ch 22 Flashcards
PP interval (measures what about artial?)
the duration between the beginning of one P wave and the beginning of the next P wave; used to calculate atrial rate and rhythm
PR interval (Purring through the SA node all the way to the AV node)
electrical impulse from the sinoatrial node through the atrioventricular node
QRS complex (the QRS code is only for the relaxing vent)
electrical impulse through the ventricles; ventricular depolarization
QT interval (relaxing then excited vents are QTs)
time from ventricular depolarization through repolarization
ST segment (STop the QRS and start the T wave)
the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave
T wave (ventricles back in action on the T wave)
repolarization of the ventricles
U wave (last one)
reflect Purkinje fiber repolarization; usually, it is not seen unless a patient’s serum potassium level is low
TP interval (you need TP at the end of the T wave for the Pee wave)
the part of an ECG that reflects the time between the end of the T wave and the beginning of the next P wave; used to identify the isoelectric line
torsades de pointes. (torsades de lethal)
lethal ventricular arrhythmia
isoelectric line
T wave to next P wave, no electrical activity = line is flat
The RR interval is used to determine ____and the PP interval to determine ____(ventricles need some R and R, the atria just need to pp)
ventricular rhythm
atrial rhythm
RR and PP -
If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called
regular. If the intervals are different, the rhythm is called irregular.
increase of 10 bpm or more in the resting heart rate…
increases the risk for sudden cardiac death, atrial fibrillation, heart failure, coronary artery disease, stroke, and cardiovascular disease
Sinus bradycardia occurs when (the esay’s sinus is slow)
the SA node creates an impulse at a slower-than-normal rate. Management depends on the cause and symptoms. Resolving the causative factors may be the only treatment needed.
All characteristics of sinus bradycardia are the same as those of normal sinus rhythm, except
for the rate
Sinus tachycardia occurs when the
sinus node creates an impulse at a faster-than-normal rate.
sinus bradycardia causes
lower metabolic needs (e.g., sleep, athletic training, hypothyroidism), vagal stimulation (e.g., from vomiting, suctioning, severe pain), medications (e.g., calcium channel blockers [e.g., nifedipine, amiodarone], beta-blockers [e.g., metoprolol]), idiopathic sinus node dysfunction, increased intracranial pressure, and coronary artery disease, especially myocardial infarction (MI) of the inferior wall.
sinus tachcardia causes
Physiologic or psychological stress (e.g., acute blood loss, anemia, shock, hypervolemia, hypovolemia, heart failure, pain, hypermetabolic states, fever, exercise, anxiety)
Medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, ecstasy)
Sinus tachycardia does not start or end (tachy sinus doesn’t happen overnight)
suddenly
Sinus arrhythmia rate increases with inspiration or expiration? (sinus arrthymias inspire me)
the sinus node creates an impulse at an irregular rhythm; the rate usually increases with inspiration and decreases with expiration.
sinus bradycardia
Ventricular and atrial rate: Less than 60 bpm in the adult
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
sinus tachycardia - BPM (tachy can’t be 120 min)
Ventricular and atrial rate: Greater than 100 bpm in the adult, but usually less than 120 bpm
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS, but may be buried in the preceding T wave
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
sinus arrhythmia
Ventricular and atrial rate: 60 to 100 bpm in the adult
Ventricular and atrial rhythm: Irregular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
premature atrial complex
A PAC is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.
PAC causes
caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction.
PACs often seen with (Jimmy is often seen with tachy)
sinus tachycardia
PAC
Ventricular and atrial rhythm: Irregular due to early P waves, creating a PP interval that is shorter than the others. This is sometimes followed by a longer-than-normal PP interval, but one that is less than twice the normal PP interval. This type of interval is called a noncompensatory pause
QRS shape and duration: The QRS that follows the early P wave is usually normal, but it may be abnormal (aberrantly conducted PAC). It may even be absent (blocked PAC)
P wave: An early and different P wave may be seen or may be hidden in the T wave; other P waves in the strip are consistent
PR interval: The early P wave has a shorter-than-normal PR interval, but still between 0.12 and 0.20 seconds
P:QRS ratio: Usually 1:1
extrinsic and and intrinsic nervous system play a part in
afib
afib
Ventricular and atrial rate: Atrial rate is 300 to 600 bpm; ventricular rate is usually 120 to 200 bpm in untreated atrial fibrillation
Ventricular and atrial rhythm: Highly irregular
QRS shape and duration: Usually normal, but may be abnormal
P wave: No discernible P waves; irregular undulating waves that vary in amplitude and shape are seen and referred to as fibrillatory or f waves
PR interval: Cannot be measured
P:QRS ratio: Many:1
no atrial kick with (Gab can’t kick, of course)
afib
afib may have a (Gabby definitely has a deficit)
pulse deficit
afib treatment
maybe aspirin or anticoagulants, catheter ablasion
atrial flutter
Ventricular and atrial rate: Atrial rate ranges between 250 and 400 bpm; ventricular rate usually ranges between 75 and 150 bpm
Ventricular and atrial rhythm: The atrial rhythm is regular; the ventricular rhythm is usually regular but may be irregular because of a change in the AV conduction
QRS shape and duration: Usually normal, but may be abnormal or absent
P wave: Saw-toothed shape; these waves are referred to as F waves
PR interval: Multiple F waves may make it difficult to determine the PR interval
P:QRS ratio: 2:1, 3:1, or 4:1
Atrial flutter occurs
because of a conduction defect in the atrium and causes a rapid, regular atrial impulse at a rate between 250 and 400 bpm. NOT all impulses are conducted to the ventricle - otherwise it would be life threatening.
