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Perf Monitoring > Test 4 continued > Flashcards

Test 4 continued Flashcards

1
Q

Electrodes

A

-detect and conduct voltage potentials from the skin and send message through leadwires to a monitor

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2
Q

Leads logic: 12 possible leads

A
  • 3 limb leads: bipolar to measure both positive and negative impulses from the heart (1 positive and 1 negative) (I,II,III)
  • 3 augmented limb leads: Use limb lead electrodes but uses central negative lead to measure positive charges through single electrode with a reference point having zero activity (aVR, aVL, aVF)
  • 6 unipolar leads (V1 on right side of sternum, V2-6 on left side)
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3
Q

Lead placement

A

Right shoulder: White
Left shoulder: black
Right side: green
Left lower: red

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4
Q

Einthoven’s triangle

A
  • Center corresponds to the vector summation of all electrical activity from the heart
  • as the current (electrons) travels to the positive pole, negative deflection
  • as the current travels to the negative pole, positive deflection
  • perpendicular current= biphasic deflection
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5
Q

Common frontal ECG Limb leads created by which leads (Einthoven’s triangle)

A

-Bipolar leads I, II, and III

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6
Q

Augmented leads

A
  • aVR, aVL, and aVF measure electrical activity between a limb and a single electrode
  • fill in the ninety degrees between leads I, II, and III
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7
Q

Precordial leads

A
  • V1-V6 placed across the chest

- provide frontal view of the heart’s electrical activity

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8
Q

The presence of different ECG leads does not effect the interpretation of cardiac rhythms

A

know it

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9
Q

Rhythm originated in SA node: Normal sinus rhythm (NSR)

SA nodal Rhythm

A
  • Rhythm: regular
  • Rate: 60-100 bpm
  • P wave: one visible before every QRS complex
  • P-R interval: Normal (less than 5 small squares; more than 5 would indicate heart block)
  • QRS duration: Normal
  • indicates the electrical impulse generated in the SA node is travelling along the normal conduction paths at a normal speed
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10
Q

Sinus bradycardia

SA nodal Rhythm

A

-HR=

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11
Q

Sinus Techycardia

SA nodal Rhythm

A

-HR= >100 bpm

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12
Q

Wandering Atrial Pacemaker

SA nodal Rhythm

A
  • Pacemaker site bounces from the SA node to other atrial sites, the AV junction, and then back to the SA node
  • HR= normal
  • Rhythm= irregular
  • P waves: at least three different morphologies, determined by the focus of the atrial stimulus
  • P-R interval: variable
  • QRS: Normal to irregular
  • Reach threshold quicker than SA node
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13
Q

Premature Atrial Contraction(s) (PAC)

SA nodal Rhythm

A

-Results when an ectopic atrial electrical signal initiates a heart beat rather than the SA node

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14
Q

Sinus Arrhythmia

SA nodal Rhythm

A
  • Generally normal in young, healthy people
  • irregular in conjuction with the respirations
  • rate increases with inspiration and decreases with expiration
  • The difference between the shortest and longest P-P interval exceeds .12
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15
Q 
Atrial Fibrillation (a-Fib)
SA nodal Rhythm
A
  • Rhythm: irregularly irregular
  • rate: 100-160 bpm but may be slower if on meds
  • P wave and P-R interval: good luck!
  • QRS duration: usually normal
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16
Q

Atrial flutter

SA nodal Rhythm

A
  • Rhythm: regular
  • Rate: 110 bpm
  • P wave replaced with multiple F (flutter) waves (2:1 to 3:1 ratio)
  • P wave/ F wave rate: 300 bpm
  • QRS duration: usually normal
  • caused by abnormal tissue in the atria generating rapid, repeating electrical stimulus
  • similar to atrial fibrillation but flutter is much more rhythmic
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17
Q

Wolff-Parkinson-White (WPW Syndrome)

SA nodal Rhythm

A
  • An accessory conduction path exists between the atria and ventricles
  • bypass the AV node and the “delaying” effect of the AV node
  • This rapid impulse conduction causes a “slurring” of the first part of the QRS complex; creating a Delta wave
  • PR interval: short (
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18
Q 
Supraventricular Tachycardia (SVT)
Non-SA nodal Rhythms
A
  • Tachycardia with impulses generated in the atria but NOT in the SA node
  • impulses usually from tissue adjacent to the AV node
  • Rhythm: regular
  • Rate: 140-220 bpm
  • P wave: usually buried in the preceding T wave because of the speed of the impulses
  • PR interval: depends on the site of the supraventricular pacemaker source
  • QRS duration: normal
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19
Q

Junctional Rhythm

Non-SA nodal Rhythms

A
  • Rhythm starts at the AV junction
  • Rhythm: regular
  • rate: 40-60 bpm
  • P wave: inverted in lead II
  • P wave rate: same as QRS rate
  • PR interval: variable
  • QRS duration: normal
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20
Q

Premature Junctional Contraction (PJC)

Non-SA nodal Rhythms

A
  • An electrical impulse starts in the ventricles
  • Rhythm: regular
  • Rate: normal
  • QRS: normalish
  • diagnosed by a big, odd QRS waveform which represents the ventricles depolarizing prematurely in response to a signal within the ventricles
  • QRS vector is odd
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21
Q

Idioventricular Rhythm

Non-SA nodal Rhythms

A
  • Rate: 20-40 bpm
  • Rhythm: regular
  • P waves: none
  • PR interval: non-existent
  • QRS: wide (>.10 seconds)
22
Q

