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EKG Certification > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

Atria

A

Thin-walled, low pressure chambers

Receive blood from systemic circulation and lungs

Atrial kick

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2
Q

What does “P wave” reflect?

A

Atrial depolarization

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3
Q

Where does rhythm begin if it has one positive P wave before each QRS complex?

A

Sinoatrial node (SA)

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4
Q

If the rhythm begins in the atria, what happens to the P wave?

A

Rhythm that begins in the atria will have a positive P wave that is shaped differently than P waves that begin in the SA node

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5
Q

What are some reasons why atrial dysrhythmias occur?

A
  1. Altered automaticity
  2. Triggered activity
  3. Reentry

Altered automaticity and triggered activity are disorders in impulse formation

Reentry is a disorder in impulse conduction

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6
Q

What are some examples of premature complexes? How are they identified?

A
  1. Premature atrial complexes (PAC)
  2. Premature junctional complexes (PJC)
  3. Premature ventricular complexes (PVC)

Premature beats are identified by their site of origin

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7
Q

Paired beats (couplet)

A

Two premature beats in a row

PAC/PAC

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8
Q

Runs or bursts

A

Three or more premature beats in a row

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9
Q

Bigeminy

A

Every other beat is a premature beat

NSR/PAC

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10
Q

Trigeminy

A

Every third beat is a premature beat

NSR/NSR/PAC

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11
Q

Quadrigeminy

A

E?very fourth beat is a premature beat

NSR/NSR/NSR/PAC

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12
Q

Premature Atrial Complexes (PAC)

A

Occur when an irritable site within the atria discharges before the next SA node impulse is due to discharge

The P wave of a PAC may be:
-biphasic (partly positive, partly negative)
-flattened
-notched
-pointed
-lost in the preceding T wave

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13
Q

How to identify a PAC?

A

Early (premature) P wave

Positive (upright) P wave (in lead II) that differ in shape from sinus P waves

Early P waves that may or may not be followed by a QRS complex

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14
Q

ECG characteristics of PACs

A

Rhythm: irregular because of the early beat(s)

Rate: usually within normal range but depends on the underlying rhythm

P waves: premature (occurring earlier then the next expected P wave), positive (upright) in lead II, one before each QRS complex, often differ in shape from sinus P waves — may be flattened, notched, pointed, biphasic, or lost in the preceding T wave

PR interval: may be normal or prolonged depending on the prematurity of the beat

QRS duration: usually 0.11sec or less but may be wide (aberrant) or absent, depending on the prematurity of the beat; the QRS of the PAC is similar in shape to those of the underlying rhythm unless the PAC is abnormally conducted

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15
Q

Non compensatory pause

A

A noncompensatory (incomplete) pause often follows PAC

Represents the delay during which the SA node resets its rhythm for the next beat

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16
Q

Compensatory pause

A

A compensatory pause is present if the period between the complex before and after a premature beat is the same as two normal R-R intervals

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17
Q

What are PACs associated with wide QRS complex called?

A

Aberrantly conducted

Indicates conduction through ventricles is abnormal

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18
Q

Nonconducted PACs

A

A PAC may occur very prematurely and close to the T wave of the preceding beat
-only a P wave may be seen with no QRS after it (appearing as a pause)

This is a noncunducted or blocked PAC
-The P wave occurred too early to be conducted

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19
Q

What causes PACs?

A
  1. Acute coronary syndromes
  2. Atrial enlargements
  3. Digitalis toxicity
  4. Electrolyte imbalance
  5. Emotional stress
  6. Heart failure
  7. Hyperthyroidism
  8. Mental and physical fatigue
  9. Stimulants: caffeine, tobacco, cocaine
  10. Sympathomimetic medications such as epinephrine
  11. Valvular heart disease
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20
Q

What can be done about PACs?

