Exam 2: EKG Flashcards by Jared winston

Why is it important to read ECG?

measuring electrical activity of the heart

if there are abnormal rhythms it can lead to decreased CO which will effect activity tolerance

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What is the path of the conduction system?

SA node
AV node
purkinjee fibers

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What branch of artery supplies SA node and what is pulse?

RCA, 60-100

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What branch of artery supplies AV node and what is pulse?

RCA, 40-60

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What branch of arteries supply ventricle and what is pulse?

LM and LAD, 20-40

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If SA node is damaged what happens?

the heart must rely on AV node for rhythm which is not good bc HR is below normal

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What are the 3 components of the ECG?

P wave
QRS wave
T wave

coincides with cardiac cycle

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What are characteristics of P wave?

this is the depolarization of the atrium, small wave as not much tissue or distance to push blood (atrial contraction)

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What are the characteristics of the QRS wave?

systolic, ventricular squeeze

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What are the characteristics of the T wave?

re polarization of ventricles, larger due to more tissue to move

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What is important about the ST segment?

elevated- MI

depressed- ischemia

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What is best way to read ECG strip?

is it regular or irregular?( distance between QRS peaks)
What is rate?
Are there P waves? (atrial issue)
does the QRS complex look the same? (ventricular issue? )

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What does NSR stand for?

normal sinus rhythm

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What are PT implications for sinus bradycardia?

yellow flag, could be normal with trained athlete

low BP and low HR = red flag

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What are PT implications of sinus tachycardia?

yellow flag at rest, however monitor vitals closely during exercise

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What is a premature atrial contraction?

early P wave that looks different from others (inverted), still getting atrial kick just not from SA node

causes: stress, infection, ischemia, hypoxia

NO PT implications due to no effect on CO

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What is atrial fibrillation?

absent, twitching atrial waves, no atrial squeeze

causes: stress genetics, HTN, heart dz

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What are PT implications of atrial fib?

yellow flag if there is a normal HR

if over 115-120 bpm then do not treat as it is affecting CO due to decrease diastolic filling time

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What is atrial flutter?

p waves in sawtooth pattern

a lot of p waves so still getting atrial kick therefore not affecting CO- yellow flag

however, if pt develops a new flutter with no history that is big red flag

What is supraventricular tach or paroxysomal atrial tach?

P waves are buried in QRS complex due to short burst of tach, HR 160-250

atrial impulses not coming from SA node

not safe to treat as decreasing diastolic filling time

causes: caffine, electrolyte imbalance

What are heart blocks?

delay or complete block of in conduction of the conduction system

causes: MI, CAD, ischemic, necrotic tissue

block occurs between SA node and AV node

What is 1st degree heart block?

prolonged P-R interval greater than .20 sec

conduction still going through AV node and can be seen in endurance athletes, also seen in digoxin and beta blockers

No PT implications as it benign and does not affect CO

What is second degree heart block Type 1 Mobitz?

progressively longer P-R interval until QRS interval is dropped

AKA: Wenkebach

causes: MI, meds

yellow flag, slightly decreasing CO but not a ton

What is 2nd Degree heart block Type 2 Mobitz?

P-R interval is prolonged but remains constant distance to QRS wave

one or several QRS waves dropped

don’t treat as the pt likely needs a pacemaker as you are losing CO

What is a 3rd degree heart block?

all impulses from AV node are blocked ventricular rates are 20-40 bpm this is a medical emergency

What is a premature ventricular contraction?

-irregular beat on top of a sinus rhythm a wide and early QRS wave, due to ventricle firing early causes: iscehmia, CAD, electrolyte imbalance, stress, MI---worsens with stressors

What is PT implication for PVC?

yellow flag however if more than 7-10 per minute do not treat CO affected due to abnormal squeeze

What is a PVC trigeminy?

PVC occurs every third beat, normal QRS two beats in between yellow flag

What is a PVC bigeminy?

worse than trigeminy as PVC occurs every two beats, normal QRS in between more on the red flag side

What is a PVC couplet?

2 PVC's in a row 1-3 in a minute yellow flag more than that is a red flag

What is PVC triplet?

3 pvc in a row worse than couplet 1-3 in a minute yellow flag anymore than 3 is V tach

What is a multifocal PVC?

PVC from multiple ectopical foci- different contractions PVC all look different greatly affects CO- RED Flag

What is ventricular tachycardia?

more than 3 PVC, absent or buried P waves- could be firing but hidden widened QRS complex causes: acute MI, ischemia, severe electrolyte imbalance medical emergency as PT will likely pass out

What is ventricle fibrillation?

erratic quivering of ventricular muscle no CO , med emergency

What is asystole?

no electrical activity

What is artifact?

poor read of the ECG likely due to pt movement or poor lead connection can palpate pulse to confirm

What is a bundle branch block?

ventricle that is blocked and is depolarized more slowly normal P wave both wide QRS- slower conduction and left with "bunny ears" not smooth all the way back up

What is a pacemaker?

device that uses electrical impulses to control beating of the heart can stimulate heart of inhibit firing

What are temporary pacemakers used for?

bradycardia after MI, during and after cardiac surgery PT: don't pull out the leads with mobility, 1 hour of bed rest after removal

What are permanent pace makers used for?

complete heart block, symptomatic bradycardia, mobile type 2 block, suppress ventricular or atrial ectopy

What are PM precautions?

no shoulder ROM above 90 for 6 weeks no pushing or pulling greater than 5 pounds for more than 6 weeks no driving 2 weeks

What does atrial pacemaker on ECG look like?

pacemaker spike super imposed on P wave, normal QRS wave after

What does a ventricular pacemaker look like on an ECG?

normal p wave with delay after due to impaired electrical conduction pacemaker needed to initiate ventricular depolarization spike right before QRS complex

What does an A-V pacemaker look like on a ECG?

2 pacemaker spikes as PM required for atrial and ventricular depolarization

Why are 12 lead ECG used?

assess likelihood of cardiac disease, detect cardiac rhythm disturbences, detect old/ acute MI or ischemia, detect atrial or ventricular hypertrophy