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EKG Technician > Electrocardiogram Technician: Module 6 and 7 > Flashcards

Electrocardiogram Technician: Module 6 and 7 Flashcards

1
Q

What is ventricular rhythm?

A

rhythm originating in the ventricles

has automaticity and excitability but a heart rate of 20 - 40 bpm

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2
Q

For ventricular rhythm, where does the electrical impulse start at?

A

Purkinje fibers

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3
Q

For ventricular rhythm, the duration and configuration of PR will be how many seconds?

A

0.12 or greater

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4
Q

What are premature ventricular contractions?

A

Extra heartbeats in the lower chamber of the heart

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5
Q

What are the types of rhythms of the ventricles?

A

premature ventricular contractions (PVCs)
Idioventricular rhythm
Accelerated idioventricular rhythm
ventricular tachycardia (V tach)
Agonal rhythm
ventricular fibrillation (vfib)
Asystole

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6
Q

Premature ventricular contractions can be caused by

A

early ectopic beats that originate in the ventricles. They have a regular PR and RR intervals with early QRS complex with compensatory pulse.

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7
Q

For Premature ventricular contractions, p waves may not

A

be identified on early complex but shape will remain consistent to original rhythm. PR interval will follow original rhythm.

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8
Q

For Premature ventricular contractions, duration of QRS complex will be

A

greater than 0.12 seconds and have a bizarre shape with T wave going opposite direction from the complex.

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9
Q

What is unifocal?

A

when early heart beat has a similar shape in every occurrence. This suggest only one area of irritation is present.

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10
Q

What is multifocal?

A

When early heart beat has different shapes and forms in every occurrence suggesting more than one area of irritation present.

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11
Q

What is interpolated?

A

When early heartbeat in ventricles occur during normal RR interval without interrupting the cycle.

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12
Q

What is occasional?

A

more than 1 to 4 premature ventricular contraction per minute

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13
Q

What are the types of Premature Complexes (Atrial and ventricular)

A

Bigeminy: every other beat is a pvc or pac
Trigeminy: every third beat is a pvc or pac
Coupling: Two PVCs or PACs occur back to back

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14
Q

The significance of Premature Complexes (Atrial and ventricular) depend on

A

frequency and it can occur in healthy normal hearts.

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15
Q

If there is low cardiac output, patient may feel

A

dizzy due to pvcs

notify a clinican about any complications due to PVCs

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16
Q

What is Idioventricular rhythm?

A

slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a prolonged QRS interval.

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17
Q

For the Idioventricular rhythm, the RR interval is

A

regular and PR interval cannot be determined because of absence.

the ventricular rate will be 20-40 bpm as purkjne fiver acts as pacemaker.

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18
Q

For the Idioventricular rhythm, the duration and configuration of the QRS complex will be

A

0.12 seconds or more

due to slow rate of heart, there will be loss of cardiac output and patient will be unconscious. Notify clinician immediately.

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19
Q

What is accelerated idioventricular rhythm?

A

rhythm created by purkinje fibers with heart rate faster than idioventricular rhythm

P waves are absent and QRS complex are bizarre with absent p waves.

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20
Q

For accelerated idioventricular rhythm, the RR interval is

A

regular and PR interval cannot be determined due to absent P waves.

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21
Q

What is the typical heart rate for accelerated idioventricular rhythm

A

40 or 50 - 120 bpm

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22
Q

For accelerated idioventricular rhythm, the duration for the QRS complex will be

A

0.12 or greater

There will be a decrease in cardiac output and patient may be unconscious. Notify likened clinician.

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23
Q

When three or more PVCs occur in a row and ventricles are in state of continuous contractions and relaxations

A

ventricular tachycardia

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24
Q

For ventricular tachycardia, the PR intervals are usually

A

unidentifiable with the RR intervals usually being regular

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25
Q

With ventricular tachycardia, the atrial rate

A

cannot be determined but the ventricular rate will be between 100 - 200 beats per minute with T waves in opposite direction of the QRS complex

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26
Q

With ventricular tachycardia, most patients are

A

unconscious immediately and if seen on waveform contact clinician immediately.

if patient is unconscious, follow your facilities guidelines and procedures for cpr and code blue.

