ECG Flashcards
Pacemaker cells possess
AUTOMATICITY (the ability to initiate an impulse)
Bundle Branches & Purkinje Fibers: - bmp (slowest ones)
20-40 bpm
pulseless electrical activity (vents don’t have pulses, of course)
looks like a normal EKG but ventricles don’t contract so there’s no cardiac output or BP
with AV blocks, is something wrong with the SA nodes?
there’s nothing wrong with SA nodes (because they come before AV)
supraventricular tachycardia - rate (the suprer hero goes 100 mph)
above ventricles but something else is causing rapid firings - rates higher than 100 bmp
SA nodes
Sinoatrial node (SA) is the pacemaker that:
Sets the rate (60-100)
Generates nerve impulses to contract both atria
P wave on ECG
Atrioventricular (AV)
SA to AV bundle transmission
Atrioventricular bundle is a - which segment on the ECG? (Ava purrs)
bundle of nerve fibers in the septum that:
Carries impulses doen the septum to the RBB
PR segment on the ECG
Allows atrial contraction
ask yourself this with every ECG (in this order) (RRP RPR QRS ST T - rip ripper)
Is the rhythm regular?
what is the rate?
are there P waves? Are they consistent? (atrial)
are there R waves? (ventricular)
waht is the P-R interval?
are the QRS complexes normal shape and duration?
is the S-T segment isoelectric? (waves go down not up - icicles go down)
Do the T waves have normal configuration? (can detect eschemia and K+ problems) don’t need to figure out rate***
P wave
P wave: Atrial depolarization
QRS Complex
QRS Complex: Ventricular depolarization (atrial repolarization is hidden)
T wave
T wave: Ventricular repolarization
measurements in seconds - PR interval: (Prrr cats age is 12 - 20)
PR interval: .12 - .2 sec
ECG paper - each square is how many seconds?
Standard paper speed= 25mm/sec
mm= .04 sec (60 sec/1500=.04 sec)
5mm= .2 sec (.04 x 5) = .2 sec (60 sec/ .2 = 300/min
heart rate determination - how to count on ecg (heart rate needs some R and R for 300 days)
Count the number of large boxes between R-R interval and divide into 300
Example: 300/4=75 bpm
rhthym can be normal, but doesn’t mean that
the pt is perfusing
Arrhythmias are no big deal UNTIL they affect…
cardiac output
VT
Vfib
Heart Blocks
Multiple PVC’s (premature ventricular contractions)
Atrial fibrillation/flutter
Junctional rhythms
how to diagnose arrthymias
ECG
3 lead, 5 lead, 12 lead, Transcutaneous paddles
EPS
Echocardiography
Tilt table testing
Genetic testing
Labs
CXR (chest x-ray)
Coronary angiography
premature atrial contraction
rhythm - irregular - it comes early and prob faster.
AFib - rate and rhythm - Gab is bigger than 150
Rhythm: Irregular
Rate: >150 (depends on AV conduction)
AV node is the bouncer at a bar and lets a few in at a time.
AFib causes (gab door)
CAD, HTN, mitral or tricuspid valve disease, PE
Afib treatments (gab gets the RAT treatment)
1 GOAL is to Control rate
Rhythm conversion
Prevent thrombus formation
Surgical ablation
AFib - assessments (assess gab bc she’s an SOB and she passes out when she beats on her chest pain)
Assess patient for SOB, decreased energy, fatigue, “feeling beats”, chest pain, light headedness, syncope, decreased ability to exert
atrial flutter rhythm (butterflies can have regular or irregular shapes)
rhythm: Regular or regularly irregular
atrial flutter Causes (butterfly causes are the PIT ishmail)
PE, thyrotoxicosis (too much thyroid hormone), ischemic heart disease
atrial flutter treatment (same as aFib)
Control rate
Rhythm conversion
Prevent thrombus formation
Surgical ablation successful in 80-90% cases
premature ventricular contraction - what about perfusion?
not good perfusion.
premature ventricular contraction - causes (jimmy was always irritated)
electrolyte imbalances, irritability of the heart, stress response. more than 6 is bad.
isolectric - what is it and when does it happen? (Jimmy Icicles)
wave goes down not up - happens with PVC
ventricular tachycardia - how does the ECG look? (Tachy Tombstones)
rapid rate, can’t decipher P waves.