atrial flutter symptoms (butterfly flying low)
chest pain, shortness of breath, and low blood pressure.
atrial flutter treatments
antithrombotic therapy, rate control, and rhythm control in the same manner as atrial fibrillation
junctional arrhythmias
A premature junctional complex is an impulse that starts in the AV nodal area before the next normal sinus impulse reaches the AV node
junction rhythm (ava has completely taken over the junction and the entire show)
the AV node, instead of the sinus node, becomes the pacemaker of the heart
junction rhythm
Ventricular and atrial rate: Ventricular rate 40 to 60 bpm; atrial rate also 40 to 60 bpm if P waves are discernible
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be abnormal
P wave: May be absent, after the QRS complex, or before the QRS; may be inverted, especially in lead II
PR interval: If the P wave is in front of the QRS, the PR interval is less than 0.12 seconds
P:QRS ratio: 1:1 or 0:1
Atrioventricular Nodal Reentry Tachycardia (reentry repeating)
common arrhythmia that occurs when an impulse is conducted to an area in the AV node that causes the impulse to be rerouted back into the same area over and over again at a very fast rate
Atrioventricular Nodal Reentry Tachycardia - onset?
an abrupt onset and an abrupt cessation with a QRS of normal duration
Atrioventricular Nodal Reentry Tachycardia - causes
caffeine, nicotine, hypoxemia, and stress. more often in women.
Atrioventricular Nodal Reentry Tachycardia
Ventricular and atrial rate: Atrial rate usually 150 to 250 bpm; ventricular rate usually 120 to 200 bpm
Ventricular and atrial rhythm: Regular; sudden onset and termination of the tachycardia
QRS shape and duration: Usually normal, but may be abnormal
P wave: Usually very difficult to discern
PR interval: If the P wave is in front of the QRS, the PR interval is less than 0.12 seconds
P:QRS ratio: 1:1, 2:1
Atrioventricular Nodal Reentry Tachycardia treatment
the goal of medical management is to alleviate symptoms and improve quality of life. catheter ablation. adenosine. calcium blocker - verapamil. digoxin.
Premature Ventricular Complex
starts in a ventricle and is conducted through the ventricles before the next normal sinus impulse. PVCs can occur in healthy people, especially with intake of caffeine, nicotine, or alcohol.
bigeminy (Jimmy is into bigamy)
every other complex is a PVC
trigeminy
every third complex is a PVC. quadgeminy - 4.
PVC
Ventricular and atrial rate: Depends on the underlying rhythm (e.g., sinus rhythm)
Ventricular and atrial rhythm: Irregular due to early QRS, creating one RR interval that is shorter than the others. The PP interval may be regular, indicating that the PVC did not depolarize the sinus node
QRS shape and duration: Duration is 0.12 seconds or longer; shape is bizarre and abnormal. When these bizarrely shaped, widened QRS complexes resemble each other, they are called unifocal. When they have at least two different morphologic appearances, they are called multifocal
P wave: Visibility of the P wave depends on the timing of the PVC; may be absent (hidden in the QRS or T wave) or in front of the QRS. If the P wave follows the QRS, the shape of the P wave may be different
PR interval: If the P wave is in front of the QRS, the PR interval is less than 0.12 seconds
P:QRS ratio: 0:1; 1:1
PVC treatment
amiodarone or beta-blockers, usually don’t need longterm treatment.
Ventricular Tachycardia (Tachy is 3 Jimmys!)
VT is defined as three or more PVCs in a row, occurring at a rate exceeding 100 bpm. Medical emergency bc the pt is almost always unresponsive and pulseless.
Ventricular Tachycardia characteristics
Ventricular and atrial rate: Ventricular rate is 100 to 200 bpm; atrial rate depends on the underlying rhythm (e.g., sinus rhythm)
Ventricular and atrial rhythm: Usually regular; atrial rhythm may also be regular
QRS shape and duration: Duration is 0.12 seconds or more; bizarre, abnormal shape
P wave: Very difficult to detect, so the atrial rate and rhythm may be indeterminable
PR interval: Very irregular, if P waves are seen
P:QRS ratio: Difficult to determine, but if P waves are apparent, there are usually more QRS complexes than P waves
VT medical management
antiarrhythmic medications, antitachycardia pacing, or direct cardioversion or defibrillation. Procainamide, amiodarone, sotalol, and lidocaine are all antiarrhythmic. cardioversion or defib.
