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NHA > Module 3F: EKG and Cardiovascular Testing > Flashcards

Module 3F: EKG and Cardiovascular Testing Flashcards

1
Q

Electrocardiogram (EKG)

A

A cardiac test that records electrical activity of the heart, provides information about heart rate and rhythm, and can show evidence of a previous heart attack.

The electrocardiograph is the instrument used to record the heart’s electrical activity.

The electrocardiogram is the representation of the results.

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2
Q

Cardiac Cycle

A

Represents one complete heartbeat; it is the contraction of the atria and ventricles and the relaxation of the entire heart.

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3
Q

Parts of an EKG

A
  • P wave
  • QRS wave
  • T wave
  • U wave
  • PR interval
  • QT interval​​​​​​​
  • ST segment
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4
Q

P wave

A

Represents atrial depolarization

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5
Q

QRS wave

A

Represents ventricular depolarization

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6
Q

T wave

A

Represents ventricular repolarization

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7
Q

U wave

A

Not always visible but represents a repolarization of the bundle of His and Purkinje fibers.

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8
Q

PR interval

A

Starts at the beginning of the P wave and ends at the beginning of the Q wave. Represents the time from the beginning of atrial depolarization to the beginning of ventricular depolarization.

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9
Q

QT interval

A

Starts at the beginning of the Q wave and ends at the end of the T wave. Represents the time from the beginning of ventricular depolarization to the end of ventricular repolarization. ​​​​​​​

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10
Q

ST segment

A

Starts at the end of the S wave and ends at the beginning of the T wave. Represents the time from the end of ventricular depolarization to the beginning of ventricular repolarization.

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11
Q

Sinus rhythms

A

Normal rhythms that originate from the firing of the sinoatrial (SA) node and are characterized by the presence of one P wave for each QRS interval on the EKG.

Describes the characteristic rhythm of the human heart.

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12
Q

Sinus dysrhythmias

A

aka arrhythmias

Characterized by slight irregularity in the QRS complexes in an otherwise normal EKG.

Can arise when the SA node fires too slowly or too quickly.

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13
Q

Sinus bradycardia

A

A dysrhythmia characterized by a heart rate less than 60/min

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14
Q

Sinus tachycardia

A

A dysrhythmia with a heart rate greater than 100/min and one P wave preceding each QRS complex.

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15
Q

Sinus arrest

A

A break in the normal EKG.

In this condition, the SA node failed to fire; it is not significant unless the person experiences symptoms such as shortness of breath, fainting, or chest pain, or if the periods of arrest last longer than 6 seconds.

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16
Q

Atrial rhythms

A

Originate from the atrial tissue but outside the SA node and are characterized by the absence of P waves on the EKG.

Commonly encountered atrial rhythms include atrial flutter, atrial fibrillation, and premature atrial contractions (PACs).

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17
Q

Atrial flutter

A

A single area within the atrial tissue firing at a faster rate than the rate the ventricles are responding to.

The result is multiple flutter waves for each QRS complex on the EKG.

Atrial flutter can be treated with medication to control the rate.

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18
Q

Premature atrial contractions (PACs)

A

A premature contraction that results when the atria are triggered to contract earlier than they should.

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19
Q

Atrial fibrillation

A

A rapid, disorganized firing of multiple sites within the atrial tissue.

This results in lots of fibrillatory waves between QRS complexes. It also results in an irregular QRS rhythm (the distance is different between any two QRS complexes on the EKG).

Patients who have atrial fibrillation are at increased risk of developing blood clots, making recognition of dysrhythmia extremely important.

Blood thinners may be prescribed to decrease the risk of stroke.

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20
Q

Premature ventricular contractions (PVCs)

A

Premature contractions in the ventricles

21
Q

Ventricular arrhythmias

A

Typically need immediate intervention

Ex: ventricular tachycardia, ventricular fibrillation, and asystole.

22
Q

Ventricular tachycardia (V-tach)

A

A regular, fast rhythm characterized by large, irregular, wide QRS complexes on the EKG. Typically, P waves are absent, not visible, or occur randomly throughout the tracing.

