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NUR 329 > EKG > Flashcards

EKG Flashcards

0
Q

When do the AV valves close?

A

During systole

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1
Q

The 2 AV valves include what 2 valves?

A

Mitral

Tricuspid

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2
Q

When do the AV valves open?

A

Diastole

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3
Q

The SL valves include what 2 valves?

A

Aortic

Pulmonic

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4
Q

When do the SL valves open?

A

During systole

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5
Q

What side of the heart is considered unoxygenated ?

A

Right side

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6
Q

What side of the heart is considered oxygenated?

A

Left side

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7
Q

Path of a blood drop through the coronary arteries

A 
Aorta
RCA
LAD
Circumflex
Left main coronary artery
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8
Q

The left main coronary artery incl what 2 vessels?

A

LAD

circumflex

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9
Q

Unoxygenated blood flow

A 
Inf/ sup VC
RA
tricuspid
RV
pulm valve
Lungs
Pulm system
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10
Q

Oxygenated blood flow

A 
Pulm veins
LA
mitral valve
LV
Aortic valve
Systemic
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11
Q

Def systole

A

Contraction of ventricles

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12
Q

Def diastole

A

Ventricular relaxation

Ventricular filling

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13
Q

What is normal HR

A

60-100 BPms

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14
Q

What is normal stroke vol range

A

60-130 mL

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15
Q

What is normal CO range

A

4-8 L / min

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16
Q

Flow of electrical conduction

A 
SA 
AV
bundle of HIS
L and R bundle branches
Purkinge fibers
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17
Q

The p wave represents what part if the cardiac cycle

A

Atrial depol

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18
Q

The QRS complex represents what part of the cardiac cycle

A

Ventricular depol and atrial repol

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19
Q

The t wave represents what part of the cardiac cycle

A

Ventricular repol

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20
Q

1 small box on the EKG strip = ___ secs

A

.04

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21
Q

1 large square on the EKG strip= ____ secs

A

.20

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22
Q

What are the 5 steps to interpreting EKGS

A 
HR
heart rhythm
P wave
PRI
QRS complex
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23
Q

Normal p wave characteristics

A

First deviation from the line

Rounded and upright

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24
Q

The p wave reflects which node firing

A

SA

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25
Q

What is the normal PRI range

A

.12-.20 secs

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26
Q

What does the QRS complex represent ?

A

Ventricular depol

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27
Q

What is the normal QRS range

A

.06-.12 secs

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28
Q

How do u obtain the PRI

A

Measure from the beginning of the p - beginning of QRS

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29
Q

How do you obtain QRS interval

A

Measure from the beginning of q- end of s

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30
Q

What does the t wave represent

A

Ventricular repol

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31
Q

T/F- sinus bradycardia is regular

A

True

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32
Q

When might sinus bradycardia be seen

A

Athletes
During sleep
In response to a vagal maneuver

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33
Q

Causes of bradycardia (10)

A 
Hypoglycemia
Hypothermia
Hypothyroidism
Prev cardiac hx
Meds
Toxic exposure
MI
Incr ICP
Lower metabolic need
Vagal stim
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34
Q

S & S of bradycardia(9)

A 
Syncope
Dizziness
Chest pain
Sob
Exercise intol
Cool, clammy skin
Altered mental status
Hypotension
Memory loss
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35
Q

Tx of bradycardia

A

Atropine
Pacing if pt is hemodynamically compromised
tx depends on if the pt is symptomatic
Give O2
Monitor O2 sat
Monitor BP and HR

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36
Q

TF- tachycardia is irreg

A

F- regular

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37
Q

Causes of tachycardia (10)

A 
Damage to cardiac tissue
HTN
fever
Stress
Excessive ETOH, caffeine, nicotine, rec drugs ( cocaine)
Meds
Pain
Electrolyte imbalance
Hyperthyroidism
Dehydration
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38
Q

S&S tachycardia

A 
Dizziness
Sob
Light headed ness
⬆️ HR
palps
Chest pain
Syncope
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39
Q

Tx of tachycardia (8)

A 
Find and treat cause
Give O2 and monitor O2 sat
Monitor BP and HR
POSSIBLY
- adenosine
- beta blocker - metoprolol
- calcium channel blocker
Cardio version
Ablation
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40
Q

