Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
61 Cards in this Set
- Front
- Back
|
ECG paper:
What do the small (light lined) squares represent horizontally? |
0.04 second
|
|
|
ECG paper:
What do the small squares (light lined) represent vertically? |
0.1 mV
|
|
|
ECG paper:
What do the large (heavy lined) squares represent horizontally? |
0.20 second
(300 large squares=1.0 minute) |
|
|
ECG paper:
What do the large (heavy lined) squares represent vertically? |
0.5 mV
|
|
|
ECG paper:
How many small squares are incorporated into each large (heavy lined) square? |
25
(5 horizontal, 5 vertical) |
|
|
What is an artifact?
|
A distortion of the baseline and waveforms seen on the ECG. Can be caused by things like muscle tremors, patients' movements, and loose electrodes.
|
|
|
What is arrhythmia?
|
Abnormal cardiac rhythm
|
|
|
What is normal sinus rhythm?
|
Normal conduction pattern of the cardiac cycle, which originates in the SA node.
|
|
|
What does the P wave represent?
|
The depolarization of the atrium (passage of electrical impulse thru the atrial muscle), causing *atrial* contraction.
|
|
|
What does the QRS complex represent?
|
The depolarization of the ventricles, causing *ventricular* contraction.
|
|
|
What does the T wave represent?
|
The REpolarization of the *ventricles*.
|
|
|
What does the PR interval (beginning of P wave to beginning of QRS complex) represent?
|
Time taken for impulse to spread through the atria, AV node and bundle of His, the bundle branches, and Purkinje fibers, to a point immediately preceding ventricular activation.
normally 0.12-0.20 sec |
|
|
What does the QRS interval (from beginning to end of QRS complex) represent?
|
Time taken for depolarization of BOTH VENTRICLES.
normally 0.04-0.12 sec |
|
|
What does QT interval (from beginning of QRS to end of T wave) represent?
|
Time taken for entire electrical depolarization AND repolarization of the VENTRICLES.
normally 0.34-0.43 sec |
|
|
What could be the significance of DISTURBANCE of the PR interval?
|
Disturbance in conduction usually in AV node, bundle of His, or bundle branches but can be in atria as well.
|
|
|
What could be the significance of DISTURBANCE of the QRS interval?
|
Disturbance in conduction in bundle branches or in ventricles.
|
|
|
What could be the significance of DISTURBANCE of the QT interval?
|
Disturbances usually affecting repolarization more than depolarization such as drug effects, electrolyte disturbances, and heart rate changes.
|
|
|
Types of Arrhythmias: Sinus Bradycardia
What happens? |
The conduction pathway is the same as that in sinus rhythm, but the sinus node discharges at a rate of < 60 beats/min.
|
|
|
Types of Arrhythmias: Sinus Bradycardia
What are the clinical associations? |
Normal in aerobically trained athletes and in other individuals during sleep. Response to carotid sinus massage, Valsalva maneuver, hypothermia, increased intraocular pressure, increased vagal tone, and admin of parasympathomimetic drugs.
Disease states: hypothyroidism, increased intracranial pressure, obstructive jaundice, and inferior wall MI. |
|
|
Types of Arrhythmias: Sinus Tachycardia
What happens? |
Conduction pathway is same as in normal sinus rhythm. Discharge rate from the sinus node is increased as a result of vagal inhibition or sympathetic stimulation.
Rate is > 100 beats/min. |
|
|
Types of Arrhythmias: Sinus tachycardia.
Clinical associations? |
Physiologic stressors such as exercise, fever, pain, hypotension, hypovolemia, anxiety, anemia, hypoxia, hypoglycemia, myocardial ischemia, CHF, and hyperthyroidism.
Causative drugs: epinephrine, norepinephrine, caffeine, atropine, theophylline, nifedipine/Procardia, hydralazine/Apresoline. |
|
|
Types of Arrhythmias: Sinus Tachycardia
Treatment? |
Determined by underlying causes. B-adrenergic blockers (ie. metoprolol, atenolol) used to reduce HR and decrease myocardial oxygen consumption.
|
|
|
Types of Arrhythmias: Premature Atrial Contraction (PAC)
What is it? |
A contraction originating from an ectopic focus in the atrium in a location other than the sinus node.
|
|
|
Types of Arrhythmias: Premature Atrial Contraction (PAC)
Clinical Associations? |
In normal heart it can result from emotional stress or use of caffeine, tobacco, or ETOH. Can also result from disease states such as infection, inflammation, hyperthyroidism, COPD, heart disease (including CAD), valvular disease, and others. Can also be caused by an enlarged atrium.
|
|
|
Types of Arrhythmias: Premature Atrial Contraction (PAC)
Significance? |
Isolated PAC not significant for healthy heart.
In heart disease, frequent PACs may indicate enhanced automaticity of the atria, or a reentry mechanism and may warn of or initiate supraventricular tachyarrhythmias. |
|
|
Types of Arrhythmias:
Paroxysmal Supraventricular Tachycardia (PSVT) What is it? |
An arrhythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His. Occurs with reentrant phenomenon. A run of repeated premature beats is initiated and is ususally heralded by a PAC. "Paroxysmal" refers to an abrupt onset and termination. Termination is sometimes followed by a brief period of asystole. Some degree of AV block may be present.
|
|
|
Types of Arrhythmias: Paroxysmal Supraventricular Tachycardia (PSVT):
Clinical associations? |
Normal heart: associated with overexertion, emotional stress, changes of position, deep inspiration, and stimulants like caffeine and tobacco.
