0A Class3&4 Exam1 Parameters Of Arrhythmias 08

Front 1

The first positive deflection before the QRS. Represents the depolarization of both the right and left atria.

Back 1

P WAVE

Front 2

Represents the depolarization of the ventricles . The repolarization of the atria is also buried here

Back 2

The QRS complex

Front 3

Represents repolarization of the ventricles

Back 3

T WAVE
May be elevated (greater than half the height of the QRS complex)
Or depressed (inverted

Front 4

Beginning of P-wave to beginning of QRS

Back 4

PR INTERVAL

Front 5

Norm for the the PR interval

Back 5

0.12 - 0.20 seconds

3-5 small squares

Front 6

Beginning of the Q wave to the place where the S wave meets the baseline

Back 6

QRS interval

Front 7

Norm for the QRS interval

Back 7

Normal is less than 0.12 seconds or less than 3 small squares on the paper

Front 8

From the end of the S wave to the beginning of the T wave

Back 8

ST segment

Flat (normal)
Elevated (above baseline)
Depressed (below baseline)

Front 9

Beginning of QRS to end of T wave

Back 9

QT interval

Front 10

Beginning of the R wave if the Q wave is not present to the place where the S wave meets the baseline (or would meet the baseline if it did not curve into the ST segment

Back 10

QRS interval

Front 11

Normally this interval is less than half the R to R interval of that complex.

Back 11

QT Interval

Called a prolonged QT interval if more than half of the R-R interval

Front 12

Basic Interpretation Guidelines

First, take a general look at the rhythm strip.
Are the complexes (in general) the same?
Then?

Back 12

systematically look at the appearance of P, QRS and T waves, and the ratio of P waves to QRS complexes

Front 13

Interpreting P-WAVES

Are p-waves ____ in the strip?
Are they all ____?
Do all p-waves ____ ____?
Is there a p-wave before every ___?
Are the P to P intervals equal?

Back 13

Are p-waves present in the strip?
Are they all upright?
Do all p-waves look alike?
Is there a p-wave before every QRS?
Are the P to P intervals equal?

Front 14

Interpreting PR-INTERVALS

Are PR intervals ____?
Are all PR intervals ____?
Are all PR intervals within normal limit for ____?

Back 14

Are PR intervals present?
Are all PR intervals equal?
Are all PR intervals within normal limit for length?

Front 15

originate in the SA node in the right atrium

Back 15

Sinus rhythms

Front 16

Sinus rhythms originate in the SA node in the right atrium & the impulse follows the ____ ____ ____ through the rest of the heart

Back 16

normal conduction pathway

Front 17

The only rhythm considered “normal”

Back 17

Normal Sinus Rhythm (NSR)

Front 18

Normal Sinus Rhythm (NSR)is the only rhythm considered “normal”

Rate: ___-___
Rhythm: ____
The P wave is ____
There is a P wave present for each ___
There is a QRS present for each ___

PR interval: ___-___

QRS interval is:

All QRS complexes:

Back 18

The only rhythm considered “normal”

Rate 60-100
Rhythm is regular
The P wave is upright
There is a P wave present for each QRS
There is a QRS present for each P wave
PR interval range: 0.12 - 0.20 seconds
QRS interval is: less than 0.12
All QRS complexes: look alike

Front 19

Rate: 50
Rhythm: regular
The P wave: upright
There is a P wave present for each QRS
There is a QRS present for each P wave
PR interval range: 0.12 - 0.20
QRS interval is less that 0.12
All QRS complexes look alike

Back 19

Sinus Brady

Rate: < 60
Rhythm: regular
The P wave is upright
P wave for ea QRS
QRS for es P
PR interval: 0.12 - 0.20
QRS interval: < 0.12
All QRS complexes look alike

Front 20

Rate: 120
Rhythm: regular
The P wave: upright
There is a P wave present for each QRS
There is a QRS present for each P wave
PR interval range: 0.16
QRS interval: 0.10
All QRS complexes look alike

This is?

Back 20

Sinus Tachy

Rate: >100
Rhythm: regular
P wave: upright
P for ea QRS
QRS present for ea P
PR interval: 0.12 - 0.20
QRS interval: < 0.12
All QRS complexes look alike

Front 21

Occurs when the SA node initiates all the electrical impulses, but at irregular intervals.

Back 21

Sinus Arrhythmia

Front 22

The P wave is upright
There is a P wave present for each QRS and a QRS present for each P wave
PR interval range is 0.16
QRS interval is 0.11.08
All QRS complexes look alike

This is?

