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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
The p wave reflects which node firing
SA
25
What is the normal PRI range
.12-.20 secs
26
What does the QRS complex represent ?
Ventricular depol
27
What is the normal QRS range
.06-.12 secs
28
How do u obtain the PRI
Measure from the beginning of the p - beginning of QRS
29
How do you obtain QRS interval
Measure from the beginning of q- end of s
30
What does the t wave represent
Ventricular repol
31
T/F- sinus bradycardia is regular
True
32
When might sinus bradycardia be seen
Athletes During sleep In response to a vagal maneuver
33
Causes of bradycardia (10)
``` Hypoglycemia Hypothermia Hypothyroidism Prev cardiac hx Meds Toxic exposure MI Incr ICP Lower metabolic need Vagal stim ```
34
S & S of bradycardia(9)
``` Syncope Dizziness Chest pain Sob Exercise intol Cool, clammy skin Altered mental status Hypotension Memory loss ```
35
Tx of bradycardia
Atropine Pacing if pt is hemodynamically compromised ***tx depends on if the pt is symptomatic*** Give O2 Monitor O2 sat Monitor BP and HR
36
TF- tachycardia is irreg
F- regular
37
Causes of tachycardia (10)
``` Damage to cardiac tissue HTN fever Stress Excessive ETOH, caffeine, nicotine, rec drugs ( cocaine) Meds Pain Electrolyte imbalance Hyperthyroidism Dehydration ```
38
S&S tachycardia
``` Dizziness Sob Light headed ness ⬆️ HR palps Chest pain Syncope ```
39
Tx of tachycardia (8)
``` 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 ```
40
When would a HR increase when a pt presents with sinus arrhythmia
During inspiration
41
When would a HR decrease when a pt presents with sinus arrhythmia
During expiration
42
Def sinus arrhythmia
A normal variation in the beating of the heart
43
Causes of sinus arrhythmia (4)
Heart disease Extreme stress Excessive consumption of caffeine, nicotine, and ETOH diet pills, cough/cold meds
44
TF- sinus arrhythmia is usually symptomatic
False- asymptomatic
45
Causes of sinus arrest (7)
``` Sleep Myocarditis Cardiomyopathy MI digitalis tox Elderly Vagal stim ```
46
S&S of sinus arrest
``` Asymptomatic Syncope Dizziness LOC bradycardia ```
47
Tx of sinus arrest
Atropine Pacemaker o2 and sat BP and hr
48
Def a-flutter
Coordinated rapid beating of the atria
49
Is the rhythm of a-flutter regular
Yes
50
Are there p waves present in a-flutter?
No - normal p waves are absent
51
What does a-flutter look like on an EKG
Saw tooth
52
Is the PRI measurable in a-flutter
No
53
In a-flutter, do all of the QRS complexes look similar
Yes
54
Causes of atrial flutter ( 7)
``` > 60 years old Valve disorder (mitral) Thickening of the heart muscle Ischemia Cardiomyopathy COPD emphysema Chest pain SOB Low BP ```
55
S&S of a-flutter (6)
``` Palps Sob Anxiety Weakness Angina Syncope ```
56
What risks are assoc w/ a-flutter ( 2)
Clot formation- stroke, PE | dramatic drop in CO
57
Tx of a-flutter (5)
- cardio version - anti arrhythmics - meds that slow ventricular rate Heparin to ⬇️ risk of thrombi o2
58
What meds may slow the ventricular rate in a-flutter ( 4)
Diltiazem Verapamil Digitalis Beta blocker
59
Is the HR regular in afib
No
60
Are there p waves in afib
No- normal p waves are absent
61
Are u able to measure PRI in afib
No
62
In afib, do all of the QRS complexes look similar
Yes
63
Causes of afib (12)
``` 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
S&S of afib (9)
``` 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
What risks are assoc w/ afib (2)
Clot | ⬇️ CO
66
Afib tx (4)
