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NURS 2245 Cardiac > Week 1 Class 2 Rhythms > Flashcards

Week 1 Class 2 Rhythms Flashcards

1
Q

Which part of the heart beat makes the P wave.

A

Both Atrium depolarization (contracting)

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2
Q

P wave begins at this location in the electric conduction system

A

SA node firing

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3
Q

PR segment on ECG comes from this area of electrical conduction system.

A

AV junction

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4
Q
  1. Define the time length a Small box on an ECG is.
  2. How many of these boxes make up a larger box.
  3. With a time frame is represented with the larger box…
A
  1. 0.04
  2. 5 × 5
  3. 0.20
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5
Q

Normal time intervals

P - R Interval (PRI) Or P - Q (PQI) ….

QRS Interval…

S-T Segment…..

Q - T Interval…..

A

P - R Interval (PRI) Or P - Q (PQI) ….

0.12 - 0.20 seconds

QRS Interval…

0.08 - 0.11 seconds

S-T Segment…..

No standard time. But usually 0.36 - 0.44

Q - T Interval…..

0.33 - 0.42 Seconds

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6
Q

Normal interval times

PR & PQ…

QRS….

ST….

QT…

A

PR & PQ: 0.12 - 0.20 or 3 small boxes - 1 large box

QRS: 0.08 - 0.11 or 2 - 3 small boxes

ST: No normal Generally 0.36 - 0.44 or 1 big box 4 small - 2 big box and 1 small

QT: 0.33 - 0.42 or 1 big box & 3 small - 2 big boxes

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7
Q

5 lead EKG placement

A

Right:

White: Right 2nd intercoast space (Right Side)

Brown: 4th intercoastal space Right sternal boarder

Green: 8th intercoastal space Right side. Near bottom of rib cage.

Left

Black 2nd intercoastal space Far left side

Red: 8th IC left hand side

Brown:

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8
Q

Purpose of the 5 color EKG leads..

What does eaxh color do…

A

White & black Record activity of arms

Red & Green: legs & ground (Green)

Brown: Chest activity

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9
Q

Bedside monitoring

Single lead shows…

A

Rate & Regularness

Time to conduct impulses

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10
Q

Describe Normal Sinus Rhythm

P wave & QRS complex

Time for waves…

A

P wave present befire each QRS complex

P = 0.12 - 0.20 or 3 small boxes - 1 large box

QRS = 0.06. - 0.10 OR 1.5 SMALL Boxes - 2.5 small boxes

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11
Q

PR interval

Measures…. (location on strip)

What it represents….

A

Beginning of P wave (Atrial depolarization/ Contraction) -

Beginning of QRS complex (Ventriclar depolarization/ Contraction)

0.12 - 0.20

PR interval represents: Time it takes impulse to travle through AV node, bundle of His, Purkinje Fibers. BEFORE reaching the Ventricles

This delay allows for ventricular filling of blood before contracting.

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12
Q

Prolonged PRI >0.20

  1. Indicates this problem…
  2. Seen with these conditions…
  3. Variable PRI times is this problem…
A
  1. 1st degree heart block - Least Serious- delay conduction through AV node.
  2. Conditions:

Ischemia (Reduction in blood) / Infarction (Death of tissue caused by lack of blood)

Meds: Beta-Blocker, CCB

Electrolyte imbalance Hyperkalemia

  1. Variable PRI times suggest
    2nd or 3rd degree heart block

Mobitiz Type 1 (Wenckebach) Progressive lengthening of PRI until QRS is dropped.

Mobitz Type II: Fixed PRI with intermittent dropped QRS complex

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13
Q

Explain the difference between 2nd degree heart block :
Mobitz Type 1 (Wenckebach) & Mobitz II.

In relation to their appearance on an ECG…

Symptoms…

A

Mobitiz Type 1 (Wenckebach) Progressive lengthening of PRI until QRS is dropped.

Rhythm: Irregular

Usually asymptomatic possible dizziness

Cause: Vagal or meds

Mobitz Type II: Fixed PRI with intermittent dropped QRS complex

Symptoms: Fatigue, syncope, dizzy

More serious pathology & often requires a pacemaker.

