Ekg Informations Flashcards
Normal Sinus Rhythm (NSR)
Rhythm: Regular
Rate: 60-100 bpm
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Sinus Bradycardia
Rhythm: Regular
Rate: Less than 60 bpm
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Sinus Tachycardia
Rhythm: Regular
Rate: 100-150 bpm
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Sinus Dysrhythmia
Rhythm: Irregular
Rate: 60-100 bpm
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Difference: like NSR but P-P and R-R intervals progressively wide, then narrow, following the pt.’s breathing pattern.
Sinus Arrest
Rhythm: Irregular
Rate: Depends on the amount of electrical activity occurring from the SA node
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
QRS do not fit equally
Sinus Exit Block
Rhythm: Irregular
Rate: Depends on the amount of electrical activity occurring from the SA node. If several impulses are blocked, the rate may be bradycardia.
P wave morphology: upright
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
QRS fit equally until next P wave
Premature Atrial Complexes (PAC)
Rhythm: Irregular
Rate: 60-100 bpm
P wave morphology: upright, with early complex, can be biphasic
PR interval: 0.12-0.20 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Wandering Atrial Pacemaker (WAP)
Rhythm: Irregular
Rate: 60-100 bpm
P wave morphology: Continuous changing (at least 3 different p waves)
PR interval: varies
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Multifocal Atrial Tachycardia
Rhythm: Irregular
Rate: 101-150 bpm
P wave morphology: varies, can be biphasic
PR interval: Varies due to the changing origin of the electrical activity
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Atrial Flutter
Rhythm: R-R Regular, occasionally irregular
Rate: 250-350 bpm
P wave morphology: sawtooth pattern, no P waves only F waves
PR interval: Unknown
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Atrial Fibrillation
Rhythm: Irregular
Rate: 375-700 bpm
P wave morphology: Unknown
PR interval: Unknown
QRS Duration & morphology: narrow, 0.06-0.10 seconds
What is the rate of a Normal sinus rhythm?
60-100 bpm
Which sinus rhythm has a rate that is consistently less than 60 bpm?
Sinus bradycardia
Which question does not need to be answered when determining the QRS measurement?
Are all the QRS complexes of equal length
Which sinus rhythm has a rate of more than 100 bpm?
Sinus tachycardia
Which rhythm shows an irregularity during inspiration and expiration?
Sinus dysrhythmia
The normal PR interval is?
0.12-0.20 seconds
If a QRS complex measures 0.12 seconds or wider, it indicates?
delayed ventricular conduction
Which of the following is a common sign of low cardiac output?
Low blood pressure
Which of the following may be a cause of sinus exit block?
digitalis
Sinus tachycardia maybe a normal finding in a patient as a result of
Children
When sinus arrest continues for 6 seconds or more, it is considered
Medical emergency
The rhythm originating in the SA node that is considered normal is
Normal sinus rhythm
The rhythms originating in the SA node that results in the heart beating regularly, but slower or faster than normal are ____________ and _____________.
bradycardia and tachycardia
The rhythm originating in the SA node that is affected by vagal tone is
Sinus Dysrhythmia
What is the rate of wandering atrial pacemaker rhythm?
60-100 bpm
Which dysrhythmia is similar to wandering atrial pacemaker, except that the rate exceeds 100 bpm?
Multifocal Atrial Tachycardia
What is the major health risk for patients who have atrial fibrillation?
Thrombus formation
Which atrial dysrhythmia has capital F waves and a classic sawtooth or picket fence appearance?
Atrial flutter
Which atrial dysrhythmia has lowercase f waves, chaotic atrial electrical activity, and irregular R-R intervals?
Atrial fibrillation
Wandering atrial pacemaker rhythm must have _______ or more differently shaped P waves.
3
When premature complexes occur in a rhythm, they interrupt the underlying rhythm, causing it to be ________ when analyzing it.
Irregular
Which of the following is a common sign of low cardiac output?
Low blood pressure
Multifocal atrial tachycardia may occasionally be confused with _______.
Wander Atrial Pacemaker
When analyzing atrial flutter, you note that there are four F waves for each QRS complex. You will represent this pattern in your interpretation as ___________.
4:1
The patient has coronary artery disease. How would you expect PACs to affect this patient?
More PACs are more likely to occur because of myocardial cells are damaged and may cause low cardiac output
What treatment is usually indicated for patients with atrial flutter?
Oxygen therapy
What is the best way to describe the rhythm pattern for atrial fibrillation?
Irregular, Chaotic
Which rhythm is considered more serious, MAT or WAP, and why?