When would a HR increase when a pt presents with sinus arrhythmia

A

During inspiration

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41
Q

When would a HR decrease when a pt presents with sinus arrhythmia

A

During expiration

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42
Q

Def sinus arrhythmia

A

A normal variation in the beating of the heart

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43
Q

Causes of sinus arrhythmia (4)

A

Heart disease
Extreme stress
Excessive consumption of caffeine, nicotine, and ETOH
diet pills, cough/cold meds

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44
Q

TF- sinus arrhythmia is usually symptomatic

A

False- asymptomatic

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45
Q

Causes of sinus arrest (7)

A 
Sleep
Myocarditis
Cardiomyopathy
MI
digitalis tox
Elderly
Vagal stim
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46
Q

S&S of sinus arrest

A 
Asymptomatic
Syncope
Dizziness
LOC
bradycardia
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47
Q

Tx of sinus arrest

A

Atropine
Pacemaker
o2 and sat
BP and hr

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48
Q

Def a-flutter

A

Coordinated rapid beating of the atria

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49
Q

Is the rhythm of a-flutter regular

A

Yes

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50
Q

Are there p waves present in a-flutter?

A

No - normal p waves are absent

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51
Q

What does a-flutter look like on an EKG

A

Saw tooth

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52
Q

Is the PRI measurable in a-flutter

A

No

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53
Q

In a-flutter, do all of the QRS complexes look similar

A

Yes

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54
Q

Causes of atrial flutter ( 7)

A 
> 60 years old
Valve disorder (mitral)
Thickening of the heart muscle
Ischemia
Cardiomyopathy
COPD
emphysema
Chest pain
SOB
Low BP
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55
Q

S&S of a-flutter (6)

A 
Palps
Sob
Anxiety
Weakness
Angina
Syncope
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56
Q

What risks are assoc w/ a-flutter ( 2)

A

Clot formation- stroke, PE

dramatic drop in CO

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57
Q

Tx of a-flutter (5)

A
  • cardio version
  • anti arrhythmics
  • meds that slow ventricular rate
    Heparin to ⬇️ risk of thrombi
    o2
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58
Q

What meds may slow the ventricular rate in a-flutter ( 4)

A

Diltiazem
Verapamil
Digitalis
Beta blocker

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59
Q

Is the HR regular in afib

A

No

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60
Q

Are there p waves in afib

A

No- normal p waves are absent

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61
Q

Are u able to measure PRI in afib

A

No

62
Q

In afib, do all of the QRS complexes look similar

A

Yes

63
Q

Causes of afib (12)

A 
Hypoxia
HTN
CHF
CAD
dysfunction of the sinus node
Mitral valve disorders
Rheumatic heart disease
Pericarditis
Hyperthyroidism
Excessive ETOH, caffeine
Pulmonary edema
Altered LOC
64
Q

S&S of afib (9)

A 
Palps
Irreg pulse
Dizziness, light headedness
Fainting
Confusion
Inflammation
Infiltration
Age
Fatigue
Sob
Sob when lying down
Tightness in the chest
CHF, CAD, HTN
OBESITY
DM
hyperthyroid
65
Q

What risks are assoc w/ afib (2)

A

Clot

⬇️ CO

66
Q

Afib tx (4)

A 
Rate control with meds
Anti thrombotic ther
Correction of rhythm- chemical or electrical cardioversion 
O2
Cardioversion
BB, CCB, amiodarone
67
Q

What meds will slow ventricular rate in afib (3)

A

Digoxin
Beta adrenergic blockers
Calcium channel blockers

68
Q

Are there p waves in ventricular abnormalities and why

A

No bc there is no atrial activity or depol

69
Q

TF- ventricular rhythms will display QRS complexes that are regular and normal sized

A

False- QRS complexes are wide and bizarre

70
Q

Def PVC

A

An ectopic beat that arises from an irritable site in the ventricles

71
Q

How do PVCs appear

A

Many diff patterns and shapes

ALWAYS WIDE AND BIZARRE!!!