VFib rate and rhythm (Velma is chaotic with no rate)
Rhythm Chaotic
Rate - None, non discernable
can defibrillate the pt.
VFib causes - how does the ECG look? (Velma’s ecg is gone)
No P, P-R interval, atrial rate or QRS duration
VFib treatment
CPR, precordial thump (strike person’s sternum), defibrillation (do it fast), medications - epinephrine, ABC, check pulses, call code right away
Vfib nursing implications
Nursing Implications
Assess patient NO palpable pulses
ABC
Call code/ask for AED (automated external defibrillator)
biphasic defibrillator
delivers shock going in both directions - sandwich the paddles between the heart. goes through posterior and anterior then back the other way. uses less electricity and causes less damage to the pt.
QRS interval in seconds (can’t stand QVC for 12 seconds)
QRS interval: < .12 sec
QT interval in seconds (QTs are 36 - 44)
QT interval: .36 - .44 sec
heart rate - how to count rapid HR? (rapidly die in 1500 bc)
Rapid heart rate, count number of small boxes between R and R and divide into 1500
Example: 1500/19 = 79 bpm
premature atrial contraction - what’s missing on ECG?
there’s a P wave missing. what is causing it?
premature ATRIAL contraction - causes (everyone has atrials)
Caffeine, meds, anxiety, sleep deprivation
afib triggers (Gab is triggered by caffeine and alcohol when she’s exhaustion and hormones)
Emotional triggers, exhaustion, caffeine, sleep deprivation, hormonal, alcohol, surgery or medical procedures
afib causes (gab plant)
pericarditis, hypoxia, hyperthyroidism, CM (cardiomyopapthy)
afib nursing interventions - bridges (gab needs hep to bridge the war)
Anticoagulant therapy
Bridges (Bridging anticoagulation refers to giving a short-acting blood thinner, usually low-molecular-weight heparin given by subcutaneous injection for 10 to 12 days around the time of the surgery/procedure, when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range)
atrial flutters - causes (Quinn butterfly after surgery)
hypoxia, quinidine toxicity, post cardiac surgery
vFib causes (MY velma is MIC junk)
Ischemic heart disease, cardiomyopathy, myocarditis
vfib - ST? (Velma on Brugunda Street)
ST elevation (end of ventricular depolarization and beginning of ventricular repolarization) with BBB (bundle branch block) in V1-V3 = Brugada Syndrome
vFib
vFib = < 40 - check this when you watch the video again
atrial flutter - rate (butterflies can be 75 years old, or 300)
Rate: 75-150 (depends on A-V conduction)
Atrial rate 200-300
Ventricular rate varies depending on A-V ratio
maybe like 3-4 P waves followed by 1 QRS
second-degree heart block, Mobitz Type 1 treatment (2nd degree atop the pine)
bolus of atropine (pine tree high)
first-degree atrioventricular (AV) block - ECG (prolonged purring gets you the 1st degree)
Delayed conduction, producing a prolonged PR interval
early warning sign of acute coronary syndrome (ACS) and heart failure (HF)
fatigue
fall in blood pressure sensed by…
baroreceptors
junction rhythms do what?
take over when the whole conduction system doesn’t work
EPS (electrophysiology studies) (ESP is irritating)
we irritate the heart to try to figure out what the pt has, identify cells that are not firing correctly
12 lead is for___, and not for___
for diagnostics, not continous monitoring
3 lead - pics of the heart or not? (3 is basic phone)
no pics of the heart
Coronary angiography measures what? (angie is pressuring me, grrrr)
measures pressure in heart
what happens with afib? (a million gabs think they’re the boss)
a whole bunch of cells become pacemakers and override SA node.
