Dysrhythmia Interpretation & EKG Interpretation Flashcards
Right coronary artery supplies what parts of the heart
inferior wall and left ventricle
the Sa node is supplied by what in 50-60% of people
RCA
in 85-90% of hearts, the RCA supplies the
AV node
two main branches of the left coronary artery
left descending artery
left circumflex
occlusion of the LAD can result in
pump failure
intraventricular conduction delays
septal wall
ventricular rupture
polorization is resting or stimulated
resting
during polarization what is inside the cell
negative
depolorization is
sitmulated
what is inside the cell during depolorization
positive
steps to the condition system
sinus node
av node
bundle of His
purkinje fivers
absolute refractory period
onset of QRS
relative refractory peroid
downslope of the T wave
supernormal peroud
end of T wave
EKG records
electrical voltages generated by depolarization of heart muscle
what are somethings an EKG can tell us
orirtentaion
condution
electrical effects
mass
presence of ischemia, injury, and infarction
high potassium is what wave
increase T wave
post MI is what wave
persistant Q wave and ST depression
current MI
ST evelation
difference between bedside telemetry and 12 lead ECG
bedside has 1-2 views and is continuous
12 lead is 12 views and 10 seconds
where do telemetry stickers go
right side white on top and green below
left side black on top and red below
brown in the middle
cloud over grass
white on right
smoke over fire
what is the most common lead to look at for 12 lead
lead 2
what leads make up the standard limb leads
I II III
what triangle do I, II, III make up
Einthoven triangle
horizontal axis on EKG
time
vertical axis on EKG
voltage/amplitiude
one block= time and size
0.04
1mm
P wave is
atrial depolorization
QRS is
ventricular depolarization
and atrial repoloarization
T wave is
ventricular depolarization
how do we measure PR interval
baseline before P and baseline before Q
Normal PR interval
0.12-0.20
what does PR interval representt
length it take the impulse to travel from atria to ventricules
QRS measures
spread of electrical impulse through ventricles
normal QRS
0.04-0.12
ST segment represents
early part of repoloraiztion of the right and left ventricles
what is the point where the QRS complex and ST segment meet
J point
what are the characteristics of a ST segment
flat and isoelectric
ST elevation defintion
segment is deviated above baseline of PR segment
ST Depression defintion
if the segment deviates below baseline of the PR segment
elevated ST means
MI
depressed ST means
post MI
T wave represents
ventricular repolorization
hyperkalemia might do what to the T wave
peak it
QT interval represents
total ventricular activity
how to measure QT
beginning of Q to end of T
what can prolong QT
meds
how to measure T wave
start to end of T wave
why might measuring the QT be important
for pro arrhythmic drugs
if the OT interval is less than half the _________ it is probably normal
RR interval
which lead do we look at the most common
lead II
long ST segments are typical of
hypocalcemia
U wave might be evident in
hypokalemia
how to find the rate
could the number of R waves in a 6 second strip and multiply by 10
how many ticks is 6 seconds
3 ticks or 2 inervals
R wave measures what rate
ventricular
P wave measures what rate
atrial
how do we determine regularity
R to R interval
each interval of the tic is worth how many seconds
3
criteria for normal sinus rhythm
rate is 60-100
regular rhythm
all intervals are within normal limits
P for every QRS
P wave look the same
criteria for normal sinus rhythm
- rate
60-100
criteria for normal sinus rhythm
- regularity
yes
criteria for normal sinus rhythm
- intervals
within normal limits
criteria for normal sinus rhythm
- P wave
looks the same is there is one for every QRS
Sinus Bradycardia criteria
rate is less than 60
rhythm us regular
intervals are within normal limits
P for every QRS
P look the same
Sinus Bradycardia criteria
- rate
less than 60
Sinus Bradycardia criteria
- regularity
yes
Sinus Bradycardia criteria
- intervals
normal limits
Sinus Bradycardia criteria
- P wave
P for every QRS
all look the same
Sinus Bradycardia be caused by
beta blockers
digitalis
calcium channel blockers
hypoxemia
Sinus Bradycardia may be normal in
athletes or while sleeping
if a patient has Sinus Bradycardia we should assess
BP and symptoms
hypoxemia causes
Sinus Bradycardia