A

Occasional PACs usually do not require treatment

Frequent PACs may induce episodes of atrial fibrillation or PSVT

Frequent PACs are treated by correcting the underlying cause:
-correcting electrolyte imbalances
-reducing stress
-reduction for eliminating stimulants
-treating heart failure

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21
Q

Wandering Atrial Pacemaker (WAP)

A

Multiform atrial rhythm - updated term for the rhythm formally known as WAP

Size, shape and direction of P waves vary

Associated with a normal or slow rate and irregular P-P, R-R, and PR intervals because of the different sites of impulse formation

QRS duration usually is 0.11 sec or less because conduction through the ventricles is usually normal

More than 3 different morphologies of P waves

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22
Q

How to recognize WAP on ECG?

A

Rhythm: usually irregular as the pacemaker site shifts from the SA node to ectopic atrial locations or AV junctions

Rate: usually 60-100 bpm but may be slower; if the rate is faster than 100bpm, the rhythm is termed MULTIFOCAL ATRIAL TACHYCARDIA

P waves: size, shape, and direction may change from beat to beat; may be upright, inverted, biphasic, rounded, flat, pointed, notched, or buried in the QRS complex

PR interval: varies as the pacemaker site shifts from the SA node to ectopic atrial locations or AV junction

QRS duration: 0.11sec or less unless abnormally conducted

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23
Q

Multifocal Atrial Tachycardia (MAT)

A

When wandering atrial pacemaker is associated with a ventricular rate faster than 100bpm, the rhythm is called multifocal atrial tachycardia (MAT)

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24
Q

How do you recognize MAT on ECG?

A

Rhythm: ventricular rhythm is always irregular as the pacemaker site shifts from the SA node to ectopic atrial locations or AV junction

Rate: one P wave before each QRS but the size, shape, and direction of the P wave may change from beat to beat; may be upright, inverted, biphasic, rounded, flat, pointed, notched, or buried in the QRS complex; at least three different P wave configurations (seen on same lead) are required for a diagnosis of MAT

PR interval: varies as the pacemaker site shifts from the SA node to ectopic atrial locations or the AV junction

QRS duration: 0.11sec or less unless abnormally conducted

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25
Q

What are some causes of MAT?

A

Exact mechanisms of MAT is unknown but may involve altered automaticity or triggered activity

Most often seen in older adults with severe chronic obstructive pulmonary disease (COPD)

Also seen in setting of acute coronary syndromes, heart failure, pneumonia, hypoxia, valvular heart disease, hypokalemia, hypomagnesemia, or theophylline or digoxin toxicity

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26
Q

What to do about MAT?

A

Common symptoms include palpitations, lightheadedness, anxiety, dyspnea, chest discomfort, and syncope

Challenge to treat - best to consult a cardiologist before starting treatment

Efforts are focused on managing the underlying cause

Patients with MAT who do not respond to medical therapy may require AV nodal ablation with subsequent cardiac pacemaker implantation

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27
Q

Supraventricular Arrhythmias

A

Begin above the bifurcation of the bundle of his

Include rhythms that begin in the — SA node / atrial tissue / AV junction

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28
Q

Supraventricular Tachycardia

A

Supraventricular rhythms with a ventricular rate faster than 100bpm at rest

Onset of SVT symptoms often begins in adulthood

Can affect the quality of life

Complaints of lightheadedness are common

A drop in blood pressure typically occurs during SVT and is greatest in the first 10 to 30 seconds

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29
Q

Atrial Tachycardia

A

3rd most common SVT. Regular rhythm that arises from an ectopic focus in the atria at a rate faster than 100bpm and does not require the AV node’s participation to maintain the dysrhythmia.

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30
Q

How to recognize Atrial Tachycardia?

A

Rhythm: regular

Rate: 101 - 250bpm

P waves: one P wave precedes each QRS complex in lead II; these P waves differ in shape from sinus P waves an isoelectric baseline is usually present between P waves; if the atrial rhythm originates in the low portion of the atrium, P waves will be negative in the inferior leads; with rapid rates, it may be challenging to distinguish P waves from T waves

PR interval: may be shorter or longer than normal; may be difficult to measure because P waves may be hidden in the T waves of preceding beats

QRS duration: 0.11 sec or less unless abnormally conducted

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31
Q

Paroxysmal supraventricular tachycardia (PSVT)

A

Describes a rapid, regular SVT that starts and ends suddenly

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32
Q

What causes Atrial Tachycardia?

