EKG Interpretation Flashcards
1
Q
Heart Rate useing R wave measurement by counting mnemonics
A
Regular rhythms
– Find a QRS that occurs on or near a dark line
– Count off on dark lines between that QRS
and the next QRS
– The count is 300, 150, 100, 75, 60, 50
2
Q
Does the rhythm originate in the sinus node?
A
must be round, upright P waves that all look the same
3
Q
Is atrial conduction normal
A
- all P waves look alike
- normal PR interval
4
Q
is ventricular conduction normal
A
Is there a QRS for every P wave?
– Does every QRS look the same?
– Is the QRS nice and neat or big and
sloppy?
5
Q
questisn to ask yourself when examining an ekg
A
What is normal for this person? • Is this strip a change from baseline? • Is this person symptomatic? – Short of Breath – Dizzy – Diaphoretic – Chest Pain – Hypotension Does this person have cardiopulmonary or vascular disease? • Where is this person and what is he or she doing
6
Q
normal sinus rhythm
A
HR 60-100 bpm • Regular • P for every QRS • PR interval normal • QRS duration normal • Impulse originates in the sinus node, follows normal conduction pathway
7
Q
sinus bradycardia
A
HR < 60 bpm • Only difference between sinus bradycardia and normal sinus rhythm • Normal in trained athletes • Can occur with increased vagal stimulation, as with suctioning or vomiting • Usually asymptomatic unless pathology present
8
Q
sinus tachycardia
A
HR > 100 bpm • Only difference between sinus tachycardia and normal sinus rhythm • Always has underlying cause • Increased sympathetic stimulation - pain, fear, anxiety, exercise, • Increased oxygen demands - fever, CHF, infection, anemia
9
Q
premature atrial complexes
A
Underlying rhythm is sinus • Beat is early • P wave of PAC looks different from other P waves • Caused by emotional stress, nicotine, caffeine, alcohol, hypoxemia, infection, myocardial ischemia, rheumatic disease, atrial damage • Causes irregular pulse when palpated
10
Q
`A-Fib
A
No coordinated electrial activity in atria • Irregularly irregular • Chaotic baseline • NO P WAVES • Ventricular response (HR) may be normal, slow, or too fast • Seen with advanced age, CHF, ischemia or infarction, cardiomyopathy, digoxin toxicity, stress or pain, rheumatic heart disease • Loss of atrial kick • Potential for rapid heart rate • Mural thrombi (30%)
11
Q
atrial flutter
A
More than one P before every QRS • P waves are called flutter waves • All look identical • Produces “sawtooth” pattern • Can be regular or irregular • Causes include rheumatic heart disease, mitral valve disease, coronary artery disease, stress, hypoxemia, pericarditis • May lead to atrial fibrillation
12
Q
premature ventricular complexes
A
Wide and bizarre QRS without a P wave • Occurs earlier than next normal sinus beat • Caused by caffeine or nicotine, stress, electrolyte imbalance, myocardial ischemia, acute infarction • Symptoms can include palpitations, shortness of breath, dizziness associated with decreased cardiac output Unifocal PVCs all look the same • Multifocal PVCs appear different, more serious • Two in a row is a pair or couplet • Can occur in patterns – Bigeminy - every other beat a PVC – Trigeminy - every third beat a PVC • Can progress to ventricular tachycardia or ventricular fibrillation
13
Q
V-tach
A
Three or more PVCs in a row • No P waves • QRS complexes are wide and bizarre • Heart rate between 100 and 250 bpm • Caused by ischemia or acute infarction, reaction to medications, electrolyte imbalance • Cardiac output severely compromised • May have palpable pulse • Usually a medical emergency
14
Q
V-fib
A
• No coordinated electrical activity in ventricles • Grossly irregular zig zag pattern of baseline • NO CARDIAC OUTPUT • Causes are similar to ventricular tachycardia • Treatment is defibrillation as soon as rhythm is identified
15
Q
junctional rhythm
A
AV node takes over as pacemaker • no P waves before the QRS • normal looking QRS • Heart rate between 40 and 60 BPM • Regular • Failure of sinus node as in digoxin toxicity, infarction, ischemia of, or trauma to the conduction system • May be symptomatic with slow heart rates
16
Q
1st degree AV block
A
Long PR interval • Regular rhythm • Normal rate • QRS complexes appear normal • Causes include coronary artery disease, rheumatic heart disease, infarction, abnormal response to medication (digoxin, beta blockers) • Usually benign, only rarely progresses to more severe block
17
Q
2nd degree AV block type 1
A
Progressive prolongation of PR interval until a QRS complex is dropped • Normal P waves with constant P-P interval • QRS complexes appear normal • Right coronary artery disease or infarction, digoxin toxicity or beta blockade • Usually asymptomatic • Rarely progresses to higher form of AV block
18
Q
2nd degree AV block type 2
A
Impulse not conducted to ventricles • QRS complex is dropped • 2 to 4 P waves for every QRS • No change in PR interval • Heart rate often less than 60 bpm • Myocardial infarction, ischemia or infarction involving the AV node or Bundle of His, digoxin toxicity • Symptoms may occur with low heart rates • Frequently progresses to complete heart block
19
Q
3rd degree or complete heart block
A
No impulses initiated above the ventricles are conducted to the ventricles • P waves regular, all look alike • QRS all look alike • Rate usually 30 to 50 bpm • Caused by acute MI, digoxin toxicity • Usually symptomatic due to decreased cardiac output • Life-threatening • Treatment is pacemaker