This dysrhythmia is caused by a single area in the ventricles firing outside the normal conduction pathway.

Patients who experience ventricular tachycardia frequently do not have a pulse, although it is possible to have a pulse with this rhythm.

Ventricular tachycardia is life-threatening and should be reported immediately. V-tach can be treated with medication and/or cardioversion. Without reversal, V-tach can progress to ventricular fibrillation.

23
Q

Ventricular fibrillation

A

A type of abnormal heart rhythm where the ventricles twitch or quiver, not pumping blood to the rest of the body.

Ventricular fibrillation does not produce a pulse, as the ventricles cannot pump any blood, and patients typically become unconscious within seconds.

24
Q

Asystole

A

The complete absence of any waves on the EKG tracing.

Immediately check that the patient is awake and alert. If so, the likely cause of the arrhythmia is a disconnected electrode. If the patient is not awake, call 911 and begin CPR.

25
Q

Artifact

A

Alteration or interference on the EKG that is not related to cardiac electrical activity; appears as distorted lines or waves.

26
Q

Somatic Tremors

A

Characterized by irregular spikes throughout the tracing and is related to muscle movement.

EX: shivering can occur when the patient is cold, causing an irregular tracing. Medical conditions such as Parkinson’s disease can also result in somatic tremors.

Somatic tremors can be reduced by decreasing patient anxiety and providing warmth and comfort as needed. If patients have conditions that lead to uncontrolled muscle movement, have them lay their hands palms-down under their buttocks to reduce somatic interference.

27
Q

AC interference

A

aka 60-cycle interference, characterized by regular spikes in the EKG tracing. It is related to poor grounding or external electricity interfering with the tracing.

Nearby electrical equipment such as lights, computers, and other items plugged into wall sockets can result in AC interference.

Ensure proper grounding of the machine by using a three-prong plug, avoiding crossed lead wires, moving the bed away from the wall, and turning off unnecessary electronic devices.

28
Q

Wandering baseline

A

Results from movement associated with breathing or poor electrode connection.

The baseline will wander away from the center of the paper, causing difficulty in tracing interpretation.

Clean the skin before attaching the electrodes. Instruct the patient to avoid using creams and lotions.

29
Q

Interrupted baseline

A

Obvious when there is a break in the tracing. A flat, horizontal line will print on the EKG tracing.

It is usually related to a disconnected or broken lead wire.

Regular cleaning, maintenance, and inspection of the lead wires will alert the MA to potential lead wire concerns.

30
Q

Preparing a patient for an EKG

A

The patient will undress from the waist up and have lower legs or ankles accessible for lead placement.

  1. Instruct patients to remove pantyhose, tights, socks, or anything covering the feet or lower legs. A drape or gown should be worn with the opening in the front. Always ask patients if they want an additional cover for added privacy or comfort.
  2. Remove jewelry (bracelets, necklaces), which can interfere with lead placement or touch the lead wires during the procedure.
  3. Turn off all electronic devices, such as cell phones, and remove them from the patient. These items could lead to artifacts on the EKG tracing.
  4. Place patients in the supine position, lying flat on their back, for the EKG. If a patient cannot lie flat on their back, elevate the head of the bed to a 45-degree angle in semi-Fowler’s position.
  5. If possible, instruct patients to avoid applying any substance to the skin (lotions, powders, oils, ointments) prior to the procedure. Help ensure the skin is clean by using alcohol wipes, soap, and water at the attachment or electrode sites. Some facilities have electrolyte pads to prep the sites of electrode placement.
  6. If chest hair is present remove with surgical clippers, if available. Use regular razors only if surgical clippers are not an option, as they often cause microabrasions and tears of the skin. Chest hair can interfere with electrode adherence to the skin.
31
Q

What is the standard EKG paper speed?

A

25 mm/second

32
Q

Electrocardiograph paper

A

Can be displayed in graph or dot matrix format, with vertical and horizontal lines or dots at 1 mm intervals.