A
  1. Acute illness with excessive catecholamine release
  2. Digitalis toxicity
  3. Electrolyte imbalance
  4. Heart disease — coronary artery disease / valvular disease / cardiomyopathy / congenital heart disease
  5. Infection
  6. Pulmonary embolism
  7. Stimulant use — caffeine / albuterol / theophylline / cocaine
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33
Q

What are some possible assessment findings and symptoms of atrial tachycardia?

A
  1. Acute changes in mental status
  2. Asymptomatic
  3. Dizziness or lightheadedness
  4. Dyspnea
  5. Fatigue
  6. Fluttering sensation in the chest
  7. Hypotension
  8. Ischemic chest discomfort
  9. Palpitations
  10. Signs of shock
  11. Syncope or near syncope
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34
Q

What to do about atrial tachycardia?

A

If symptomatic because of the rapid rate:

  1. Apply a pulse oximeter and administer oxygen, if indicated
  2. Obtain vital signs
  3. Establish IV access
  4. Obtain a 12 lead ECG
  5. Vagal maneuvers
  6. Adenosine
  7. Beta blockers
  8. Calcium channel blockers
  9. Synchronized cardioversion
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35
Q

Vagal maneuvers

A

Carotid sinus massage

Application of a cold stimulus to the face

Valsalva maneuver

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36
Q

Adenosine

A

Can interrupt Reentry pathways involving the AV node

Rapid onset of action

Short half-life

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37
Q

Synchronized Cardioversion

A

Delivery of an electrical shock to the heart timed to occurring during QRS

Used to treat rhythms with a creaky identifiably QRS complex and a rapid ventricular rate in a patient with a pulse and signs of hemodynamic compromise

Examples of rhythms treated with cardioversion include narrow-QRS tachycardias, A-Fib, atrial flutter, and monomorphic ventricular tachycardia

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38
Q

Antrioventricular Nodal Reentrant Tachycardia (AVNRT)

A

Most common SVT

Results from a Reentry circuit that uses two separate pathways leading into the AV node
1. One pathway conducts impulses rapidly but has a long refractory period (slow recovery time)
2. The other pathway conducts impulses slowly but has a short refractory period (fast recovery time)
3. Under the right conditions, these fast and slow pathways can form an electrical circuit or loop (Reentry circuit)

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39
Q

How to recognize AVNRT?

A

Rhythm: ventricular rhythm is usually very regular

Rate: 150-250bpm

P waves: often hidden in the QRS complex; if the ventricles are stimulated first and then the atria, a negative P wave will appear after the QRS in leads II, III, and aVF; when the atria are depolarized after the ventricles, the P wave typically distorts the end of the QRS complex

PR interval: P waves are not seen before the QRS complex; therefore, the PR interval is not measurable

QRS duration: 0.11sec or less unless abnormally conducted

40
Q

What causes AVNRT?

A

Can occur at any age but is most often seen in young adults who have no structural heart disease or ischemic heart disease

AVNRT also occurs in individuals with:

  1. Chronic obstructive pulmonary disease
  2. Coronary artery disease
  3. Valvular heart disease
  4. Heart failure
  5. Digitalis toxicity
41
Q

What triggers AVNRT?

A
  1. Hypoxia
  2. Stress
  3. Anxiety
  4. Caffeine
  5. Smoking
  6. Sleep deprivation
  7. Many medications
42
Q

What are some findings and symptoms of AVNRT?

A

Possible assessment findings and symptoms:

  1. Chest pain or pressure
  2. Dizziness
  3. Dyspnea
  4. Heart failure
  5. Lightheadedness
  6. Nausea
  7. Neck pulsations
  8. Palpitations (common)
  9. Signs of shock
  10. Syncope
  11. Weakness
43
Q

What can be done about AVNRT in a stable patient?

A
  1. Apply pulse oximeter — administer supplemental oxygen, if indicated
  2. Obtain vital signs
  3. Establish IV access
  4. Apply cardiac monitor
  5. Obtain 12 lead ECG
  6. Vagal maneuvers
  7. Adenosine
  8. Calcium channel blockers or beta blockers
44
Q

What can be done in an unstable patient about AVNRT?