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14
Q
  1. 3rd Degree aka…
  2. Cause….
  3. Describe appearance on EKG…
  4. Signs & Symptoms…
  5. Treatment….
A
  1. Complete heart block
  2. Electrical signals from atria isn’t making it to the ventricles

Congenital
Heart disease
MI
Meds Digoxin
Structure damage
Heart valve problem

  1. Fewer QRS complexes than P waves. “Missing P waves” Regular rate

(Ventriclar rate is lower than atrial rate)

  1. Low BP, Mental Status change, pale / clammy skin
  2. Activate Emergency Response
    Atropine
    Temporary Pace Maker / Permanent Pacemaker
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15
Q

Sinus Bradycardia

Rate…

Rhythm…

Pacemaker Site…

A

<60

Rhythm: Normal

Pacemaker Site: SA node

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16
Q

Sinus Tachycardia

Rate…

Rhythm…

Pacemaker site…

A

> 100

Rhythm: Regular

Pacemaker site: SA node

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17
Q

Sinus Dysrhthmias

Rate…

Rhythm…

Pacemaker site…

A

60 - 100 normal

Rhythm: Irregular

Pacemaker site: SA node

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18
Q

PR interval

How to measure…

What abnormalities suggest…

A

Start of P wave to Beginning of QRS complex.

Normal 0.12 - 0.20

Abnormalities

Prolonged:

1st degree heart block / conduction delays

2nd Degree Mobitz Type 1 Wenckebach
Progressive lengthening of PRI until QRS is dropped

2nd Degree Mobitz Type 2
PRI is normal QRS is dropped- More dangerous- Block at or below Bundle of His, Structural Abnormalities.

Can progress to Type 3 Total Heart block

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19
Q

Premature Atrial Contractions

Describe…

Causes…

Treatment…

A

Extra Heart beat originates from ectopic focus in the atria.

Typically benign

ECG

P wave Abnormal, maybe burried in the T wave / Close to QRS complex

PRI normal / Slightly prolonged

QRS Narrow

Causes:
Stress, fatigue, caffeine, alcohol, drug

Electrolyte imbalance
Hyperthyroidism
Hypertension
CAD
Atrial enlargement

Meds

Sympathomimetic
- bronchodilator
Digoxin toxicity

Treatment:

None normally- happens with stress & caffeine

Frequent >1 in 10 beats - further evaluation

Education: Avoid drugs & stress. If frequent notify HCP

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20
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

Describe…

Rhythm….

P waves….

QRS complex…

Cuases…

Clinical Presentation….

Nursing interventions….

Stable / Unstable

Treatment….

Pacemaker site…

A

HR 150 - 250. Originates in atria / AV node due to abnormal electrical circuit.
BEGINS & ENDS SUDDEN (PAROXSYMAL)

Rhythm: Normal

P wave: Hidden in T wave or inverted if visible

QRS: Narrow <0.12, unless there is a bundle branch block.

Causes:

Stess, anxiety, fatigue
Caffeine, alcohol, drugs, smoking

Underlying conditions:

Congenital Heart conditions (Wolff-Parkinson-White Syndrome)

Hypokalemia

Structure disease/ ischemia

Digoxin

Presents:

Palpation
Dizzy
SOB
Chest discomfort (May resemble angina - Chest pain causes by lack of blood “Ischemia “
Fatigue

Nursing interventions

Stable:

Valsalva Maneuver
Notify HCP
Administer Adenosine if ordered

Unstable:

Prepare for synchronized Cardioversion

Oxygen if SpO² < 94%

Establish IV access

Treatment:

Adenosine IV push, may terminate rhythm

Beta Blockers/ CCB

Antiarrhythmic
For recurrent PSVT (amiodarone)

Longterm

Referred for Electrophysiologic Study
Ablation therapy for recurrent or severe cases

Pacemaker site: Atrial Outside the SA node

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21
Q

Which type of medication will you give for SVT & PSTV

This medication is given after less invasive interventions are tried ( Valsalva Maneuver)

Describe administration….
What scary side effect may happen…

A

Adenosine

Rapid IV push 1 - 2 seconds follow by saline flush.

6 mg, if no response 12 mg, follow by 12 mg if necessary

Scary SE
Asystole may is normal and expected before rhythm is restored.

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22
Q

Atrial Flutter

Rate (Atrial / Ventriclar)…

Rhythm….

Pacemaker….

P waves…

PRI…

QRS….

