Ekg Exam

Front 1

Name and Location of the Top of the Heart

Back 1

Base and in level with the second intercostal space

Front 2

The name and location of the bottom of the heart.

Back 2

Apex and is formed by the tip of the left ventricle and is to the left of the sternum, above the diaphram, and level with 5th intercostal space midclavicular line

Front 3

What do the Atria do

Back 3

Receives incoming blood

Front 4

What do the Ventricles do

Back 4

pump blood out of the heart.

Front 5

How many valves control blood flow in the heart?
What are they named

Back 5

4; Tricuspid, pulmonic, mitral, aortic

Front 6

Three layers of the heart
outermost, middle, inner

Back 6

Pericardium, Myocardium, Endocardium

Front 7

Automaticity

Back 7

ability of the pacemaker cells to generate their own electrical impulse

Front 8

Excitability

Back 8

ability of cardiac cells to respond to an electrical impulse.

Front 9

Conductivity

Back 9

ability of cardiac cells to conduct an electrical impulse

Front 10

contractility

Back 10

ability of cardiac cell to cause contraction of cardiac muscle

Front 11

Primary Cation inside the cardiac cell

Back 11

K+

Front 12

Primary Cation outside the cardiac cell

Back 12

Na+

Front 13

This was is caused by depolarization of right and left atria.

Back 13

Pwave- first deflection of cardiac cycle.

Front 14

Isoelectric line

Back 14

baseline, or flat line that occurs on EKG when no electrical activity is present

Front 15

Ectopic Pacemaker

Back 15

A pacemaker other than the sinus node

Front 16

Altered Automaticity

Back 16

An ectopic pacemaker site can take over the role of the pacemaker either because it ursurps control from the sinus node by accelerating its own (enhanced) automaticity; or because the sinus node relinquishes its role by decreasing it automaticity.

Front 17

Altered Automaticity: Causes:

Back 17

causes myocardial ischemia or injury, hypoxia, increase in sympathetic tone, digitalis toxicity, hypokalemia, and hypocalcemia.

Front 18

Triggered Activity: definition

Back 18

results from abnormal electrical impulses that occur during repolarization when cells are normally quiet. May result in:
Atrial, Junctional, or Ventricular beats occuring singularly, in pairs, or in runs.

Front 19

Triggered Activity: causes

Back 19

causes may include myocardial ischemia or injury, hypoxia, increase in sympathetic tone, digitalis toxicity.

Front 20

Digitalis Toxicity

Back 20

Too much of the medication Digitalis ingested

Front 21

Reentry definition

Back 21

An impulse can travel through an area of myocardium, depolarize it, and then reenter that same area to depolarize it again. Involves a circular movement of the impulse, which continues as long as it encounters receptive cells.
May also result in Atrial, Ventricular, Junctional beats occuring single, in pairs or in runs.

Front 22

Reentry Causes

Back 22

causes include: myocardial ischemia or injury, hyperkalemia, and presence of an accessory conduction pathway between atria and ventricles.

Front 23

How would you distinguish between and normal and ectopic pwave

Back 23

ectopic pwaves from the atria differ in morphology

Front 24

Examples of slower atrial rhythms

Back 24

premature atrial contractions, wandering atrial pacemaker

Front 25

Examples of faster Atrial Rhythms

Back 25

Atrial Flutter and Atrial Fibrulation

Front 26

Wandering Atrial Pacemaker: indication & Treatment

Back 26

Rhythm: regular or irregular
Rate: Normal or Slow
Pwaves: vary in size, shape and direction across strip
everything else is normal
Treatment: if HR is slow review and eliminate meds if possible.
if symptomatic bradycardia- treat for that

Front 27

Wandering Atrial Pacemaker: definition

Back 27

Occurs when pacemaker site shifts back and forth between SA node and ectopic atrial sites.
Commonly seen in COPD patients.