sinus tachycardia criteria
rate is above 100
regular rhythm
intervals are within normal limits
P wave for every QRS
P wave look the same
sinus tachycardia criteria
- rate
above 100
sinus tachycardia criteria
- regularity
yes
sinus tachycardia criteria
- intervals
normal limits
sinus tachycardia criteria
- P wave
for every QRS and looks the same
sinus tachycardia can be caused by
fever
stress
caffeine
pain
exercise
shock
hypoxemia
increased symaptehic tone
hypovolemia
how do we treat sinus tachycardia
treat the underlying cause
criteria for sinus arrhythmia/dysrhythmia
- rate between 60-100
- rhythm is irregular
- all intervals are within normal limits
- P for every QRS
- P look the same
sinus arrhythmia/dysrhythmia critera
- rate
60-100
sinus arrhythmia/dysrhythmia critera
- regularity
no, irregular
sinus arrhythmia/dysrhythmia criteria
- intervals
normal
sinus arrhythmia/dysrhythmia
- P wave
for every QRS and all look the same
in sinus arrhythmia/dysrhythmia, the SA node can increase or decrease with
respirations
who might sinus arrhythmia or dysrhythmia be more common in
children and athletes
premature atrial contraction criteria
any rate
rhythm is irrgeular because of the early beat
intervals are normal limits
P for every QRS
P look the same EXCEPT the P in front of the PAC will be different
premature atrial contraction criteria
- rate
any rate
premature atrial contraction criteria
- regularity
it is irregular because of the early beat but the underlying rhythm may be regular
premature atrial contraction criteria
- interval
normal
premature atrial contraction criteria
- P wave for every QRS
yes
premature atrial contraction criteria
- P wave look the same
no the P in the PAC will be different
SVT/PVST criteria
rate 150-250
regular
QRS intervals can be within normal limits
Can be a P wave but it is most likely hidden in T wave
difference between SVT and PSVT
paroxysmal starts and stops abruptly
sustained is continous
SVT/PVST criteria
- rate
150-150
SVT/PVST criteria
- regularity
regular
SVT/PVST criteria
- intervals
QRS is normal
* most of the time there is no P wave so we cannot determine PR
SVT/PVST criteria
- P wave
there can be one but more like it is hidden in the T wave
atrial flutter criteria
atrial rate is 250-350
* ventricular can vary
regular or regularly irregular
no PR interval/QRS may be normal
NO P WAVES, called flutter waves
how might atrial flutter look
jagged saw tooth edges or picked fence
what is the problem with atrial flutter
loss of atrial kick and ventricular condition is too fast or too slow to allow good filling of the ventricles
atrial flutter criteria
- atrial rate
250-350
atrial flutter criteria
- ventricular rate
can vary
atrial flutter criteria
- regularity
regular or regularly irregular
atrial flutter criteria
- intervals
QRS may be normal
NO PR
atrial flutter criteria
- P waves
NO P WAVES
* called flutter waves
atrial fib criteria
rhythm is IRREGULARLY IRREGULAR
no PR interval, QRS may be normal
atrial fib criteria
- P waves
no regular P waves, then meaning no PR interval
atrial fib criteria
- rhythm
irregularly irregular
atrial fib criteria
- QRS interval
may be normal
atrial fib criteria
- flutter waves compared to QRS
more flutter waves
atrial fib at risk for
mural thrombi
cardiac output: due to loss of arterial kick
junctional rhythm criteria
rate can depend on type, anywhere between 40 and above 100
regular
P wave can be in three different places
- inverted before or after the QRS
- buried in the QRS
- normal after the QRS
junctional rhythm criteria
- rate
vary
junctional rhythm criteria
- regularity
yes
junctional rhythm criteria
- p wave places
inverted before or after the QRS
normal after the QRS
buried in the QRS
junctional rhythm criteria
- if a P wave occurs before a QRS what will the PR interval be
0.12 or less
premature junctional contractions criteria
rate can vary
irregular
P wave is present in the normal beats but follows criteria for junctional rhythm
premature ventricular contractions criteria
rate varies
irregular
No P wave in the PVC
PVC classification
- apperence of the contraction
unifocal: look the same
multifocal: look different
PVC classification
- numbers
couplet: 2 in a row
triplet: 3 in a row
bigeminy: every other
trigeminy: every third
in a PVC, anything more than what would be considered V tach
3
why might PVC happen
acid base imbalances
hyper/hypokalemia
