EKG pictures Flashcards
1st DEGREE HEART BLOCK
P wave looks normal, harmless
If you measure the PR interval, it will be greater than 0.20
2nd DEGREE HEART BLOCK - TYPE 1 (WENEKEBACH)
Gradual lengthening of the PR interval until QRS is dropped
P > P & R > R INTERVALS WILL NOT BE REGULAR/NORMAL
2nd DEGREE HEART BLOCK - TYPE 2
You do not have growing PR interval; AV node is not conducting all of the P wave that is coming through
3rd DEGREE HEART BLOCK
P to Ps are regular, QRS complex is regular, not a P wave before every QRS complex
If impulse is controlled below AV node, pulse rate could be in the 20s
A-FIB; ARTIAL FIBRILLATION
- No P wave-No contraction
- No atrial kick
- Irregular R to R because the gatekeeper, the AV node does not know which impulse to let through.
- Blood Pooling and clot formation
A-FIB - V-TACH - ARTIAL FLUTTER COMPARISON
AICD - Automated Implantable cardioverter defibrillator
ASYSTOLE
- Also known as ventricular standstill
- No P waves, No QRS complexes
- Verify lead placement and patient condition
- No electrical activity
- No shocking this Rhythm
- Can give epinephrine and CPR
ATRIAL FLUTTER
•Saw tooth P waves
CARDIOVERSION
Need informed consent unless used in an emergent situation
Hold Digoxin 48 hrs prior to doing a cardioversion
DNR; can do if used as a treatment but may not need to do if it is during an emergent situation
Do not want any oxygen blowing over the chest area when performing cardioversion
CARDIOVERSION
Need informed consent unless used in an emergent situation
Hold Digoxin 48 hrs prior to doing a cardioversion
DNR; can do if used as a treatment but may not need to do if it is during an emergent situation
Do not want any oxygen blowing over the chest area when performing cardioversion
CONDUCTION PATHWAY
- SA (sinoatrial) node
- Internodal Tract
- Right and Left Atria
- AV (atrioventricular) Node
- Bundle of HIS
- Bundle Branches
- Purkinje Fibers
- Ventricle
DEFIBRILLATION
ONLY OPTION TO CHANGE RHYTHMS
EKG of PACEMAKER + PACEMAKER SPIKES PRESENT
SPIKES REPRESENT THAT PACEMAKER IS FIRING!!
HR ASSESSMENT VIA EKG STRIP:
- Obtain a 6 second sample
- Count the R intervals between the QRS complex and multiply by 10
- 7 X 10 = 70
- The heart rate for this normal sinus rhythm ECG is 70 beats per minute
NORMAL SINUS RHYTHM
THIS IS A NORMAL SINUS RHYTHM:
We know this because of:
- it is normal with HR 60-100 bpm
- are the P to Ps normal, consistent?; regular intervals? Does the space between look the same for them all?
- there is a P wave for every QRS
- does the R to R interval look consistent? The same for them all?
- 7x10 = 70 BPM OR 18 between each R wave 1500/18 = 83 BPM
NORMAL TIME MEASURMENTS:
.16 PR interval
.04 QR complex
ST segment
QT interval .40
***each EKG box is .04 seconds so however many boxes you count, multiply by .04
PQRST ON EKG
- P wave = atrial contraction/depolarization
- PR interval = time from atrial depolarization to ventricular contraction
- QRS complex = ventricular contraction/ depolarization
- ST segment = beginning of ventricular depolarization
- T wave = ventricular repolarization
- QT interval = entire depolarization and repolarization of the ventricles
PAC - PREMATURE ATRAIL CONTRACTION
•PVC’s are QRS complexes that can appear wide and irregular
PACEMAKER - FAILURE TO SENSE
Pacemaker is firing on its own free will at random, caused by improper lead placement or lead damage, battery failure
Can cause V-tach
PACEMAKER - EXTERNAL VIEW
PACEMAKER PLACEMENT - INTERNAL VIEW
PACEMAKER - DUAL CHAMBER PACEMAKER
1 spike before atria and 1 before QRS complex, this is a dual chamber pacemaker
PACEMAKER SPIKE + NO ATRIAL/VENTRICULAR RESPONSE
Pacing spikes are noted without atrial or ventricular responses (spike, QRS, then there are spikes and NO QRS)
PACEMAKER W/ VENTRICULAR PLACED RHYTHM
Spike is right before the QRS complex, no P wave is present (document that it is a ventricularly paced rhythm and document the rate)
PVC - PREMATURE VENTRICULAR CONTRACTION > MULTIFOCAL
PVC - PREMATURE VENTRICULAR CONTRACTION > UNIFOCAL
SINUS BRADYCARDIA - LESS THAN 60 BPM
SINUS TACHYCARDIA - MORE THAN 100 BPM
SVT - SUPRAVENTRICULAR TACHYCARDIA
- HR 150-220
- Short PR interval
- Normal QRS
TORSADES DE POINTES
- Looks similar to VT
- It has small and large QRS complexes
- Heart Rate is usually 200-250
- low magnesium levels
- Pulseless
V-TACH - VENTRICULAR TACHYCARDIA
- Very wide QRS
- No P wave
- Looks like a Tombstone
- Typical rate 150-250 beats/min
- Patient can have a pulse or not
- Often the rhythm before V-FIB
V-FIB - VENTRICULAR FIBRILLATION
- No P waves, no QRS complexes
- Both fine and course in appearance
- Quivering heart
- No blood pressure, no pulse
- Assess lead placement