72
Q

Is the rate of PVCs usually normal

A

Yes, usually

73
Q

Describe rhythm with PVCSs

A

Irreg during PVCs

74
Q

Are p waves present with PVCs

A

No

75
Q

Is PRI measurable with PVCs

A

No

76
Q

Do all QRS COMPLEXES look similar with PVCs

A

No- varies; wide and bizarre

77
Q

Causes of PVCs ( 8)

A 
Exercise
Stress
Caffeine
Heart disease, MI, CHF, cardiomyopathy, mitral valve prolapse
Electrolyte imbalance
Hypoxia
Tricyclics antidepressants
Digitalis tox
78
Q

S and s of PVCs (4)

A

Palps
Weakness
Dizziness
Hypotension

79
Q

Risks a/w PVCs (3)

A

Decr CO
heart failure
May convert to VTACH or VFIB

80
Q

PVC tx (4)

A

O2 @ 2 L
Treat cause
Lidocaine
Monitor pt and freq of PVCs

81
Q

Def Idioventricular arrhythmia

A

A last ditch effort of the ventricles to try to prevent cardiac standstill

82
Q

Special notes about IVA (3)

A

SA and AV have failed
Rate bx 20-40 BPms
CO is compromised

83
Q

Rate of IVA

A

Ventricular- 20-40

84
Q

Is the rhythm reg or irreg with IVA

A

Usually reg

85
Q

P waves absent or present with IVA

A

Absent

86
Q

QRS complexes appearance with IVA

A

Wide and bizarre

T wave deflection

87
Q

S and s of IVA (6)

A 
Pale
Cool skin
Weakness
Dizziness
Hypotension
Change in LOC/ mental status
88
Q

Tx of IVA ( 4)

A

Atropine
Pacing
Dopamine when hypotensive
CPR

89
Q

Rhythm in VTACH

A

Atrial rhythm not distinguishable

Ventricular rhythm usually reg

90
Q

Pt wave present in vtach

A

No

91
Q

How do QRS look in VTACH

A

Wide and bizarre

92
Q

Causes of VTACH ( 6)

A 
Underlying heart disease
Mi
Meds
Electrolyte imbalance
Digitalis tox
CHF
93
Q

S and s of VTACH (8)

A 
Chest pain/discomfort
Syncope
Dizziness
Palps
Sob
Absent/rapid pulse
Loss of consciousness
Hypotension
94
Q

VTACH tx if pt has no pulse (2)

A

Begin CPR

defib ASAP

95
Q

VTACH tx if pt has pulse (6)

A 
- amiodarone 
Lidocaine
Anti arrhythmics
ICD
ablation 
O2
96
Q

Def v fib

A

Electrical impulses initiated by multiple ventricular sites

97
Q

What is the rate in v fib

A

Not discernible

98
Q

Is the rhythm reg in v fib

A

No

99
Q

P waves in v fib

A

No

100
Q

Causes of v fib (7)

A 
AMI
untreated VT
electrolyte imbalance
Hypothermia
Mi
Drug tox ornOD
Trauma
101
Q

S and s of v fib (2)

A

Loss of consciousness

Absent pulse

102
Q

Tx of v fib (3)

A

* CHECK YOUR PT!!!*
CPR
defib

103
Q

Def a systole

A

Ventricular standstill

104
Q

EKG char of asystole (5)

A 
No rate
No rhythm
No p wave
No PRI
No QRS complexes
105
Q

Causes of asystole (5)

A 
Mi
Failure of pacemakers
Cardiac tamponade
Prolonged v fib
PE
106
Q

S and s of asystole ( 3)

A

No palpable pulse
No BP
Loss of consciousness

107
Q

Def pulseless electrical activity (PEA)

A

The absence of a pulse or myocardial muscle activity with presence if organized electrical activity on the cardiac monitor.

Pt is clinically dead despite some type of organized rhythm on monitor

108
Q

Causes of PEA (12)

A 
*hypovol
Hypoxia
Acidosis
Hypo/hyperkalemia
Hypothermia
Toxins
Tamponade ( cardiac)
Tension pneumothorax
Thrombosis- coronary or pulm
Trauma
Massive mi
OD of tricyclics antidepressants
109
Q

S and s of PEA (3)

A

Pulselessness
No BP
Loss of consciousness

110
Q

What is Tridal and how is it admin

A

Iv form of NG

Mcg/min

111
Q

How is dobutamine and dopamine admin

A

Mcg/kg/ min

112
Q

Def electrical mechanical dissociation

A

When u can see PQRST on the screen,but the heart is not actually beating _ residual electrical activity