``` Rate control with meds Anti thrombotic ther Correction of rhythm- chemical or electrical cardioversion O2 Cardioversion BB, CCB, amiodarone ```
67
What meds will slow ventricular rate in afib (3)
Digoxin Beta adrenergic blockers Calcium channel blockers
68
Are there p waves in ventricular abnormalities and why
No bc there is no atrial activity or depol
69
TF- ventricular rhythms will display QRS complexes that are regular and normal sized
False- QRS complexes are wide and bizarre
70
Def PVC
An ectopic beat that arises from an irritable site in the ventricles
71
How do PVCs appear
Many diff patterns and shapes | ***ALWAYS WIDE AND BIZARRE!!!***
72
Is the rate of PVCs usually normal
Yes, usually
73
Describe rhythm with PVCSs
Irreg during PVCs
74
Are p waves present with PVCs
No
75
Is PRI measurable with PVCs
No
76
Do all QRS COMPLEXES look similar with PVCs
No- varies; wide and bizarre
77
Causes of PVCs ( 8)
``` Exercise Stress Caffeine Heart disease, MI, CHF, cardiomyopathy, mitral valve prolapse Electrolyte imbalance Hypoxia Tricyclics antidepressants Digitalis tox ```
78
S and s of PVCs (4)
Palps Weakness Dizziness Hypotension
79
Risks a/w PVCs (3)
Decr CO heart failure May convert to VTACH or VFIB
80
PVC tx (4)
O2 @ 2 L Treat cause Lidocaine Monitor pt and freq of PVCs
81
Def Idioventricular arrhythmia
A last ditch effort of the ventricles to try to prevent cardiac standstill
82
Special notes about IVA (3)
SA and AV have failed Rate bx 20-40 BPms CO is compromised
83
Rate of IVA
Ventricular- 20-40
84
Is the rhythm reg or irreg with IVA
Usually reg
85
P waves absent or present with IVA
Absent
86
QRS complexes appearance with IVA
Wide and bizarre | T wave deflection
87
S and s of IVA (6)
``` Pale Cool skin Weakness Dizziness Hypotension Change in LOC/ mental status ```
88
Tx of IVA ( 4)
Atropine Pacing Dopamine when hypotensive CPR
89
Rhythm in VTACH
Atrial rhythm not distinguishable | Ventricular rhythm usually reg
90
Pt wave present in vtach
No
91
How do QRS look in VTACH
Wide and bizarre
92
Causes of VTACH ( 6)
``` Underlying heart disease Mi Meds Electrolyte imbalance Digitalis tox CHF ```
93
S and s of VTACH (8)
``` Chest pain/discomfort Syncope Dizziness Palps Sob Absent/rapid pulse Loss of consciousness Hypotension ```
94
VTACH tx if pt has no pulse (2)
Begin CPR | defib ASAP
95
VTACH tx if pt has pulse (6)
``` - amiodarone Lidocaine Anti arrhythmics ICD ablation O2 ```
96
Def v fib
Electrical impulses initiated by multiple ventricular sites
97
What is the rate in v fib
Not discernible
98
Is the rhythm reg in v fib
No
99
P waves in v fib
No
100
Causes of v fib (7)
``` AMI untreated VT electrolyte imbalance Hypothermia Mi Drug tox ornOD Trauma ```
101
S and s of v fib (2)
Loss of consciousness | Absent pulse
102
Tx of v fib (3)
*** CHECK YOUR PT!!!*** CPR defib
103
Def a systole
Ventricular standstill
104
EKG char of asystole (5)
``` No rate No rhythm No p wave No PRI No QRS complexes ```
105
Causes of asystole (5)
``` Mi Failure of pacemakers Cardiac tamponade Prolonged v fib PE ```
106
S and s of asystole ( 3)
No palpable pulse No BP Loss of consciousness
107
Def pulseless electrical activity (PEA)
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
Causes of PEA (12)
``` *hypovol Hypoxia Acidosis Hypo/hyperkalemia Hypothermia Toxins Tamponade ( cardiac) Tension pneumothorax Thrombosis- coronary or pulm Trauma Massive mi OD of tricyclics antidepressants ```
109
S and s of PEA (3)
Pulselessness No BP Loss of consciousness
110
What is Tridal and how is it admin
Iv form of NG | Mcg/min
111
How is dobutamine and dopamine admin
