Topic 4: Heart Dysrhythmias & ECG/EKG Flashcards
What does the P wave represent?
atrial depolarization
What does the QRS complex represent?
ventricular depolarization and atrial repolarization
What does the T wave represent?
ventricular repolarization
P-R interval is how many seconds
0.12 - 0.20 sec (3 - 5 small squares)
QRS width is how many seconds
0.08 - 0.12 sec (2 - 3 small squares)
Q-T interval is how many seconds
0.35 - 0.43 sec
5 lead EKG placement
White lead - right sternum / clavicle area
Black lead - Left sternum / clavicle area
Red lead - Left lower thoracic area
Green lead - Right lower thoracic area
Brown lead - just below and to the right of the bottom of the sternum
normal rhytms are considered ______
sinus (originating from the SA node)
what conducts first in a “normal” heart
SA node
Sinus Rhythm (SR, NSR) characteristics
*P waves are present & appear at regular time intervals
*P wave rate is constant
*Each P wave is followed by a QRS complex
*QRS complexes are of normal width (slim)
*The intervals between QRS complexes are equal
*The heart rate is between 60 and 100 beats per minute
Sinus Tachycardia characteristics of ECG and rate
same a normal siuns rhythm EXCEPT HR is 101-180 bpm
s/s of sinus tachycardia
SOB, dyspnea, diaphoresis
decrease CO, decrease BP
rapid, regular pulse, possible palpitation
cause of sinus tachycardia
exercise, fever, pain, stimulants. hyper/hypovolemia, anxiety, and CVD (anemia, HF, or valvular heart diseases can increase the heart’s workload.), hypotension
treatment for sinus tachycardia
TREAT cause
VALSALVA MANEUVER
fever- antipyretic
reduce stimulant
reduce pain
drug therapy for sinus tachycardia
B-blocker
CCB
adenosine
sinus bradycardia characteristics if ECG and rate
same as normal sinus rhythm EXCEPT HR < 60 bpm
s/s of sinus bradycardia
fatigue, lightheadedness, syncope, symptomatic
cause of sinus bradycardia
vagal maneuver (bearing down)
> responsible for the “rest and digest” activities in the body.
Vagal maneuvers, such as bearing down (as if having a bowel movement), can stimulate the vagus nerve = a reduction in HR
meds (CCB, B-blockers)
> These drugs are often used to treat hypertension and certain heart rhythm disorders. They work by relaxing the muscles of your heart and blood vessels.
vomiting, hypothermia
> Forceful or repeated vomiting can also stimulate the vagus nerve, leading to a reflex decrease in heart rate.
common in trained athletes
treatment of sinus bradycardia
try to arouse the patient
head of the bed FLAT
fall preacutions
atropine
drug therapy of sinus bradycardia
ATROPINE only if showing decreased perfusion (cool, pale, clammy)
atrial fibrillation
rapid, random, ineffective contractions of the atrium
Causes of atrial fibrillation
CAD, HTN, HF (any underlying heart disease)
surgery
treatment/drug therapy for atrial fibrillation
CCB (Diltiazem!!!), B-Blockers, amiodarone, digoxin (all for rate control)
anticoagulants
what is a big concern with A-fib
BLOOD STASIS!! can lead to clots
what drug is used for clots in A-fib
Warfarin
what is important to know about warfarin
monitor INR
Vit K is the antidote
moderate green leafy veggies
what needs to be checked before giving digoxin
apical pulse (60 or greater)
toxicity: 0.5-2.0, visual changes, N/V, anorexia
potassium below 3.5 increases the risk for toxixity
s/s of atrial fibrillation
usually asymptomatic
if symptomatic: dizzy, faint, fatigue, SOB, chest pain, fluttering in chest, irregular pulse, change in LOC, dyspnea, asymptomatic or syncope
atrial fibrillation characteristics of ECG and rate
-absence or inconsistent (fibrillary) p wave
-Appears irregular, often changes speed of the heart rate
350-600bpm
Transcutaneous Pacemaker
external pacemaker used as a temporary emergency measure for maintaining adequate heart rate
Cardioversion
restoration of a normal heart rhythm by electric shock
Transcutaneous Pacemaker & Cardioversion is used with what type of dysrhythmia
atrial fibrillation
normal digoxin range
0.5-2ng/mL
Premature Ventricular Contraction (PVC) characteristics of ECG and rate
underlying rhythm can be any rate, regualr or irregular, PVCs can occur at variable rates
-wide and distorted QRS complex, Pwave barely visible
what is Premature Ventricular Contraction (PVC) caused by
*Caused by the hearts demand for O2
-stimulants (caffiene, alcohol, nicotine, epi, etc), electrolyte imbalance, hypoxia, fever, exercise, emotional stress
s/s Premature Ventricular Contraction (PVC)
*Almost always *asymptomatic, noticed on tele strip
Premature Ventricular Contraction (PVC) treatment:
treat the cause
O2 therapy for hypoxia
elecrolyte replacement
3 or more PVC’s occur consecutively
indicates Ventricular Tachycardia
Ventricular Tachycardia characteristics of ECG and rate
*Ventricular rate is 150-250bpm
*Regular to slightly irregular rhythm
p wave and Pr interval not visible, ORS wide and distorted
causes of ventricular tachycardia
post MI, CAC, hypoxemia, electrolyte imbalance (decrease K and Mg), drug toxicity
s/s ventricular tachycardia
*asymptomatic if it lasts a short amount of time due to anxiety
*If it happens for an extended amount of time death can occur
a patient in V-tach is a patient that is trying to….
CODE!
a patient in V-tach may or may not have
a pulse
treatments for a patient in V-tach: IV antidyrhythmics
-Procainamide
-Lidocaine
-Adenosine
what is done if the pulse is present in v-tach
assess VS, call rapid response, prepare to call code, give IV dysrhythmias
what is done if no pulse is present in v-tach
CALL CODE, begin CPR, early D-fib
v-tach with no pulse
defibrillation
v-tach with pulse
cardioversion
Torsades de Points
-Lethal heart rhythm. Occurs if QT interval is prolonged greater than 0.50 seconds……this is why it is importnt to monitor for a prolonged QT interval.
-Treated with IV magnesium sulfate, cardioversion, correct causative factors
the quivering of te ventricles in v-tach means
NO CARDIAC OUTPUT, MEDICAL EMERGENCY IF THERE IS NO PULSE
cause of ventricular fibrillation
untreated v-tach, MI, hyperkalemia, electric shock, hypoxemia, acidosis, drug toxicity
s/s ventricular fibrillation
-Poor to no cardiac output
-loss of consciousness
-no pulse
-BP and respirations leading to brain damage
-death if not reversed
V FIB
D FIB
V tach treatment
*check pulse, Call a CODE, start CPR, & early defibrillation
*Amiodarone, Epinephrine, Lidocaine
*Best results if ACLS is started in the first 30 seconds
if a patient goes into cardiac arrest
-check pulse
-Call a Code
-Start CPR
-Start ACLS when trained ACLS professional arrives (rapid response or code team)
defibrillator
a device that delivers an electric shock to the heart to restore its normal rhythm
Digoxin toxicity symptoms
nausea, vomiting, diarrhea, vision changes, arrythmias, electrolyte imbalance
asystole
flatline
rate of asystole
none
asystole is ___
FATAL- client is clinically DEAD (unresponsive, no respiration or heart beat)
causes of asytole
long cardiac Hx, HF, MI
treatment for asystole
NO DEFIBRILLATION (no pulse)
-epi, atropone, CPR w/ ACLS
