1. Is there 1 p wave for every 1 QRS wave? 2. Is the PR Interval 0.12-0.20 seconds? 3. Is the QRS less that 0.12 seconds? 4. Is the rate 60-100 bpm? 5. Is the rhythm regular?

P wave: normal PR Interval: 0.12-0.20 QRS: 100 Regularity: Regular

EKG Interpretation Flashcards by Elizabeth McGee

Normal PR Interval

0.12-0.2 sec

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Normal QRS Complex

<0.12 sec

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EKG Interpretation

Is there 1 p wave for every 1 QRS wave?
Is the PR Interval 0.12-0.20 seconds?
Is the QRS less that 0.12 seconds?
Is the rate 60-100 bpm?
Is the rhythm regular?

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Normal Sinus Rhythm

P wave: normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: 60-100
Regularity: Regular

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Sinus Tachycardia

P wave: normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: >100
Regularity: Regular

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Sinus Bradycardia

P wave: normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: <60
Regularity: Regular

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Sinus Bradycardia causes

Sleep
Inactivity
Very athletic
Drugs
MI

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Sinus Bradycardia Interventions

Fix the cause!

Atropine

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Sinus Tachycardia Causes

Caffeine
Exercise
Fever
Anxiety
Drugs
Pain
Hypotension
Volume depletion

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Sinus Tachycardia Interventions

Fix the cause!

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First Degree Heart Block

P wave: normal
PR Interval: >0.20
QRS: <0.12
Rate: 60-100
Regularity: Regular

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First Degree Heart Block Causes

Often an incidental finding

(Peds) Infection
Myocarditis
Congenital Heart Disease

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First Degree Heart Block interventions

Fix the cause!

Treatment is usually not required
If extreme, pacing

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Second Degree Heart Block, Type 1
(AKA: Motiz 1, Wenkebach)

P wave: normal
PR Interval: longer, longer, longer…drop
QRS: <0.12
Rate: 60-100
Regularity: Regular

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Second Degree Heart Block, Type 1 causes

Ischemia
Myocarditis
Status post-cardiac surgery

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Second Degree Heart Block, Type 1 interventions

Fix the cause!

Asymptomatic: no treatment
Symptomatic: pacing

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Second Degree Heart Block, Type 2

P wave: Not a P for every QRS
PR Interval: 0.12-0.20
QRS: <0.12
Rate:>100
Regularity: Regulare

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Second Degree Heart Block, Type 2 causes

MI
Ischemia

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Second Degree Heart Block, Type 2 interventions

Fix the cause!

Pacing

Third Degree Heart Block

P wave: normal
PR Interval: variable
QRS: <0.12
Rate: <60
Regularity: Irregular

Third Degree Heart Block causes

Damage to the heart

MI
Heart valve disease
Rheumatic fever
Sarcoidosis

Third Degree Heart Block interventions

Fix the cause!

Pacing

Pacemaker Education

Keep pacemaker identification card in wallet.
Baths and showers are ok for permanent pacemakers.
Do not apply pressure over the generator and do not wear tight clothing.
Operating household appliances is safe.
Notify airport security of pacemaker.
For temporary pacemakers, don’t let lead wires get wet
Contraindication for MRI

Atrial Flutter

P wave: “saw tooth”
PR Interval: none
QRS: <0.12
Atrial Rate: 250-400
Ventricular Rate: Varies
Regularity: Regular or Irregular

A-flutter causes

Heart disease MI CHF Pericarditis

A-flutter interventions

Fix the cause! Cardioversion Pacing Anti-arrhytmics (amiodarone) Beta blockers (metoprolol) Calcium Channel blockers (diltiazem)

Atrial Fibrillation

P wave: "wavy" PR Interval: none QRS: <0.12 Atrial Rate: >400 Ventricular rate: Varies Regularity: Irregular

A-fib causes

Heart disease Pulmonary disease Stress Alcohol Caffeine

A-fib interventions

Fix the cause! Cardioversion Anti-arrhythmics (amiodarone) Beta blockers (metoprolol) Surgery (ablation)

Supraventricular Tachycardia (SVT)

P wave: hidden PR Interval: immeasurable QRS: <0.12 Rate: 150-250 Regularity: Regular

SVT causes

Caffeine CHF Fatigue Hypoxia Altered pacemaker in the heart

SVT interventions

Fix the cause! Vagal Maneuvers Cardioversion Adenosine (site closest to heart, central line preferred)

Ventricular Tachycardia

P wave: none PR Interval: none QRS: >0.11 "wide and bizarre" Rate: 150-250 Regularity: Regular

V-tach causes

MI Ischemia Digoxin toxicity Hypoxia Acidosis Hypokalemia Hypotension

V-tach interventions

Fix the cause! With pulse: Cardioversion Without pulse: CPR Defibrillate Epinephrine

Ventricular Fibrillation

P wave: none PR Interval: none QRS: none Rate: none Regularity: Irregular

V-fib causes

MI Ischemia'Hypoxia Acidosis Hypokalemia Hypotension Most common cause of sudden death!

V-fib interventions

Fix the cause! CPR Defibrillate Epinephrine

Asystole

P wave: none PR Interval: none QRS: none Rate: none Regularity: n/a

Asystole causes

Follows VT/VF in cardiac arrest Acidosis Hypoxia Hypokalemia Hypothermia Overdose

Asystole interventions

Fix the cause! CPR Epinephrine (Q3-5 minutes)

Hyperkalemia EKG changes

Wide, flat P waves Prolonged PR interval Widened QRS complex Depressed ST segment Tall, peaked T wave

Hypokalemia EKG changes

Slightly prolonged PR interval Slightly peaked P wave ST depression Flat/shallow/inverted T wave Prominent U waves

Hypermagnesemia EKG changes

Wide, flat P wave Prolonged PR interval Widened QRS complex Tall T wave

Hypomagnesemia EKG changes

Prolonged PR interval Lengthened QT interval Risk for: V-tach Torsades de Pointes

Hypercalcemia EKG changes

Shortened QT interval Risk for: Bradycardia V-fib

Hypocalcemia EKG changes

Lengthened QT interval Risk for: V-tach