Back 22

Sinus Arrhythmia

The P wave: upright
There is a P wave present for each QRS
There is a QRS present for each P wave
PR interval range is 0.12-0.20
QRS interval is less that 0.12
All QRS complexes look alike

Front 23

Generally not serious unless CO decreases &Pt is medically unstable.

Back 23

Sinus arrhythmia

Front 24

May change with respirations & is normal for infants & young children.

May indicate a diseased SA node or CAD in adults

Back 24

Sinus Arrhythmia

Front 25

An individual complex that occurs earlier than the next expected complex in the underlying rhythm.

Originates from an atrial site outside the SA node.

The underlying rhythm is generally sinus.

Looks just like the rest of the beats of the strip, but comes early in the rhythm &
P wave may look a little different
Followed by a pause before the rhythm continues

Back 25

Premature Atrial Contraction (PAC)

Must also identify the underlying rhythm

Front 26

Sudden onset tachycardia with a rate greater than 151

Caused by an irritable site in the atria

Beats look like the underlying rhythm, but rate is faster

Ventricles don’t fill well, so patient may be symptomatic

Back 26

Paroxysmal Atrial Tachycardia (PAT)

Front 27

Paroxysmal Atrial Tachycardia (PAT) is caused by?

Back 27

irritable site in the atria

Front 28

With Paroxysmal Atrial Tachycardia (PAT) the patient may not feel well because?

Back 28

Ventricles don’t fill well

Must be able to see the beginning of the acceleration to be termed PAT

Front 29

Patient doesn't feel well
Experienced a sudden elevation in HR to 160
On the EKG, beats look like the underlying rhythm but the rate is faster

Back 29

Paroxysmal Atrial Tachycardia (PAT)

Sudden onset tachycardia
Rate: >151
Frequently initiated by a PAC
Caused by an irritable site in the atria
Beats look like the underlying rhythm, but rate is faster
Ventricles don’t fill well, so patient may be symptomatic
Must be able to see the beginning of the acceleration to be termed PAT

Front 30

Occurs when a single irritable site in the atria initiates many electrical impulses at a rapid rate.

Impulses are conducted so rapidly that normal P waves are not produced

There is not a QRS present for each wave
QRS complexes are 0.10 seconds and appear somewhat regularly through the rhythm
Rate is 50

Back 30

Atrial flutter

Occurs when a single irritable site in the atria initiates many electrical impulses at a rapid rate
Impulses are conducted so rapidly that normal p waves are not produced
Saw-toothed, jagged flutter waves appear on the rhythm strip rather than p waves
There is not a QRS present for each flutter wave
QRS complexes usually are less than 0.12 seconds and appear somewhat regularly through the rhythm

Front 31

Many times the flutter is so regular that it is easy to determine the ratio of waves to QRS complexes
Two F waves/1 QRS is called a ____

Three F waves/1 QRS is called a ____

Ventricular impulses may occur very regularly, so that the rhythm is ____

Back 31

2 :1 block
3:1 block

is regular

Front 32

There is no P wave, but rather there is a wavy, fibrillatory line between each QRS
Since there isn't a P wave there is no PR interval

Back 32

A FIB

Front 33

Occurs when there is general increase in irritability of all the cardiac cells of the atria
The atria are not completely depolarized with each impulse and are quivering, not forcefully contracting

Back 33

Atrial fibrillation (A fib)

Rhythm: irregular
Rate: 350-500 (not a true contraction rate)
Every once in a while, an impulse slips through causing a ventricular beat
Ventricular rate: < 60 is atrial fibrillation w/slow ventricular response

Ventricular rate: 60-100 is called atrial fibrillation

Ventricular rate: 101-150 is call atrial fibrillation w/rapid ventricular response

Ventricular rate > 150 is called uncontrolled atrial fibrillation

Front 34

Rhythms that start in the AV area are called?

Back 34

Junctional rhythms

Front 35

This occurs when SA fails to initiate electrical impulses to cause the heart to contract & the AV node acts as a secondary pacemaker though slower & not as efficient as the SA.

Back 35

Junctional rhythms

Front 36

When an impulse impulse starts in the AV node there may not be a P Wave.

However, the electrical impulse from the AV node can travel back into the SA area causing an impulse. In this case the resultant P wave not “normal.”

These characteristic P wave changes are what identify a junctional rhythm. Name the 3 types of abnormal characteristics reflected in an EKG as a result?


