EKG Flashcards
NORMAL SINUS RHYTHM
rhythm: regular
rate: 60 ~ 100
p wave: present / upright / uniform
PRI: 0.12 ~ 0.20 sec (3~5 sm sq)
QRS: present / uniform / <3 sm sq
SINUS BRADYCARDIA
rhythm: regular
rate: <60
p wave: present / upright / uniform
PRI: 0.12 ~ 0.20sec (3~5 sm sq)
QRS: present / uniform / <3 sm sq
SINUS TACHYCARDIA
rhythm: regular
rate: >100
p wave: present / upright / uniform
PRI: 0.12 ~ 0.20sec (3~5 smsq)
QRS: present / uniform / <3 smsq
SINUS ARRHYTHMIA
rhythm: regularly irregular (2-3 smsq difference)
rate: 60 ~ 100
p wave: present / upright / uniform
PRI: 0.12 ~ 0.20sec (3-5 smsq)
QRS: present / uniform / <3smsq
SINUS ARREST / PAUSE
rhythm: regularly irregular (due to random pause)
rate: 60 ~ 100 (needs to guesstimate)
p wave: present / upright / uniform
PRI: 0.12 ~ 0.20sec (3-5 smsq)
QRS: present / uniform / <3 smsq
[SA fails to initiate impulse -> no P wave -> nothing follows]
PREMATURE ATRIAL COMPLEX (PAC)
rhythm: irregular (regularly or irregularly)
rate: varies
p wave: present / upright / abnormal shape
PRI: 3~5 smsq
QRS: present / uniform / <3 smsq
NOT A RHYTHM
- atria fires before SA node, producing a beat sooner
- overall wave looks normal; just occurs early
- T and P looks almost continuous
SUPRAVENTRICULAR TACHYCARDIA (SVT)
rhythm: regular
rate: 150 ~ 250
p wave: masked by QRS
PRI: can’t determine (no P)
QRS: present / uniform / <3 smsq
PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (PSVT)
aka PAROXYSMAL ATRIAL TACHYCARDIA (PAT)
rhythm: Regular
rate: 150 ~ 250
p wave: masked by QRS
PRI: can’t determine (no P)
QRS: present / uniform / <3 smsq
SUDDEN occurrence of SVT and reversion to normal rhythm
need to witness to declare
ATRIAL FIBRILLATION (A-FIB)
rhythm: irregularly irregular
rate: atrial = 350-400; ventricular = varies
p wave: abnormal, quivers
PRI: can’t determine
QRS: <3 smsq
atria quivers/fibrillates; no contraction
rate <60, ~ w/ slow ventricular response;
rate>120, ~ w/ fast ventricular response
ATRIAL FLUTTER
rhythm: regular
rate: atrial 250~400; ventricular=varies
p wave: F waves (sawtooth shape)
PRI: varies
QRS: present / uniform / <3 smsq
WANDERING ATRIAL PACEMAKER (WAP)
rhythm: irregularly irregular
rate: 60 ~ 100
p wave: present / upright / not uniform
PRI: varies
QRS: <3 smsq
NOT A RHYTHM
pacemaker moves from SA node to elsewhere in Atria
so p wave shape is different and irregularly irregular
MULTIFOCAL ATRIAL TACHYCARDIA (MAT)
rhythm: irregularly irregular
rate: >100
p wave: present / upright / not uniform
PRI: varies
QRS: <3 smsq
NOT A RHYTHM
basically tachy WAP
JUNCTIONAL (ESCAPE) RHYTHM
rhythm: regular
rate: 40 ~ 60
p wave: inverted or absent / before, during, after QRS / uniform
PRI: <3 smsq or not measurable
QRS: present / uniform / <3 smsq
originates @/around AV node and Bundle of His and travel down; may travel up as well
ACCELERATED JUNCTIONAL RHYTHM
rhythm: regular
rate: 60 ~ 100
p wave: inverted or absent / before, during, or after QRS