A

Unstable patient — signs/symptoms of hemodynamic compromise are present)

  1. Apply pulse oximeter — administer oxygen, if indicated
  2. Establish IV access
  3. Administer sedation — if the patient is awake and time permits
  4. Synchronized cardioversion
45
Q

Antrioventricular Reentrant Tachycardia (AVRT)

A

Antrioventricular Reentrant tachycardia (AVRT) involves a pathway of impulse conduction outside the AV node and bundle of his

Preexcitation
-impulse begins above the ventricles but travels via a pathway other than the AV node and bundle of his
-the supraventricular impulse excites the ventricles earlier than normal

46
Q

How to recognize WPW ?

A

Rhythm: regular unease associated with A-Fib

Rate: usually 60-100bpm if the underlying rhythm is sinus in origin

P waves: normal and positive in lead II unless WPW is associated with A-Fib

PR interval: 0.12sec or less if P waves are observed because the impulse travels very quickly across the accessory pathway, bypassing the normal delay in the AV node

QRS duration: usually more than 0.12sec; slurred upstroke of the QRS complex (delta wave) may be seen in one or more leads

Summary — Short PR interval / Delta wave / QRS widening / Secondary ST and T wave changes

47
Q

Delta wave

A

Initial slurred deflection at the beginning of the QRS complex that may be positive or negative

48
Q

Preexcitation

A

Premature activation of the ventricles by a supraventricular impulse arising from the censors pathway

49
Q

What causes Wolf-Parkinson White Pattern (WPW) ?

A

Most people with WPW syndrome have no associated heart disease

WPW syndrome is one of the most common causes of tachydysrhythmias in infants and children

Although the accessory pathway in WPW syndrome is believed to be congenital in origin, the symptoms associated with Preexcitation often do not appear until the patient is a teenager or young adult

50
Q

Common signs and symptoms associated with AVRT and a rapid ventricular rate:

A
  1. Anxiety
  2. Chest discomfort
  3. Dizziness
  4. Lightheadedness
  5. Palpitations (common)
  6. Shortness of breath during exercise
  7. Signs of shock
  8. Weakness
51
Q

What to do about AVRT?

A

If the patient is symptomatic because of the rapid ventricular rate, treatment will depend on the following
1. Severity of patients symptoms
2. Width of the QRS complex (wide or narrow)
3. Regularity of the ventricular rhythm

Consultation with a cardiologist is recommended

52
Q

Atrial Flutter

A

Ectopic atrial rhythm in which an irritable site within the atria fires regularly at a very rapid rate

F waves (capital F)

Regularly irregular

No P waves

53
Q

How to recognize atrial flutter?

A

Rhythm: atrial regular; ventricular regular or irregular depending on AV conduction and blockade

Rate: atrial rate typically ranges from 240-300bpm; ventricular rate varies and is determined by AV blockade; the ventricular rate will usually not exceed 180bpm as a result of the intrinsic conduction rate of the AV junction

P waves: no identifiable P waves; saw-toothed flutter waves are present

PR interval: not measurable

QRS duration: 0.11sec or less but may be widened if flutter waves are buried in the QRS complex or abnormally conducted

54
Q

What conditions are associated with atrial flutter?

A
  1. Cardiac surgery
  2. Cardiomyopathy
  3. Chronic lung disease
  4. Complication of myocardial infraction
  5. Digitalis or quinidine toxicity
55
Q

What causes atrial flutter?

A

Often precipitated by brief episodes of AT or by A-Fib — may last for seconds to hours and occasionally persists for 24hrs or longer

Chronic atrial flutter is unusual — rhythm usually converts to sinus rhythm or A-Fib either on its own or with treatment

56
Q

Atrial Fibrillation (A-Fib)

A

Occurs because of altered automaticity in one or several rapidly firing sites in the atria or Reentry involving one or more circuits in the atria

57
Q

How to recognize A-Fib?

A

No P waves

Has f waves (tiny waves — don’t maintain same morphology)

Rhythm is irregular

Can’t calculate PRI — no P waves

58
Q

What causes A-Fib?

