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Study Guide Flashcards

1
Q

What are the intrinsic cardiac Pacemakers and their rates?

A
  • SA node (intrinsic rate 60-100)
  • AV node (Intrinsic rate 40-60)
  • Bundle branches (Intrinsic rate (20-40)
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2
Q

What is the SA nodes intrinsic rate?

A

60-100 BPM

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3
Q

What is the AV nodes intrinsic rate?

A

40-60 BPM

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4
Q

What is the intrinsic rate of the Bundle branches?

A

20-40 BPM

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5
Q

What is the normal path of cardiac conduction?

A
  • Originates in the SA Node
  • AV Node causing atrial depolarization
  • AV Node slightly delays impulse
  • Bundle of HIS
  • Bundle Branches
  • Purkinje Fibers causing ventricular depolarization
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6
Q

What part of the EKG represents the absence of electrical activity/base line?

A

The Isoelectric Line

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7
Q

What does the P-Wave represent?

A

atrial depolarization

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8
Q

What does the QRS complex represent?

A

ventricular depolarization

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9
Q

What do the ST segment and T-Wave represent?

A

ventricular repolarization

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10
Q

hat part of the EKG represents the absolute and relative refractory periods?

A

1) QRS to peak of T-wave

2) the rest of the T-wave

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11
Q

Which part of the ECG represents ventricular depol and repol?

A

QT Interval

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12
Q

What is the normal length of the QT Interval?

A
  • normally less than half the length of the R-R interval

- 360 - 440 ms

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13
Q

The small box of the ECG measures how many seconds?

A

0.04 secs along the horizontal axis

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14
Q

The small box of the ECG measures how many mV?

A

1 mV along the vertical axis

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15
Q

The large box of the ECG measures how many seconds?

A

0.20 secs along the horizontal axis

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16
Q

How many small boxes make up one large box on an ECG strip?

A

5 small = 1 large box

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17
Q

A six second strip has how many large boxes?

A

30 boxes

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18
Q

Five big boxes is how many seconds?

A

1 sec

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19
Q

How do you measure the PRI and what its the normal length?

A
  • beginning of the P-wave to the beginning of the QRS complex
  • normal = 0.12-0.20 secs or 3-5 sm boxes
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20
Q

What is the normal length of the QRS complex?

A

0.04 - 0.10 secs or 1-2.5 sm boxes

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21
Q

How do you calculate the HR on an irregular rhythm on an ECG?

A

count the # of P and R waves in a six second strip and x10

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22
Q

What is the 1500 rule for calculating the HR on an ECG?

A
  • 1500 / # of small boxes b/t two consecutive P or R-waves
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23
Q

What is the 300 rule for calculating the HR on an ECG?

A
  • 300 / # of large boxes b/t two consecutive P or R-waves
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24
Q

How do you calculate the HR on an ECG using the standard rule?

A
  • use for regular rhythms only
  • count and label 6 consecutive lg boxes
  • 1 = 300
  • 2 = 150
  • 3 = 100
  • 4 = 75
  • 5 = 60
  • 6 = 50
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25
Q

Criteria for NSR?

A 
Impulse starts in SA node
Rate: A and V = 60-100
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
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26
Q

Criteria for Sinus Bradycardia?

A 
Impulse starts in SA node
Rate: A and V = < 60
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
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27
Q

Criteria for Sinus Tachycardia?

A 
Impulse starts in SA node
Rate: A and V = 100 - 150
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
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28
Q

Criteria for Sinus Arrythmias

A

Impulse starts in SA node but activity varies with respiration
Rate: A and V = 100 - 150, but varies
Rhythm: A and V irregular (P-P and R-R irregular)
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs

29
Q

How is the HR of a Sinus Arrhythmia affected by respiration?

A

rate slows with expiration and increases with inspiration

30
Q

What is happening during a sinus pause/arrest?

A

The SA node fails to fire, creating a pause on the ECG strip. The underlying rhythm is a sinus rhythm except for the pause.

31
Q

How do you treat a patient with sinus pause/arrest that is symptomatic?

A
  • symptomatic if the patient is experiencing frequent/prolonged (>3 secs) episodes or other symptoms
  • pt may require a pacer
32
Q

What are the effects of the parasympathetic nervous system on the HR?

A

slows the HR through the release of acetylcholine and stimulation of the vagus nerve (vagal maneuvers)

33
Q

What are the effects of the sympathetic nervous system on the HR?

A
  • speeds up the HR through the release of Epi and NE

- fight or flight system

34
Q

A deep, wide QRS is indicative of?

A

an MI or intraventricular conduction delay (IVCD)

35
Q

Notched R-waves are indicative of?

36
Q

What is the normal length of the QT Interval for a male?