These characteristic p wave changes are what identify a junctional rhythm

Back 36

1-inverted
2-buried
3-retrograde

Front 37

With a junctional rhythm, if the electrical impulse originates high in the AV node, the atria are depolarized rather quickly, but the electrical stimulus moves upward to them, rather than down from the SA node.

This results in what kind of wave?

Back 37

inverted

Front 38

With a junctional rhythm, depolarization of the atria and depolarization of the ventricles take place at closer to the same time. As a result of this, what would you see on an EKG?

Back 38

The PR interval may be shorter in addition to an inverted P Wave

Front 39

Why would a P wave invert on an EKG?

Back 39

If the electrical impulse originates high in the AV node, the atria are depolarized rather quickly, but the electrical stimulus moves upward to them, rather than down from the SA node

Front 40

Why would a PR interval be shorter in a junctional rhythm reflecting an inverted P wave?

Back 40

The PR interval may also be shorter because the depolarization of the atria and the depolarization of the ventricles take place at closer to the same time

Front 41

When an electrical impulse originates more toward the middle of the AV junctional area, the distance the impulse travels back to fire the atria and the distance the impulse moves down to fire the ventricles is more similar. Therefore, depolarization occurs at almost the same time. What is reflected on an EKG as a result of this?

Back 41

Buried P waves

Front 42

When the electrical impulse originates in the lower part of the AV junctional area, the distance the impulse travels to fire the atria is greater than the distance to fire the ventricles

How will this reflect on an EKG?

Back 42

Retrograde P wave

Therefore, the P wave comes after the QRS

Front 43

Occurs when there is a partial or complete interruption in the cardiac electrical conduction system & can occur anywhere in the system.
The resultant tracing will look different depending upon where the interruption occurs.

What is this called?

Back 43

Heart Blocks

Front 44

A block that occurs when the electrical impulse traveling from the atria is interrupted at the AV junction & when the interruption becomes longer with each impulse.
This progression continues until an impulse is completely blocked from the ventricles.

Back 44

2nd degree heart block

Front 45

Mobitz I (Wenckebach) block is also known as a?

Back 45

Second degree heart blocks

Proggggrrrrressssssivvve ~

Front 46

With a 2nd degree heart block (AKA: Mobitz I (Wenckebach))what happens to the PR interval & the QRS?

Back 46

The PR interval gets longer and longer and then there is a P wave with no QRS

Front 47

With a 2nd degree heart block (AKA: Mobitz I (Wenckebach))what happens to the ventricles?

Back 47

The progression continues until in impulse is completely blocked from the ventricles

Front 48

With a 2nd degree heart block (AKA: Mobitz I [Wenckebach]) what happens to the electrical impulse traveling from the atria?

Back 48

This block occurs when the electrical impulse traveling from the atria is interrupted at the AV junction and when the interruption becomes longer with each impulse.

Front 49

Caused by a delay in the conduction of an electrical impulse between the atria and the bundle of His.
All the electrical impulses eventually conduct to the ventricles, but the interruption causes a delay.

Back 49

1st Degree Heart Block

Front 50

How would you expect to see a 1st degree heart block on an EKG?

Back 50

A prolongation of the PR interval (> 0.20 second)

Front 51

With a 1st degree heart block there is a delay in the conduction of an electrical impulse. Where does this delay occur?

Back 51

atria and the bundle of His.

Front 52

With a 1st degree heart block there is a delay in the conduction of an electrical impulse. This delay occurs in the atria and the bundle of His. What occurs after this?

Back 52

All the electrical impulses eventually conduct to the ventricles, but the interruption causes a delay.

Front 53

Mobitz II Heart block is also known as a?

Back 53

2nd degree block.

Front 54

Occurs with there is an intermittent interruption in the electrical conduction system near or below the AV junction.
What is it called?

Back 54

MOBITZ II

Front 55

A Mobitz II Heart block is is considered a 2nd degree heart block. What would you expect to see on an EKG?

Back 55

Normal PR intervals but suddenly there is a P wave with no answering QRS

Front 56

PR intervals are normal, but suddenly there is a P wave with no answering QRS.

What is happening?

Back 56

there is an intermittent interruption in the electrical conduction system near or below the AV junction

Mobitz II Heart block (2nd degree heart block)

Front 57

An "AV dissociation" is also known as a?

Back 57

Third Degree heart block

a complete heart block

Front 58

Occurs when the electrical impulse is completely blocked between the atria and the ventricles.
What is this called?