  • The vertical axis represents gain or amplitude. Each small horizontal square represents 0.04 seconds.
  • Large squares are identified by darker lines and include five small boxes horizontally and vertically representing 0.20 seconds.
  • The paper should run at the normal speed of 25 mm/second. Normal amplitude is 10 mm or 1 mv.
33
Q

EKG Leads

A

Leads I, II, and III are bipolar and record impulses that travel from a negative to a positive pole at specific positions in the heart.
1. Lead I records impulses between the right and left arms.
2. Lead II records impulses between the right arm and left leg.
3. Lead III records impulses between the left arm and left leg.

Leads aVL, aVR, and aVF are unipolar. Due to poor illustration of the waveforms, they must be augmented and therefore get assistance from two poles to enhance the tracing.
1. In aVL, the left leg and right arm assist with the left arm tracing.
2. In aVR, the left arm and left leg assist with the right arm tracing.
3. In aVF, the right and left arms assist with the left leg tracing.

34
Q

Universal lead wire colors

A

White: right arm
Black: left arm
Red: left leg
Green: right leg
V1: red
V2: yellow
V3: green
V4: blue
V5: orange
V6: purple
(Precordial leads can be all brown or can be individually colored.)

35
Q

V1 Lead Placement

A

right side of the sternum at the fourth intercostal space

36
Q

V2 Lead Placement

A

left side of the sternum, directly across from V1 at the fourth intercostal space

37
Q

V3 Lead Placement

A

left side of the chest, midway between V2 and V4
* V4 is placed before V3 because of this.

38
Q

V4 Lead Placement

A

left side of the chest, fifth intercostal space, midclavicular line

39
Q

V5 Lead Placement

A

left side of the chest, fifth intercostal space, anterior axillary line

40
Q

V6 Lead Placement

A

left side of the chest, fifth intercostal space, midaxillary line

41
Q

Lead I

A

Records impulses between the right and left arms

42
Q

Lead II

A

Records impulses between the right arm and left leg

43
Q

Lead III

A

Records impulses between the left arm and left leg

44
Q

Techniques and Methods for EKGs

A
  • Explaining the procedure to the patient helps reassure apprehensive patients. Heavy breathing or sighing can cause a wandering baseline artifact.
  • The chest, upper arms, and lower legs must be uncovered to allow proper placement of the electrodes.
  • Proper positioning of the electrocardiograph machine reduces 60-cycle interference artifacts.
  • After the use of the electrodes, close the sealable pouch to preserve moisture and prevent the remaining electrodes from drying out.
  • Positioning the chest electrodes downward prevents the lead wires from pulling and causing artifacts.
45
Q

Stress testing

A

Monitoring the heart during exercise on a treadmill or stationary bike to evaluate how the heart responds to stress.

Patients might receive thallium, a dye that provides additional information on blood flow within the heart.

Patients who cannot run on a treadmill or ride a stationary bike may receive a non-exercise stress test that involves a medication that mimics the stress placed on the heart during activity.

46
Q

What should the MA check for after the EKG has been recorded to ensure validity?

A
  1. After the EKG has been recorded, check the printout to ensure the standardization mark is 10 mm high.
  2. Check the direction of the R wave in lead I. The R wave on lead I should have a positive deflection. If it has a negative deflection, the limb leads are not attached correctly. Items that should be visible include a baseline tracking through the middle of the tracing and no abnormal spikes in the baseline.
47
Q

Standard calibration box on the EKG

A

10 mm tall by 5 mm wide

48
Q

Holter Monitoring

A

A portable device for cardiac monitoring that is worn for at least 24 hours.

  1. Instruct patients to assume their normal activities and keep a diary of those activities while wearing the monitoring device.
  2. The diary activities should include the time of the activity and details pertaining to the activity.
  3. Patients should also press the “event” button on the monitor if they experience any cardiac symptoms (such as palpitations) or neurological symptoms (such as syncope) and record a description of the activity surrounding the symptoms.
  4. Patients should not move the electrodes. They should avoid showers until the electrodes are removed. Exposure to electrical forces such as metal detectors should also be avoided.
  5. Typically, patients will wear a Holter monitor for 24 to 72 hours, based on the provider’s orders.

NHA (17 decks)

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