A

Rate (Atrial / Ventriclar)
Atrial 250 - 350
Ventricular Varies

Rhythm
Usually Regular

Pacemaker
Atrial Outside SA node

P waves
F (Flutter) Waves present

PRI Normal

QRS Normal

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23
Q

A Flutter has this appearance with the P waves…

A

Saw tooth

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24
Q

A Flutter

Associated Conditions…

Symptoms…

Treatment….

A

Associated Conditions:

Structure heart disease
Hyperthyroidism
Post-cardiac surgery

Symptoms:

Palpation
Dizzy
Fatigue
SOB
Chest discomfort
Maybe asymptomatic

Treatment:

Rate Control:
Beta Blockers / CCB

Rhythm Conversion:
Cardioversion or Antiarrhythmic drugs (Amiodarone)

Anticoagulantion:

To reduce stroke in persistent A Flutter

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25
Q

A Fibrillation

Rate…

Rhythm…

Pacemaker site…

P waves….

PRI….

QRS….

A

Rate:
Atrial 350 - 750
Ventricular Varies

Rhythm:

Irregularly Irregular

Pacemaker site:

Atrial Outisde SA node

P waves

None discernible F waves Present

PRI

None

QRS

Normal

26
Q

A fib results in chaotic Atrial depolarization

Result:

Irregularly Irregular ventricular rhythm
Decreased cardiac output due to loss of Atrial Kick.

Sign & Symptoms…..

Complications…

Nursing Responsibilities…

Assessment…
Acute management…
Chronic management…

A

Signs

Palpation
Irregular pulse
Chest discomfort
Dizzy
SOB
Hypotension
STROKE Symptoms: Slurred Speech, Unilateral weakness, Confusion- due to embolism

Tjromboembolic Events: Blood statis in atria can lead to clot

Heart failure: Loss of Atrial Kick and rapid ventricle response can worsen heart function

Cardiomyopathy:
Chronic uncontrolled AF may lead to Atrial & Ventriclar remodeling

Nurse Responsibility

Assess:
BP, HR, OX Sat
Ask about palpation, fatigue, dizzy, chest discomfort
Monitor ECT

ACUTE MANAGEMENT

Beta-blockers (metoprolol)
CCB (Diltiazem)
Digoxin

MONITOR THESE MEDICATIONS FOR HYPOTENSION & BRADYCARDIA

Rhythm Control:
Adminster Antiarrhythmic (Amiodarone)
Assist with Cardioversion if indicated

Anticoagulantion
Adminster Heparin, Warfarin, Apixaban

27
Q

Most common Dysrhthmia….

Symptoms depende on….

A

A Fib

Ventricular rate

28
Q

Amlodipine
Nifedipine
Felodipine
Nicardipine
Diltiazem
Verapamil

This type of medication…

What affect…

Conditions to use it in…

A

Calcium Channel Blockers

Slows down Cardiac Conduction, Contractility.

Dilation of coronary arteries.

Conditions it treats:

A fib, A Flutter, SVT

29
Q

What conditions are a Contradictions for CCB.

A

hypotension, bradycardia, heart failure,

30
Q

CHADS2 Score

Purpose….

Scoring:

C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A: Age ≥75 years (1 point)
D: Diabetes mellitus (1 point)
S: Prior stroke or transient ischemic attack (2 points)

A

Purpose:
Estimates stroke risk in patients with AF.

31
Q

CHADS2 is a scoring chart used to determine likely hood of stroke with A fib.

Describe….

A

C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A: Age ≥75 years (1 point)
D: Diabetes mellitus (1 point)
S: Prior stroke or transient ischemic attack (2 points)

32
Q

What is CHADS2 VASC2 Used for….

Describe…..

A

A more refined scoring system to determine Use of Anticoagulants in a patient with Afib to prevent stroke.

C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A2: Age ≥75 years (2 points)
D: Diabetes mellitus (1 point)
S2: Prior stroke or TIA (2 points)
V: Vascular disease (e.g., PAD, MI, aortic plaque) (1 point)
A: Age 65–74 years (1 point)
Sc: Sex category (female) (1 point)

Total Range: 0–9

33
Q

Vitamin K agonist

This medication…

Target IRN level for effective use…
Target IRN level for age >75…
Normal healthy IRN level…

Antidote for Vitamin K agonist Warfarin (Coumadin)

Normal IRN level

A

Warfarin (Coumadin)

Target IRN 2.0 - 3.0
>75 1.6 - 2.5
Normal healthy: 0.8 - 1.2

Antidote: Vitamin K Phytonadione or Phylloquinone.