A
  • normal is 0.036 - 0.044 secs

- males: 0.039 - 0.041 secs

37
Q

What is the normal length of the QT Interval for a female?

A
  • normal is 0.036 - 0.044 secs

- males: 0.036 - 0.044 secs

38
Q

What is the normal length of the QTc for a female?

A

< 0.44 secs

39
Q

What is the normal length of the QT Interval for a male?

A

< 0.42 secs

40
Q

Criteria for a P-wave that indicates origination of the impulse from the SA node?

A

Shape: round, upright
Height: 2 - 3 mm
Time: 0.06 - 0.12 secs

41
Q

Notched or pointy P-wave(s) are indicative of?

A

atrial enlargement r/t to:

  • COPD
  • pulmonary emboli
  • valvular disease
  • CHF
42
Q

The following PRI values are indicative of:

1) > 0.20 secs
2) < 0.12 secs

A

1) conduction delay

2) impulse originated outside of the SA node

43
Q

An elevated ST segment is indicative of?

44
Q

A depressed ST segment is indicative of?

A

acute ischemia

45
Q

Tall or peaked T- waves are indicative of ___1___ while an inverted T-wave indicates ___2___?

A

1) potassium (k+) abnormality

2) myocardial ischemia

46
Q

An inverted U-wave is indicative of?

47
Q

What is the treatment for a patient with Sinus Bradycardia and is symptomatic?

A
  • assess the pt (CAB, BP)
  • give O2
  • start IV
  • atropine: 0.5 mg quick IV push
  • epi or dopamine continuous IV infusion
  • transcutaneous pacine
48
Q

Dosing, administration and considerations for atropine?

A
  • 0.5 mg quick IV push

- can worsen MI if present, need to closely monitor the patient

49
Q

What happens when atropine is given to slowly?

A

may cause paradoxical bradycardia, needs to be given quickly (IV push)

50
Q

What is the treatment for Sinus Tachycardia?

A
  • assess the patient,
  • treat the symptoms
  • treat the source last
51
Q

Sinus Arrythmias are common in what patient demographic?

A
  • ventilated patients
  • with MI
  • infants, children and the elderly
  • with medications
52
Q

What is the 1st step when identifying an ectopic beat/rhythm?

A

identify the underlying rhythm

53
Q

What are escape beats?

A

beats that appear after they are expected

54
Q

What is the key indentifier of a premature atrial complex (PAC)?

A

an early p-wave which may look different from the others

55
Q

Criteria for an Aberantly Conducted PAC?

A
  • early P-wave and Wide QRS (> 0.10 secs)

- ventricles are not fully repolarized so are late to fire

56
Q

Criteria for a Nonconducted or Blocked PAC?

A
  • early P wave with NO following QRS

- atria fires to early, no time for ventricles to fire

57
Q

Treatment for PAC’s?

A
  • infrequent PAC’s do not require treatment

- frequent: reduce/eliminate causes (stress, smoke, caffeine)

58
Q

Criteria for Atrial Flutter?

A 
Rate: 
- A = 250 - 400 BPM
- V = Controlled < 100
          uncontrolled > 100
Rhythm: A = regular, V = regular or irregular
P-Waves: absent/replace with SAW TOOTH waves
PRI: not measureable
QRS: 0.04 - 0.10 secs
59
Q

What is the treatment for A-Flutter?

A

1) assess the pt
2) control the ventricular rate if > 100 (meds then cardioversion)
4) try to convert the rhythm

60
Q

What medications are used for A-Flutter with an uncontrolled ventricular rate?

A

CCB, Beta-Blockers, or Digoxin to reduce/control the rate

61
Q

What is the most effective treatment for an uncontrolled/unstable A-Flutter?

A

Cardioversion

62
Q

What methods can be used to convert an atrial ectopic rhythm?

A

antiarrhythmics, cardioversion, ablation, or overdrive pacing

63
Q

Criteria for Atrial Fibrillation?

A 
Rate: 
- A = > 300 or not measurable
- V = controlled < 100, uncontrolled > 100
Rhythm: ventricular usually regular
P-Waves: none
PRI: not measurable
QRS: 0.04 - 0.10 secs
64
Q

What is the treatment for controlled A-Fib?

A

anticoagulants and antiarrhythmics

65
Q

What is the treatment for uncontrolled and stable A-Fib?

A

CCB, Beta Blockers and digoxin to slow the HR

66
Q

What is the treatment for unstable A-Fib?

A

cardioversion

67
Q

What is the primary concern with A-flutter and A-Fib?

A

the ventricular rate

68
Q

Criteria for Junctional Rhythms?

A

Rate: 40 - 60
Rhythm: ventricular is regular (pacing occurs at the av junction)
P-Waves:
- inverted
- may come B4, after or be hidden in the QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10 secs

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