EKG Rhythms Flashcards
Name this rhythm
NSR
Name this rhythm
Sinus tachy
Name this rhythm
Premature Atrial Contraction
Name this rhythm
A-fib
Name this rhythm
Atrial Fibrillation
or
A-fib
W/ RVR
What is this rhythm
Atrial flutter
or
A flutter
What is this rhythm
Super ventricular tachycardia
or
SVT
Junctional rhythm
What is this rhythm
Accelerated Juntional
What rhythm is this?
Junctional tachycardia
What rhythm is this
PVC
What rhythm is this
PVC
What rhythm is this
PVC Couplet
What rhythm is this
PVC triplet
What rhythm is this
PVC Bigeminy
What rhythm is this?
PVC Trigeminy
What rhythm is this
Ventricular tachycardia
or
V-tach
What rhythm is this
V-tach
What rhythm is this
Ventricular Fibrillation
or
V-fib
What rhythm is this?
Ventricular Fibrillation
or
V-fib
What rhythm is this?
Idioventricular Rhythm
or
IVR
What rhythm is this?
Accelerated IVR
What rhythm is this?
Agonal rhythm
What rhythm is this?
Asystole
What type of heart block is this?
1st degree heart block
If the R is far from P, then you have a 1st Degree
What type of heart block is this?
2nd degree heart block - type II
or
Mobitz II
If some Ps don’t get through, Then you have a Mobitz II
What type of heart block is this?
2nd degree block - type 1 wenkeback or
Mobitz I
Longer, longer, longer, BLOCK Then you have a WENKEBACH
What type of heart block is this?
3rd Degree block
or
Complete heart block
If Qs and Ps don’t agree, Then you have a 3rd Degree
Conditions that can cause Sinus tach
- Infection
- Fever
- Anemia
- Hypovolemia
- Hypotension
- PE
- MI
- Stimulant drugs
How to treat sinus tach
- Treat the underlying cause
- Oxygen
- vagal maneuvers or carotid massage
- Beta blockers
Non-cardiac causes of Sinus Brady
- Hyperkalemia
- Increased ICP
- Hypothyroidism
- Hypothermia
- Sleep/deep relaxation
- Glaucoma
- Valsalva’s maneuver
- Vomiting
Cardiac diseases that can cause sinus brady
- SA node disease
- Cardiomyopathy
- Myocarditis
- Myocardial Ischemia
- Immediately after an inferior wall MI
Drugs that can cause Sinus brady
- Beta blockers
- Calcium channel blockers
- Lithium
- Antiarrythmics (Sotalol, Amiodarone, Propafenone, Quinidine)
How to treat sinus brady
- Atropine
- Transcutaneous Pacing
- Oxygen
S/S of sinus brady
- Hypotension
- Dizziness
- Lightheaded
- Fainting
- SHOB
- Sweating
- Anxiety
What rhythm is this?
a regular rhythm that has the same characteristics as an N S R except the HR is greater than 100 bpm.
Sinus tach
What is this rhythm?
non–life-threatening dysrhythmias that can be seen in N S R. In this dysrhythmia, a pacemaker cell close to the S A node fires earlier than expected. This is an irregular rhythm due to the early impulse or beat.
Premature atrial contractions
or
PAC’s
Causes of PAC’s
- Hypoxia
- Ischemia
- Electrolyte imbalance
- Medication toxicities - Dig
- excessive Stimulant ingestion
- Infection
- CAD
S/S of PAC’s
- SHOB
- Sweating
- Anxiety
- Palpitations
How to treat PAC’s
Treat underlying cause
What rhythm is this?
has no P waves. It is best described as multiple pacemaker cells generating independent electrical impulses and causing chaos within the atria. It is characterized as irregularly irregular. The Q R S complexes are usually narrow with irregular R–R intervals.
Atrial fibrillation
or
A-FIB
Causes of AFIB
- Cardiomyopathy
- Pericarditis
- Hyperthyroidism
- HTN
- Valvular Dx
- Obesity
- DM
- CKD
- Cardiac procedures or surgery
- CAD
Meds for Afib
- Calcium channel blockers
- Beta-blockers
- Cardioversion
- Anticoags
- Anti-anxiety meds
How is new onset A-fib treated initially?
Meds to control HR i.e. digoxin, beta-blockers, calcium channel blockers.
Once heart rate is managed for a patient with new onset A-fib, what is considered?
- Antiarrythmic medications
- cardiac ablation
- Cardioversion
The scarring/destroying the tissue in the heart responsible for the irregular rhythm
Cardiac ablation
Cardioversion is considered after what is attained and why?
adequate coagualtion d/t delivering the shock could dislodge a clot on the wall of the atria which can travel to the brain or lungs
How long after onset of a-fib should cardioverson be done?
within the first 48 hrs of onset
What rhythm is this?
a dysrhythmia produced by a pacemaker cell other than the S A node. Because the S A node is not the primary pacemaker in this rhythm, there are no P waves. Flutter waves (F waves), however, are present. F waves resemble a sawtooth pattern between narrow Q R S complexes.