A

Can occur in patients with or without detectable heart disease or related symptoms

Increased risk of stroke
1. Atria do not contract effectively
2. Blood pools within the atria, forming clots
3. Clot dislodges and moves to artery in the brain

59
Q

What causes A-Fib? (cardiovascular conditions)

A

Cardiovascular conditions:

  1. Coronary artery disease
  2. Dilated cardiomyopathy
  3. Heart failure
  4. Hypertension
  5. Hypertrophic cardiomyopathy
  6. Ischemic heart disease
  7. pericardial disease
  8. Rheumatic heart disease
  9. Stroke, transient ischemic attack, thromboembolism
  10. Valvular disease
  11. Vascular disease
60
Q

What causes A-Fib? (Potentially reversible causes)

A

Potentially reversible causes:

  1. Electrocution
  2. Excessive alcohol intake (holiday heart)
  3. Hyperthyroidism
  4. Myocardial infraction
  5. Myocarditis
  6. Open heart or thoracic surgery
  7. Pericarditis
  8. Pneumonia
  9. Pulmonary embolism
61
Q

What to do about atrial flutter and atrial fibrillation?

A

Cardiology consult

Treatment strategies — rate control / rhythm control

Consider synchronized cardioversion if the patient is hemodynamically unstable

62
Q

The most common type of supraventricular tachycardia (SVT) in adults is?
A. AT
B. AVRT
C. AVNRT
D. Atrial flutter

A

C

AVNRT, which is caused by reentry in the area of the AV node, is the most common type of SVT in adults

63
Q

All supraventricular dysrhythmias
A. Involve accessory pathways
B. Begin above the bifurcation of the bundle of his
C. Begin below the bifurcation of the bundle of his
D. Require the AV nodes participation to sustain the dysrhythmia

A

B

A supraventricular rhythm originates from a site above the bifurcation of the bundle of his, such as the SA node, atria, or AV junction

64
Q

Which of the following dysrhythmias is most likely to be associated with a reduction in cardiac output and loss of atrial kick?
A. AFib
B. PACs
C. Sinus tachycardia
D. Wandering atrial pacemaker

A

A

With AFib, rapid impulses cause the muscles of the atria to quiver (fibrillation), resulting in ineffective atrial contraction, decreased stroke volume, a subsequent decrease in cardiac output, and loss of atrial kick

65
Q

Which of the following ECG characteristics distinguishes atrial flutter from other atrial dysrhythmias?
A. The presence of fibrillatory waves
B. P waves of varying size and amplitude
C. The presence of delta eaves before the QRS
D. The “saw-tooth” or “picket-fence” appearance of wave forms before the QRS

A

D

With atrial flutter, atrial waveforms are produced that resemble the teeth of a saw or a picket fence; these are called flutter waves or F waves

66
Q

The Wolff-Parkinson’s-white pattern is associated with
A. Delta wave
B. Flutter waves
C. Fibrillatory waves
D. A long PR interval
E. a short PR interval
F. A wide QRS complex
G a narrow QRS complex

A

A, E, F

The WPW patter includes a triad (meaning 3) of ECG findings that consist of the following: 1. A short PRI, 2. A delta wave, 3. A wide QRS. In addition, secondary ST and T wave changes are often present

67
Q

In AFib, the PR interval is usually
A. Not measurable
B. Within normal limits
C. Less than 0.20 second in duration
D. More than 0.20 second in duration

A

A

A PRI cannot be measured with AFib because there are no P waves associated with dysrhythmia

68
Q

Signs and symptoms experienced during a tachydysrhythmia are usually primarily related to
A. Atrial irritability
B. Vasoconstriction
C. Slowed conduction through the AV node
D. Decreased ventricular filling time and stroke volume

A

D

Signs and symptoms experienced during a tachydysrhythmia are usually primarily related to a decrease in the length of time spent in diastole. Remember that as the heart rate increases, there is less time for the ventricles to fill and less blood for the ventricles to pump out with each contraction. Thus, excessively fast heart rate can lead to decrease cardiac output