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27
Q

What is agonal rhythm?

A

rhythm that occurs when SA node, AV node, and Purkinje fibers have failed and ventricular rate is less than 20 beats per minute.

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28
Q

For agonal rhythm, the RR interval may be

A

regular or irregular with absent p wave

The PR interval will be indeterminable due to absent p wave and QRS complex will have a duration 0.12 seconds or greater with a wide appearance.

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29
Q

For agonal rhythm, there will be a loss of cardiac output

A

and patient will be unconscious. Notify clinician immediately, follow cpr, and call code blue team.

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30
Q

What is Ventricular fibrillation (vfib)

A

From of chaotic electrical activity within ventricles that causes no cardiac output.

31
Q

For ventricular fibrillation, the RR interval will be

A

irregular with vfib and ventricular rate will be greater than 300 bpm

32
Q

For ventricular fibrillation, the p wave will be

A

non-identifiable because of speed of ventricles. The PR interval and QRS complex will not be determined.

33
Q

For ventricular fibrillation, if patient is conscious and talking

A

check leads for loose and disconnected electrodes. If unconscious follow facility for CPR and initiate code team for advanced life support.

34
Q

A flatline and no electrical activity present in the heart

A

asystole

rhythm will be slow and have no waveform

35
Q

Asystole is a life threatening situation because patient is

A

in cardiac arrest and you must follow facility’s policy for resuscitation.

36
Q

What is the electronic pacemaker spike?

A

a thin line on ECG tracing. Indicates electrical stimulation from outside source.

Pace spike may come before the P wave and/or QRS complex

37
Q

AV delay is similar to PR interval on normal rhythm tracing and it measures

A

from atrial spike to ventricular spike.

It is usually measured from 0.12 to 0.20 seconds. If patient has functioning SA node measure from P wave to being of ventricular spike.

38
Q

What are the five steps to evaluate the function of a pacemaker?

A

Rate and regularity of rhythm being paced

Rate and regularity of normal rhythm

Are leads sensing appropriately both atrial and/or ventricular

Are leads capturing appropriately both atrial and/or ventricular

Is the av delay appropriate

39
Q

What are the possible complications with pacemakers?

A

Weak battery: slow discharge with diminished sensing and electrical output.

Program complications: sensing is set too low for pacemaker to see normal contractions.

Malfunctioning: failure to keep the appropriate rhythm

Malsensing: pacemaker fails to sense

Loss of capture: pacemaker fails to initiate the electrical shock.

Oversensing: pacemaker will sense outside sources like electricity and may not depolarize heart as needed.

40
Q

What is the basic cause of arrhythmia?

A

narrowed heart arteries, heart attack, abnormal heart valves, and heart failure.

41
Q

Where is a pacemaker located

A

It is surgically implanted in the chest, below the collar bone.

42
Q

What is the exercise stress test?

A

A non invasive procedure performed with a licensed clinician that involves a treadmill or bicycle.

43
Q

What is an EKG Techs responsibility with stress test?

A

Provide Safety
Educate patient before starting the procedure
Attach electrodes properly and safely
Instructing patient on what to report (discomfort during test)
Monitor patient including active blood pressure

44
Q

Failure to report complications may result in

A

severe patient problems such as inaccurate results. Could result in overtreatment or lack of treatment.

45
Q

What does a stress test evaluate?

A

how the heart and blood vessels respond to basic physical activity. This is typically conducted when a clinician suspects coronary vascular disease

46
Q

Narrowed or obstructed arteries may

A

change ECG tracing, specifically of ventricular contraction to ventricular relaxation (ST segment)

47
Q

What can help to diagnose the cause of chest pain if activity induced?

A

stress test

It can also help to determine functionality of the heart after surgery or heart attack and be used to screen for certain heart diseases when no symptoms are present.

48
Q

True or False: The stress test can be used to help identify cause of abnormal heart rhythms that develop during physical activity and see effectiveness of heart medication

A

True

49
Q

Exercise stress tests monitor

A

heart rate
breathing
blood pressure
electrocardiogram

50
Q

What are the two other types of stress test?