Atrial Flutter
or
A flutter
What could cause Atrial flutter
- Acute MI
- Mitral valve disease
- Thyrotoxicosis
- COPD
- Chest surgery - Coronary artery bypass or pneumonectomy
- Medication toxicities - dig
S/S of Atrial Flutter & Atrial fibrillation
- Palpitations
- SHOB
- Hypotension
- Lightheaded
- Fainting
- Sweating
- Anxiety
Treatment for Atrial flutter
6
- Antiarrythmic
- Anticoagulants
- Beta-blocker
- Ca++ channel blockers
- Consider cardioversion
- Oxygen
Complications of A-fib & A-flutter
- Loss of cardiac output
- Blood clots
What rhythm is this?
a rapid heart rhythm that originates above the ventricles. It most commonly appears as a regular, narrow Q R S complex tachycardia. Heart rates greater than 100 bpm, can be as fast as 150 – 250 bpm.
Supraventricular tachycardia
or
SVT
SVT is an umbrella term for what narrow complex tachycardias?
- Sinus tach
- A-fib w/ RVR
- A-Flutter w/ RVR
- Junctional tach
S/S of SVT
- Hypotension
- Dizziness
- Lightheaded
- Fainting
- SHOB
- Sweating
- Anxiety
- Palpitations
Treatment for SVT
And other rhythms that fall under it
6 - AABCCO
- Adenosine
- Amniodarone
- Beta blockers
- Calcium Channel blockers
- Cardioversion (Possibly)
- Oxygen
Causes of SVT
- Infection
- Fever
- Hypovolemia
- Hypoxia
- Ischemia
- Electrolyte imbalance
- Stimulants
- MI
- Med toxicities
Before treating SVT what needs to be done?
The underlying rhythm needs to be identified
What rhythm is this?
- Originates in AV Node
- Causes the impulse to split and travel backwards up to the Atria, causing an inverted or absent P-wave
- Rates can vary
Junctional rhythms
What are the types of junctional rhythms?
- Junctional tachycardia
- Accelerated junctional rhythm
If a junctional rhythm has a rate from 61-100 BPM how is it identified?
Accelerated junctional rhythm
If a junctional rhythm has a HR greater than 100 BPM how is it identified?
Junctional tachycardia
Treatment for junctional rhythms
4 - ADOT
- Atropine
- Depends on symptoms and cause
- Oxygen
- Transcutaneous Pacing
What rhythm is this?
rhythms that originate somewhere within the ventricles. When an impulse starts in the ventricle, there is no P wave, and the Q R S is usually wide
Premature Ventricular Contractions
or
PVC’s
Causes of PVC’s
- Hypoxia
- MI
- Cardiomyopathy
- Electrolyte imbalance
- Stimulants
- HTN
- Recreational drug use
- Medication toxicities
Treatment of PVC’s
Treatment of PVCs is based on the patient’s symptoms. If the patient is symptomatic, treatment includes correcting the cause and, rarely, antiarrhythmic therapy.
What rhythm is this?
- Three or more PVCs in a row.
- Can be a life-threatening dysrhythmia as a result of the significant reduction in cardiac output that can occur.
Ventricular Tachycardia
or
V-tach
Causes of V-tach
- Hypoxia
- MI
- Cardiomyopathy
- Electrolyte imbalance
- Stimulants
- HTN
- Recreational drug use
- Medication toxicities
If you have a patient in V-Tach what do you need to do FIRST?
Assess for a pulse
How to treat V-Tach with a pulse?
- Antiarrythmic - amniodarone
- Electrolyte r/p - K & Mg
- Cardioversion
During cardioversion, when is the shock delivered?
at the time of ventricular depolarization
How to treat pulseless V-Tach?
- CPR
- Defibrillation
- A lethal dysrhythmia requiring immediate treatment.
- It is the most frequently seen rhythm in cardiac arrests occurring outside of the hospital.
- Occurs when the ventricle has multiple chaotic impulses rapidly firing.
- This chaotic firing prevents the ventricles from pushing blood out of the heart, stopping cardiac output, and causing death.
