EKG Flashcards
1
Q
Normal PR Interval
A
0.12 - 0.2 seconds (5 small squares)
2
Q
Where is the electrical impulse generated from if the EKG is showing normal sinus rhythm?
A
SA node
3
Q
PR interval for sinus bradycardia
A
Normal (0.12 - 0.2 seconds)
4
Q
Where is the electrical impulse generated from in the EKG is showing normal sinus rhythm?
A
Could possibly be the AV node but could also be the SA node
5
Q
Sinus Bradycardia Treatments
A
If patient is symptomatic:
- Atropine 0.5 mg IVP every 3-5 minutes with maximum total dose of 3 mg
- Transcutaneous pacing
6
Q
Possible Symptoms a Bradycardic Patient might experience
A
- Hypotension
- Diaphoretic
- Drowsiness
- Cyanotic/Dusky
7
Q
Causes of Sinus Bradycardia
A
- Lower metabolic needs
- Vagal stimulation
- Medications
- Increased ICP
- MI
- Hypovolemia
- Hypoxia
- Hypo/hyperkalemia
- Hypothermia
- Toxins
- Cardiac tamponade
- Tension pneumothorax
- Thrombosis
- Trauma
8
Q
HR range for sinus tachycardia
A
More than 100 but less than 120
9
Q
PR interval for sinus tachycardia
A
Normal (0.12 - 0.20 seconds)
10
Q
Causes of Sinus Tachycardia
A
- Physiologic or psychological stress
- Medications
- Stimulants
- Illicit Drugs
- Autonomic dysfunction
11
Q
Physiologic or Psychological Stress that can Cause Sinus Tachycardia
A
- Acute blood loss
- Shock
- Fever
- Exercise
- Anxiety
- Fluid overload
12
Q
Medications that can cause Sinus Tachycardia
A
- Catecholamine’s
- Aminophylline
- Atropine
13
Q
Stimulants that can cause Sinus Tachycardia
A
- Caffeine
2. Nicotine
14
Q
Illicit drugs that can cause Sinus Tachycardia
A
- Cocaine
2. Ecstacy
15
Q
Treatment for Sinus Tachycardia
A
- Correct the cause
- Beta-blockers
- Calcium-channel blockers
16
Q
What does Atrial Flutter look like on an EKG?
A
Saw tooth or picket fence appearance
17
Q
Is the rhythm regular or irregular for atrial flutter?
A
Regular
18
Q
Atrial Flutter Rate
A
- Atrial rate ranges from 250 to 400
2. Ventricular rate ranges from 75 to 150
19
Q
PR interval for Atrial Flutter
A
Not measurable
20
Q
Causes of Atrial Flutter
A
- COPD
- Valvular disease
- Thyrotoxicosis (thyroid storm)
- S/P Cardiac Surgery
21
Q
Treatment of Atrial Flutter
A
- Vagal maneuvers
- Adenosine
- Electrical cardioversion
- Catheter ablation
22
Q
S/Sx of Atrial Flutter
A
- Patient may or may not be symptomatic
- Chest pain
- SOB
- Decreased BP
* If a patient is asymptomatic, they might just put them on an anticoagulant but possibly no other therapy
23
Q
Atrial Fibrillation Rhythm
A
Irregularly irregular
24
Q
Atrial Fibrillation Rate
A
- Atrial rate from 300 to 600
2. Ventricular rate from 120 to 200
25
PR interval for atrial fibrillation
Not measurable
26
Causes of Atrial Fibrillation
1. Valvular heart disease
2. Inflammatory or infiltrative disease
3. CAD
4. HTN
5. Heart failure
6. Hyperthyroidism
7. Pulmonary HTN
8. Pulmonary embolism
9. Obstructive sleep apnea
10. S/P cardiac or pulmonary surgery
27
Treatment of Atrial Fibrillation
1. Electrical cardioversion
2. Amiodarone
3. Flecainide
4. Propafenone
5. Ibutilide
6. Catheter ablation
7. Antithrombotic therapy
28
Special Consideration for a patient with Atrial Fibrillation
First obtain an H/P, how long has the patient been in this rhythm or is it new onset?
29
Supraventricular Tachycardia Rhythm
Regular
30
Supraventricular Tachycardia Rate
140 - 220
31
PR interval for Supraventricular Tachycardia
Depends on site of supraventricular pacemaker (where is the impulse coming from)
32
Where is the electrical impulse coming from in a patient with SVT
Impulses stimulating the heart are not being generated by the SA node, but instead are coming from a collection of tissue around and involving the AV node
33
Causes of SVT
1. Caffeine
2. Nicotine
3. Hypoxemia
4. Stress
5. CAD
6. Cardiomyopathy
34
Treatment of SVT
1. Vagal maneuvers
2. Adenosine (6 mg, then 12 mg)
3. Calcium channel blockers
4. Cardioversion
35
Premature Ventricular Complex Rhythm
Depends on the underlying rhythm
36
Premature Ventricular Complex Rate
Irregular due to early QRS
37
PR interval for Premature Ventricular Complex
Normal (0.12 - 0.20 seconds)
38
Causes of Premature Ventricular Complex (PVC)
1. Caffeine
2. Nicotine
3. Alcohol
4. Cardiac ischemia or infarction
5. Heart failure
6. Digitalis toxicity
7. Hypoxia
8. Acidosis
9. Electrolyte imbalances
39
Treatment for PVC
1. If the patient has no underlying disease or infrequent changes, no treatment is required
2. Amiodarone
3. Lidocaine
* if not treated, they can progress to V-tach
40
PVC's can cause problems if...
