there is a pulse, then amiodarone

Question 59

what do you always do first BEFORE treatment of dysrhythmias

Answer 59

assess patient

Question 60

describe polymorphic

Answer 60

no P waves associated with QRS poor cardiac output QRS complexes occuring from different foci

Question 61

what is the procedure for V-fib if no pulse

Answer 61

1)epi 2) compressions 3) amiodarone 4) compressions

Question 62

describe V-fib

Answer 62

ALWAYS SHOCK- defib no contraction of heart muscle only twitching no cardiac output/sudden death

Question 63

describe idioventricular

Answer 63

slow rhythm no P or QRS waves poor output