Ventricular fibrillation
or
V-FIB
Causes of V-fib
- Hypoxia
- Hypovolemia
- MI
- PE
- Acidosis
- Electrolyte imbalance
- Hypoglycemia
- Cardiac tamponade
- Toxins
Meds used in treatment for pt in V-fib
- Antiarrythmics
- Epinephrine
Nursing interventions for V-fib
- Call a Code
- Start and maintain CPR
- Defibrillate per ACLS guidelines
- Ensure IV access
- Free-flowing NS fluid bolus
- Administer meds
Nursing interventions for V-fib with a pulse
- Stay with client
- Call Rapid Response
- Frequent assessment for symptoms
- Obtain ECG
- Ensure IV access
- Administer meds as ordered
- Prepare for cardioversion
Meds used to treat V-Tach
- Antiarrythmics
- Electrolyte r/p
Nursing Interventions for PVC’s
Assess client frequently:
* LOC
* Palpable pulses
* BP and HR
* Symptoms
Meds used to treat Junctional rhythms
- Atropine
- Anti-anxiety meds
Nursing interventions for junctional rhythms
- Get help and stay with client
- Assess client frequently (q5min): LOC, palpable pulses, BP, and HR
- Obtain ECG
- Ensure IV access
- Administer meds as ordered
- Prepare for Transcutaneous pacing
*
Meds used to treat SVT
And all the other rhythms under it’s ‘umbrella’
- Adenosine
- Calcium channel blockers
- Beta-blockers
- Amnioderone
Nursing interventions for A-flutter & A-fib
- Stay with client
- Assess client frequently (Q5 min): LOC, palpable pulses, BP and HR
- ECG
- Ensure IV Access
- Administer meds as ordered
- Prepare for cardioversion
Meds used to treat A-fib
- Calcium channel blockers
- Beta-blockers
- Anticoags
Nursing interventions for PAC’s
Assess client frequently (q 5 min)
* LOC
* Palpable pulses
* BP and HR
* Symptoms
Nursing interventions for Sinus tach
- Oxygen as ordered
- Assess client frequently (q 5 min): LOC, palpable pulses, BP, and HR
- Contact provider
- Call Rapid Response
- EKG
- Ensure IV access
- Administer meds as ordered
- Anticipate antianxiety drugs
- DO NOT LEAVE CLIENT
Meds given to treat Sinus tach
- Beta-blockers
- Anti-anxiety meds
Nursing Interventions for Sinus brady
- Oxygen as ordered
- Assess client frequently (q 5 min): LOC, palpable pulses, BP, and HR
- Contact provider
- Call Rapid Response
- EKG
- Ensure IV access
- Administer meds as ordered
- Prepare for transcutaneous pacing
- Place defib/pacing pads on client
- Anticipate sedation, if BP stable
- DO NOT LEAVE CLIENT
Meds used to treat Sinus brady
Atropine
S/S of a Idioventricular rhythm
- Dizziness
- Lightheaded
- Fainting
- SHOB
- Sweating
- Anxiety
- Palpitations
- Hypotension
- Decreased LOC
Causes of Idioventricular Rhythm
- Hypoxia
- Hypovolemia
- Ischemia
- Electrolyte imbalance
- Stimulants
- Toxins (cocaine, dig, anesthetics)
Heart conditions that can cause an IVR
- MI
- Post cardiac arrest
- myocarditis
- CM
- Congenital heart disease
What is this rhythm?
occurs when the S A and A V nodes fail to function and the rhythm is generated from the ventricle. The rate is usually less than 40 bpm.
Idioventricular rhythm
or
IVR
Nursing interventions for an IVR
- Call Rapid Response
- Stay with client
- Frequent assessment of symptoms: LOC, BP, and HR
- Palpable pulses
- Obtain ECG
- Ensure IV access
- Administer meds as ordered
- Prepare for transcutaneous pacing
Treatment for IVR
based on the patient’s symptoms. If the patient is symptomatic, the treatment includes correcting the cause, pacing, and atropine.
How to treat Asystole
- Check for pulse
- CPR
- Epi
Nursing Interventions for IVR
- Call a Code
- Start CPR
- Ensure IV access
- Free-flowing NS IV fluids
- Administer emergency meds
Is asystole a shockable rhythm?
NO
Causes of Asystole
- Hypoxia
- Hypovolemia
- Acidosis
- Cardiac tamponade
- MI
- PE
- Electrolyte imbalance
- Hypoglycemia
- Toxins
Causes of heart blocks
- Acute Coronary Syndrome (ACS)
- Unstable angina
- NSTEMI
- MISTEMI
- Electrolyte imbalances
- Medication toxicities
Treatment for 1st degree heart block
No specific tmnt, treat underlying cause
Nursing interventions for 1st degree heart block
- Obtain VS
- Assess client for symptoms
- Obtain ECG
- Assess for causes
When the R is far from the P you have a…
1st degree
Tmnt for symptomatic 2nd degree type II heart block
temporary pacing
A second degree heart block type II is considered
Life threatening
2nd degree heart block type II can quickly progress to what>
Third degree heart block
Tmnt of symptomatic 3rd degree heart block
- Initially based on treating the patient’s symptoms, such as hypotension or SOB.
- Attempts are made to reverse the cause(s) if possible.
- Transcutaneous pacing is indicated in symptomatic CHB.
- Long-term treatment is typically the insertion of a permanent pacemaker.
Effects of dysrhythmias on cardiac output
- Dysrhythmias cause changes in normal HR/rhythm which causes decrease in cardiac output.
- Some dysrhythmias are lethal and can cause complete loss of cardiac output which results in cardiopulmonary arrest
Nursing Interventions for a suspected Dysrhythmia
- Perform ECG & Identify rhythm
- Determine if symptomatic or asymptomatic
- If Symptomatic assess: VS, LOC, Diaphoresis, Chest Pain, Poor peripheral circulation, n|v
- Evaluate electrolytes and cardiac enzymes
Nursing actions when treating a dysrhythmia
- Administer anti arrhythmic therapy as ordered
- Preform ECG/maintain cont ECG monitoring as ordered
- Be prepared to administer advanced cardiac life support
- Document occurrence of dysrhythmias
- Teach patient to Immediately report chest pain/discomfort
- Teach patient to recognize signs of complications