PRI: <3 smsq or not measurable
QRS: present / uniform / <3 smsq
JUNCTIONAL TACHYCARDIA
rhythm: regular
rate: >100
p wave: inverted or absent / before, during, or after QRS
PRI: <3 smsq or can’t measure
QRS: present / uniform / <3 smsq
PREMATURE JUNCTIONAL CONTRACTION
rhythm: irregular during
rate: varies
p wave: inverted or absent / before, during, after QRS
PRI: <3 smsq or not measurable
QRS: present / uniform / <3 smsq
NOT A RHYTHM
~PAC + inverted p followed by a slight pause
FIRST-DEGREE HEART BLOCK
rhythm: regular
rate: varies
p wave: present / upright / uniform
PRI: consistently >5smsq
QRS: present / uniform / <3 smsq
LEAST SERIOUS
SA node’s impulse is delayed longer at AV node/BoH
SECOND-DEGREE TYPE 1 HEART BLOCK
(WENCKEBACH)
rhythm: atrial=regular; ventricular=irregular
rate: ventricular is progressively slower than atrial (falls behind)
p wave: present / upright / uniform
PRI: progressively prolongs until 1 QRS fails; repeats
QRS: present / uniform / <3 smsq
NOT A RHYTHM
each impulse is delayed a little longer and doesn’t fire; repeats
SECOND-DEGREE TYPE 2 HEART BLOCK
(CLASSICAL)
rhythm: atrial=regular; ventricular=irregular
rate: sure
p wave: present / upright / uniform
PRI: constant
QRS: present / uniform / sudden absence / <3 smsq
NOT A RHYTHM
sudden drop of QRS w/o PRI changes (like type 1)
THIRD-DEGREE HEART BLOCK
rhythm: regular
rate: intrinsic; atrial = 60~100 / ventricular = <60
p wave: present / upright / uniform
PRI: varies
QRS: present / uniform / varies
NOT A RHYTHM
p wave and QRS (atria and ventricle) impulses independently
PREMATURE VENTRICULAR COMPLEX
rhythm: irregular during
rate: varies
p wave: absent
PRI: not measurable
QRS: wide / >3 smsq / unifocal vs multifocal
NOT A RHYTHM
ventricles takes over w/o impulses from SA or AV nodes
PVC COUPLET
2 PVCs back to back
PVC SALVOS
“RUNS OF VENTRICULAR TACHYCARDIA”
3 or more PVCs in a row
PVC BI, TRI, QUADGEMINY
single PVC at every 2nd, 3rd, 4th beat
IDIOVENTRICULAR RHYTHM
“VENTRICULAR ESCAPE RHYTHM”
rhythm: regular
rate: 20 ~ 40
p wave: none
PRI: not measurable
QRS: wide / >3 smsq
ACCELERATED IDIOVENTRICULAR RHYTHM
rhythm: regular
rate: 40 ~ 100
p wave: none
PRI: not measurable
QRS: abnormal / >3 smsq
MONOMORPHIC VENTRICULAR TACHYCARDIA
rhythm: regular
rate: >100
p wave: none
PRI: not measurable
QRS: usually monomorphic / wide / >3 smsq
TORSADES DE POINTES
POLYMORPHIC VENTRICULAR TACHYCARDIA
rhythm: regular
rate: >100
p wave: none
PRI: not measurable
QRS: polymorhpic / wide / >3 smsq
VENTRICULAR FIBRILLATION
rhythm: irregular
rate: cant determine
p wave: none
PRI: none
QRS: none
entire heart is fibrillating w/o organized contraction
coarse (early stage) vs fine
chaotic wave ht length vs very shallow squiggly line
ASYSTOLE
rhythm: none
rate: none
p wave: none
PRI: none
QRS: none
FLAT LINE
AGONAL RHYTHM
rhythm: usually regular
rate: <20
p wave: none
PRI: none
QRS: wide / >3 smsq
PULSELESS ELECTRICAL ACTIVITY (PEA)
any rhythm without palpable pulse