Mcg/kg/ min
112
Def electrical mechanical dissociation
When u can see PQRST on the screen,but the heart is not actually beating _ residual electrical activity
113
What can an EKG tell us abt electrical fx (2)
Rhythm disturbances | Conduction disturbances
114
Def irritability
A site along the conduction pathway becomes irritable and speeds up, thus overriding higher pacemaking sites for control of the heart
115
TF- the sympathetic NS affects the ventricles and the atrial
True
116
How does the sympathetic NS affect cardiac activity
Incr - HR - conduction - irritability
117
TF- the parasympathetic NS affects both the atria and the ventricles
False- only the atria
118
How does the parasympathetic NS affect cardiac activity
Decr - HR - conduction - irritability
119
Absolute refractory period
Cannot produce a new/early impulse
120
Relative refractory period
May produce a new impulse if strong enough
121
What does widened or abnormal QRS complexes indicate
Conduction started at the ventricles
122
Def atrial tach
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
A tach rate
150-250 BPms
124
A tach rhythm
Reg
125
A tach p waves
Atrial p waves differ from sinus waves- can get lost in t waves
126
A tach PRI
.12-.20
127
Causes of a tach (3)
Intrinsic Metab Drugs
128
A- tach tx (2)
Rate control | Adenosine
129
Def PAC
Pacemaker is an irritable focus within the atria that fires prematurely and produces a single ectopic beat. Impulses are conducted normally to ventricles
130
Regularity of PAC
Regular except for PAC
131
Rate of PAC
Usually normal
132
PAC- p wave
PAC p wave differs from sinus p wave May be flattened or notched May be lost in t wave
133
PAC- PRI
Usually normal but can be > .20 secs
134
PAC- QRS
Normal
135
PAC- tx (1)
Amiodarone - usually given for ventricles,but also works for PAC, COPD, decr CO - prevents a-fib
136
When might you see a PAC (4)
Post open heart Mi Age Irritability
137
How do you report PAC
Normal sinus rhythm with x(#) PAC
138
PAC causes (6)
``` Caffeine ETOH Nicotine Stretched myocardium (hypervolemia) Hyper metabolic states Ischemia, infarct, injury ```
139
PAC tx (2)
Treat underlying | No tx of asymptomatic
140
Def a-fib
Many irritable sites within the atria fire repetitively, causing ineffective atrial depol
141
A-fib p wave char
Grossly irreg | Unable to discern p waves or PRI
142
What is the difference bx cardioversion and defib
-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
Antidotes for coumadin
FFP Protamine sulfate if FFP N/A Vit k
144
Def artificial pacemaker
A device used to provide artificial electrical stimulus to myocardial tissue to induce myocardial depol
145
Pacemaker classifications
``` Single chamber Dual chamber Chamber paced Chamber response Response ```
146
TF - if the spike is before the P wave, the pacemaker is pacing the ventricle
False- atrium
147
Pacemaker malfunxs (4)
Failure to capture- failure to sense Battery failure Competition Runaway pacemaker
148
Complications of pacemaker use (5)
``` Hematoma / bleeding Dislocation of lead Skel muscle/ phrenic nerve stimulation Cardiac tamponade Pacemaker malfx ```
149
Def Implantable cardioverter defib
A device that detects and terminated life threatening episodes of tachy or fib. Anti tach pacing
150
What are invasive methods to dx and tx dysrhythmias
Electrophysiology studies | Cardiac conduction surgery
151
EPS studies
EPS mapping ablation ther Device testing
152
Cardiac conduction surgery
Maze procedure | Catheter ablation ther

NUR 329 (6 decks)

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