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EKG Competency for RNs > Reading EKGs > Flashcards

Reading EKGs Flashcards

1
Q

What are symptoms of arrhythmia?

A

Syncope

Dizziness

Chest pain

Palpitations

Sudden death

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2
Q

What are the 7 sinus rhythms?

A

NSR

Sinus tachycardia

Sinus bradycardia

Sinus arrhythmia

Sinus arrest

Sinoatrial exit block

Sick sinus syndrome

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3
Q

What are the 6 atrial rhythms?

A

Premature atrial complex

Focal atrial tachycardia

Wandering atrial pacemaker

Multifocal atrial tachycardia

Atrial flutter

Atrial fibrillation

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4
Q

What are the 6 types of rhythms originating at the AV node?

A

Premature junctional complex

Junctional escape beat

Junctional rhythm

Accelerated junctional

Junctional tachycardia

AV nodal reentrant tachycardia

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5
Q

What are the 9 rhythms that originate in the purkinje fibers?

A

Premature ventricular contractions (bigeminy, trigeminy, couplets)

Ventricular escape beat

Idioventricular rhythm

Accelerated idioventricular

Monomorphic ventricular tachycardia

Polymorphic ventricular tachycardia

Torsades de pointes

Ventricular fibrillation

Capture beats

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6
Q

What is a sinus rhythm?

A

Rhythms that originate in the SA node. Can be slow, fast, or irregular.

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7
Q

What is an ectopic rhythm?

A

Rhythms with electrical activity originating from a focus outside the sinus node.

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8
Q

What is a premature rhythm?

A

Rhythms with beats that occur before the next expected normal beat.

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9
Q

What is a reentrant rhythm?

A

A cyclical rhythm.

Electrical energy is trapped in a circular pattern.

Can occur anywhere in the heart.

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10
Q

What is a conduction block?

A

It’s a rhythm where the impulse is generated in the SA node but is blocked or delayed somewhere between the atria and the ventricles.

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11
Q

What is preexcitation syndrome?

A

Rhythm syndrome with premature activation and contraction of the ventricles due to an abnormal conduction pathway.

Usually due to a congenital abnormality of myocardial muscle.

Atria and ventricles are connected outside the normal conduction path.

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12
Q

Bradycardia vs Bradyarrhythmia

A

Bradycardia is a slow rhythm that is generated in the SA node.

Bradyarrhythmia is a slow rhythm that is abnormal and originates outside the SA node.

(<60 bpm)

Same principle applies to tachy-cardia/arrhythmia.

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13
Q

What does a notched P wave indicate?

A

Delay of left atrial activation.

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14
Q

Absent P waves

A

Reflect rhythms originating below the atria.

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15
Q

Peaked P wave

A

>2.5 mm

Represents more tissue depolarization.

Caused by right atrial enlargement.

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16
Q

What does the PR interval indicate? How long should it be?

A

It reflects the status of conduction through the atrium, the AV node, and the His-Purkinje system.

It should be 0.12-0.2 sec wide.

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17
Q

What does a shortened PR indicate?

A

<0.12 seconds long

Indicates tachycardia, AV junctional rhythms, Wolff-Parkinson-White syndrome, and Lown-Ganong-Levine syndrome.

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18
Q

What is a prolonged PR associated with?

A

Bradycardia

AV block

Hypothyroidism

Hypothermia

19
Q

What is the PR interval’s relationship with the HR?

A

The PR interval is shortened as heart rate increases and lengthened as HR decreases.

20
Q

How long should the QRS complex last?

A

Normal QRS duration is <0.12 seconds long.

21
Q

What are significant Q waves a sign of?

A

Previous MI

22
Q

Name 4 causes of a wide QRS.

A

Left BBB

Right BBB

Electrolyte disorders

Paced rhythms

23
Q

What does an abnormal ST segment indicate?

A

Usually a sign of myocardic ischemia

24
Q

What are 9 things that can cause ST depression?

A

Ischemia

Digoxin toxicity

Pulmonary embolism

Hyperventilation

Conduction abnormalities (RBBB and LBBB)

Ventricular hypertrophy

CNS disease

Hypomagnesemia

Acute neurological events

25
Q

What are some causes of ST elevation?

(Hint: there are 15)

A

Injury or infarction

Digoxin toxicity

Pulmonary embolism

Hyperventilation

Ventricular hypertrophy

CNS disease

Conduction abnormalities (RBBB and LBBB)

Hypothermia

Hypertrophic cardiomyopathy

Acute neurologic events

Acute sympathetic stress

Brugada syndrome

Cardiac contusion

Idioventricular rhythm

Paced rhythms

26
Q

How does the U wave normally deflect?

A

Usually deflects in the same direction as the T wave.

27
Q

When can you see U waves? What causes them?

A

More easily seen in bradycardias.

Caused by late repolarization of the papillary muscles and Purkinje fibers.

28
Q

What does a negatively deflected U wave indicate?

A

Can be a sign of evolving MI.

29
Q

What is an indication for prominent U waves?

A

Hypokalemia.

30
Q

How long should the QT interval last?

A

Should be less than half of the preceeding R-R interval.

31
Q

What causes a shortened QT?

A

Hypercalcemia

Hyperkalemia

Digoxin

32
Q

What can a prolonged QT indicate?

A

Heart failure

Ischemic heart disease

Rheumatic fever

Myocarditis

Electrolyte disturbance

Hypothermia

33
Q

What drugs can cause a prolonged QT?

A

Quinidine

Procainamide

Phenothiazines

Amiodarone

Sotalol

34
Q

What are the 10 steps of EKG analysis?

A
  1. Calibration
  2. Rhythm
  3. Rate
  4. P wave
  5. PR interval
  6. QRS complex
  7. ST segment
  8. T wave
  9. U wave
  10. QT duration
35
Q

What are you looking for when you check calibration?

A

Make sure paper speed is 25 mm/sec

Make sure voltage scale is calibrated to 10

36
Q

What are you looking for when you look at the rhythm of an EKG?

A

Is it regular?

If not, is it regularly irregular or irregularly irregular?

37
Q

What are you looking for when you look at the rate of an EKG?

A

Is it normal, fast, or slow.

38
Q

What are you looking for when you look at the P wave?

A

Is it positively or negatively deflected?

How long does it last? (should be < 0.12 sec)

Is it notched or peaked?

39
Q

What are you looking for when you examine the PR interval?

A

Check its length–is it normal, shortened, or prolonged?

(Should be 0.12-0.20 sec long.)

40
Q

What are you looking for when you examine the QRS complex?

A

Is it normal in duration? (<0.12 sec long)

Is it regular?

Is the q wave significant?

41
Q

What are you looking for when you examine the ST segment?

A

Is it normal, depressed, or elevated?

42
Q

What are you looking for when you examine the T wave?

A

Direction of deflection (should be same as QRS)

Is it peaked or flat?

43
Q

What are you looking for when you examine the U wave?

A

Its presence is more easily noted in bradycardia.

Should deflect in the same direction as the QRS complex and T wave.

44
Q

What are you looking for when you examine the QT duration?

A

Is it normal, shortened, or prolonged?

Should be < half of the preceeding R-R interval.

EKG Competency for RNs (4 decks)

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