Patients w/ Conduction Probs Flashcards
How many seconds are the tiny boxes worth on a 6 second strip?
0.04 seconds
How much are the bigger boxes worth on a six second strip?
0.20 seconds
How many boxes are in a 6 seconds strip?
30
1R 2R 3P 4PR 5QRS
1 Rate 2 Rhythm is regular or irregular? 3 P-wave 4 PR interval 5 QRS complex < .12 seconds?
How do you find the rate for step 1 on a 6 second strip?
Count how many QRS complexes appear on a 6 second strip and multiply by 10
What do you determine in step 2 about the rhythm?
If it is regular or irregular-look at QRS complexes
What do you determine about the P-wave in step 3?
do they all look alike and do they come before and after the QRS complexes
What is a normal PR Interval?
0.12-0.20 seconds
How do you measure the PR intervals?
Measure from the beginning of the P-wave to the beginning of the QRS complex
-count how many tiny boxes are between and multiply by 0.04 seconds
How do you measure the QRS duration in step 5?
measure from beginning of QRS complex to the end and multiply be 0.04 seconds
What does the P-wave represent?
the electrical impulse starting in the SA node and spreading throughout the atria
-atrial depolarization
What does the PR interval represent?
the time needed for SA node stimulation, atrial node depolarization, and conduction through AV node before ventricular depolarization
What does the QRS complex represent?
ventricular depolarization
How long is a normal QRS duration?
less than .12 seconds
What does the T-wave represent?
ventricular repolarization or electrical recovery
When does NORMAL Sinus Rhythm occur?
when the electrical impulse starts at the SA node and travels through the normal conduction pathway
Normal Sinus Rhythm serves as a what?
Baseline
Normal Sinus Rhythm Characteristics
Rate: 60-100 Rhythm: regular P-wave: normal and consistent PR Interval: b/t .12-.20 QRS duration: less than .12 seconds
What is the ONLY difference b/t Normal Sinus Rhythm and Sinus Arrhythmia?
Irregular Rhythm
A Sinus Arrhythmia’s irregular rhythm may correlate w/ what?
Breathing
Rate increases w/ inspiration and decreases w/ expiration
When does Sinus Bradycardia occur?
when the SA node creates an impulse at a slower rate than normal
What is the ONLY difference b/w Sinus Brady and Normal Sinus Rhythm?
rate is less than 60 bpm
What are some causes of Sinus Brady?
- sleep
- pain
- athleticism
- vomiting/hypovolemia
- suctioning
- medications
- increased intracranial pressure
- MI
- anemia
What medications may cause Sinus Brady?
- calcium channel blockers
- amiodarone
- beta blockers
- digoxin
Sinus Brady ECG Characteristics
Rate: < 60 bpm Rhythm: regular P-wave: present before and after QRS and looks same PR: normal QRS: normal
Treatment for symptomatic Sinus Brady may be what?
- transcutaneous pacing
- atropine
- dopamine
- epinephrine
When does Sinus Tachycardia occur?
When SA node creates an impulse at a faster rate than normal
What are some causes of Sinus Tachy?
- stress
- medications
- stimulants
- drugs
- emotions/agitation
- blood loss/hemorrhage/hypovolemia
- sepsis
- hyperthyroidism
- anemia
- infection/inflammation
ECG Characteristics of Sinus Tachycardia
Rate: > 100 bpm Rhythm: regular P-wave: before and after QRS and same PR: normal QRS: normal
What is a Premature Atrial Complex (PAC)?
single ECG complex that occurs when electrical impulse starts in the atrium before the next normal impulse from the SA node
What may cause a PAC?
- caffeine
- alcohol
- nicotine
- hypervolemia
- anxiety
- hypokalemia
- injury/infarction
ECG Characteristics w/ PAC
Rate: depends on underlying rhythm Rhythm: irregular P-wave: all same except one PR interval: all normal except one QRS duration: normal
How many PAC’s occurring in one strip is considered to be a sign of worsening arrhythmia?
more than 6 per min
Where does Atrial Flutter occur?
in the Atrium
What is the ATRIAL rate for atrial flutter?
220-350 bpm
What happens w/ Atrial Flutter?
The atrial rate is faster than what the AV node can conduct so not all atrial impulses are conducted to the ventricle
Causes of Atrial Flutter
- CAD
- hypertension
- mitral/tricuspid valve disease
- hyperthyroidism
- chronic lung disease
- pulmonary emboli
- cardiomyopathy
S/S of Atrial Flutter IF present
- fatigue
- light headed
- chest pain
- SOB
- low BP
- blood clots
ECG Characteristics for Atrial FLUTTER
Rate: Atrial 220-350 bpm; Ventricular 75-150 bpm
Rhythm: usually regular
P-wave: flutter waves-“saw tooth pattern”
PR: not measurable
QRS: normal
What is the initial treatment for Atrial Flutter?
Cardioversion or radiofrequency ablation
Atrial Fibrillation causes what?
Rapid, disorganized , and uncoordinated electrical activity w/in the atria
A-fib can appear as what?
- transient, starting and stopping suddenly
- occur for short period of time
- may be persistent
Long-standing Persistent A-fib
continuous AF or lasting longer than 12 months
When is the term “Permanent A-fib” used?
when the physician and patient together decide to stop further attempts of NSR
Nonvalvular A-fib
AF exists in the absence of preexisting heart valve problems
Patients in A-fib are at an increased risk for what?
- blood clots/DVT
- Pulmonary embolism
- MI
- stroke
- kidney infarction
- myocardial ischemia
- heart failure
S/S of A-fib
- asymptomatic
- decreased CO
- fatigue
- malaise
ECG Characteristics of A-fib
Rate: Atrial Rate 300-400, w/ variable ventricle response Rhythm: irregular P wave: no discernible p-wave PR: not measurable QRS: normal
