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1
Q

Small boxes (5 x) inside large box

What does the Vertical length mean?

Horizontal?

A

Verticle = 1mV millivolt

Horizontal = 0.04 seconds

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2
Q

5 small boxes lengthwise inside a large box = How long

How many large boxes = 1 second?

A

0.20 seconds
(1 small box = 0.04 seconds)

5 large boxes = 1 second

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3
Q

Blood Flow

Deoxygenated blood leaves vena cava and enters 1. ______

Right Atrium- 2. ______ - Right Ventricle

Right Ventricle- Pulmonary Artery (becomes oxygenated - in lungs)

Lungs to Pulmonary Vein

Pulmonary vein to 3. _____

Left Atrium- 4. ____ - Left Ventricle

Left Ventricle- Aortaic Valve - Aorta

Aorta sends oxygen rich blood through system

A
  1. Right Atrium
  2. Tricuspid Valve
  3. Left Atrium
  4. bicuspid valve
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4
Q

Atrial depolarization (contraction)
Is a negative state associated with this wave

This is a resting state where the heart is Polarized and negative

Which wave?

A

P-wave

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5
Q

Depolarization leads to (Contraction or Relaxation)

A

Contractions

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6
Q

Repolarization leads to (Contraction / Relaxation)

A

Relaxation

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7
Q

Electrical conduction

Starts: Which chamber/ Node (BMP)

The starting pulse causes which Wave / Type of polarization

A

Start: Right Atrium/ SA node - 60 - 100

P-wave / Atrial depolarization (Contraction)

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8
Q

SA node to AV node.

What is the purpose of the AV node?

A

Slow down the contractions 40 - 60 BPM

Allow the Atrium to empty fully

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9
Q

AV node (Gatekeeper) to the Bundle of Hiss leads to this

A

Ventricle Depolarization (Contraction)

QRS complex

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10
Q

AV node - Bundle of Hiss - Perkenji Fibers

This type of conduction/ Wave

A

Ventricular Depolarization/ Contraction

QRS complex

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11
Q

P wave is a measurement of…

A

Atrial depolarization (contraction)

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12
Q

P - R segment (between P & QRS)

Demonstrates what?

A

Delay AV node creates

AV node is the Gatekeeper which slows down to allow Atria to Empty Fully

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13
Q

PR interval differs from the PR segment how?

A

PR interval = Demonstrates time it takes for electrical signals to go from Atria to AV node.

PR segment = Delay AV node created

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14
Q

PR interval is measured

PR segment is measured

A

PR interval = Beginning P wave - Beginning QRS complex
(Heart Block)

PR segment = Flat line between the end of the P-wave and the start of the QRS complex.

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15
Q

PR interval can be useful to determine if a patient has this problem…

Is measured where?

A

Heart Block

Time between atrial depolarization and ventricular depolarization

Measured:

Beginning P wave - beginning QRS

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16
Q

Ventricular depolarization (Contraction) Is represented by this wave…

A

QRS Complex

Atrial Repolarization (Relaxation) also happens

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17
Q

Represents completion of ventricular depolarization & beginning of ventricular Repolarization.

Should be flat. (Isoelectric)

A

S-T segment

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18
Q

Represents beginning of Ventricular Repolarization (Relax)

This wave

A

T wave

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19
Q

U wave may appear after T wave due too….

This is an abnormal wave / finding

A

Hypokalemia

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20
Q

This wave

Represents the time it takes for electrical signals to cause the ventricles to contract & then rest

A

Q-T intervals

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21
Q

Use an EKG strip that is atleast how long?

A

6 sec

30 squares

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22
Q

Count P waves in a 6 second strip and multiply by 10

Gives this value

A

HR, BPM

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23
Q

How to determine if a strip is Sinus Bradycardia.

What is Sinsu Bradycardia

A

Regular features on strip

Fewer than 6 P waves in 6 second strip

Sinus Bradycardia = Regular, Slow heart

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24
Q

SA node damage
Low thyroid hormone
Older adult
Weak/Damage heart
Raised ICP
Athletes
Toxicity (beta blockers, CCB, DIGOXIN)
Hyperkalemia
Vagal Response

A

Sinus Bradycardia

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25
Q

If patient has Sinus Bradycardia and is showing symptoms (Hypotension, chest pain, fatigue, Diaphoresis)

What is the treatment?

