EKG pictures

Question 1

Answer 1

1st DEGREE HEART BLOCK

P wave looks normal, harmless

If you measure the PR interval, it will be greater than 0.20

Question 2

Answer 2

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

Question 3

Answer 3

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

Question 4

Answer 4

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

Question 5

Answer 5

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

Question 6

Answer 6

A-FIB - V-TACH - ARTIAL FLUTTER COMPARISON

Question 7

Answer 7

AICD - Automated Implantable cardioverter defibrillator

Question 8

Answer 8

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

Question 9

Answer 9

ATRIAL FLUTTER

•Saw tooth P waves

Question 10

Answer 10

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

Question 11

Answer 11

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

Question 12

Answer 12

CONDUCTION PATHWAY

• SA (sinoatrial) node
• Internodal Tract
• Right and Left Atria
• AV (atrioventricular) Node
• Bundle of HIS
• Bundle Branches
• Purkinje Fibers
• Ventricle

Question 13

Answer 13

DEFIBRILLATION

ONLY OPTION TO CHANGE RHYTHMS

Question 14

Answer 14

EKG of PACEMAKER + PACEMAKER SPIKES PRESENT

SPIKES REPRESENT THAT PACEMAKER IS FIRING!!

Question 15

Answer 15

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

Question 16

Answer 16

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

Question 17

Answer 17

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

Question 18

Answer 18

PAC - PREMATURE ATRAIL CONTRACTION

•PVC’s are QRS complexes that can appear wide and irregular

Question 19

Answer 19

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

Question 20

Answer 20

PACEMAKER - EXTERNAL VIEW

Question 21

Answer 21

PACEMAKER PLACEMENT - INTERNAL VIEW

Question 22

Answer 22

PACEMAKER - DUAL CHAMBER PACEMAKER

1 spike before atria and 1 before QRS complex, this is a dual chamber pacemaker

Question 23

Answer 23

PACEMAKER SPIKE + NO ATRIAL/VENTRICULAR RESPONSE

Pacing spikes are noted without atrial or ventricular responses (spike, QRS, then there are spikes and NO QRS)

Question 24

Answer 24

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)

Question 25

Answer 25

PVC - PREMATURE VENTRICULAR CONTRACTION > MULTIFOCAL

Question 26

Answer 26

PVC - PREMATURE VENTRICULAR CONTRACTION > UNIFOCAL

Question 27

Answer 27

SINUS BRADYCARDIA - LESS THAN 60 BPM

Question 28

Answer 28

SINUS TACHYCARDIA - MORE THAN 100 BPM

Question 29

Answer 29

SVT - SUPRAVENTRICULAR TACHYCARDIA

• HR 150-220
• Short PR interval
• Normal QRS

Question 30

Answer 30

TORSADES DE POINTES

• Looks similar to VT
• It has small and large QRS complexes
• Heart Rate is usually 200-250
• low magnesium levels
• Pulseless

Question 31

Answer 31

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

Question 32

Answer 32

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