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ACLS > Recognizing Cardiac Arrhythmias > Flashcards

Recognizing Cardiac Arrhythmias Flashcards

0
Q

What is the ability to transmit the impulse to the next cell?

A

Conductivity

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1
Q

What is the ability to spontaneously initiate an electrical impulse?

A

Automaticity

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2
Q

What is the ability to shorten the fibers in the heart when receiving the impulse?

A

Contractility

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3
Q

What is the ability to respond to an electrical stimulus?

A

Excitability

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4
Q

What is the sequence of a normal electrical impulse in the heart?

A 
SA node
Atria
AV node
Bundle of His
Bundle of Branches
Purkinje Fibers
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5
Q

What is the natural pacemaker of the heart?

A

SA node

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6
Q

Where is the SA node found?

A

Endocardial surface of right atrium near superior vena cava

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7
Q

Normally, what is the rate of impulse for SA node?

A

60 to 100 times a minute

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8
Q

What is the function of the AV node?

A

The AV node slows the impulse conduction between atria and ventricles; allows time for contracting atria to fill ventricles before ventricles contract

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9
Q

Where is the AV node located?

A

Low in the septal wall of the right atrium

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10
Q

What are modified muscle fibers in the heart called?

A

Bundle of His

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11
Q

What are the distal bundle branches called and where are they found?

A

Purkinje fibers are found across the surface of the ventricles from the endocardium to the myocardium

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12
Q

What do the Purkinje fibers do?

A

The Purkinje fibers that receive an impulse signals the blood filled ventricles to contract

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13
Q

What are the two safety measures of the heart if the SA node fails to fire?

A

AV node will generate an impulse 40-60 times a minute

The ventricles will fire an impulse at 20-40 times a minute if both SA and AV nodes fail to generate an impulse

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14
Q

What causes a disturbance in impulse?

A

Automaticity or conductivity

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15
Q

What causes tachycardia?

A

An increase in automaticity

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16
Q

What causes bradycardia?

A

A decrease in automaticity

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17
Q

If there is an increase in conductivity what kind of arrhythmia occurs?

A

Wolff-Parkinson-White syndrome

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18
Q

What kind of arrhythmia occurs of conductivity is too slow?

A

An AV block

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19
Q

What is an example of a combined automaticity and conductivity disturbance?

A

Atrial Tachycardia with a 4:1 block

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20
Q

What is commonly used to monitor the precise sequence of electrical events in cardiac cycle?

A

ECG

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21
Q

What are two types of ECG recordings?

A

12 lead and single lead(rhythm strip)

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22
Q

What are the wave forms in one cardiac cycle?

A

P, Q, R, S, T

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23
Q

What does the P wave represent?

A

Atrial depolarization

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24
Q

What does the PR interval represent?

A

The time it takes for an impulse to travel from atria through atrioventricular nodes and Bundle of His; PR interval measures from the beginning of P wave to the beginning of QRS complex

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25
Q

What does the QRS complex represent?

A

Ventricular depolarization(the Rome it takes for an impulse to travel through the Bundle of His to the Purkinje fibers)

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26
Q

What does the ST segment represent?

A

Part of ventricular repolarization

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27
Q

What does the T wave represent?

A

Ventricular repolarization

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28
Q

What does the U wave represent?

A

U wave signifies a problem and is not seen in most patients

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29
Q

What does the QT interval represent?

A

Ventricular depolarization and repolarization

30
Q

Using a 5 lead wire system, what is the placement of electrodes?

A 
RA-right arm/white (2nd superior R rib)
LA-left arm/black (2nd superior L rib)
RL-right leg/green (under last R rib)
LL-left leg/red (under last L rib)
C-chest/brown (midway sternum R side)
31
Q

What are the 8 steps for interpreting a rhythm strip?

A 
Determine Rhythm
Determine Rate
Duration of PR interval
Duration of QRS complex
Evaluate T wave
Duration of QT interval
Evaluate other components
32
Q

What are two ways of measuring rhythm?

A

Paper and pencil

Calipers method

33
Q

Using the paper and pencil method, what do you measure?

A

R to R distance between QRS complexes. If equidistant, patient has a regular ventricular rhythm

34
Q

Using paper and pencil method, measuring what indicates regular atrial rhythm if equidistant ?

A

P to P waves

35
Q

What are three methods of determining heart rate?

A

X 10 method
1,500 method
Sequence method

36
Q

What is the simplest, most common technique for calculating heart rate?

A

X 10 method
Best of heart rate is irregular
Count P waves to determine atrial rate and R waves to determine ventricular rate over a 6 second time period and multiply by 10

37
Q

Which method of determining heart rate is best used if heart rate is regular?

A

1,500 method

Locate to P waves, identify identical points in each wave and count the number of small boxes between the two points, then divide 1,500 by the number of small boxes (1,500 small boxes=1 minute) to determine atrial rate. To determine ventricular rate, use same method using two consecutive R waves.

38
Q

Which method is best used to get an estimated heart rate only?