A

Active Rapid Response
Medications:
Atropine
Dopamine
Epinephrine

If no symptoms: Athlete / Older Continue Monitor

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26
Q

Can a temporary pace maker be given for Sinus Bradycardia

A

Yes or permanent

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27
Q

Rhythm strips is normal but has more than 10 P waves in a 6 second (30 boxes) strip

A

Sinus Tachycardia

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28
Q

Causes:

Temperature Elevated
Aerobics
Cardiac disease (MI CHF)
Hyperthyroidism
Pain
Hemorrhage/ Hypovolemic shock
Stress
Anemia
Respiratory conditions
Medication:( Albuterol, Atropine, Nicotine)

A

Sinus Tachycardia

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29
Q

A Fib

The Atrium are contracting how?

What negative effect

A

Fast, Irregular rate

Quivering instead of contract

Negative Effect:
Blood pools & can Clot

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30
Q

A Fib

The Atrium are contracting how?

A

Fast, Irregular rate

Quivering instead of contract

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31
Q

P waves not present before QRS complexes.

P waves are replaced by irregular Fibrillatiory Lines (Fine or Course)

A

A fib

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32
Q

What does QRS (Ventricular Rate) look like with A Fib

A

Irregular intervals

Normal to fast >100

A fib is characterized by lack of P waves, replaced by irregular fibrillatory waves

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33
Q

If QRS (Ventricular Rate) >100 during A Fib it’s called.

Possible outcomes

A

Uncontrolled A-fib

Heart failure

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34
Q

Causes

After heart surgery

Valve problem

MI, CAD

COPD

Sleep apnea

A

A fib

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35
Q

Treatment:

For A Fib

A

Controlled <100 QRS

Monitor

Uncontrolled >100 QRS

Anticoagulants, beta-blockers, calcium-channel blockers, or digoxin.
Synchronized Cardioversion
Ablation (removing muscle fibers in the heart that cause abnormal rhythms )

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36
Q

Uncontrolled A Fib Treatment

Before Cardioversion Shock

Patient may need this type of medication

This type of test can be preformed to see if medication is needed

A

Anticoagulants

Transesophageal echocardiogram

TEE

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37
Q

Post Cardioversion for Uncontrolled A Fib give patient this type of medication

A

Anticoagulants

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38
Q

Cardizem (Diltiazem) CCB
Adenosine - Antiarrhythmic
Amiodarone - Antiarrhythmic

  1. These medications can be given to an A Fib Patient to have which Treatment effect
  2. What are some other types of medications that can treat A-fib
A
  1. Cardioversion- Restore regular heart Rhythm
  2. Warfarin, beta blockers, CCB (Diltiazem)
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39
Q

If
Adenosine - Antiarrhythmic
Amiodarone - Antiarrhythmic
Beta Blockers
CCB
Anticoagulants

Don’t help A-fib or Atrial Flutter. what procedure maybe done?

A

Ablation

Destroys tissue in heart to prevent it from abnormal firing

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40
Q

How does A-fib & A-flutters appearance differ in the EKG

A

Atrial Flutter = No “P” wave, Saw-tooth like waves before QRS complex. Regular

A-Fib No “P” wave but several small little “bumps” in place of the “P” wave

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41
Q

Atrial Flutter Medications

A

Antiarrhythmic Amiodarone
Anticoagulants Warfarin
CCB (Diltiazem/Cardizem)
Beta Blockers
Digoxin (HF)

Same as A-fib

42
Q

When to preform Cardioversion with Atrial Flutter / A-Fib

A

Unstable

More than 100 QRS in 60 secs

&

After TEE Transesophageal Echocardiogram to ensure no blood clots

If clots give Heparin & Warfarin

43
Q

Hallmark

Wide QRS complex >0.12 secs with a bizarre appearance

A

V Tach

44
Q

V Tach can have various presentations:

Monomorphic (All Same Size & Shape)

Polymorphic (Different size & shapes)

On variation of Polymorphic is…

A

Torsades de Pointes:

Looks like Tornado

45
Q

Causes:

Hypokalemia
MI
Digoxin
CHF, CAD, Valve disease

A

V Tach

Monomorphic

46
Q

Causes:

