Walraven Cards

Question 1

Name the 8 main parts of the conduction system

Answer 1

SA Node
Intraatrial pathway
Internodal Pathway
AV Junction
Bundle of His
L. Bundle Branch
R. Bundle Branch
Purkinje Fibers

Question 2

What chambers does the sympathetic nervous system affect and how?

Answer 2

Ventricles

Increases Chronotropic, Inotropic, Dromotropic

Question 3

What chambers does the parasympathetic nervous system affect and how?

Answer 3

Atria

Decreases Chronotropic, Inotropic, Dromotropic

Question 4

How do you measure PRI? What is normal?

Answer 4

From beginning of the P wave to beginning of QRS complex.

.12-.2 sec (3-5) boxes

Question 5

How do you measure QRS? What is normal?

Answer 5

From beginning of Q wave to end of S wave.

Less than .12 sec (3 boxes)

Question 6

What is a P-wave?

Answer 6

Atrial depolarization

Should be before the QRS, can be inverted in a retrograde, after or during the QRS, may be nonexistent, or multiples of

Question 7

What is the PR segment?

Answer 7

The end of the P wave to the beginning of the QRS. Measures the conduction delay at the AV node.

Question 8

What is the QRS complex?

Answer 8

Ventricular depolarization

Should be < 3 boxes wide

Question 9

What is a T wave?

Answer 9

Ventricular repolarization

Should follow a QRS and about 1/2 the amplitude of the QRS

Question 10

What is the isoelectric line?

Answer 10

When there is either no electrical activity in the heart or when + and - charges are balanced.
How you measure degree of ST elevation or depression

Question 11

What are the inherent rates for:

1. SA Node
2. AV Node
3. Ventricles

Answer 11

1. 60-100
2. 40-60
3. 20-40

Question 12

How do you calculate HR when it is irregular, or you just need an estimate?

Answer 12

of R-R waves on a 6 sec strip x 10.

Question 13

How do you calculate HR when it is regular and you need it to be quick and accurate?

Answer 13

Each large box = 300, 150, 100, 75, 60, 50
or
divide by 300
(less accurate with very fast and very slow rates)

Question 14

How do you calculate HR when you are most concerned about accuracy?

Answer 14

Count the # of small boxes between R waves and divide by 1500.

Question 15

Rules for NSR (normal sinus rhythm)

Answer 15

Regularity: Constant RRI and regular
Rate: HR 60-100, atrial rate = ventricular rate
P wave: uniform, 1 P/QRS
PRI: .12-.20 sec or 3-5 boxes, consistent
QRS: <.12 sec or 3 boxes

Question 16

Rules for Sinus Bradycardia

Answer 16

Regularity: Constant RRI and regular
Rate: HR <.12 sec or 3 boxes

Question 17

Rules for Sinus Tachycardia

Answer 17

Regularity: Constant RRI and regular
Rate: HR >100<.12 sec or 3 boxes

Question 18

Rules for Sinus Arrhythmia

Answer 18

Regularity: Variable RRI, may change with respirations
Rate: HR 60-100, atrial rate = ventricular rate
P wave: uniform, 1 P/QRS
PRI: .12-.20 sec or 3-5 boxes, consistent
QRS: <.12 sec or 3 boxes

Question 19

Rules for Wandering Pacemaker

Answer 19

Regularity: RRI slightly irregular due to changing pacemaker sites
Rate: HR 60-100, atrial rate = ventricular rate
P wave: shape changes as pacemaker site changes, 1 P/QRS but some P may be difficult to see
PRI: .12-.20 sec or 3-5 boxes, slightly variable as pacemaker site changes
QRS: <.12 sec or 3 boxes

Question 20

Rules for Atrial Flutter

Answer 20

Regularity: Atrial rate is regular, ventricular rate regular only if AV node conducts with a consistent pattern
Rate: HR 250-350, ventricular rate dependent upon ratio of conducted impulses through AV node
P wave: multiple wave with well defined sawtooth appearance
PRI: Undeterminable
QRS: <.12 sec or 3 boxes

Question 21

Rules for Premature Atrial Complex

Answer 21

Regularity: Single ectopic beat will interrupt regularity of underlying rhythm
Rate: Depends on underlying rhythm
P wave: P-wave of ectopic beat looks different from all others, may be hidden in T wave
PRI: .12-.20 sec or 3-5 boxes, may be prolonged, will likely be different in ectopic beat
QRS: <.12 sec or 3 boxes

Question 22

Rules for Atrial Tachycardia

Answer 22

Regularity: Constant RRI and regular
Rate: HR 150-250, atrial rate = ventricular rate
P wave: uniform, 1 P/QRS
PRI: .12-.20 sec or 3-5 boxes, consistent
QRS: <.12 sec or 3 boxes

Question 23

Rules for Atrial Fibrillation

Answer 23

Regularity: Atrial rate is unmeasurable, Ventricular rate is grossly irregular
Rate: Exceeds 350, unmeasurable. “Controlled” ventricular rate 100
P wave: none, grossly chaotic
PRI: Undeterminable
QRS: <.12 sec or 3 boxes