A

Sequence method

Find a P wave that peaks on heavy black line. Assign the numbers 300, 150, 100, 75, 60, and 50 to next 6 heavy black lines. Find P next wave peak and estimate atrial rate based in the number assigned to nearest heavy black line. Estimate ventricular rate using same procedure using R wave.

39
Q

What is the normal rate?

A

60-100 beats per minute

40
Q

In a normal cardiac rhythm, are the P wave and R wave intervals the same?

A

Yes

41
Q

When evaluating the P wave, what should you consider?

A

Are P waves present?
Do they have the same shape?
Is the shape normal?
Do all P waves point in the same direction?
Do P waves have a 1:1 ratio with QRS complexes?
Is the distance between each P wave and its QRS complex the same?

42
Q

What is the normal duration of the PR interval?

A

0.12-0.20 seconds

43
Q

What is the normal duration of the QRS complex?

A

0.06-0.10 seconds

44
Q

When evaluating the T wave, what should you analyze?

A

Are T waves present?
Do all T waves have the same size and shape?
Could a P wave be hidden in a T wave?
Do the T waves point in the same direction of QRS complexes?

45
Q

What is the usual duration of a QT interval?

A

0.36-0.44 seconds (9-11 squares)

46
Q

In NSR, what is seen in a rhythm strip?

A
  • Atrial and ventricular rhythms are regular
  • Atrial and ventricular rates are 60-100 beats/ minute
  • P wave is present for each QRS complex and upright and rounded in shape
  • PR interval is 0.12-0.20 seconds
  • QRS complex is 0.06-0.10 seconds
  • T wave is normally shapes and upright
  • QT interval is 0.36-0.44 seconds
47
Q

What two things occur during narrow complex tachycardias?

A

Accelerated heart rate and a narrow QRS complex

48
Q

What are some examples of narrow complex tachycardias?

A 
Sinus tachycardia
Atrial fibrillation
Atrial flutter
Atrial tachycardia
Multi focal atrial tachycardia (MAT)
Wolff-Parkinson's-White syndrome (WPW)
Junctional tachycardia
49
Q

In sinus tachycardia, what is the range of heart rates?

A

100-150 beats/minute

50
Q

Persistent sinus tachycardia may lead to what two problems, especially if associated with acute myocardial infarction?

A

Ischemia and myocardial damage die to raising O2 requirements

51
Q

In sinus tachycardia, is NSR present?

A

Yes

52
Q

In sinus tachycardia, is the P wave present and is there a 1:1 ratio of P waves to QRS complex?

A

Yes

53
Q

In sinus tachycardia, how do the PR interval, QRS complex, and T wave appear?

A

Within normal limits and constant

54
Q

What interval is often shortened but within normal limits?

A

QT interval

55
Q

What are some common causes for sinus tachycardia?

A 
Caffeine
Smoking
Alcohol
Exercise
Fever
Stress 
Pain
Increase in sympathetic tone/decrease in vagal tone
56
Q

What are common symptoms of sinus tachycardia?

A

Rapid, regular heart rate of 100-150 beats/ minute

Palpitations or angina

57
Q

If patient is symptomatic for sinus tachycardia, what medication is usually given?

A

A beta-blocker such as metoprolol (Lopressor)

58
Q

What is atrial fibrillation?

A

Chaotic, asynchronous, electrical activity in atrial tissue

59
Q

What Is an ectopic beat?

A

A contraction that occurs as an impulse generated from a site other than the SA node

60
Q

An ectopic impulse causes the atria to quiver instead of contract at how many beats per minute?

A

400-600 times/minute

61
Q

Are P waves discernible on an ECG?

A

No. P waves are represented by f waves or fibrillatory waves

62
Q

Is A-fib constant?

A

No. A-funny occur paroxysmal or sustained

63
Q

Can A-fib occur after a PAC?

A

Yes. PAC (premature atrial contraction)

64
Q

On an ECG, is the rhythm regular during A-fib?

A

No. Grossly irregular.

65
Q

Is the atrial rate discernible in A-fib?

A

Atrial rate is between 400-600 beats/ minute.

Ventricular rate varies from 40-250 beats/minute

66
Q

Is a P wave present in A-fib?

A

No. f waves represent atrial tetanization from rapid atrial depolarizations

67
Q

Is the PR interval discernible in A-fib?

A

No

68
Q

Is the QRS complex abnormal in A-fib?

A

QRS complex is normal on duration and configuration

69
Q

Is the QT interval measurable in A-fib?

A

No

70
Q

What are some common causes of A-fib?

A 
Rheumatic heart disease
Hypertension
Valvular disorders
MÍ
CAD
Cardiomyopathy 
COPD
Increased sympathetic activity during exercise
71
Q

What are common symptoms to look for in A-fib?

A

Irregular pulse rhythm with a normal or rapid rate

Signs or symptoms of decrease cardiac output

72
Q

How would you treat A-fib?

A

If hemodynamically unstable, use synchronized cardioversion at 120-200 joules

Use a beta-andrenergic blocker such as esmolol I.V., calcium channel blocker such as diltiazem (Cardizem)

If A-fib< 48 hrs, administer amiodarone (Cordarone), or digoxin

Consider anticoagulants if A-fib> 49 hours

ACLS (2 decks)

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