Medications that increase QT interval
Amiodarone, Sotalol, Procainamide

Low Calcium, Magnesium, Potassium levels

A

V- Tach Polymorphic

Torsade de pointes

47
Q

This rhythm can lead to V Fib which can lead to death

A

V-Tach

48
Q

Treatment for V Tach

Stable

A

Least invasive to most invasive

Amiodarone IV
Synchronized Cardioversion

49
Q

Treatment

V Tach Unstable (Symptoms but has Pulse)

Hypotension, mental changes, weak pulse, cool / clammy, chest pain

A

Synchronized Cardioversion

Antiarrhythmic meds Amiodarone

50
Q

Treatment

V Tach - No Pulse

A

CPR
Defibrillation
Epinephrine

51
Q

Chaotic rapid rhythm that has no real organization to it

A

V Fib deadly

52
Q

Causes

MI / heart disease

Low / High Potassium

Hypoxia

Drug OD

A

V fib

53
Q

V Fib Treatment

A

Call code

Start CPR

D FIB

Epinephrine, Amiodarone, Lidocaine

54
Q

Which do you do first in Asystole

CPR or Cardioversion

A

CPR

55
Q

Causes

Hypothermia, hypovolemia, Hypoxia

Toxins, Thrombosis, tension pneumothorax

A

Asystole

56
Q

Describe PEA rhythm

A

Pulseless electrical activity

P & QRS complexes may or may not be present.

Appears as a “Sinus” rhythm

57
Q

PEA pulseless electric activity

Treatment

A

CPR

NON SHOCKABLE

Epinephrine

58
Q

AV heart blocks

1st degree

2nd degree (Type 1 & 2)

3rd degree

Names

A

1st degree

2nd degree
Type 1 Wenckebach aka Mobitz Type 1
Type 2 Mobitz Type 2

3rd degree (Complete Heart Block)

59
Q

How to ID a Type 1 Mobitz aka Winkiebach Heart Block on a Rhythm Sheet?

A

Appears as normal sinus rhythm but has a prolonged PR Interval (>5 small boxes)

60
Q

Normal QRS size

A

<0.12 sec / 3 small boxes

61
Q

This type of heart block

Electric signal from Atria to Ventricles is slowed down to the point doesn’t stimulate contraction.

Appearance on rhythm strips:

PR intervals = prolonged (gradually get longer)
Occasional missing QRS complex

A

2nd degree heart block

Mobitz type 1 or Wenckebach

62
Q

Second degree heart block
Type 2 Mobitiz type 2

Dropped QRS complex

What is the difference between Type 1 (also Dropped QRS) & Type 2

A

Type 1 is a gradual lengthening of the PR interval

Type 2 PR interval stays consistent but then has missing QRS complex

63
Q

PR interval (beginning of P - beginning QRS)

Prolonged PR Interval Indicates what heart problem?

A

Heart Block

64
Q

P waves measures

A

<0.12 secs

< 3 squares

65
Q

PR interval
(Start of P wave - Start QRS)

Measurement….

Longer than normal Measurement indicates….

A

0.12 - 0.20 Normal
3 - 5 boxes

> 0.20 = Possible Heart Block

66
Q

QT interval

the time it takes for the ventricles to contract and then recover

Should be how long?

A

0.35 - 0.44

9 - 12 Boxesish

67
Q

First-degree atrioventricular (AV) block is PR interval of greater than ____ without disruption of atrial to ventricular conduction.

A

0.20

68
Q

During a premature ventricular contraction (PVC), the heartbeat is initiated by the 1.______ rather than the SA node.

Given that a PVC occurs before a regular heartbeat, there is a pause before the next regular heartbeat.

In patients with PVCs, the ECG may reveal other findings that include: electrolyte abnormalities (peaked 2. ___ waves, prolongation of3. ___);

left ventricular hypertrophy; with an old MI, one may see Q waves, loss of R waves, and/or a bundle branch block; and acute ischemia may present with ST-segment elevation/depression and/or T wave inversion.

A
  1. Purkinje fibers
  2. T
  3. QT
69
Q

Healthy P waves associated with atrial depolarization (Discharge energy) and measure…

A

0.12 sec ( 3 small boxes)

Repolarization = Rest

70
Q

It’s measured from the beginning of the P wave’s upslope to the beginning of the QRS wave

Time between atrial depolarization and ventricular depolarization.