MAT because, is usually triggered by an acute exacerbation of emphysema, congestive Heart failure (CHF), or acute mitral valve regurgitation
Premature Junctional complex (PJC)
Rhythm: Irregular
Rate: depends on the rhythm and number of PJCs present
P wave morphology: inverted
PR interval: Less than normal
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Junctional Escape Rhythm
Rhythm: Regular
Rate: 40- 60 bpm
P wave morphology: inverted
PR interval: less than 0.12 secs, constant
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Accelerated Junctional Rhythm
Rhythm: Regular
Rate: 60-100 bpm
P wave morphology: inverted
PR interval: less than 0.12 secs, constant
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Junctional Tachycardia
Rhythm: Regular
Rate: 100-180 bpm
P wave morphology: inverted
PR interval: less than 0.12 seconds
QRS Duration & morphology: narrow, 0.06-0.10 seconds
Supraventricular Tachycardia (SVT)
Rhythm: Regular
Rate: 150-250 bpm
P wave morphology: unknown
PR interval: unknown
QRS Duration & morphology: narrow, 0.12 or greater with a delta wave
What is the normal, inherent rate for the AV junction?
40-60 bpm
Which of the following dysrhythmias is not considered part of the supraventricular tachycardia classification?
Atrial Fibrillation
What sign or symptom might a patient complain about when experiencing a supraventricular tachycardia in an unstable condition?
Sensation of a racing heart
The criterion needed to classify a dysrhythmia as a supraventricular tachycardia is?
a heart rate between 150 and 350 bpm with narrow QRS complex
What is the primary difficulty in determining a supraventricular rhythm?
When is the identification of the specific dysrhythmia important in terms of treatment of the patient?
What is the heart rate range for junctional escape rhythm?
40-60bpm
What is the heart rate range for accelerated junctional rhythm?
60-100 bpm
What is the heart rate range for junctional tachycardia?
100-150 bpm
Describe why P waves are inverted or buried within the QRS complex with junctional dysrhythmias.
What happens in the heart during a heart block dysrhythmia?
Causes a delay or absence of ventricular depolarization
First Degree AV Block
Rhythm: Regular,
Rate: 60-100 bpm
P wave morphology: upright
PR Interval: greater than 0.12 (longer)
QRS duration and morphology: 0.06- 0.10 seconds
consistently long PR interval
Second Degree AV Block, Type l ( Mobitz l or Wenckebach)
Rhythm: P-P Regular, R-R irregular due to the blocked impulse (s)
Rate: Atrial 60-100 bpm, Ventricular slower than atrial rate
P wave morphology: upright (*longer longer longer drop, you have a wenckebach)
PR Interval: progressively greater than 0.12 (longer)
QRS duration and morphology: 0.06- 0.10 seconds
Second Degree AV Block, Type ll (Mobitz ll)
Rhythm: P-P regular, R-R may or may not be irregular due to pattern
Rate: Atrial 60-100 bpm, Ventricular slower than atrial, A and V rates are not the same
P wave morphology: upright
PR Interval: constant and remains constant even after QRS drop
QRS duration and morphology: 0.06- 0.10 seconds
Third Degree AV Block (complete heart block)
Rhythm: P-P and R-R intervals regular but different
Rate: Atrial 60-100 bpm, ventricular slow between 20- 40 or 40- 60 bpm
P wave morphology: upright but maybe buried. Not every p wave will have a QRS following it
PR Interval: varies due to atrial and ventricular depolarizing at different rates
QRS duration and morphology: maybe either within normal limits or wide
Which heart block rhythm has the distinguishing feature of a PR interval that measures greater than 0.20 second and measures the same duration each time?
First Degree Heart Block
Which of the following heart block dysrhythmias is identified by a repetitious
Prolonging PR interval pattern after each blocked QRS complex?
Mobitz I or Wenchebach
Which of the following heart block dysthythmias is identified by missing QRS complexes and a consistent PR interval measurement?
Mobitz II
Which of the following heart block dysrhythmias is identified by regular P-P and R-R intervals that are firing at two distinctly different rates?
Third Degree Heart Block (complete)
P-P intervals are _______ with all heart block dysrhythmias.
regular
QRS complexes that measure 0.12 seconds or greater with a rate between 20 and 40 bpm indicate that the impulses causing ventricular depolarization are coming from that _____?
Purkinje fiber
What is the typical heart rate range for first degree heart block?
60-100 bpm
Frequent non-conducted QRS complexes are likely to cause signs of?
Low cardiac output
Which heart block dysrhythmias has regular P-P and R-R intervals with both having the same rate?
First Degree Heart Block
Which heart block dysrhythmia is known as the “classical” heart block?
Mobitz II
Which of the heart block rhythm is the most serious?
Third Degree heart Block
How can you tell the difference between a Mobitz I and a Mobitz II?