Accelerated Idioventricular Rhythm

Non-SA nodal Rhythms

A

-an idioventricular rhythm with a rate of 41-100 bpm

23
Q

Unifocal Premature Ventricular Contraction (PVC)

Non-SA nodal Rhythms

A

-arises from single premature beat so each PVC is identicle

24
Q

Multifocal premature Ventricular Contractions (PVC’s)

Non-SA nodal Rhythms

A

-arises from two or more premature beats so each QRS complex is different

25
Q

Bigeminy

Non-SA nodal Rhythms

A
  • One good, one bad PVC

- they repeat like that

26
Q

Trigeminy

Non-SA nodal Rhythms

A
  • Two good, one bad PVC

- they repeat like that

27
Q

Quadrigeminy

Non-SA nodal Rhythms

A
  • Three good, one bad PVC

- they repeat like that

28
Q

Couplets

Non-SA nodal Rhythms

A

-Coupled PVC (occur in pairs

29
Q

Bundle Branch Blocks (BBBs)

Non-SA nodal Rhythms

A
  • dopolarization delay through the bundle branches causing a widening of the QRS complex
  • RBBB and LBBB depending on the side the delay occurs
  • ideally requires evaluation of the V1 and V6 leads
30
Q

Right Bundle Branch Block (RBBB) causes

A
  • MI, coronary artery disease CAD, cardiomyopathy, Pulmonary embolism
  • V1: T wave inversion
  • V6: wide S and upright T
31
Q

Left Bundle Branch Block (LBBB) causes

A
  • NEVER occurs “normally”
  • Hypertension, aortic stenosis, and coronary artery disease
  • V1: wide S and positive T
  • V6: No initial Q
32
Q

1st degree AV Block (AVB)

Non-SA nodal Rhythms

A
  • conduction delay through the AV node (the signal eventually reaches the ventricles normally)
  • prolonged PR interval (>5 small squares)
33
Q

2nd degree heart block and two types

Non-SA nodal Rhythms

A
  • some of the arterial beats get through to stimulate the ventricles
    1. Mobitz type I or Wenkebach
    2. Mobitz type II
34
Q

Mobitz type I/ Wenkebach

like a relationship

A

-the PR interval keeps lengthening until a QRS complex is eventually dropped then it starts back to regular and does it again

35
Q

Mobitz type II

A

-the PR interval remains relatively constant but intermittently atrial contractions are not always followed by ventricular contractions (a P wave not followed by QRS then back to normal)

36
Q

3rd degree Heart Block (CHB)

A
  • atrial contractions are normal but this electrical activity does not reach the ventricles
  • so the ventricles must generate their own electrical activity
  • ventricular escape beats have a slower rate
37
Q

3rd degree Heart Block (CHB) symptoms

A

-Rythm: regular
-Rate: SLOW
-P wave: unrelated
-P wave rate: normal but faster than QRS rate
PR interval: VARIABLE
-QRS duration: PROLONGED
-no atrial impulses pass through the av node and the ventricles generate their own inherent rhythm

38
Q

Really deadly rhythms

A
  • ventricular tachycardia
  • ventricular fibrillation
  • asystole
39
Q

Ventricular tachycardia (V-Tach)

A
  • Rhythm: regular
  • Rate: 180-190 bpm
  • P wave: not seen
  • QRS duration: prolonged
  • result from abnormal tissues in the ventricles generating a rapid and irregular heart rhythm. Poor cardiac ooutput is usually associated with v-tach and causes the patient to go into cardiovascular arrest. Shock this rhythm if patient is unconscious and pulseless
40
Q

V-Tach: Monophoric

A

-there is only one form of ventricular tachycardia

41
Q

V-tach: Polymorphic

A

-more than one form of ventricular tachycardia

42
Q

Tarsades de Points (“Twisting of the Points”)

A
  • Looks like a twisted streamer
  • QRS complex keeps cyclically reversing polarity
  • represents polymorphic v-tach with long QT intervals
43
Q

Ventricular Fibrillation (V-Fib)

A

A disorganized series of electrical signals cause the ventricles to quiver

  • zero cardiac output
  • brain is not perfused
  • if not on bypass, the patient requires defibrillation ASAP or they die
  • if on bypass, this is an unpleasant but not necessarily life-threatening cosmetic problem that must be addressed before being taken off CPB
44
Q

Ventricular Fibrillation symptoms

A
  • Rhythm: irregular
  • Rate: 300+ and disorganized
  • P wave: not seen
  • QRS duration: not recognizable
45
Q

Course ventricular fibrillation

A
  • very bad

- larger peaks

46
Q

Fine ventricular fibrillation

A
  • worse than course ventricular fibrillation
  • pre-death
  • very small peaks
47
Q

Asystole

A
  • Rhythm: flat
  • Rate: 0 bpm
  • P wave: none
  • QRS duration: none
  • induced on CPB with cardioplegia
  • if not on bypass, immediate CPR or death
48
Q

Ischemia

A
  • insufficient blood supply

- decreased ST segment

49
Q

Injury

A
  • heart cell damage

- increased ST segment

50
Q

Infarction (necrosis)

A
  • cellular death (apoptosis)

- Deep Q wave

51
Q

Evolving MI

A

Ischemia to Injury leading to infarction

Perf Monitoring (6 decks)

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