Name this “wave form”

Normal measurement…

What does an abnormal measurement mean…

A

PR interval

Normal PR interval = 0.12 - 0.20 (3 - 5 small boxes)

> 0.20 heart block

71
Q

QRS Complex represents ventricular depolarization, which is the beginning of systole and ventricular contraction.

What is the normal time on ECG

A

QRS Complex normal time = 0.12 ( 3 small boxes )

72
Q

QT interval: ventricular Depolarization and Repolarization

Normal time

A

0.36 - 0.44

9 - 11 Lil boxes

73
Q

ST segment after the QRS complex should be isoletric (flat)

What does elevated/ depressed ST segment mean?

A

Elevation / Depression: Total blockage of one of the heart’s main supply arteries - lack of oxygen ischemia

74
Q

Before Cardioversion for Unstable A Fib >100 BPM & S/S ( Hypotension/ decreased cardiac output)

What is done?
Why?

A

Transesophageal Echocardiogram (TEE) “ - Gram = contrast dyes are used Mostly Iodine”

TEE checks for blood clots

If blood clots present give anticoagulant

low molecular-weight heparin (LMWH) and warfarin:
LMWH: Used as a bridge, 1 mg/kg twice daily

75
Q

P wave not present
Replace by F waves
Irregular QRS intervals
<100 QRS per min

What is the heart condition
What are the Interventions

A

Stable / Controlled A Fib

If symptom free no Hypotension or decreased cardiac output

Monitor to ensure QRS stays <100 BPM

76
Q

Causes

Post surgery
Mitral valve problems
CAD
MI
Pericardis

Name rhythm problem
Describe pattern
Level of seriousness & possible interventions

A

A Fib

Lack of P wave - replaced with R waves
Irregular QRS complexes

Can be serious if QRS >100 BPM

Interventions: Transesophageal Echocardiogram (TEE) looking for blood clots

Heprin & Warfarin if clots present

Synchronized Cardioversion on R wave after TEE & Anticoagulants

Only if QRS >100

77
Q

Causes

Increase body temp
Cardiac disease
Hyperthyroidism
Pain
Hypovolemia
Anemia Respiratory Conditions

Name Rhythm
Describe
Possible interventions

A

Sinus Tachycardia
Normal rhythm wave features but >100 BPM

Interventions: Medications: beta blockers, Calcium channel blockers, Pain meds, Antipyretics

78
Q

Cushing’s triad is a set of physiological signs that indicate a response to increased intracranial pressure (ICP) in the brain:

A

Widened pulse pressure: An increase in systolic pressure and a decrease in diastolic pressure

Bradycardia: A slow heart rate

Irregular respirations: Also known as Cheyne-Stokes breathing

79
Q

Before giving Digoxin check…

A

Apical pulse
<60 hold Digoxin

80
Q

Meds to give for Bradycardia

A

Atropine, Dopamine, Epinephrine

81
Q

Unstable A Fib patients can be cardioverted via these medications

A

Cardizem (Diltiazem) - CCB & Antihypertensive

Adenosine - Antiarrhythmic
Amiodarone - Antiarrhythmic

82
Q

____ is a procedure that may be done to the heart to help with A Fib.

A

Ablation: Destroy tissue in the heart to prevent abnormal firing

83
Q

A Flutter will have this appearance in the rhythm strip

Give these medications to help

A

Saw tooth

CCB - Diltiazem/ Cardizem
Beta Blockers Propranolol
Digoxin - With heart failure

Antiarrhythmic- Amiodarone
Anticoagulants - Warfarin

84
Q

Unstable A Flutter >100 QRS BPM

This intervention

A

Synchronized Cardioversion

85
Q

V Tach has this defining charactistic

It is described as looking….

A

QRS Complex > .12 (3 boxes)

Bizarre

86
Q

List medications that prolong QT interval

This can lead to Polymorphic V Tach Torsade de pointes

Also, low calcium, K, mag levels can too

A

Amiodarone
Sotalol
Procainamide

87
Q

Is V Tach (Wide QRS >.12 “3 BOXES”) Always an emergency?