post MI
PVC how do the QRS look
wide
why do PVC not have a P wave
stimulus originates in the ventricle
V tach criteria
101-250 rate
pulse or pulsless
usually regular
normally P waves are absent
v tach rate
101-250
will a patient always be unstable with v tach
no they can be stable
what is the first thing we do for v tach
check for a pulse
if a patient is in v tach with a pulse what do we do
meds
valsalva manöver
synchronized cardioversion
what do we do if a patient is in v tach with no pulse
defibrillator and CPR
difference between synchronized cardio and defibrillator
synchronized cardio looks where the R wave is
the most common cause of sustained monomorphic V Tach in American adults is
coronary artery disease with prior myocardia infarction
causes of V tach
overdose
dig tox
heart disease
mitral valve prolapse
trauma
acid base imbalance
electrolyte imbalance
treatment of v tach depends on
pulse and symptoms
for V tach what is our treatment
underlying cause
torsades is caused by
long QT (commonly caused by meds)
hypokalemia
subarachnoid bleed
v fib criteria
rate cannot be determined
irregular, no pattern
no distinguishable waves
NO PULSE
will V fib have a pulse
NO
treatment of V fib
CPR and defibrillator
problem in V fib
ventricular myocardium quivers and there is no effective myocardial contraction and no pulse
two types of V fib
fine and course
indioventricular rhythm criteria
20-40
regular
No P wave
long QRS
T wave opposite direction
what happens during indioventricular rhythm
SA node and Av junction fail to initiate electrical impulse
* explains why pulse is low
indioventricular rhythm caused by
MI
dig tox
metabolic imbalances
indioventricular rhythm vs accelerated idioventricualr rhythm
accelerated is 40-100
asystole pulse
none
what is the issue for the AV blocks
delay or interruption of the electrical links between atrium and ventricle
who might first degree be normal in
athelets
first degree can also happen because of
ischemia/injury
medication therapy
hyperkalemia
first degree AV block criteria
rate: normal
regular
P wave normal
PR EXCEEDS 0.20
what is the difference between sinus and first degree heart block
PR is longer than 0.20
second degree wnkebach criteria
rate: atrial is greater than ventricular
rhythm irregular
PR interval: lengthens with each cycle until P wave appears without QRS
saying for wenkebach
longer longer longer drop
one baseball bat hits the ball further further gone
second degree type one indicates
atria are being depolarized normally but not every impulse is being conducted to the ventricles
second degree heart block type 2
rate: atrial faster than ventricle
rhythm is regular or irregular
PR interval is fixed and constant
random dropped QRS
only difference between 2nd degree type 1 and 2
type 1 the PR interval is not fixed
type 2 the PR interval is fixed
both have dropped QRS
what rhythm has a higher tendency to progress to complete heart blood
2nd degree type 2
complete or 3rd degree heart block criteria
atria and ventricles beat independently of each other
not a QRS for every P wave
PR interval varies without pattern, not fixed
what will we always do for complete heart blood
pace them
if there is a rhythm but no pulse what is it
pulsesless electrical activity
pulsesless electrical activity is a what type of situation, not a specific dysrhythmia
clinical
why might PEA occur (H and T)
Hypovolemia
hypoxia
acidosis
kalmia
hypothermia
hypoglycemia
toxins
tamponade
tension pneumo
thrombosis
trauma
In v tach, when the QRS complexes are the same shape and amplitude this is called
monomorhpic VT
In complete heart block how can we determine the impulse to the ventricles
narrow: junctional
wide: ventricular
treatment of pulses electrical activity
whatever the problem is
SVT is rapid for what time peroid
whole strip
purkinjie fiber rate
20-40BPM
bundle of His/av node intrinsic rate
40-60
SA node intrinsic rate
60-100
what artery is called the widow maker
LCA
SVT rate
150
treatment for SVT or PVST
adenosine
difference between PSVT and SVT
PSVT starts and stops suddenly
SVT is susatiend and needs intervention
2 rhythms where you might have to shock
V fib and V tach (pulsless)
treatment of unstable VT
cardioversion
treatment for bradycardia
atropine
med treatment for torsades
mag
idioventricular are slow or fast
slow
how to differentiate between bundle branch block and indioventricukar
BBB has p waves
