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chapter 18 egans special topics > ECG's > Flashcards

ECG's Flashcards

1
Q

What are the signs and symptoms of cardiac disease?

A

Dyspnea, chest pain, SOB, palpations, weakness, lethargy, or syncope

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2
Q

What is Polarized?

A

The resting state or the state in which there is no electrical activity.

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3
Q

What is depolarization?

A

When stimulation of the polarized cells causes an influx of Na+ into the interior portion of the cell. Depolarization causes the cardiac muscles to contract.

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4
Q

The electrical impulse system has 3 types of cardiac cells capable of electrical excitation, what are they called?

A

1.Pacemaker cells (SA node, AV node)
2. Purkinjie Fibers
3. Atrial and Ventricular muscle cells

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5
Q

The impulse conducting system is responsible for what?

A

Initiating the heartbeat and controlling the heart rate, and also controls the contraction of the heart chambers.

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6
Q

Where is the SA node located?

A

Upper right atrium

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7
Q

Of the 3 electrical impulses (Pacemaker SA ,AV, Purkinjie fibers, Atrial and ventricular muscle cells) which has the greatest degree of automaticity and paces the heart?

A

SA Node

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8
Q

Any heartbeat originating outside of the SA node is considered what?

A

Ectopic

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9
Q

The SA node is innervated by what?

A

The Autonomic Nervous System which allows the sympathetic and parasympathetic to influence the heart rate.

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10
Q

This is considered the backup pacemaker because it has the 2nd greatest degree of automaticity

A

The AV node and paces ventricular activity at a lower heart rate of 40 to 60 BPM.

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11
Q

Why is the electrical impulse temporarily delayed at the AV node?

A

It allows time for the ventricle to fill with blood.

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12
Q

Where is the AV node located?

A

It is located in the interventricular septum.

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13
Q

What stimulates contraction of the myocardium?

A

The Purkinje fibers

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14
Q

What happens when the atrium and the ventricles contract?

A

The blood moves

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15
Q

What is the function of the Purkinje Fibers?

A

The Purkinje Fibers stimulate contraction of the myocardium causing a coordinated contraction of the ventricles.

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16
Q

What leads are bipolar?

A

The Limb leads 1,2,3,

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17
Q

What leads are unipolar?

A

The precordial (chest) leads: V1, V2, V3, V4, V5, V6, and
Limb leads: aVR, aVL and aVF

18
Q

Depolarization of the atria is seen as what wave on an ECG?

A

P wave (less than 0.12 seconds)

19
Q

Ventricle depolarization is seen as what on the ECG?

A

QRS complex (less than 0.12 seconds)

20
Q

The wave of repolarization in the ventricles?

A

T wave

21
Q

The typical PR interval is how long?

A

0.12 to 0.20 seconds

22
Q

The PR interval refers to the distance of what?

A

The start of atrial depolarization to the start of ventricular depolarization.

23
Q

A prolonged PR interval (longer than 0.20 seconds) indicates what?

A

A PR interval lasting longer than 0.20 seconds indicates there is an abnormal delay at the AV node and a block is present. (First degree heart block)

24
Q

This represents the time from the end of ventricular depolarization to the start of ventricular repolarization.

A

The ST segment

25
Q

An elevated ST segment is typically seen in what conditions?

A

MI (elevated ST segment)
Ischemia, Angina (depressed ST segment)

26
Q

Causes of Sinus Tachycardia

A

Pain, anxiety, fever, hypovolemia, hypoxemia
Treatment: Eliminate the underlying cause

27
Q

Causes of Sinus Bradycardia

A

Hypothermia, SA node abnormalities
Treatment: Atropine to stimulate the heart rate

28
Q

An arrhythmia characterized by irregular spacing of the QRS complexes and may occur from the effects of breathing on the heart or as a side effect of digoxin.

A

Sinus arrhythmia- Typically does not require treatment

29
Q

An arrhythmia where the PR interval is longer than 0.20 seconds. This tracing indicates that the impulse from the SA node is getting to the ventricles but is abnormally delayed in passing the AV node.

A

First Degree Heart block
-Treatment is typically not needed

30
Q

An arrhythmia in which there is an abnormality in the AV junction delays or blocks conduction of the impulse through the AV node.

