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Med-Surg #2 > ECG > Flashcards

ECG Flashcards

ECG

1
Q

Sa node fires and stimulates atrial contraction

normal duration - 0.06-0.12

A

P wave

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2
Q

Beginning of P wave to beginning of QRS complex
time taken for impulse to spread from SA node to purkinje fibers
immediately preceding ventricular contraction
normal duration - 0.12 - 0.20

A

PR Interval

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3
Q

Beginning to end of QRS complex
represent depolarization(contraction) of both ventricles (systole)
normal duration - < 0.12 (3 small squares)

A

QRS Complex(interval)

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4
Q

Measured from S wave to beginning of T wave
represents time between ventricular depolarization and depolarization (diastole)
normal duration - 0.12

A

ST segment

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5
Q

time for ventricular repolarization (resting phase)

normal interval - 0.16

A

T wave

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6
Q

from beginning of QRS complex to end of T wave
represents time taken for entire depolarization and depolarization of ventricles
Normal duration - 0.34-0.43

A

QT interval

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7
Q

rhythm that initiates in SA node at rate of 60-100 times per min.
follow normal conduction pattern of cardiac cycle.

A

Normal Sinus rhythm

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8
Q

secondary pacemaker at the rate of 40-60 times per min. delay allows for atrial contraction and filling of ventricles. Not considered lethal.

A

Atrial dysrhythmia - Originates at AV node

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9
Q

secondary pacemaker at the rate of 20-40 times per minute.

A

Ventricular Rhythm - Originates at His-Purkinje system. - carry electrical impulse directly to ventricles

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10
Q

1 rule of ECG

A

Check the patient. How are they tolerating rhythm, S/S, Lethal dysrhythmia?

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11
Q

reversal of charges at the cell membrane when the cells are stimulated that allow sodium to flow into the cell making the inside of the cell positive.

A

depolarization

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12
Q

restoration of the polarized state at a cell membrane making the inside of the cell negative

A

repolarization

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13
Q

Ability to initiate an impulse spontaneously and continuously

A

automaticity

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14
Q

ability to be electrically stimulated

A

excitability

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15
Q

Ability to transmit an impulse along a membrane in an orderly manner

A

conductivity

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16
Q

Ability to respond mechanically to an impulse

A

contractility

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17
Q

One complete contraction and relaxation cycle of the heart.

A

cardiac cycle

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18
Q

Pulse < 60. PR interval normal, QRS for Each P wave

A

Sinus Bradycardia

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19
Q

Pulse 100-200. PR interval normal. QRS for each P wave

A

Sinus Tachycardia

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20
Q

Information obtainable from ECG

A

HR, Rhythm/regularity, Impulse conduction intervals, abnormal conduction pathways

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21
Q

a printed record of electrical activity that defines the graphic representation of the electrical activity of the heart

A

the ECG (Electrocardiogram)

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22
Q

5 steps to ECG strip interpretation

A
  1. HR
  2. Heart Rhythm
  3. P-wave
  4. PRI
  5. QRS Complex
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23
Q

Step 1 - HR

A

Six second strip count R wave multiple by 10.

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24
Q

Step 2 - Heart Rhythm

A

Regular or Irregular?
Established pattern between QRS complexes?
Measure ventricular rhythm between r-r
Measure atria rhythm between p-p

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25
Q

Step 3 - P-wave

A

Are they present?
Do they occur regularly?
Is there a P for each QRS?
Do they all look similar?

26
Q

Step 4 - PR Interval

A

Normal - 0.12-0.20 (3-5 small boxes)
Are they < or >?
Are they consistent?

27
Q

Step 5 - QRS Complex

A

Are they narrow (< 0.12)?
Are they wide (>0.12)?
Are they similar across strip

28
Q

Steps for emergency management

A 
1- ensure ABCs
2 - Administer O2 via nasal canula or non-rebreather mask
3 - Obtain baseline vitals
4 - Obtain ECG
5 - Initiate continuous ECG monitoring
6 - Identify underlying rate and rhythm
7 - Identify dysrhythmia
8 - Establish IV access
29
Q

S/S Sinus Bradycardia

A

pale,cool skin, hypotension, weakness, angina, dizziness, syncope, confusion, SOB

30
Q

TX Sinus Bradycardia

A

Administer atropine, possible pacemaker therapy, Hold drugs or reduce dosage if they are the cause.

31
Q

S/S Sinus Tachycardia

A

Dizziness, dyspnea, hypotension due to decreased cardiac output. Increased myocardial O2 consumption associaed with increased HR. Angina or increased MI

32
Q

TX Sinus Tachycardia

A

treat underlying cause. (pain, hypovolemia) also IV beta blockers may reduce HR and O2 consumption.