69
Q

On the ECG, an impulse that begins in the atria and occurs earlier than the next expected sinus beat will appear as a
A. P wave that appears after the QRS complex
B. QRS measuring more than 0.11 second in duration
C. P wave with a PR interval measuring more than 0.20 sec
D. P wave that may appear in the T wave of the preceding beat

A

D

When compared with the P-P intervals of the underlying rhythm, a PAC is premature — occurring before the next expected sinus P wave. PACs are identified by early (premature) P waves, positive (upright) P waves (in lead II) that differ in shape from sinus P waves (atrial P waves may be flattened, notched, pointed, biphasic, or lost in the preceding T wave) and early P waves that may or may not be followed by QRS

70
Q

A compensatory pause is a
A. Series of waveforms
B. Delay that occurs following a premature beat that resets the SA node
C. Period during the cardiac cycle during which cardiac cells cannot be stimulated to conduct an electrical impulse no matter how strong the stimulus is
D. Period during the cardiac cycle during which cardiac cells can be stimulated to conduct an electrical impulse, if exposed to a stronger than normal stimulus

A

B

A compensatory pause is a delay that occurs following a premature beat that resets the SA node. A series of waveforms is called a complex. The cardiac cycle period during which cardiac cells cannot be stimulated to conduct an electrical impulse, no matter how strong the stimulus, describes the effective (absolute) refractory period. The period during the cardiac cycle during which cardiac cells can be stimulated to conduct an electrical impulse, if exposed to a stronger than normal stimulus, describes the relative refractory period

71
Q

Which of the following are typical ECG characteristics associated with wandering atrial pacemaker?
A. Rhythm is usually irregular
B. Rate is usually faster than 100bpm
C. Delta waves are seen in one or more leads
D. QRS is often more than 0.12 sec in duration
E. P waves differing in size, shape and direction
F. PR intervals vary because of shifting pacemaker sites

A

A, F

ECG characteristics of WAP include:
Rhythm: irregular
Rate: 60 to 100bpm — if faster than 100bmp name is multifocal atrial tachycardia
P waves: size, shape, and direction may change from beat to beat; may be upright, inverted, biphasic, rounded, flat, pointed, notched, or buried in the QRS
PRI: varies
QRS: 0.11sec or less

72
Q

A 35 year old woman is complaining of palpitations. She is alert and oriented to person, place, time and event. Her blood pressure is 144/82 mm Hg, ventilations 18/min and unlabored. She appears anxious and states her “heart is racing.”

Which of the following statements is correct concerning the assessment of this patient?
A. Despite the patients age, palpitations generally indicate the presence of cardiac disease
B. A complaint of palpitations is a cause for concern only if they are of sudden onset and their rhythm is irregular
C. A complaint of palpitations is always associated with evidence of rhythm disturbance on the cardiac monitor
D. Information relayed by the patient can provide important clues about her cardiovascular status

A

D

Information relayed by the patient as part of the history can provide important clues to her cardiovascular (and pulmonary) status. Ask questions to determine the patient’s description of her symptoms when and how often they occur, how long they last, possible triggers, and what measures she has taken to relieve them. A complaint of palpitations, warrants, timely assessments, and intervention, whether or not the rhythm is regular. It is essential to determine if chest pain or discomfort, difficulty breathing, or shortness of breath, accompany her palpitations. Some practitioners recommend having the patient “tap out” the rhythm of the palpitations to help determine rhythmicity. Palpitations that occur regularly with a sudden onset and usually are caused by AVNRT or AVRT. Irregular palpitations may be the result of premature comp, a fib, or multifocal atrial tachycardia. Patient may report palpitations when there is no evidence of a rhythm disturbance on the cardiac monitor. this occurs most often in patients with anxiety disorders, although symptoms, such as chest pain or discomfort, dyspnea, palpitations, edema, and syncope are classic cardiac disease symptoms. They may also occur because of other organ system diseases (such as musculoskeletal, pulmonary, renal, and gastrointestinal)

73
Q

A 35 year old woman is complaining of palpitations. She is alert and oriented to person, place, time and event. Her blood pressure is 144/82 mm Hg, ventilations 18/min and unlabored. She appears anxious and states her “heart is racing.”