1. More than 6 per minute
2. Multifocal/polymorphic
3. Occur 2 in a row
4. Occur on the T wave
41
Ventricular Tachycardia Rhythm
Regular
42
Ventricular Tachycardia Rate
Range from 100 to 200
43
Causes of Ventricular Tachycardia
1. CNS disease
2. Hypokalemia
3. Hypocalcemia
4. Hypomagnesemia
44
Treatment of Ventricular Tachycardia
1. Cardioversion if patient has a pulse
2. Defibrillation if patient is pulseless
3. Replace electrolytes
4. Amiodarone
5. Isuprel
45
Ventricular Fibrillation Rhythm
Extremely Irregular
46
Ventricular Fibrillation Rate
Greater than 300
47
Causes of Ventricular Fibrillation
1. CAD
2. MI
3. Untreated V-tach
4. Cardiomyopathy
5. Vavlular heart disease
6. Acid-base imbalance
7. Electrolyte imbalance
8. Electrical shock
48
Treatment of Ventricular Fibrillation
Defibrillation
49
Causes of Asystole
1. Hypoxia
2. Acidosis
3. Severe electrolyte imbalance
4. Drug overdose
5. Hypovolemia
6. Cardiac tamponade
7. Tension pneumothorax
8. Coronary/pulmonary thrombosis
9. Trauma
10. Hypothermia
50
Treatment of Asystole
CPR
51
Third Degree AV Block Rhythm
Regular
52
Third Degree AV Block Rate
Varies
53
PR interval for 3rd Degree AV Block
Irregular
54
3rd Degree AV Block is also called what?
Complete Heart Block
55
Treatment of 3rd Degree Heart Block
Pacing
| * This patient will have decreased cardiac output
56
Potential Complications of Dysrhythmias
1. Cardiac Arrest
2. Heart Failure
3. Thromboembolic Event
57
Defibrillation
Shocking the patient is depolarizing the patient. It resets polarization so that the SA node picks up and starts
58
Defibrillation is the treatment for what arrhythmias?
1. Pulseless V-tach
| 2. V-fib
59
Nursing Responsibilities for Defibrillation
1. Start CPR before defibrillation
2. Turn device on (apply gel if needed)
3. Ensure device in defibrillation mode
4. Select electric charge 300-360 joules (or follow MD order)
5. If using paddles, apply 20 lbs of pressure
6. Ensure all personnel are clear of patient/bed prior to shocking the patient
7. After defibrillation, check the patient an monitor
60
Cardioversion is the treatment for which arrhythmias?
1. SVT
2. A-Fib
3. A-Flutter
4. Stable V-tach (pulse is present)
61
Cardioversion
- The shock is synchronized with the rhythm
- The MD can control the amount of joules
- Synchronized hits in the QRS complex during ventricle depolarization
- Even if the pads are pushed a little too early, it's ok, it will wait until the QRS complex
62
Nursing Responsibilities for Cardioversion
1. Consent may be obtained if not emergent
2. Patient may be given a sedative: diazepam or midazolam
3. Usually try 3-4 times
63
Pacemaker Therapy
- Used to treat conduction defects or dysrhythmias
- Uses a pulse generator to provide an electrical stimulus to the heart when the heart fails to conduct its own at a rate that maintains cardiac output
64
Fixed (Asynchronus) Pacemaker
Pacemaker is set at a rate determined by the MD
65
Demand (Synchronus) Pacemaker
Pacemaker fires when rate falls below set rate determined by MD
66
Temporary Pacemaker
Uses an external pulse generator attached to a lead threaded intravenously into the right ventricle
67
Types of Temporary Pacemakers
1. Epicardial - directly in the heart
| 2. Endocardial - threaded through a central vein
68
Permanent Pacemakers
Use an internal pulse generator placed in a subcutaneous pocket in the subclavian space or abdominal wall
69
What kind of arrhythmias would require a pacemaker?