34
Q

Difference in use between Vitamin K agonist Warfarin (Coumadin) &
Heparin, Enoxaparin (Lovenox)

A

Heparin, Enoxaparin (Lovenox)
Acute situations requiring rapid anticoagulation (e.g., pulmonary embolism, deep vein thrombosis, myocardial infarction).

Bridging therapy before starting warfarin or before surgery.

Warfarin

When Used:

Long-term anticoagulation for conditions like atrial fibrillation, mechanical heart valves, or chronic DVT/PE.

Reason: Slower onset of action but ideal for chronic management.

35
Q

PTT (Partial Thromboplastin Time):

Target PTT for Therapeutic Use with these medications….

60–80 seconds (1.5–2.5 times the normal value).

Normal PTT:

25–35 seconds.

A

Target therapeutic use for:
Heparin, Enoxaparin (Lovenox)

36
Q

What is the target time at type of blood clotting value for

Heparin & Enoxaparin (Lovenox)…

Vitamin K agonist: Warfarin (Coumadin)

A

Heparin & Enoxaparin (Lovenox)
PTT:
80 seconds (1.5–2.5 times the normal value).
Normal PTT: 25–35 seconds.

Vitamin K agonist Warfarin (Coumadin)
INR 2 - 3 seconds unless >75 1.6 - 2.5 seconds

37
Q

Antidote for Heparin or Enoxaparin (Lovenox)

A

Protamine Sulfate.

38
Q

Direct Thrombin inhibitors

Dabigatran - Pradaxa has a specific antidote ______

Rivaroxaban (Xarelto)
Apixaban (Eliquis)

Antidote _____

A

Dabigatran
(idarucizumab)

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Andexanet alfa (Andexxa)

39
Q

Which area of the heart is the primary source of blood clots in A Fib….

Treatment…

A

Atrial appendage

Atrial appendage closure

40
Q

Ventricular Escape Complexes

Rate…

Rhythm….

Pacemaker site…

P waves…

PRI…..

QRS….

General appearance…

A

Rate 15 - 40

Rhythm Escape Complex Irregular/ Escape Rhythm, Regular

Pacemaker site Ventricle

P waves None

PRI None

QRS: Wide QRS, Bizarre

General appearance: Huge QRS with a peak on Left Side

41
Q

Premature Ventriclar Contractions

Rate

Rhythm

Pacemaker site

P wave

PRI

QRS

General appearance

A

Rate Underlying rhythm

Rhythm Interupts regular underlying rhythm

Pacemaker site Ventricle

P wave None

PRI None

QRS >0.12,

General appearance: Wide QRS complexes, Irregularly spaced

42
Q

V Tach

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate 100 - 250

Rhythm Usually regular

Pacemaker site Ventricle

P waves Usually absent, if present not associated with QRS

PRI None

QRS >0.12 Wide, Bizarre

General appearance Tombstone

43
Q

V Fib

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate no organized Rhythm

Rhythm no organized Rhythm

Pacemaker site Numerous ventricular foci

P waves Usually absent

PRI NONE

QRS NONE

General appearance: Squiggly lines No P waves nor QRS

44
Q

Asynchronous countershock depolarizes myocardium to allow ____ to regain control

Defibrillation

A

SA node

45
Q

Pacemakers can be
Temporary
Transcutaneous
External
Epicardial

or

Permanent
Ventricular
Atrial- Ventricular
Biventricular
S-ICD

Precautions…. (4)

A

Incision care

Restricted arm motion for 1 - 2 months (Lead Displacement- hematoma)

Avoid electromagnetic fields

Regular follow up

46
Q

1st degree block

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate Depends on underlying rhythm

Rhythm Usually regular

Pacemaker site SA node or Atrial

P waves Normal

PRI >0.20 sec

QRS Normal

General appearance. Regular rhythm but the PRI is consistently longer than 0.20

47
Q

2nd degree type 1 AV block Winkebach

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate: Atrial Normal, Ventriclar Normal to Slow

Rhythm Atrial Regular Ventriclar Irregular

Pacemaker site SA node or Atrial

P waves Normal, sone P waves will not be followed by QRS complex

PRI Increases in length until a QRS is dropped

QRS Normal

General appearance Increasing PRI until a QRS is dropped

48
Q

Type 2 second degee AV block

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate Atrial normal Ventriclar maybe slow