113
Q

What can an EKG tell us abt electrical fx (2)

A

Rhythm disturbances

Conduction disturbances

114
Q

Def irritability

A

A site along the conduction pathway becomes irritable and speeds up, thus overriding higher pacemaking sites for control of the heart

115
Q

TF- the sympathetic NS affects the ventricles and the atrial

A

True

116
Q

How does the sympathetic NS affect cardiac activity

A

Incr

  • HR
  • conduction
  • irritability
117
Q

TF- the parasympathetic NS affects both the atria and the ventricles

A

False- only the atria

118
Q

How does the parasympathetic NS affect cardiac activity

A

Decr

  • HR
  • conduction
  • irritability
119
Q

Absolute refractory period

A

Cannot produce a new/early impulse

120
Q

Relative refractory period

A

May produce a new impulse if strong enough

121
Q

What does widened or abnormal QRS complexes indicate

A

Conduction started at the ventricles

122
Q

Def atrial tach

A

Pacemaker is a single irritable site within the atria that fires repetitively at a very high rate and then conducted normally down the pathway

123
Q

A tach rate

A

150-250 BPms

124
Q

A tach rhythm

A

Reg

125
Q

A tach p waves

A

Atrial p waves differ from sinus waves- can get lost in t waves

126
Q

A tach PRI

A

.12-.20

127
Q

Causes of a tach (3)

A

Intrinsic
Metab
Drugs

128
Q

A- tach tx (2)

A

Rate control

Adenosine

129
Q

Def PAC

A

Pacemaker is an irritable focus within the atria that fires prematurely and produces a single ectopic beat. Impulses are conducted normally to ventricles

130
Q

Regularity of PAC

A

Regular except for PAC

131
Q

Rate of PAC

A

Usually normal

132
Q

PAC- p wave

A

PAC p wave differs from sinus p wave
May be flattened or notched
May be lost in t wave

133
Q

PAC- PRI

A

Usually normal but can be > .20 secs

134
Q

PAC- QRS

A

Normal

135
Q

PAC- tx (1)

A

Amiodarone

  • usually given for ventricles,but also works for PAC, COPD, decr CO
  • prevents a-fib
136
Q

When might you see a PAC (4)

A

Post open heart
Mi
Age
Irritability

137
Q

How do you report PAC

A

Normal sinus rhythm with x(#) PAC

138
Q

PAC causes (6)

A 
Caffeine
ETOH
Nicotine 
Stretched myocardium (hypervolemia) 
Hyper metabolic states
Ischemia, infarct, injury
139
Q

PAC tx (2)

A

Treat underlying

No tx of asymptomatic

140
Q

Def a-fib

A

Many irritable sites within the atria fire repetitively, causing ineffective atrial depol

141
Q

A-fib p wave char

A

Grossly irreg

Unable to discern p waves or PRI

142
Q

What is the difference bx cardioversion and defib

A

-Cardioversion is a planned shock at smaller amt of jewels and is only for new onset afib
- defib is for pts who have coded
200, 300, 360

143
Q

Antidotes for coumadin

A

FFP
Protamine sulfate if FFP N/A
Vit k

144
Q

Def artificial pacemaker

A

A device used to provide artificial electrical stimulus to myocardial tissue to induce myocardial depol

145
Q

Pacemaker classifications

A 
Single chamber
Dual chamber
Chamber paced
Chamber response
Response
146
Q

TF - if the spike is before the P wave, the pacemaker is pacing the ventricle

A

False- atrium

147
Q

Pacemaker malfunxs (4)

A

Failure to capture- failure to sense
Battery failure
Competition
Runaway pacemaker

148
Q

Complications of pacemaker use (5)

A 
Hematoma / bleeding
Dislocation of lead
Skel muscle/ phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfx
149
Q

Def Implantable cardioverter defib

A

A device that detects and terminated life threatening episodes of tachy or fib.
Anti tach pacing

150
Q

What are invasive methods to dx and tx dysrhythmias

A

Electrophysiology studies

Cardiac conduction surgery

151
Q

EPS studies

A

EPS
mapping ablation ther
Device testing

152
Q

Cardiac conduction surgery

A

Maze procedure

Catheter ablation ther

NUR 329 (6 decks)

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