Characterized by a progressively increasing PR interval with consecutive beats until one impulse does not pass onto the ventricles until the QRS complex is completely dropped.

A

Second Degree heart block type 1 (Wenckebach or Mobitz type 1)
-Treatment is typically not needed

31
Q

An arrhythmia in which there is a series of P waves not followed by a QRS complex (the ventricle is not receiving an impulse to contract) then a P wave that is followed by a QRS complex.

A

Second Degree heart block type 2 (Mobitz type 2)
-Treatment includes ATROPINE for a better CO until a pacemaker is placed.

32
Q

An arrhythmia in which the atria and the ventricles are not communicating. There is no relationship between the P waves and QRS complexes.
Often caused by a MI or drug toxicity especially DIGITALIS.

A

Third Degree Heart Block
-Treatment includes ATROPINE to speed up the ventricles and a pacemaker.

33
Q

The rapid depolarization of the atria from an ectopic source. Depolarization occurring at a rate of 250 to 350 BPM. All of the P waves will have the same appearance resulting in a saw-toothed pattern. THERE ARE NUMEROUS P WAVES FOR EVERY ONE QRS COMPLEX.

A

Atrial flutter
-Caused by hypoxemia, rheumatic heart disease, CHD, PE, stress and renal failure.
-Treatment includes digoxin, calcium blockers or b blockers and sometimes cardioversion.

34
Q

When the atrial muscle quivers in an irregular pattern that does not result in a coordinated contraction, no true P waves are seen, QRS complexes occur with no predictable pattern.

A

Atrial Fibrillation

This is a very serious arrhythmia due to the loss of the atrial kick that helps move blood into the ventricles, helping them to fill before systole. BLOOD CAN BECOME STAGNANT IN THE ATRIA AND LEAD TO THE FORMATION OF CLOTS
-Treatment includes anticoagulants, medications to slow the HR such as beta blockers, calcium channel blockers, cardioversion.

35
Q

When a portion of the impulse-conducting system or myocardium other than the SA node becomes diseased and triggers depolarization of the surrounding cardiac cells.
Characterized by bizarre, unique and wide QRS complexes.

A

PVC’s
May occur as a result of stress, caffeine intake, nicotine use or electrolyte imbalance.

-Treatment must be prompt to avoid progression to V Tach and V FIB
-May occur after every other beat (Bigeminy) or 3rd beat (Trigeminy)

36
Q

A run of 3 or more PVC’s. Series of wide QRS complexes with no preceding P wave, a hallmark is 3rd degree AV block because the ventricles are beating independently of the atria

A

V Tachycardia
- Treatment includes cardioversion followed by antiarrhythmic drugs, ICD, beta blockers

37
Q

This is the most life-threatening arrhythmia and is defined as erratic quivering of the ventricle muscle. The ECG will show irregular fluctuations with a zigzag pattern.

A

V FIB
-Treatment calls for rapid defibrillation CPR, administration of 02 and anti-arrhythmic meds, treatment of the underlying cause of ischemia.
-Survivors often receive and ICD.

38
Q

This is a very serious condition in which there is a dissociation of the electrical and mechanical activity of the heart. The heart generates an ECG pattern, but there is no pulse.

A

PEA
- A PEA is very rare and generally does not occur without a precipitating event such as a tension pneumothorax, MI, drug overdose or sever electrolyte disturbance.
- Treatment involves CPR, emergency life support.

39
Q

Where are each of the precordial leads placed?

A

V1- 4th int. costal space to the right of sternum
V2- 4th int. costal space to the left of the sternum
V3- Midway between V2 and V4
V4- 5th intercostal space midclavicular line
V5-Anterior axillary line, aligned with V4.
V6- Mid axillary line in straight line with V4, V5.

40
Q

How many actual leads are in a 12 lead-ECG?

A

10 leads with 12 different views of the heart.

41
Q

ECG patterns

A

Atrial flutter-Saw tooth pattern
Atrial Fibrillation- Baseline pattern is erratic and no true P waves are seen.
V Tach-Witches hat
V Fib-Zig-zag pattern

chapter 18 egans special topics (9 decks)

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