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Med surge 2024 > Dysrhythmia Interpretation & EKG Interpretation > Flashcards

Dysrhythmia Interpretation & EKG Interpretation Flashcards

1
Q

Right coronary artery supplies what parts of the heart

A

inferior wall and left ventricle

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2
Q

the Sa node is supplied by what in 50-60% of people

A

RCA

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3
Q

in 85-90% of hearts, the RCA supplies the

A

AV node

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4
Q

two main branches of the left coronary artery

A

left descending artery
left circumflex

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5
Q

occlusion of the LAD can result in

A

pump failure
intraventricular conduction delays
septal wall
ventricular rupture

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6
Q

polorization is resting or stimulated

A

resting

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7
Q

during polarization what is inside the cell

A

negative

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8
Q

depolorization is

A

sitmulated

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9
Q

what is inside the cell during depolorization

A

positive

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10
Q

steps to the condition system

A

sinus node
av node
bundle of His
purkinje fivers

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11
Q

absolute refractory period

A

onset of QRS

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12
Q

relative refractory peroid

A

downslope of the T wave

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13
Q

supernormal peroud

A

end of T wave

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14
Q

EKG records

A

electrical voltages generated by depolarization of heart muscle

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15
Q

what are somethings an EKG can tell us

A

orirtentaion
condution
electrical effects
mass
presence of ischemia, injury, and infarction

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16
Q

high potassium is what wave

A

increase T wave

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17
Q

post MI is what wave

A

persistant Q wave and ST depression

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18
Q

current MI

A

ST evelation

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19
Q

difference between bedside telemetry and 12 lead ECG

A

bedside has 1-2 views and is continuous
12 lead is 12 views and 10 seconds

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20
Q

where do telemetry stickers go

A

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

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21
Q

what is the most common lead to look at for 12 lead

A

lead 2

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22
Q

what leads make up the standard limb leads

A

I II III

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23
Q

what triangle do I, II, III make up

A

Einthoven triangle

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24
Q

horizontal axis on EKG

A

time

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25
Q

vertical axis on EKG

A

voltage/amplitiude

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26
Q

one block= time and size

A

0.04
1mm

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27
Q

P wave is

A

atrial depolorization

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28
Q

QRS is

A

ventricular depolarization
and atrial repoloarization

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29
Q

T wave is

A

ventricular depolarization

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30
Q

how do we measure PR interval

A

baseline before P and baseline before Q

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31
Q

Normal PR interval

A

0.12-0.20

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32
Q

what does PR interval representt

A

length it take the impulse to travel from atria to ventricules

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33
Q

QRS measures

A

spread of electrical impulse through ventricles

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34
Q

normal QRS

A

0.04-0.12

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35
Q

ST segment represents

A

early part of repoloraiztion of the right and left ventricles

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36
Q

what is the point where the QRS complex and ST segment meet

A

J point

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37
Q

what are the characteristics of a ST segment

A

flat and isoelectric

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38
Q

ST elevation defintion

A

segment is deviated above baseline of PR segment

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39
Q

ST Depression defintion

A

if the segment deviates below baseline of the PR segment

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40
Q

elevated ST means

A

MI

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41
Q

depressed ST means

A

post MI

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42
Q

T wave represents

A

ventricular repolorization

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43
Q

hyperkalemia might do what to the T wave

A

peak it

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44
Q

QT interval represents

A

total ventricular activity

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45
Q

how to measure QT

A

beginning of Q to end of T

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46
Q

what can prolong QT

A

meds

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47
Q

how to measure T wave

A

start to end of T wave

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48
Q

why might measuring the QT be important

A

for pro arrhythmic drugs

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49
Q

if the OT interval is less than half the _________ it is probably normal

A

RR interval

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50
Q

which lead do we look at the most common

A

lead II

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51
Q

long ST segments are typical of

A

hypocalcemia

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52
Q

U wave might be evident in

A

hypokalemia

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53
Q

how to find the rate

A

could the number of R waves in a 6 second strip and multiply by 10

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54
Q

how many ticks is 6 seconds

A

3 ticks or 2 inervals

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55
Q

R wave measures what rate

A

ventricular

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56
Q

P wave measures what rate

A

atrial

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57
Q

how do we determine regularity

A

R to R interval

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58
Q

each interval of the tic is worth how many seconds

A

3

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59
Q

criteria for normal sinus rhythm

A

rate is 60-100
regular rhythm
all intervals are within normal limits
P for every QRS
P wave look the same