1. 3rd degree AV Block
2. Sick Sinus Syndrome
3. Asystole
70
S/Sx of Low Cardiac Output
1. Dizziness
2. Bradycardia
3. Restlessness
4. Hypotension
71
Potential Complications after Pacemaker Placement
1. Infection
2. Pneumothorax
3. Arrhythmias
72
Patient Care of Pacemaker
1. Monitor incision
2. Avoid large magnetic fields
3. Avoid heavy lifting for 2 weeks
4. Medical identification
73
Pacemaker on an EKG
- Pacing is detected on ECG by sharp spike noted before the P wave with atrial pacing or before the QRS with ventricular pacing
- If nurse caring for patient does not see pacer spikes, the voltage must be increased so that spikes are seen
74
Implantable Cardioverter Defibrillator
- Detects life threatening changes in the rhythm (tachycardia, fibrillation)
- Automatically delivers an electrical shock to convert the dysrhythmia
- Life vest are used until a patient can have an AICD placed
75
Electrophysiological Studies
- An electrophysiology study (EPS) is one of the most accurate and reliable methods of evaluating heart rhythms
- The procedure is performed by an electrophysiologist who will attempt to reproduce dysrhythmias to determine the type and location
76
Cardiac Conduction Surgery
- Maze procedure is performed to treat atrial fibrillation (refractory)
- Catheter ablation therapy is a curative procedure that involves the application of energy through a catheter tip to cauterize electrical tissue causing the dysrhythmias
77
P Wave
Atrial Depolarization (atrial contraction)
78
QRS Complex
Depolarization of ventricles (contraction of ventricles)
79
What does the SA node do?
- It is the primary pacemakers
| - Highest degree of automaticity, causes depolarization
80
What does the AV node do?
- It is the backup pacemaker in the 40-60 bpm range
| - Atrial junction, slower to allow the ventricle chamber to fill more completely
81
Purkinje Fibers
Could take over as pacemaker if HR gets to 20-30 bpm range if needed
82
Bundle of His
Ventricle sends blood to pulmonary artery and the aorta
83
Stroke Volume
Injected blood into the system circulation in one beat
84
Contractility
The ability of the cells to shorten when depolarized by an electrical impulse
85
Automaticity
The ability of the cell to spontaneously generate and discharge an electrical impulse
86
Excitability
The ability of the cell to respond by depolarization. The response can be influenced by: hormones, electrolytes, meds, O2, nutrition
87
Refractory
The period which the cells resist stimulation
- Relative refractory
- Absolute refractory
88
Relative Refractory
A greater than normal stimulus is required to generate another action potential
89
Absolute Refractory
Depolarization will not occur no matter how strong the stimulus
90
What is the PR interval?
Measures the amount of time it takes for impulse to travel from atrial depolarization to the beginning of ventricle depolarization (0.12-0.20 seconds); SA node to AV node
91
Normal length of QRS interval
Complex is normally less than 0.12 seconds in duration
92
ST segment
End of ventricle depolarization to the beginning of ventricle repolarization
- Isoelectric or flat
- Elevated or depressed may indicate disease or injury of ventricle muscle
93
T Wave
Repolarization of ventricles (return to resting state) and are most vulnerable to dangerous stimuli
* Should be up, if downward displacement = injury, ischemia, or infarction
94
QT interval
The amount of time for ventricle to depolarize and repolarize (usually 0.32-0.40 seconds)
95
Conditions that can change the shape and size of PR interval
1. Digitalis
2. Beta-blockers
3. Age and conduction disease
4. Atrial enlargement
5. Valvular heart disease
96
Conditions or medications that change the QRS
1. Ventricle enlargement
2. Dysrhythmic meds, Quinidine, Procainamide, Flocainidine
3. Ventricle electrical conduction defects
4. COPD
5. Hyperkalemia
6. Hypokalemia
97
Conditions that cause the QT interval to prolong
1. Low HR
2. Hypocalcemia
3. Hypokalemia
4. Ischemia
5. Infarction
98
P Wave for Normal Sinus Rhythm
Visible before each QRS complex
99
QRS Duration for Normal Sinus Rhythm
Normal (< 0.12 seconds)
100
QRS Duration for Sinus Bradycardia
Normal (< 0.12 seconds)
101
P Wave for Sinus Bradycardia
Visible before each QRS complex
102
QRS Duration for Sinus Tachycardia
Normal (< 0.12 seconds)
103
P Wave for Sinus Tachycardia
Visible before each QRS complex
104
QRS Duration for Atrial Flutter
Usually normal (< 0.12 seconds)
105
P Wave for Atrial Flutter
Saw-tooth shape (referred to as F waves)
106
P Wave Rate for Atrial Flutter
300 beats per minute
107
QRS Duration for Atrial Fibrillation
Usually normal (< 0.12 seconds)
108
P Wave for Atrial Fibrillation
Not distinguishable as the atria are firing off all over
109
QRS Duration for SVT
Usually normal (< 0.12 seconds)
110
P Wave for SVT
Cannot be seen
111
QRS Shape for PVC
Bizarre and abnormal
112
P Wave for PVC
Ratio 1:1
113
P Wave Rate for PVC
Normal and same as QRS rate
114
QRS Duration for V-tach
Prolonged with a bizarre abnormal shape
115
P Wave for V-tach
Not seen
116
QRS Duration for V-fib
Not recognizable
117
P Wave for V-fib
Not seen
118
QRS Duration for 3rd Degree Block
Usually abnormal
119
P Wave for 3rd Degree AV Block
Unrelated to QRS complex
120
P Wave Rate for 3rd Degree AV Block
Normal but faster than QRS rate