if we can’t convert the rate, ppl need to be on anticoagulants bc the blood is sloshing around and causes clots
with afib, where do you feel the beats?
in neck or temple region usually (palpitations)
vfib pattern on ecg
random squiggly line
ventricular tachycardia pattern on ecg (T for tachy, T for tombstone)
V Tac = Tombstone patterns
ventricular tachycardia causes (Be Tachy without the sheriff)
low K and low mag
ventricular tachycardia treatment - but WHEN?
EARLY defib
vfib treatment
CPR before anything
when to shock with vfib? (if you can C, count a pulse, C cardiovert)
no pulse = dfib
with pulse = cardiovert
Afib on ecg (fib s floPPing)
no P wave, so fib floPPing
Afib causes (don’t memorize this one)
valve disease, HF, pulm. HTN, COPD, and after heart surgery.
afib treatment (just cardio and 2 meds)
cardioversion (after TTE to rule out clots)
digoxin for long term - but check ATP before giving (apical pulse, toxicity, potassium less than 3.5)
anticoagulants - warafin (vitamin K antidote, monitor INR)
atrial flutter on ecg (butterfly with teeth)
saw tooth (looks like little teeth) - causes and treament same as afib
SVT on ecg (supraventricular tachycardia) (super fast = super ventricular)
close and fast
SVT causes (super hero front door)
stimulants, exercise, hyopxia, heart disease
treatment for SVT (super hero just needs vegas and Alden and do cardio version)
vagal maneuver, ice on neck, adenosine (HR may stop, this is good and normal)
cardioversion
hold digoxin before what procedure? ( digoxin can’t do cardio)
cardioversion
torsades de pointes on ecg (torsades tornados)
tornado of points
torsades de pointes causes (without the sheriff there are tornados)
low magnesium
magnesium mellows out the
heart waves, without HR is crazy.
aystole (assist fully)
flat line. DO NOT defibrillate - can’t shock bc there is no electricity
wide or bizarre QRS =
v tach
chaotic or unorganized ecg
fibrillation
chaotic with no P waves =
afib
bizarre = (bizarre is tacky)
tachycardia
bizarre = (bizarre is tacky)
tachycardiara
rhthym with premature ventricular contraction? (Jimmy’s rhythm was mostly normal, but sometimes abnormal)
rhythm should be normal w/ some abnormal moments.
What are the known causes of sinus tachycardia?
hypovolemia
ventricular bigeminy cardiac rhythm
The rhythm has a normal beat, then a premature beat pattern
removal of an arterial or venous catheter - how to reverse vasoval response?
The vasovagal response is reversed by promptly elevating the lower extremities above the level of the heart, infusing a bolus of IV fluid, and administering IV atropine to treat the bradycardia.
ECG impulse travels where?
travels through the atrial muscles, causing them to contract
ECG - how to calculate ventricular rate?
count the QRS complexes and multiply by 6, which would be 15 x 6 = 90 bpm
right leg lead is
neutral
horizontal axis on ECG measures..
The horizontal axis measures time.
The vertical axis on ECG measures (vertical voltage)
amplitude or voltage
how to calculate atrial rate on EKG? (atria needs some R and R)
count the P waves in 30 large squares and multiply by 10, which would be 4 x 10 = 40 bpm
how to calculate ventricular rate on EKG?
count the QRS complexes in 30 large squares and multiply by 4, which would be 4 x 10 = 40 bpm
sinus arrhtyhmia
R and R is greater than .12
Lymphangitis is (just inflammation)
inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites.
Lymphadenitis (the dentist is enlarged)
enlargement in one or more lymph nodes, usually due to infection
Lymphedema
swelling due to build-up of lymph fluid in the body