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60
Q

criteria for normal sinus rhythm
- rate

A

60-100

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61
Q

criteria for normal sinus rhythm
- regularity

A

yes

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62
Q

criteria for normal sinus rhythm
- intervals

A

within normal limits

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63
Q

criteria for normal sinus rhythm
- P wave

A

looks the same is there is one for every QRS

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64
Q

Sinus Bradycardia criteria

A

rate is less than 60
rhythm us regular
intervals are within normal limits
P for every QRS
P look the same

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65
Q

Sinus Bradycardia criteria
- rate

A

less than 60

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66
Q

Sinus Bradycardia criteria
- regularity

A

yes

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67
Q

Sinus Bradycardia criteria
- intervals

A

normal limits

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68
Q

Sinus Bradycardia criteria
- P wave

A

P for every QRS
all look the same

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69
Q

Sinus Bradycardia be caused by

A

beta blockers
digitalis
calcium channel blockers
hypoxemia

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70
Q

Sinus Bradycardia may be normal in

A

athletes or while sleeping

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71
Q

if a patient has Sinus Bradycardia we should assess

A

BP and symptoms

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72
Q

hypoxemia causes

A

Sinus Bradycardia

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73
Q

sinus tachycardia criteria

A

rate is above 100
regular rhythm
intervals are within normal limits
P wave for every QRS
P wave look the same

74
Q

sinus tachycardia criteria
- rate

A

above 100

75
Q

sinus tachycardia criteria
- regularity

A

yes

76
Q

sinus tachycardia criteria
- intervals

A

normal limits

77
Q

sinus tachycardia criteria
- P wave

A

for every QRS and looks the same

78
Q

sinus tachycardia can be caused by

A

fever
stress
caffeine
pain
exercise
shock
hypoxemia
increased symaptehic tone
hypovolemia

79
Q

how do we treat sinus tachycardia

A

treat the underlying cause

80
Q

criteria for sinus arrhythmia/dysrhythmia

A
  • rate between 60-100
  • rhythm is irregular
  • all intervals are within normal limits
  • P for every QRS
  • P look the same
81
Q

sinus arrhythmia/dysrhythmia critera
- rate

A

60-100

82
Q

sinus arrhythmia/dysrhythmia critera
- regularity

A

no, irregular

83
Q

sinus arrhythmia/dysrhythmia criteria
- intervals

A

normal

84
Q

sinus arrhythmia/dysrhythmia
- P wave

A

for every QRS and all look the same

85
Q

in sinus arrhythmia/dysrhythmia, the SA node can increase or decrease with

A

respirations

86
Q

who might sinus arrhythmia or dysrhythmia be more common in

A

children and athletes

87
Q

premature atrial contraction criteria

A

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

88
Q

premature atrial contraction criteria
- rate

A

any rate

89
Q

premature atrial contraction criteria
- regularity

A

it is irregular because of the early beat but the underlying rhythm may be regular

