EKG

Question 1

P wave

Answer 1

• Atrial depolarization
  
  • Arial squeeze and contract

Question 2

QRS complex

Answer 2

• Ventricle depolarization
• Ventricle squeeze and contract

Question 3

T Wave

Answer 3

• Ventricular repolarization
• Getting ready to contract again

Question 4

Measuring

Answer 4

• 5 big boxes = 1 second
  
  • Little boxes = 0.04 seconds
  • Bix box = 0.20 seconds

Question 5

Steps to Interpretation

Answer 5

1. Is there 1 P wave for every QRS wave?
   
   2. Is the PR interval 0.12 - 0.20 seconds (3-5 little boxes)
      ○ Beginning of P wave to Q
   3. Is the QRS less then 0.12 seconds?
      ○ Tall and Narrow (Q-S)
   4. Is the rate between 60-100
      ○ Count QRS complexes x10 = rate
   5. Is the rhythm regular?
      Same amount of boxes between R complexes

Question 6

Normal Sinus Rhythm

Answer 6

• P-wave: Normal
  
  • PR interval: 0.12 - 0.20
  • QRS: < 0.12
  • Rate: 60 - 100
    Regularity: Regular

Question 7

Sinus Bradycardia

Answer 7

• Interpretation
  ○ P-wave: Normal
  ○ PR Interval: 0.12-0.20
  ○ QRS: <0.12
  ○ Rate: <60
  ○ Regularity: Regular
  
  • Causes
    ○ Sleep
    ○ Inactivity
    ○ Very athletic
    ○ Drugs
    ○ MI
  • Interventions
    ○ Fix the cause
    Atropine

Question 8

Sinus Tachycardia

Answer 8

• Interpretations
  ○ P-wave: Normal
  ○ PR Interval: 0.12-0.20
  ○ QRS: <0.12
  ○ Rate: >100
  ○ Regularity: Regular
  
  • Causes
    ○ Hypotension
    ○ Volume depletion
    ○ Caffeine
    ○ Exercise
    ○ Fever
    ○ Anxiety
    ○ Drugs
    ○ Pain
  • Interventions
    ○ Fix cause
    ○ Fever: acetaminophen
    ○ Pain: pain meds
    Hypotension: iv fluids

Question 9

First Degree Heart Block

Answer 9

• Interpretation
  ○ P-wave: Normal
  ○ PR Interval: >.20
  ○ QRS: <0.12
  ○ Rate: 60-100
  ○ Regularity: Regular
  
  • Causes
    ○ Peds: infection
    ○ Myocarditis
    ○ Congenital heart disease
  • Intervention
    ○ Fix the cause
    ○ Tx generally not required
    If extreme: pace maker

Question 10

Second Degree Heart Block - Type 1 (Winkebach)

Answer 10

• Interpretation
  ○ P-wave: Not a QRS for every P wave
  ○ PR Interval: longer, longer, longer….drop
  ○ QRS: <0.12
  ○ Rate: 60-100
  ○ Regularity: Regular
  
  • Causes
    ○ Ischemia
    ○ Myocarditis
    ○ Status post-cardiac surgery
  • Interventions
    ○ Treat cause
    ○ Asymptomatic: no tx
    Symptomatic: pace maker

Question 11

Second Degree Heart Block - Type 2 (Mobitz II)

Answer 11

• Interpretation
  ○ P-wave: Not a QRS for every P
  ○ PR Interval: 0.12-0.20
  ○ QRS: <0.12
  ○ Rate: <60
  ○ Regularity: Regular
  
  • Causes
    ○ MI
    ○ Ischemia
  • Interventions
    ○ Fix the cause
    Pacemaker

Question 12

Third degree Heart Block

Answer 12

• Interpretation
  ○ P-wave: Normal
  ○ PR Interval: Variable
  ○ QRS: <0.12
  ○ Rate: <60
  ○ Regularity: Irregular
  
  • Causes
    ○ Damage to the heart
    § MI
    § Heart valve disease
    § Rheumatic fever
    § Sarcoidosis
  • Interventions
    § Fix the cause
    Pacemaker!!