A

Yes, active rapid response

They will go into V fib

88
Q

Stable V Tach (No symptoms, has pulse)

Which interventions will be expected

A

IV Amiodarone - Antiarrhythmic

If not effective Synchronized Cardioversion

89
Q

V Tach (QRS Complex >.12) Bizarre looking wave

No Pulse

What are the Interventions

A

CPR First. Need a pulse to shock

  • Pulse then, defibrillation

Then Epinephrine

Then amiodarone, lidocaine,

90
Q

Polymorphic V-tach (Torsade de pointes)

Stable (has pulse): Interventions

Unstable: Interventions

A

Stable: Give Magnesium Sulfate STOP QT interval widening medication. Amiodarone or Procainamide

Unstable: treat like V fib. CPR & Defib. Once stable possible ICD (cardioverter defibrillator) Implantation

91
Q

V Fibs rhythm is described how?

A

Chaotic, rapid rhythm with no real organization

92
Q

With V Fib Patient will have no pulse.

What are the Interventions

A

Call a code

CPR

Defibrillation when pulse is present

Epinephrine

Amiodarone/ Lidocaine

93
Q

Asystole. What is the first thing you do?

A

Check the patient for a pulse.

Always assess patient first then machine

94
Q

Pulseless Electrical Activity: Describe

Causes…

Interventions

A

Rhythm shows Sinus Rhythm but patient has no pulse.

Causes: Hypoxia, Hypovolemia, Electrolyte imbalance, Thrombosis, Trauma, Cardiac Disease

Interventions:
Code Blue
CPR
Rhythm Checks
Non Shockable

Meds: Epinephrine

95
Q

1st degree heart block
PR interval > 0.20 (5 small boxes) - Occurs regularly throughout the Rhythm

Other factors are the same as Sinus Rhythm

Interventions:

A

Interventions: If on CCB, Beta Blockers, Digoxin

Dosage may need to be adjusted

If symptoms like Bradycardia (atropine) & possible pacemaker insertion

96
Q

2nd Degree- Type 1 heart block
(Wenckebach or Mobitz Type 1)

Causes: MI - due to ischemia depriving tissue of oxygen, Rheumatic fever, increased Vagal Tone

Treatment: Adjust CBC, Beta Blockers, Digoxin- Give Atropine/ Temp Pacing

Differs from

Mobitz Type 2
Causes: MI, CAD, CBC, Beta blockers, digoxin

Describe ECG appearance

Which is more serious

A

2nd Degree- Type 1 heart block
(Wenckebach or Mobitz Type 1) = Gradual lengthen of PR Interval & eventual missing QRS complex

Second Degree Type II

PR interval doesn’t get progressively longer. But does have missing QRS interval

Second degree Type II is more serious

97
Q

P waves & QRS complexes = Regular

However, fewer QRS complexes than P waves

Describes this condition

A

3rd degree heart block

Most serious

98
Q

ECG patient has sinus Bradycardia with rate of 52. What is your next nursing action

  1. Prepare to admin atropine IV push
  2. Set-up for Transcutaneous pacing
  3. Assess the patient
  4. Call rapid response
A
  1. Assess the patient

Always assess first. This patient maybe an athlete or elderly who normally have lower HR

99
Q

V Fib Patient. CPR has already been started and Patient remains in V Fib. In addition to CPR what will next action be?

  1. Atropine
  2. Defibrillation
  3. Epinephrine
  4. Synchronized Cardioversion
A
  1. Defibrillation

V Fib = D Fib

100
Q

First degree Heart Block is characterized by a PR interval >.20 seconds.

Which medication below can cause 1st degree heart block

A. Lisinopril
B. Diltiazem
C. Furosemide
D. Clopidogrel

A

B. Diltiazem (CBC)
Slow down conduction through AV node.

101
Q

______ occurs when PR interval follows a pattern of gradual lengthen and absence of QRS complex.

_____ is a constant PR interval >.20 followed by occasional missing QRS complexes

Which is more serious

A

Second degree (Wenckebach/ Mobitz 1) occurs when PR interval follows a pattern of gradual lengthen and absence of QRS complex.

Second Degree (Mobitz Type 2) is a constant PR interval >.20 followed by occasional missing QRS complexes

Mobitz 2 is more serious

NCLEX: ECG Rhythm (2 decks)

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