90
Q

premature atrial contraction criteria
- interval

A

normal

91
Q

premature atrial contraction criteria
- P wave for every QRS

A

yes

92
Q

premature atrial contraction criteria
- P wave look the same

A

no the P in the PAC will be different

93
Q

SVT/PVST criteria

A

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

94
Q

difference between SVT and PSVT

A

paroxysmal starts and stops abruptly
sustained is continous

95
Q

SVT/PVST criteria
- rate

A

150-150

96
Q

SVT/PVST criteria
- regularity

A

regular

97
Q

SVT/PVST criteria
- intervals

A

QRS is normal
* most of the time there is no P wave so we cannot determine PR

98
Q

SVT/PVST criteria
- P wave

A

there can be one but more like it is hidden in the T wave

99
Q

atrial flutter criteria

A

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

100
Q

how might atrial flutter look

A

jagged saw tooth edges or picked fence

101
Q

what is the problem with atrial flutter

A

loss of atrial kick and ventricular condition is too fast or too slow to allow good filling of the ventricles

102
Q

atrial flutter criteria
- atrial rate

A

250-350

103
Q

atrial flutter criteria
- ventricular rate

A

can vary

104
Q

atrial flutter criteria
- regularity

A

regular or regularly irregular

105
Q

atrial flutter criteria
- intervals

A

QRS may be normal
NO PR

106
Q

atrial flutter criteria
- P waves

A

NO P WAVES
* called flutter waves

107
Q

atrial fib criteria

A

rhythm is IRREGULARLY IRREGULAR
no PR interval, QRS may be normal

108
Q

atrial fib criteria
- P waves

A

no regular P waves, then meaning no PR interval

109
Q

atrial fib criteria
- rhythm

A

irregularly irregular

110
Q

atrial fib criteria
- QRS interval

A

may be normal

111
Q

atrial fib criteria
- flutter waves compared to QRS

A

more flutter waves

112
Q

atrial fib at risk for

A

mural thrombi
cardiac output: due to loss of arterial kick

113
Q

junctional rhythm criteria

A

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

114
Q

junctional rhythm criteria
- rate

A

vary

115
Q

junctional rhythm criteria
- regularity

A

yes

116
Q

junctional rhythm criteria
- p wave places

A

inverted before or after the QRS
normal after the QRS
buried in the QRS

117
Q

junctional rhythm criteria
- if a P wave occurs before a QRS what will the PR interval be

A

0.12 or less

118
Q

premature junctional contractions criteria

A

rate can vary
irregular
P wave is present in the normal beats but follows criteria for junctional rhythm

119
Q

premature ventricular contractions criteria

A

rate varies
irregular
No P wave in the PVC

120
Q

PVC classification
- apperence of the contraction

A

unifocal: look the same
multifocal: look different

121
Q

PVC classification
- numbers

A

couplet: 2 in a row
triplet: 3 in a row

bigeminy: every other
trigeminy: every third

122
Q

in a PVC, anything more than what would be considered V tach

A

3

123
Q

why might PVC happen

A

acid base imbalances
hyper/hypokalemia
post MI

124
Q

PVC how do the QRS look

A

wide

125
Q

why do PVC not have a P wave

A

stimulus originates in the ventricle

126
Q

V tach criteria

A

101-250 rate
pulse or pulsless
usually regular
normally P waves are absent

127
Q

v tach rate

A

101-250

128
Q

will a patient always be unstable with v tach

A

no they can be stable

129
Q

what is the first thing we do for v tach

A

check for a pulse

130
Q

if a patient is in v tach with a pulse what do we do

A

meds
valsalva manöver
synchronized cardioversion

131
Q

what do we do if a patient is in v tach with no pulse

A

defibrillator and CPR

132
Q

difference between synchronized cardio and defibrillator

A

synchronized cardio looks where the R wave is

133
Q

the most common cause of sustained monomorphic V Tach in American adults is

A

coronary artery disease with prior myocardia infarction

134
Q

causes of V tach

A

overdose
dig tox
heart disease
mitral valve prolapse
trauma
acid base imbalance
electrolyte imbalance

135
Q

treatment of v tach depends on

A

pulse and symptoms

136
Q

for V tach what is our treatment

A

underlying cause

137
Q

torsades is caused by

A

long QT (commonly caused by meds)
hypokalemia
subarachnoid bleed

138
Q

v fib criteria

A

rate cannot be determined
irregular, no pattern
no distinguishable waves
NO PULSE