Question 13

Atrial Flutter

Answer 13

• Interpretation
  ○ P-wave: “saw-tooth”
  ○ PR Interval: none
  ○ QRS: <0.12
  ○ Atrial Rate: 250-400 Ventricular
  ○ Rate: Varies
  ○ Regularity: Regular or Irregular
  
  • Causes
    ○ Heart disease
    ○ MI
    ○ CHF
    ○ Pericarditis
  • Intervention
    ○ Fix the cause
    ○ Cardioversion
    ○ Pacemaker
    ○ Antiarrhythmics: Amiodarone
    ○ Beta Blockers: Metoprolol
    Calcium Channel Blockers: Diltiazem

Question 14

Atrial Fibrillation

Answer 14

• Interpretation
  ○ P-wave: ‘wavy’
  ○ PR Interval: none
  ○ QRS: <0.12
  ○ Atrial Rate: >400
  ○ Ventricular rate: Varies
  ○ Regularity: irregular
  
  • Causes
    ○ Heart disease
    ○ Pulmonary disease
    ○ Stress
    ○ Alcohol
    ○ Caffeine
  • Interventions
    ○ Cardioversion
    ○ Antiarrhythmics: Amiodarone
    ○ Beta Blockers: Metoprolol
    ○ Surgery: Ablation
    MUST BE ANTICOALTED

Question 15

Supraventricular Tachycardia (SVT)

Answer 15

• Interpretation
  ○ P-wave: hidden
  ○ PR Interval: immeasurable
  ○ QRS: <0.12
  ○ Rate: 150-250
  ○ Regularity: Regular
  
  • Causes
    ○ Caffeine
    ○ CHF
    ○ Fatigue
    ○ Hypoxia
    ○ Altered pacemaker in the heart
  • Interventions
    ○ Fix the cause
    ○ Cardioversion
    ○ Adenosine (Rapid push) flat line and come back
    Vagal maneuver (bear down)

Question 16

Ventricular Tachycardia (V-Tach)

Answer 16

• Interpretation
  ○ P-wave: none
  ○ PR Interval: none
  ○ QRS: >0.11 - ‘wide & bizarre’
  ○ Rate: 150-250
  ○ Regularity: Regular
  
  • Causes
    ○ MI
    ○ Ischemia
    ○ Digoxin toxicity
    ○ Hypoxia
    ○ Acidosis
    ○ Hypokalemia
    ○ Hypotension
  • Intervention
    ○ Pulse (YES): Cardioversion
    Pulse (NO): CPR, defibrillate, epinephrine

Question 17

Ventricular Fibrillation (V-fib)

Answer 17

• Interpretation
  ○ P-wave: none
  ○ PR Interval: none
  ○ QRS: none
  ○ Rate: none
  ○ Regularity: Irregular
  
  • Causes
    ○ MI
    ○ Ischemia
    ○ Hypoxia
    ○ Acidosis
    ○ Hypokalemia
    ○ Hypotension
    ○ Most common cause of sudden death
  • Intervention
    ○ CPR
    ○ *Defibrillate
    Epinephrine

Question 18

Asystole

Answer 18

• Interpretation
  ○ P-wave: none
  ○ PR Interval: none
  ○ QRS: none
  ○ Rate: none
  ○ Regularity: n/a
  
  • Cause
    ○ Follows VT/VF
    ○ Acidosis
    ○ Hypoxia
    ○ Hypokalemia
    ○ Hypothermia
    ○ Overdose
  • Intervention
    ○ CPR
    Epinephrine

Question 19

Potassium EKG abnormalities

Answer 19

Hyperkalemia
- Prolonged PR
- Tall, peaked T wave
- Wide, flat P wave
- Wide QRS
- ST depression

Hypokalemia
- Prolonged PR
- Shallow T wave
- Peaked P wave
- ST depression
- Prominent U wave

Question 20

Calcium EKG abnormalities

Answer 20

Hypercalcemia
- Short QT interval

Hypocalcemia
- Prolonged QT interval

Question 21

Magnesium EKG abnormalities

Answer 21

Hypermagnesemia
- Prolonged PR
- Wide, flat P wave
- Wide QRS
- ST depression
- Tall T wave

Hypomagnesemia
- Prolonged PR
- Long QT