33
Q

Premature atrial contraction (PAC)

A

Atrial contraction originating from somewhere other than SA Node. created a distorted P wave.

34
Q

PAC clinical causes

A

may result from emotional stress, physical fatigue, caffeine, tobacco, alcohol. Also hypoxia, electrolyte imbalance, COPD, hyperthyroidism, heart disease.

35
Q

Atrial Flutter

A

atrial tachydysrhythmia identified by recurring regular sawtooth shaped flutter waves that originate mostly from rt atrium.

36
Q

Atrial Fibrillation

A

total disorganization of atrial electro activity. Most common clinically significant dysrhythmia. Pwaves are replaced by chaotic fibrillatory wave (350-600 per min). results in decreased CO because of ineffective atrial contraction. Cause for 20% of strokes.

37
Q

SA or AV node fails to initiate impulse. Ventricle pace heart

A

ventricular rhythms

38
Q

Premature QRS complex that is wide and distorted in shape. Associated with stimulants (caffeine, alcohol, nicotine,epinephrine)

A

Premature Ventricular Contraction (PVC)

39
Q

Three or more consecutive PVCs. May or may not have pulse.
Associated with MI, CAD, electrolyte imbalance, cardiomyopathy, mitral valve prolapse. Also can be seen with no cardiac disease.

A

Ventricular Tachycardia

40
Q

MI, mitral valve prolapse, HF, CAD

A

Disease states associated with PVCs

41
Q

TX PVC

A

relates to cause. (O2, electrolyte replacement), Drugs - Beta adrenergic blockers ( procainamide, lidocaine)

42
Q

ventricles fire with no order or rhythm. No pulse. Lethal rhythm. ventricles quiver with no effective contraction. Start CPR and defib immediately.

A

Ventricular fibrillation

43
Q

Most common lethal rhythm with electrolyte imbalance (usually magnesium). Has prolonged QT intervals.

A

torsades de pointes

44
Q

No ventricular activity. patient is unresponsive, pulseless, apneic. Patient usually has end stage cardiac disease.

A

Asystole

45
Q

electrical activity on ECK but patient has no pulse. Most common causes hypovolemia, hypoxia, metabolic acidosis, hyper/hypokalemia, hypothermia, drug overdose, MI. TX is CPR and drug therapy (epinephrine)

A

Pulseless Electrical Activity(PEA)

46
Q

Block of electrical impulse. PR interval is very important.

A

heart block

47
Q

Normal HR and rhythm, normal P wave. Prolonged PRI. normal QRS. patient is asymptomatic.

A

1st degree heart block

48
Q

Gradual lengthening of PRI. occurs because of prolonged AV conduction time until atrial impulse is non-conducted and QRS is missing

A

2nd degree heart block (Mobitz type I or wenckebach)

49
Q

P wave non-conducted without lengthening PRI. heartbeats get dropped. will need pacemaker

A

2nd degree heart block (Mobitz type II )

50
Q

No impulses from atria are conducted to ventricles. No communication between atria and ventricles. They work independently.

A

3rd degree heart block ( complete)

51
Q

common causes of Dysrhythmias

A

accessory pathways, cardiomyopathy, conduction defects, heart failure, myocardial cell degeneration, MI, valve disease

52
Q

Other causes of Dysrhythmias

A

acid-base imbalance, alcohol, caffeine, tobacco, drug effects, electric shock, hypoxia, poisoning, near drowning

53
Q

S/S of dysrhythmias

A

Change BP, Dec O2 sat, chest/neck/shoulder/back/jaw/arm pain, dizziness, syncope, dyspnea, diaphoresis, pallor, N&V, anxiety restlessness, DEC LOC/confusion, feeling impending doom, numbness/tingling arms, weakness, fatigue, cold clammy skin, palpitations

54
Q

Dysrhythmias treatments

A

Med review, Synchronized cardioversion, Ablation therapy, pacemakers, defibrillation

55
Q

check pt, sychronized cardioversion, digitalis, diltiazem, heparin/coumadin, ablation

A

Atrial flutter tx

56
Q

check pt, check leads, risk of clots, digitalis, amiodarone, procainamide, syn cardio, ablation

A

Atrial fibrillation tx

57
Q

Ask patient to bear down/cough hard

A

valsalva maneuver - (for SVT)

58
Q

Care of pt with AICD

A

dressing- sutures in place, oozing from site, infection, keep left arm down below shoulder, ID card

59
Q

Pacemakers

A

Implantable, temporary, atrial or ventricular, set of low and high HR

60
Q

Blurred vision, green/yellow halos, bradycardia, anorexia, monitor electrolytes

A

Digoxin toxicity

Med-Surg #2 (3 decks)

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