Rhythm maybe regular or irregular

Pacemaker site SA node or Atrial

P waves Normal some P waves not followed by QRS

PRI Constant >0.20

QRS Normal

General appearance. Constant >0.20 PRI with dropped QRS complexes

49
Q

3rd Degree AV block

Rate

Rhythm

Pacemaker site

P waves

PRI

QRS

General appearance

A

Rate Atrial Normal Ventriclar 20-40-60

Rhythm Regular

Pacemaker site SA & AV node or Ventricle

P waves Normal with No Correlation to QRS

PRI No relationship to QRS

QRS >0.12

General appearance P & QRS are not dependent on eachother

50
Q

________ life-threatening condition where fluid accumulates in the pericardial sac, exerting pressure on the heart and impairing its ability to fill and pump effectively.

A

Cardiac tamponade

51
Q

How to treat Pulseless Electrical Activity…

A

Treat the cause.

Hypovolemia
Tension pneumothorax
Cardiac Tamponade
Hypoxia

52
Q

SVT, 160 - 180 HR, 88/56 BP, SOB, Palpation, weakness

INITIAL REACTIONS…

A

Notify HCP - Hemodynamically unstable

Provide oxygen if <95%

Establish IV

Vagal maneuver

Adenosine (if ordered) 6 mg IV push 1 - 2 seconds, 20 mL saline flush. 2nd dose if ineffective

Prepare for synchronized Cardioversion
- consent
- Sedation- Versed
- Monitor patient response

Reassess

53
Q

In which cases will the nurse give adenosine.

Severe Bronchospastic Disease: Asthma or COPD exacerbation risk.

Supraventricular Tachycardia (SVT): Narrow QRS tachycardia with a rate >150 bpm.

Regular, Stable Tachycardia: Symptomatic (e.g., palpitations, chest discomfort, SOB) and unresponsive to vagal maneuvers.

Second- or Third-Degree AV Block: Without a functioning pacemaker.
Sinus Node Dysfunction: Without a pacemaker.

Wide Complex Tachycardia (diagnostic): To distinguish SVT with aberrancy from ventricular tachycardia under physician direction.

Atrial Fibrillation/Flutter with Accessory Pathway (e.g., WPW syndrome): Risk of triggering ventricular fibrillation.

A

Supraventricular Tachycardia (SVT): Narrow QRS tachycardia with a rate >150 bpm.

Regular, Stable Tachycardia: Symptomatic (e.g., palpitations, chest discomfort, SOB) and unresponsive to vagal maneuvers.

Wide Complex Tachycardia (diagnostic): To distinguish SVT with aberrancy from ventricular tachycardia under physician direction.

When a Nurse Cannot Give Adenosine

Atrial Fibrillation/Flutter with Accessory Pathway (e.g., WPW syndrome): Risk of triggering ventricular fibrillation.

Second- or Third-Degree AV Block: Without a functioning pacemaker.

Sinus Node Dysfunction: Without a pacemaker.

Severe Bronchospastic Disease: Asthma or COPD exacerbation risk.

54
Q

Which is the preferred treatment of reoccurring Symptomatic SVT

A

Diltiazem

CCB

55
Q

When a coronary vessel is mostly originates completely occuleded, the cells that depend on the oxygen become Ischemic, then necrotic, and die.

This result is known as ….

A

MI

56
Q
  1. Nitrates cause blood vessels to….
  2. Results in drop in PVR & BP and decreased venous return to the heart. These actions (Decrease / Increase ) myocardial workload and restore balamce to the heart’s Supply-and-demand ratio.
A
  1. Relax and dilate
  2. Decrease
57
Q

Angina Pectoris occurs when…

SS….

Stable vs Unstable…

A

Myocardial oxygen demand cannot be meet

Pain, anxiety, SOB, Fatigue

Stable: Oxygen demand is meet when at rest.

Unstable: Oxygen demand may not be meet when at rest

58
Q

Drug of choice for treating Acute Anginal Attack

A

Sublingual Nitroglycerin

59
Q

Beta-Blockers work by…

A

Prevent activation of Sympathetic NS (which increases heart stuff)

60
Q

Leading cause of death US & world wide

A

ASCVD

61
Q

____ is the bais of our clot-dissolving system

A

Plasminogen

62
Q

____ drugs are used to stop bleeding

A

Hemostatic

NURS 2245 Cardiac (8 decks)

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