Heart PPT Flashcards
The SA node is the _____ pacemaker.
primary
Electrical _____ = depolarization -> mechanical contraction = systole
stimulation
Electrical _____ = repolarization -> mechanical relaxation = diastole
relaxation
Cardiac Conduction System
SA Node Atria AV Node Bundle of His Bundle of Branches Purkinje fibers Ventricles
_____ is the noninvasive, first line of investigation that provides information about the function of cardiac conduction system.
EKG
EKG’s can help identify enlarged chambers or thickened heart muscle, ______, and ischemic heart disease or MI.
arrhythmias
Each electrode creates an imaginary line or ____ looking at the electrical activity directly in front of it.
“lead”
To assure good conduction with electrode placement, don’t use _____, prep area with clean dry guaze, clip hair if needed. You also want to avoid ______. Don’t shave because it makes a difference in connection by taking the top layer of skin off.
alcohol
bony areas
With the 3 lead monitor what are the placements of the electrodes.
white on the right
smoke over fire
What are the 5 lead EKG placements of electrodes?
Smoke over fire, white on the right. Snow over grass. V1 4th Intercostal space
A 12-Lead ECG has _____ leads, but gives 12 images.
10 leads
_____: fourth intercostal space, right sternal border
V1
____: level with V5 at left midaxillary line
V6
_____: fourth intercostal space, left sternal border
V2
____: directly between leads V2 and V4
V3
_____: level with V4 at left anterior axillary line
V5
____: fifth intercostal space, left midclavicular line
V4
Errors in diagnosis can occur from incorrect lead placement or ______.
patient movement
While telemetry and EKGs are important to monitor, you must always _____ your patients condition.
consider/assess
EKG paper is graph paper made up of boxes ______
1 mm by 1 mm.
On EKG paper the ______ axis corresponds with time and rate.
horizontal
On EKG paper the ______ axis corresponds with amplitude/voltage of the impulse.
vertical
On EKG paper each small box =s ____ seconds.
0.04 seconds
On EKG paper five small boxes =’s or one big box ____ seconds.
0.2 seconds
On EKG paper five big boxes =’s _____ seconds.
1.0 seconds
30 big boxes on the EKG strip =’s ____ seconds.
6.0 seconds
The accurate and quickest way to determine heart rate you should count _____ in six second strip, multiply by 10. If your rhythm is irregular, counting ____ intervals is more accurate.
QRS complexes
RR
The most accurate way to determine the heart rate is to count the small boxes between QRS complexes (RR intervals) and divide by _____.
1500
i.e. 1500/25 = 60 bpm
To determine the rhythm look at the ___ or ____ intervals.
R-R or P-P
Regular intervals are the same or with a
0.8 second
To determine the rhythm you can use paper or _____.
calipers
P wave =’s ______
atrial depolarization
The _____ is when depolarization of the atria and electrical impulse is moving from the SA node towards the ventricles.
P wave
P waves can be different shapes, sizes, depending on ______.
atrial conduction
Beats that have originated in the atria usually have narrow ______.
QRS complexes
P wave is normally less than _______.
0.11 seconds
PR interval lasts from the beginning of P to the beginning of _____.
QRS
The ______ interval represents time from SA stimulation through atrial depolarization and AV node conduction.
PR interval
A PR Interval normally lasts _______.
0.12 - .20 seconds
The ______ represents ventricular depolarization.
QRS complex
The shape of the QRS complex depends on the _____.
lead selected
If the ______ is abnormal is can represent myocardial necrosis.
QRS complex
The QRS complex should be less than ____.
.12 seconds
A _____ represents ventricular repolarization.
T wave
When a T waves is tall, peaked it indicates _______.
hyperkalemia
When a T waves is inverted it it indicates ______.
injury
_____ segment represents early ventricular repolarization.
ST
The ST segment goes from the end of the QRS to the beginning of the _____.
T wave
______ should be flat against isoelectric line.
ST segment
ST depression can indicate
hypokalemia
MI
ventricular hypertrophy
ST elevation can indicate
MI
pericarditis
hyperkalemia
The ______ represents total time for ventricular depolarization and repolarization.
QT interval
The ____ interval begins at the start of the QRS to the end of T wave.
QT
With a prolonged QT there is a risk for
Torsades de Pointes
Sudden death
The ____ interval should be 0.32 - 0.40 seconds for HR 65-95 bpm.
QT
The _____ is not always present & easy to mistake for P wave
u waves
The U wave follows the _____ and is thought to be the result of slow repolarization of Purkinje fibers
T wave
A U wave may be result of electrolyte imbalance (hypokalemia), _____, or heart disease
HTN
What should you do if you see artifact on the telemetry monitor?
Assess the patient
Normal Sinus Rhythm the HR should range from _____ to _____ with a regular rhythm.
HR 60 to 100
With a normal sinus rhythm the P:QRS ration should be ______.
1:1
With a normal sinus rhythm the _____ are upright and uniform, 1 before each QRS.
P waves
The ______ is the ideal or normal rhythm.
Normal sinus rhythm
______ and arrhythmias are used interhangeably.
dysrhythmia
Dysrhythmias can be premature complexes, bradydsrhythmias, or _________.
tachydysrhythmias
Common dysrhythmias can be classified as sinus, atrial, ______, or ventricular.
AV nodal/junctional
With dysrhythmias a patient may or ____ have symptoms (depending on cause and rhythm).
may not
Dysrhythmias can be caused by
heart disease electrolyte imbalance medications hypoxia drugs stress caffeine
______ are early rhythm complexes that occur when cells other than the SA node fires an early impulse
Premature complexes
What are the three classifications of premature complexes?
Atrial (PAC)
junctional (PJC)
ventricular (PVC)
A ______ creates a ‘pause’ that may cause skipped beats or a ’flip flop’ feeling in the chest
premature complex
Bradydysrhythmias occur when the heart rate is less than ____.
60 bpm
Bradydysrhythmias can cause decreased perfusion if rate is too slow to provide _______ and BP.
adequate cardiac output
Bradydysrhythmias can lead to myocardia ischemia and _____, hypotension, and heart failure.
infarction
Tachydysrhythmias occur when the heart rate is over ______.
100 bpm
Tachydysrhythmias is especially dangerous in pts with ______>
CAD
________ increase the work of the heart and O2 demand of myocardium.
Tachydysrhythmias
Sustained Brady & Tachydysrhythmias can result in….
Chest pain and/or palpitations Anxiety, restlessness Changes in VS Signs of HF Signs of shock AMS or loss of consciousness
Care of the Patient with a Dysrhythmia
VS & telemetry monitoring Assess chest pain, perfusion, laboratory values (which ones?), activity tolerance, respiratory distress Evaluate effectiveness of medications Psychosocial needs Education `
P waves proceed _____ waves.
QRS
How do you treat sinus bradycardia?
treat underlying cause
atropine
fluid replacement
pacing
Causes of sinus bradycardia?
Valsalva maneuver vagal stimulation MI Meds (BB & CCB) athletes increased ICP hypothyroid
Sinus Tachycardia bpm
100-120
How to treat sinus tachycardia?
treat underlying symptoms - if necessary
Causes of sinus tachycardia?
fever blood loss sepsis shock exercise CHF pain anxiety meds caffeine nicotine alcohol recreational drugs