Back 58

Third Degree heart block

a complete heart block

Front 59

With a Third Degree heart block what would you expect to see on the EKG strip?

Back 59

It is as if there were two separate hearts beating

The atria impulses show up as P waves
The ventricles create there own impulses that show up as QRS complexes, but there is no cause and effect between the two

Front 60

With a Third Degree heart block where is the electrical impulse blocked?

Back 60

between the atria and the ventricles

Front 61

If there are no impulses coming from the atria or from the junction (or if the ventricles become irritable), what happens?

Back 61

the ventricles can initiate their own impulse

Front 62

Since the cells of the heart are automatistic, if there are no impulses coming from the atria or from the junction (or if the ventricles become irritable) the ventricles can initiate their own impulse (ventricular beats). How would this be indicated on an EKG strip?

Back 62

wide & bizarre

Front 63

Since the cells of the heart are automatistic, if there are no impulses coming from the atria or from the junction (or if the ventricles become irritable) the ventricles can initiate their own impulse. This results in funny looking beats. Why?

Back 63

impulse arise far distant from the normal area

Front 64

What are ventricular beats caused from & how do they look on an EKG?

Back 64

no impulses coming from the atria or from the junction so ventricles initiate their own impulse appearing WIDE & BIZZARE on the EKG.

Front 65

We know impulses from the SA range from 60-100, and from secondary pace makers such as the AV (40-60) & the HIS-Purkinje sytem (20-40)per/minute. How many impulses a minute does the ventricles produce per minute when impulses are not produced by the atria or the junction?

Back 65

20-40 impulses per minute

Generally this is not enough to sustain life.

Front 66

An individual complex that originates from an area below the bundle of His & occurs earlier than the next expected complex in the underlying rhythm.
This is called?

Back 66

Premature Ventricular Contractions (PVC)

Front 67

PVC’s can have many different configurations. Why is this?

Back 67

It depends on where in the ventricles the impulse arises

Front 68

What rhythm are the terms belo associated with?

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 68

PVC's

Front 69

three PVC’s in a row is called?

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 69

Triplet

Front 70

A PVC that occurs in every third complex is called?

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 70

Trigeminal

Front 71

more than 3 PVC’s in a row:

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 71

Run of V tach

Front 72

two PVC’s in a row:

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 72

Couplet

Front 73

PVC that occurs every other complex

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 73

Bigeminal

Front 74

PVC that occurs every 4th complex:

Bigeminal
Trigeminal
Quadrigeminal
Couplet
Triplet
Run of V tach

Back 74

Quadrigeminal

Front 75

A life-threatening dysrhythmia that usually originates from a single site in the ventricles at a rate of 100-125 impulses per minute. This condition is called?

Back 75

Ventricular tachycardia

Front 76

Why is Ventricular Tachycardia (V tach) a life threatening condition?

Back 76

because as the rate increases the ventricles do not have time to empty and refill completely, thereby decreasing the stroke volume and the cardiac output

Front 77

How many impulses occur per minute in V tach?

Back 77

100-125 impulses per minutes

Front 78

With V-Tach, as the rate increases the ventricles do not have time to empty and refill completely. This results in?

Back 78

decreasing stroke volume and cardiac output

Front 79

Sometimes, V tach is started by a PVC that occurs at the same time as the T wave of the previous beat.
This time of repolarization (T wave) is a period of vulnerability when it is easy to cause loss of control. This is known as?

Back 79

R on T phenomenon

Front 80

Sometimes, V tach is started by a PVC that occurs at the same time as the T wave of the previous beat.
This time of repolarization (T wave) is a period of vulnerability when it is easy to cause loss of control. This is known as?

Back 80

R on T phenomenon

Front 81

A lethal dysrhythmia in which cardiac cells do not have time to react to one impulse before another one arrives resulting in cardiac chaos. As a result, There is no cardiac output from the rhythm. This is an event called?

Back 81

Ventricular Fibrillation (V fib)

Front 82

Ventricular Fibrillation (V fib) origiginates from where?

Back 82

many different sites within the ventricles.

Front 83

With V-Fib, there is no cardiac output from the rhythm therfore, the patient does not have a pulse. Death will occur under these circumstances within what time?

Back 83

minutes

Front 84

Occurs when there is a complete lack of electrical activity in both the atria and the ventricles. ???

Back 84

Asystole

Front 85

Asystole appears as a slightly wavy or straight line on the monitor strip?

Back 85

Asystole