EKG Practice Flashcards
NSR
P wave before every QRS complex
HR 60-100, regular rhythm
Normal P wave (upright in leads 1 and 2)
PR interval remains constant (0.12-0.2 seconds)
NSR Considerations
None
Sinus Tachy
P wave before every QRS complex
HR >100 bpm (100-180), regular rhythm
Normal P wave axis (upright in leads 1 and 2)
PR interval remains constant (0.12-0.2 seconds)
Sinus Tachy Considerations
May affect CO/preload
Check lab work (K+, Mg, Ca+)
May need rate control drug if tachy is frequent/uncontrolled
Sinus Brady
P wave before every QRS complex
HR >100 bpm (100-180), regular rhythm
Normal P wave axis (upright in leads 1 and 2)
PR interval remains constant (0.12-0.2 seconds)
Sinus Brady Considerations
May affect cardiac perfusion Check lab work (K+, Mg, Ca+) May need atropine (anti-cholinergic) if vagal stimulation May be a heart block May need pacemaker if severe/chronic
Premature atrial contractions
P wave before every QRS complex
Premature – occurs earlier than expected
P wave is ectopic; originates outside the SA node
Compensatory pause after PAC
PAC Considerations
Check lab work (K+, Mg, Ca+)
Usually no interventions needed
Supraventricular Tachy
P wave not observed
Dysrhythmia originates at or above AV node
Narrow QRS complex
HR >100, but many times 160+
Supraventricular Tachy Considerations
Stable vs unstable Check labs (K+, Mg, Ca+), replete as needed EKG May need IV fluid resuscitation May need adenosine/cardioversion
A Fib
P wave not observed
Irregularly irregular rhythm, variable ventricular rate
Narrow QRS complex
Absence of isoelectric baseline
A Fib Considerations
Stable vs unstable
Acute vs chronic
Check labs, replete as needed
EKG, TEE (transesophageal ECG)
May need IV fluid resuscitation, anticoags
May need amiodarone or other antiarrhythmic
Atrial Flutter
P wave not observed, but saw-tooth flutter waves
Regular or irregular rhythm, variable ventricular rate
Normal, narrow QRS complex
Atrial rate 250-350
Atrial Flutter Considerations
Stable vs unstable
Check labs, replete as needed
EKG, TEE (transesophageal ECG)
May need IV fluid resuscitation, anticoags
May need amiodarone or other antiarrhythmic
Premature Ventricular Contractions
Ectopic ventricular cardiac focus
Premature and bizarrely shaped QRS
Unusually long
Usually not life threatening
PVC Bigeminy
PVC every other beat
Tx based on sx
Could cause heart enlargement or clots
Can feel like chest fluttering
PVC Trigeminy
PVC every third beat
Tx based on sx
Could cause heart enlargement or clots
Could cause chest fluttering
PVC Multifocal
PVC morphology looks different
Ectopic ventricle foci from different areas
Sometimes tx is needed
PVC Considerations
Stable vs unstable Check lab works, replete as needed Calcium channel blockers May need amiodarone or other antiarrhythmic May need cardiac ablation
1st Degree Heart Block
P wave slightly delayed without interruption (PR interval >20 s, 5 small squares)
Electrical signals are slowed, but pass successfully
Regular rhythm
Normal, narrow QRS complex
No sx
2nd Degree Heart Block
Type 1 Wenckebach
AKA Mobitz-1
Progressive prolongation of the PR interval
Irregular rhythm, RR interval progressively shortens with each beat of the cycle
Normal, narrow QRS complex
Usually due to a reversible conduction block in the AV node
Wenckebach Considerations
Stable vs unstable
Can be scheduled for EP ablation
Pacemaker if needed, symptomatic
2nd Degree Heart Block
Type 2 Mobitz 2
Irregular rhythm, intermittently non-conducted P waves
Normal, narrow QRS complex
Disease of the distal conduction system (His-Purkinje system)
Mobitz 2 Considerations
Stable vs unstable
Can be scheduled for EP ablation
Pacemaker if needed, symptomatic
Junctional Rhythm
Electrical activation occurs near the AV node
Absent P wave
Normal, narrow QRS complex, regular rhythm
Can create bradycardia
Junctional Rhythm Considerations
Stable vs unstable
Pacemaker if needed, symptomatic bradycardia
V Tach
Very broad complexes
Absent P wave
Most common is monomorphic (one origin), but can be polymorphic
Can be stable or unstable (hypotension, chest pain, decreased LOC)
V Tach Considerations
Stable vs unstable
Antiarrhythmic drugs (amiodarone)
Ventricular cardioversion
V Fib
Chaotic irregular deflections of varying amplitudes
Absent P wave, QRS complex, and T wave
Rate is 150-500 bpm, no effective perfusion
Amplitude decreases with duration (coarse VF to fine VF)
V Fib Considerations
Immediate intervention
Ventricular defibrillation
CPR
ACLS algorithm
Asystole
Cardiac arrest rhythm; heart standstill
No electrical activity
P waves and QRS complex are absent
No pulse; asystole confirmed in 2 separate leads when pronouncing death
Asystole Considerations
Immediate intervention
CPR
ACLS algorithm
Pulseless Electrical Activity
Cardiac standstill
Presence of organized cardiac electrical activity
Any rhythm can be present on tele
No pulse
A Paced
Electrical conduction of the atria
Presence of pacer spike prior to the P wave
V Paced
Electrical conduction of the ventricles
Presence of pacer spike prior to the QRS wave
Creates wide QRS
AV Paced
Electrical conduction of the atrium and the ventricles
Presence of 2 pacer spikes prior to the P and QRS wave
Creates wide QRS