139
Q

will V fib have a pulse

A

NO

140
Q

treatment of V fib

A

CPR and defibrillator

141
Q

problem in V fib

A

ventricular myocardium quivers and there is no effective myocardial contraction and no pulse

142
Q

two types of V fib

A

fine and course

143
Q

indioventricular rhythm criteria

A

20-40
regular
No P wave
long QRS
T wave opposite direction

144
Q

what happens during indioventricular rhythm

A

SA node and Av junction fail to initiate electrical impulse
* explains why pulse is low

145
Q

indioventricular rhythm caused by

A

MI
dig tox
metabolic imbalances

146
Q

indioventricular rhythm vs accelerated idioventricualr rhythm

A

accelerated is 40-100

147
Q

asystole pulse

A

none

148
Q

what is the issue for the AV blocks

A

delay or interruption of the electrical links between atrium and ventricle

149
Q

who might first degree be normal in

A

athelets

150
Q

first degree can also happen because of

A

ischemia/injury
medication therapy
hyperkalemia

151
Q

first degree AV block criteria

A

rate: normal
regular
P wave normal
PR EXCEEDS 0.20

152
Q

what is the difference between sinus and first degree heart block

A

PR is longer than 0.20

153
Q

second degree wnkebach criteria

A

rate: atrial is greater than ventricular
rhythm irregular
PR interval: lengthens with each cycle until P wave appears without QRS

154
Q

saying for wenkebach

A

longer longer longer drop
one baseball bat hits the ball further further gone

155
Q

second degree type one indicates

A

atria are being depolarized normally but not every impulse is being conducted to the ventricles

156
Q

second degree heart block type 2

A

rate: atrial faster than ventricle
rhythm is regular or irregular
PR interval is fixed and constant
random dropped QRS

157
Q

only difference between 2nd degree type 1 and 2

A

type 1 the PR interval is not fixed
type 2 the PR interval is fixed
both have dropped QRS

158
Q

what rhythm has a higher tendency to progress to complete heart blood

A

2nd degree type 2

159
Q

complete or 3rd degree heart block criteria

A

atria and ventricles beat independently of each other
not a QRS for every P wave
PR interval varies without pattern, not fixed

160
Q

what will we always do for complete heart blood

A

pace them

161
Q

if there is a rhythm but no pulse what is it

A

pulsesless electrical activity

162
Q

pulsesless electrical activity is a what type of situation, not a specific dysrhythmia

A

clinical

163
Q

why might PEA occur (H and T)

A

Hypovolemia
hypoxia
acidosis
kalmia
hypothermia
hypoglycemia
toxins
tamponade
tension pneumo
thrombosis
trauma

164
Q

In v tach, when the QRS complexes are the same shape and amplitude this is called

A

monomorhpic VT

165
Q

In complete heart block how can we determine the impulse to the ventricles

A

narrow: junctional
wide: ventricular

166
Q

treatment of pulses electrical activity

A

whatever the problem is

167
Q

SVT is rapid for what time peroid

A

whole strip

168
Q

purkinjie fiber rate

A

20-40BPM

169
Q

bundle of His/av node intrinsic rate

A

40-60

170
Q

SA node intrinsic rate

A

60-100

171
Q

what artery is called the widow maker

A

LCA

172
Q

SVT rate

A

150

173
Q

treatment for SVT or PVST

A

adenosine

174
Q

difference between PSVT and SVT

A

PSVT starts and stops suddenly
SVT is susatiend and needs intervention

175
Q

2 rhythms where you might have to shock

A

V fib and V tach (pulsless)

176
Q

treatment of unstable VT

A

cardioversion

177
Q

treatment for bradycardia

A

atropine

178
Q

med treatment for torsades

A

mag

179
Q

idioventricular are slow or fast

A

slow

180
Q

how to differentiate between bundle branch block and indioventricukar

A

BBB has p waves

Med surge 2024 (6 decks)

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