A

Thallium Stress Test
Prepontine -Thallium Stress Test

51
Q

What is the thallium stress test?

A

Also known as nuclear stress test is when thallium is injected intravenously by clinician one to two minutes after stress test

Once the thallium is injected, a cardiologist views the heart with scanner immediately after exercise and again after 3-4 hours.

52
Q

What is the Prepontine -Thallium Stress Test

A

Same as thallium stress test but it is performed on patients that cannot exercise for some reason.

Persantine is administered which causes heart to have artificial exercise effect.

53
Q

Before stress test procedure, a patient should be advised to

A

not drink coffee, alcohol, or smoke 3 hours before test.

The patient should also be informed to not eat two hours before the test and bring comfortable clothes and shoes.

54
Q

Some medications can interfere with stress test so

A

medications should be checked and confirmed with licensed clinician

55
Q

What are the required forms a patient so have at and before test

A

Patient History
Informed consent agreement

56
Q

Informed consent is

A

required for any and all procedures unless its an extreme emergency. This also includes ECGs.

It is important to give patient any and all information that you can

57
Q

ECG Techs must inform patients that the stress test

A

is not timed, but it can take 45 minutes to an hours, start to finish

Explain safety precautions you will use to keep patient calm

58
Q

For various test and services

A

many facilities may have brochures. Sometime they may not have enough information for the patient.

59
Q

The clinician should explain

A

why the procedure is being done

60
Q

What are the steps to explain to patient for ECG procedure

A

10 electrodes are attached to you
Electrodes transmit heart’s electrical activity to ecg machine
ECG machine creates wave pattern representing heart’s rhythm

61
Q

When should you not conduct a stress test?

A

Heart aneurysm
uncontrolled disturbances
inflammation of heart
anemia
hypertension
chest pain
CHF - Congestive heart failure

62
Q

What are the steps to follow when performing a stress test?

A

Before patient enters the room, have equipment such as blood pressure tools, shaving tools, alcohol solution, cotton swabs, and electrodes ready.

As soon as patient arrives, be sure to verify that they had no alcohol, caffeine, or tobacco for past 3 hours.

If ordered by doctor, all medical history and consent forms need to be signed.

Shave patient if not done so, rub with alcohol to remove any lotion and natural oils.

Ruff up the skin so that the electrodes can adhere to skin better

63
Q

Steps for ECG tech to know for procedure

A

Make sure to attach blood pressure cuff and electrodes placed on feet and abdomen

Perform 3 EKGs and blood pressure measurements to get a baseline
(Sitting, standing, and supine)

64
Q

How many stages is the stress test divided into?

A

2, 3-5 minute stages

At end of each stage blood pressure and EKG are checked

65
Q

The exercise period may last

A

15-30 minutes depending on patient’s cardiac condition and physician may stop the test at any time if test leads to additional complications.

66
Q

Have patient hyperventilate for

A

30 seconds and record changes

67
Q

What is the goal of stress test?

A

To reach patient heart rate without complications

68
Q

How to calculate target heart rate?

A

220 - ((patient’s age) x (0.06 +0.85)

69
Q

During stress test, you should monitor

A

Blood pressure
Pulse
Signs and symptoms of distress

70
Q

During stress test, you should watch patient closely for

A

Skin color changes (cynosis)
breathing pattern
amount of sweat and any facial expression of discomfort.

71
Q

Once stress test is complete

A

monitor patient for 10-20 minutes of a cooling off period

Also monitor for changes in symptoms and ecg

heart rate and rhythm

blood pressure

Possible oxygen saturation changes

72
Q

If abnormality occurs during stress test, additional testing may be required such as

A

echocardiogram or coronary angiogram

73
Q

After stress test, tell patient to rest for several hours and

A

avoid stimulants for 3 hours

If results are taken to outside lab, it will take two days to return

74
Q

Any questions about ECG or stress test should be referred to

A

the clinician

EKG Technician (8 decks)

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