Mobitz I: PR longer longer longer-> QRS drops
Mobitz II: Constant PR -> some QRS drop
What should you do if the patient has a third degree heart block?
pacemaker and call physician
Why does it take longer than normal to depolarize the ventricles during a ventricular dysrhythmia?
Because current is not traveling down the normal ventricular conduction pathway to activate both the right and left ventricles simultaneously
Agonal Rhythm
Rhythm: Irregular
Rate: A- Unknown V-less than 20 bpm
P wave morphology: unknown
PR Interval: Unknown
QRS duration and morphology: 0.12 or greater, wide and bizarre
Idioventricular Rhythm
Rhythm: P-P unknown, R-R regular
Rate: A- unknown, V- 20-40 bpm
P wave morphology: unknown
PR Interval: unknown
QRS duration and morphology: 0.12 seconds or greater, wide and bizarre
Accelerated Idioventricular Rhythm
Rhythm: P-P unknown, R-R regular
Rate: A- unknown, V- 40-100 bpm
P wave morphology: unknown
PR Interval: unknown
QRS duration and morphology: 0.12 seconds or greater, wide and bizarre
Ventricular Tachycardia
Rhythm: P-P unknown, R-R regular
Rate: A- unknown, V- 100-200 bpm
P wave morphology: unknown
PR Interval: unknown
QRS duration and morphology: 0.12 seconds or greater, wide and bizarre w/ increase amplitude
Another type of Ventricular Tachycardia is?
Torsades de Pointes
Difference between traditional ventricular tachycardia and Torsades de pointes?
Traditional: Consistent morphology
Torsades de pointes: changing voltages and durations due to the depolarization impulses in ventricles (different directions)
Ventricular Fibrillation
Rhythm: Both P-P and R-R=Unknown
Rate: Both A and V = Unknown
P wave morphology: unknown
PR Interval: unknown
QRS duration and morphology: Unknown
apnea
The absence of breathing
Asystole
aka Flatline
Rhythm: none
Rate: none
P wave morphology: none
PR Interval: none
QRS duration and morphology: none
Which ventricular dysrhythmia has no P waves?
Idioventricular
Which ventricular dysrhythmia has a heart rate between 40-100 bpm?
Accelerated Idioventricular
Which ventricular dysrhythmia has a heart rate less than 20 bpm?
Agonal
Which ventricular dysrhythmia has a heart rate between 20-40 bpm?
Idioventricular
What is unique about ventricular dysrhythmias with regard to the P-P intervals?
There are no P waves, so the P-P interval cannot be measured.
QRS complexes that measure 0.12 seconds or greater with a heart rate between 20 and 40 bpm indicate that the impulses causing ventricular depolarization are coming from the ______?
Purkinje Fibers
Ventricular fibrillation is typically described as “_______”
chaotic
Which of the following dysrhythmias is not considered to be a medical emergency?
Occasional PVCs
What is the difference between idioventricular rhythm and accelerated idioventricular rhythm?
idioventricular-20-40 bpm
accelerated idio- 40-100 bpm
How are agonal rhythm and asystole the same?
Less than 20 bpm
No consistent cardiac rhythm
What is the difference between ventricular tachycardia and ventricular fibrillation?
Ventricular Tachycardia: can calculate rate with a pattern
Ventricular Fib: None
Branch Bundle Blocks (BBB)
Rhythm: Regular and Irregular patterns are possible depends on SA and AV underlying rhythm
Rate: Depends on basic rhythm
P wave morphology: Depends on basic rhythm
PR Interval: 0.12- 0.20 seconds
QRS duration and morphology: 0.12 seconds or greater, Widening of QRS duration indicates presence of BBB
LBBB (Left Bundle Branch Block)
If majority of ventricular depolarization is positively deflected? LBBB or RBBB?
Also referred to as ?
RBBB (Right Bundle Branch Block)
Bunny ears
If majority of ventricular depolarization is negative deflected? LBBB or RBBB?
Characteristic?
LBBB (Left Bundle Branch Block)
QS complex is deep wave with no preceding R wave.
You observe a wide QRS complex while continuously monitoring a patient in lead II. Which lead placement is referenced to evaluate the location of blockage in the bundle branch system?
Lead V1
The labeling of the EKG rhythm strip for documentation of the bundle branch block should include what other information besides the bundle branch designation?
Why do the QRS complexes in bundle branch block have a longer than normal duration of more than 0.12 seconds?
The electric current is delayed between the SA and AV node
Which of the following rhythms cannot be an underlying rhythm in patients with bundle branch block?
-Accelerated junctional rhythm
-Atrial flutter
-Sinus bradycardia
-ventricular tachycardia
ventricular tachycardia
Fill in the blank
The view referred to when differentiating left from right BBB is _________.
V1
Fill in the blank
The QRS complex is __________ for a BBB.
0.12 seconds or longer
or deeper