A pulse oximeter has been applied. The patients oxygen saturation on room air is 97%. The cardiac monitor reveals the rhythm below. This rhythm recorded in lead II is
A. Sinus tachycardia
B. AVNRT
C. AVRT
D. AFib

A

B

The rhythm shown is AVNRT at 188bpm

74
Q

A 35 year old woman is complaining of palpitations. She is alert and oriented to person, place, time and event. Her blood pressure is 144/82 mm Hg, ventilations 18/min and unlabored. She appears anxious and states her “heart is racing.”

The PR interval in Fig 4.23 (we established this was a AVNRT rhythm)
A. Is 0.06 sec
B. Is 0.12 sec
C. Is 0.20 sec
D. Cannot be measured

A

D

The PRI cannot be measured because the are no P waves visible

75
Q

A 35 year old woman is complaining of palpitations. She is alert and oriented to person, place, time and event. Her blood pressure is 144/82 mm Hg, ventilations 18/min and unlabored. She appears anxious and states her “heart is racing.”

Intravenous (IV) access has been established. A repeat set of vital signs revels the following: blood pressure 140/82mm Hg, pulse 188, ventilations 20. The patients anxiety has increased. She denies chest discomfort and shortness of breath. Her skin is pink and warm, but moist. Which of the following interventions are likely to be ordered based on the information provided?
A. Administer IV atropine
B. Attempt vagal maneuvers
C. Begin chest compressions
D. Administer supplemental oxygen
E. Administer sedation and perform synchronized cardioversion

A

B

The patient is symptomatic but stable. Because atropine is administered to increase heart rate and this patient is already tachycardic, contraindicated in this situation. Vagal maneuvers may be tried. If vagal maneuvers were unsuccessful, anticipate orders for IV administration of adenosine. Chest compressions are not indicated (the patient is responsive, breathing, and pulse). Oxygen administration is not indicated because the patients oxygen saturation is 97% on a room air. Sedation and cardioversion would be appropriate if the patient were unstable (showing signs of hemodynamic compromise)

76
Q

Most common form of Preexcitation ____________

A

Wolf - Parkinson - White (WPW) pattern

77
Q

Common complaint in a patient with rapid heart rate ____________

A

Palpitations

78
Q

Term used to describe rhythms that originate from above the ventricles but in which the impulse travels by a pathway other than the AV node and bundle of his ____________

A

Preexcitation

79
Q

Baseline appearance in atrial fibrillation __________

A

Erratic

80
Q

ECG finding associated with WPW pattern _____________

A

Delta wave

81
Q

Patients who experience AFib are at increased rate of having this __________

A

Stroke

82
Q

Blood pushed into the ventricles because of atrial contraction __________

A

Atrial kick

83
Q

An extra bundle of working myocardial tissue that forms a connection between the atria and ventricles outside the normal conduction system _____________

A

Accessory pathway

84
Q

Methods used to stimulate the vagus nerve in an attempt to slow conduction through the AV node ________

A

Vagal maneuvers

85
Q

This condition may cause or be caused by AFib _________

A

Heart failure

86
Q

Atrial flutter or fibrillation with rapid ventricular rate ________

A

Uncontrolled

87
Q

Every other beat that comes from somewhere other than the SA node ___________

A

Bigeminy

88
Q

An early P wave with no QRS following it ____________

A

Nonconduted PAC

89
Q

Earlier than expected ___________

A

Premature

90
Q

These should be avoided in the presence of severe underlying pulmonary disease ________

A

Beta blockers

91
Q

Blowing or swishing sound within a vessel _________

A

Bruit

92
Q

The name given a PAC associated with a wide QRS complex

A

Aberrantly conducted PAC

93
Q

Drug of choice for AVNRT ____________

A

Adenosine

94
Q

The most significant risk factor for AFib _________

A

Hypertension

95
Q

Every third beat comes from somewhere other than the SA node _________

A

Trigeminy

96
Q

Before elective cardioversion, prophylactic treatment with a(n) _________ is recommended for the patient in atrial flutter or fibrillation

A

Anticoagulant

EKG Certification (12 decks)

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