Front 28

WAP distinguishing feature

Back 28

distinguishing figure of this rhythm is changing pwave morphology across rhythm strip

Front 29

Multifocal Atrial Tachycardia: definition

Back 29

Occurs when WAP is associated with a HR > 100bpm. occurs in Severe COPD Patients.

Front 30

Premature Atrial Contraction: definition

Back 30

an early beat originating from an ectopic site in the atrium which interrupts the regularity of the basic rhythm.

Front 31

Premature Atrial Contraction: identification

Back 31

Rhythm: usually regular, irregular with PACs
Rate: whatever the underlying rhythm is
Pwaves: the one associated with ectopic beat is usually irregular in shape etc. sometimes hidden in twave

Front 32

Abberancy: definition & cause

Back 32

this results in a wide QRS complex of .12 second or greater. Indicating that conduction through the ventricles is abnormal.

Front 33

Noncompensatory Pause (usually seen with PAC)

Back 33

the measurement form the R wave before ectopic beat to the R wave after ectopic beat is less than two R-R intervals of the underlying rhythm.

Front 34

Compensatory Pause (usually seen with PVC)

Back 34

A pause that is equal to two R-R intervals

Front 35

To differentiate between the 2 different types of pauses, what is necessary?

Back 35

underlying rhythm must be regular.

Front 36

Bigeminal

Back 36

Ectopic beat appearing every other beat

Front 37

Trigemial

Back 37

Ectopic beat appearing every third beat.

Front 38

Quadrigeminal

Back 38

Ectopic beat appearing every fourth beat

Front 39

Couplets

Back 39

Ectopic beats appearing in pairs.

Front 40

Atrial Escape Beat

Back 40

occurs when an ectopic beat appears late instead of early. Usually during a pause in the uderlying rhythm when SA node fails to initiate an impulse or when conduction is blocked for any reason.

Front 41

Nonconducted Premature Atrial Contraction: indictation

Back 41

Rhythm: underlying rhythm regular until ectopic beat.
Rate: that of underlying rhythm
Pwaves: same as any PAC
PR interval:absent with this particular PAC
QRS Complex: absent with this particular PAC
EXAMINE PREVIOUS T WAVES

Front 42

Paroxysmal Atrial Tachycardia

Back 42

Rhythm: regular
Rate: 140-250 bpm
Pwaves: abnormal
PR- usually not measurable
QRS- normal
(A run of three or more PACs)

Front 43

Paroxysmal Atrial Tachycardia treatment

Back 43

priorities of treatment depend on patients tolerance to the rhythm. If patient if symptomatic, vegal nerve stimulation or sedation may be needed

Front 44

Palpatations

Back 44

rapid heart rate.

Front 45

Cardioversion

Back 45

synchronized electrical shock.

Front 46

Vegal Maneuvers

Back 46

works by slowing heart rate through increasing parasympathetic tone:
coughing, bearing down(valsalva maneuver), squatting, breath holding, carotid sinus pressure, stimulation of gag reflex, immersion of face in ice water

Front 47

Meds to slow HR when Vegal Maneuvers fail

Back 47

3 intermittent 10-10-12 mL doses of adenosine
or
Ca channel blocker (block conduction, or terminates reentry mechanism)

Front 48

Atrial Flutter: identify

Back 48

Rhythm: regular and irregular
Rate: 250-400 bpm
Pwaves: sawtooth deflections with baseline so effected that there is no isoelectric line
PR: not measurable
QRS normal

Front 49

Atrial Flutter: Definition

Back 49

originates in an ectopic pacemaker site in the atria, typically depolarizing at a rate between 250-400 bpm
Also, measure _:_ AV conduction
...^...^ = 3:1 AV conduction

Front 50

How would one determine Atrial rate in the circumstance of Atrial Flutter

Back 50

if the underlying R-R is regular, calculate the rate of R-R and then multiply this by the number of preceding Flutter (atria) waves