Disease states: rheumatic heart disease, digitalis toxicity, CAD, cor pulmonale. often occurs in presence of Wolff-Parkinson-White (WPW) syndrome. |
|
|
Types of Arrhythmias: Paroxysmal Supraventricular Tachycardia (PSVT):
ECG characteristics? |
HR is 100-300 beats per minute
P wave often hidden in preceding T wave and has abnormal contour. PR interval may be proloned, shortened. or normal, and QRS complex may have normal or abnormal contour. |
|
|
Normal Sinus Rhythm
|
Rate: 60-100 beats/min
Rhythm: Regular P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Sinus Brady
|
All normal criteria except a rate < 60
Rate: < 60 Rhythm: Regular P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Sinus Tachycardia
|
All normal criteria except a rate > 100
Rate: > 100 Rhythm: Regular P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Sinus Arrhythmia
|
Rate: 60-100 beats/min
Rhythm: Irregular P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Sinus Block
|
Rate: 60-100 beats/min
Rhythm: Irregular due to pause. When you measure the R-R interval it will fit exactly in the pause P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Sinus Arrest
|
Rate: 60-100 beats/min
Rhythm: Irregular due to the pause. When you measure the R-R Interval, it will not fit in the pause P Waves: Present, ↑, one before every QRS PR Interval: ≤ .20 QRS: .08-.12 |
|
|
Premature Atrial Complex PAC
|
The complex will come early and will have an upright P wave (usually a little skinner and taller than normal). Will have an irregular rhythm due to early beat. The underlying rhythm is usually sinus
|
|
|
Atrial Tachycardia
|
Rate will be > 150 with a visible P wave (There will be two humps between each complex)
|
|
|
Supraventricular Tachycardia (SVT)
|
Rate: > 150
Rhythm: Always Regular P wave: No visible P waves (One hump between each QRS complex) |
|
|
Wandering Atrial Pacemaker (WAP)
|
Will have three different shaped P waves in 6-sec strip, will have a regular rhythm. It is rare. Due to different places in the atria trying to pace the heart.
|
|
|
Multifocal Atrial Tachycardia (MAT)
|
A WAP with a rate > 100
Never use electricity to treat only drugs |
|
|
Atrial flutter
|
Sawtooth or picket fence baseline
Cannot tell P’s from T’s Atria is firing faster than the ventricle Can be regular or irregular If rate is > 100 uncontrolled ventricular response If rate is < 100 controlled ventricular response |
|
|
Atrial Fibrillation
|
Most common dysrhythmia
Will have at least two out of three criteria -chaotic baseline -irregular rhythm-ALWAYS -no identifiable P wave If rate is > 100 uncontrolled ventricular response If rate is < 100 controlled ventricular response |
|
|
Wolf Parkinson White Syndrome (WPW Syndrome)
|
Will have a delta symbol in QRS
Significance: Pt. is predisposed to lethal dysrhythmia’s because of vulnerability |
|
|
Junctional Rhythms (Rate: 40-60 beats/min)
|
-The rhythm is ALWAYS regular
-Will be no P wave or an inverted P wave |
|
|
Premature Junctional Complex (PJC)
|
Early beat with no P wave or an inverted P wave
|
|
|
Accelerated Junctional Rhythm
|
Rate > than 60 with no P wave or and inverted P wave
|
|
|
Junctional Tachycardia
|
Rate > 100 with no P wave or inverted P wave
|
|
|
Junctional Escape Beat
|
Junctional beat that comes late. Beat will have no p wave or inverted P wave that will come late
|
|
|
Premature Ventricular Complex (PVC)
|
Early complex with wide, bizarre QRS
-unifocal: 2 PVCs that look alike -multifocal: 2 or more PVCs that don’t look alike -couplet: 2 PVCs in a row -bigeminy: every other beat is a PVC -trigeminy: every third beat is a PVC |
|
|
Idioventricular Rhythm (IVR)
|
Rate:20-40
Normally regular rhythm Will have all ventricular beats (wide, bizarre QRS): |
|
|
Accelerated IVR (AVIR)
|
Rate > 40 with all ventricular beats
|
|
|
Ventricular tachycardia
|
Wide, fast, regular
Ventricular rhythm with rate > 100 Lethal rhythm |
|
|
Ventricular tachycardia
|
Can be monomorphic V-Tach (Same shaped QRS) or polymorphic tach ( different shaped QRS)
With monomorphic v-tach-check to see of they have a pulse or not if yes with pulse give O2, IV acess If no pulse defib If unstable with pulse Cardioversion |
|
|
Torsades de Pointe
|
polymorphic v-tach, twisting pattern
|
|
|
Short Run of V tach
|
3 or more PVCs in a row
|
|
|
Ventricular fibrillation (v-fib)
|
Rate, rhythm, P wave’s, QRS, cannot be identified. Just looks like line is quivering (fibrillation)
|
|
|
Asystole
|
Total absence of ventricular activity
There will be very little quivering of the baseline No pulse, No rate, No rhythm, No activity Action CPR, IV access, transcutaneous pacing, medication therapy |
|
|
Pulseless Electrical Activity (PEA)
|
Rhythm will appear to be normal, but the patient will have no pulse
Nothing is wrong with the electrical system of the heart, but the mechanical system is not working Action CPR The most common cause is hypovolemia |
|
|
1st degree Heart Block
|
All is normal except the PR interval is Greater than .20
Will have the same number of P’s as QRS’s |
|
|
2nd degree Mobitz I (Wenkebach)
|
Will have more P’s than QRS’s
The PR interval will longer until the QRS gets dropped (the cycle will repeat) |
|
|
2nd degree Mobitz II
|
Will have more P’s than QRS
The PR interval will be the same for each complex |
|
|
3rd degree Complete Block
|
Will have mores P’s than QRS
PR interval will vary (no pattern) TREAT WITH PACEMAKER + Atropine |