VT treatment if ejection fraction is less than 35%, consider
implantable cardioverter defibrillator
vfib (velma in the movie 300)
Ventricular rate: Greater than 300 bpm
Ventricular rhythm: Extremely irregular, without a specific pattern
QRS shape and duration: Irregular, undulating waves with changing amplitudes. There are no recognizable QRS complexes
vfib characteristics
absence of an audible heartbeat, a palpable pulse, and respirations. medical emergency.
Idioventricular Rhythm (idiot below Ava)
also called ventricular escape rhythm, occurs when the impulse starts in the conduction system below the AV node (SA node fails or signal can’t be conducted to AV).
Idioventricular Rhythm
Ventricular rate: Between 20 and 40 bpm; if the rate exceeds 40 bpm, the rhythm is known as accelerated idioventricular rhythm
Ventricular rhythm: Regular
QRS shape and duration: Bizarre, abnormal shape; duration is 0.12 seconds or more
Idioventricular rhythm symptoms
commonly causes the patient to lose consciousness and experience other signs and symptoms of reduced cardiac output
Ventricular Asystole
Commonly called flatline, ventricular asystole is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration
Ventricular asystole treatment
CPR. identify causes - known as the Hs and Ts: hypoxia, hypovolemia, hydrogen ion (acid–base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hypothermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary)
first degree AV block
Ventricular and atrial rate: Depends on the underlying rhythm
Ventricular and atrial rhythm: Depends on the underlying rhythm
QRS shape and duration: Usually normal, but may be abnormal
P wave: In front of the QRS complex; shows sinus rhythm, regular shape
PR interval: Greater than 0.20 seconds; PR interval measurement is constant.
P:QRS ratio: 1:1
Second-Degree Atrioventricular Block, Type I (Wenckebach) (just one escaped the second degree)
occurs when there is a repeating pattern in which all but one of a series of atrial impulses are conducted through the AV node into the ventricles
Second-degree AV block, type II
occurs when only some of the atrial impulses are conducted through the AV node into the ventricles
Third-Degree Atrioventricular Block (Blocking ava got me the 3rd degree)
occurs when no atrial impulse is conducted through the AV node into the ventricles. two impulses stimulate the heart: one stimulates the ventricles, represented by the QRS complex, and one stimulates the atria, represented by the P wave.
Medical Management of Conduction Abnormalities (AV block) (Ava needs a pacemaker)
treatment is directed toward increasing the heart rate to maintain a normal cardiac output. pacemaker.
Arrhythmia assessment
health history, cardiac output, such as syncope, lightheadedness, dizziness, fatigue, chest discomfort, palpitations. meds. skin, which may be pale and cool. Signs of fluid retention, such as neck vein distention and crackles and wheezes auscultated in the lungs, may be detected. rate and rhythm.
Arrhythmia nursing intervention
blood pressure, pulse rate and rhythm, rate and depth of respiration, lightheadedness, dizziness, or fainting, med effectiveness.
bradycardia meds
I.V. push atropine
acute mitral regurgitation symptoms
dyspnea, fatigue, and weakness.
pt should do what before taking meds?
take pulse
difference btwn cardioversion and defibrillator
In cardioversion, the delivery of the electrical current is synchronized with the patient’s electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized.
dfib paddles
Paddles or pads should be placed so that they do not touch the patient’s clothing or bed linen and are not near medication patches or in the direct flow of oxygen.
dfib synchronized mode only used for (think, sychronized is…)
cardioversion
signs cardioversion worked (pulses and bp)
conversion to sinus rhythm, adequate peripheral pulses, and adequate blood pressure
setting for defibs (mono is 360 degrees around the world)
monophasic - 360, biphasic 150 -200 joules (this can be increased with shocks afterwards)
EPS (electrophysiology study)
Identify where impulses form and travel to
check function of SA and AV nodes
Identify the exact site where the arrhythmia originates
Assess the effectiveness of antiarrhythmic medications and devices for the patient with an arrhythmia
Treat certain arrhythmias through the destruction of the causative cells (ablation)
pacemaker used when pt
a permanent or temporary slower-than-normal impulse formation, or a symptomatic AV or ventricular conduction disturbance
pacemaker most common complication (commonly dislodges)
dislodgment of the pacing electrode.
what should pt do after permanent pacemaker is inserted?
restrict activity on the side of the implantation
pacemaker complications (pacemakers collapse my lungs with tampons)
infection, Pneumothorax or hemothorax, Bleeding and hematoma, Cardiac perforation, cardiac tamponade
signs of pacemaker malfunction
bradycardia as well as signs and symptoms of decreased cardiac output (e.g., diaphoresis, orthostatic hypotension, syncope
pacemaker precautions
Gas-powered engines should be turned off before working on them. Objects that contain magnets (e.g., the earpiece of a phone, large stereo speakers, jewelry) should not be near the generator for longer than a few seconds. phones 6 to 12 inches away. Welding and the use of a chain saw should be avoided.
implantable cardioverter defibrillator (ICD)
detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. vest.
nursing management - pacemaker and ICD
heart rate and rhythm are monitored, appearance or increasing frequency of arrhythmia reported to provider. observe for infection. continuous throbbing or pain. should be reported to provider.
pacemaker and ICD - change dressing
as needed
afib - increased risk of embolism and stroke on which side?
the left side
