10) EKG Flashcards
(109 cards)
1
Q
EKG
A
Graphic representation of the electrical impulses of the heart to ID arrhythmias
2
Q
What is the path of electrical conduction through the heart?
A
SA node–>AV node–>Bundle of HIS–>L & R Bundle Branches–>Purkinje Fibers
3
Q
What do P waves represent?
A
Atrial depolarization
4
Q
How should a normal P wave look?
A
Nice & rounded
5
Q
What follows a P wave?
A
Atrial contraction
6
Q
What does the PR interval represent?
A
Slowing of conduction through the AV node
7
Q
What does the QRS complex represent?
A
Ventricular depolarization followed by ventricular contraction
8
Q
What does the ST segment represent?
A
Initiation of ventricular depolarization
9
Q
How should the ST segment look?
A
Straight line
10
Q
On a normal EKG, how should the RR interval be?
A
Regular
11
Q
Why is a basic understanding of single-lead EKG’s necessary?
A
It can help a PT determine the safety of certain interventions in pt’s w/abn’s
12
Q
What is a single-lead EKG used for?
A
To detect rate & rhythm abn’s
13
Q
Can a single-lead EKG detect ischemia?
A
No
14
Q
Where are single-lead EKG’s most commonly done?
A
*ICU *Step-downs *CPPT rehab
15
Q
What us a twelve-lead EKG used for?
A
To determine ischemia or infarction
16
Q
When is a 12-lead EKG ordered?
A
When there’s a change in pt condition or suspected ischemia
17
Q
V1 & V2
A
Septum
18
Q
V3 & V4
A
Anterior Left Ventricle
19
Q
V5 & V6
A
Lateral Left Ventricle
20
Q
On an EKG, what is indicated by heightened R waves & deeper S waves?
A
Ventricular Hypertrophy
21
Q
How can ventricular hypertrophy be ID’ed on an EKG?
A
Look for heightened R waves & deeper S waves
22
Q
True or False:Ventricular hypertrophy can be seen in both healthy & sick pt’s.
A
True
23
Q
W/what cardiac dysfxns can ventricular hypertrophy be present?
A
LV dysfxn & CHF
24
Q
On an EKG, what indicates myocardial ischemia?
A
ST depression or T wave inversion w/angina
25
What is ST depression or T wave inversion indicative of?
Myocardial ischemia
26
On an EKG, what indicates an MI?
ST elevation
27
What is ST elevation indicative of?
MI
28
Is ST elevation a medical emergency?
Yes
29
What length of time is 1 small box equal to?
.04sec
30
What length of time is 1 big box equal to?
.20 seconds
31
What length of time is each tick mark equal to?
3 seconds
32
What is one method of calculating HR?
Count # of QRS complexes in 6sec & multiply by 10
33
What is the square counting method good for?
Regular rhythms
34
How do you do the square counting method?
1) 1st thick line after QRS complex is 300 2) Count backwards in the sequence at each thick line (300-150-100-75-60-50) 3) Stop when you get to the next QRS complex. The # you're at is the HR
35
Step by step approach for interpreting EKG's:
\*Are the RR intervals equal? \*Does each beat begin w/a P wave? \*Is every P wave followed by a QRS complex? \*Is each QRS complex followed by a T wave? \*Are the PR intervals equal? \*Do all the QRS complexes look the same?
36
Characteristics of normal sinus rhythm
\*P waves are constant & upright \*Each P wave is followed by a QRS complex \*Each QRST is followed by a O wave \*PR interval is constant at .12-.2 sec \*HR is 60-100bpm
37
What are T-wave changes indicative of?
Hyperkalemia
38
What do U waves represent?
Purkinje repolarization
39
Are U waves normal to see?
Yes but they can also be indicative of hypokalemia, hypercalcemia, & MI
40
What are Q waves indicative of?
Absence of electrical activity so sign of previous MI
41
What is a widened QT interval indicative of?
Impending ventricular arrhythmia
42
What is a widened QT interval commonly misdx'ed as?
Seizures
43
Dysrhythmia/Arrhythmia
Any rhythm other than NSR
44
Sinus arrhythmia
SA node is intact & working
45
Junctional arrhythmia
Premature impulses that arise from the AV node or junctional tissue
46
What is the most dangerous location for arrhythmia & why?
Ventricle bc it can alter cardiac output
47
Tachyarrythmia
HR \>100bpm
48
Bradyarrhythmia
HR \<60bpm
49
Ectopy
Electrical activity outside of the normal pathways
50
Sinus Tachycardia
HR \>100bpm
51
What causes sinus tachycardia
\*Stimulants \*Stress \*Fever \*Hemmorrhage
52
What is the tx for sinus tachycardia?
Eliminate the cause & beta-blockers
53
Sinus Bradycardia
HR \<60bpm
54
What causes sinus bradycardia?
\*Beta-blockers \*Incr vagal stimulation \*Being a highly trained athlete
55
Sx's of sinus bradycardia
\*Syncope \*Dizziness \*Angina \*Diaphoresis
56
Tx for sinus bradycardia
Do nothing unless pt is symptomatic \*Atropine or pacemaker
57
Sinus Arrhythmia
Inconsistent RR intervals
58
What can cause sinus arrhythmia?
Normal respiration
59
True or False: Normal respiration can cause sinus arrhythmia.
True
60
What population is sinus arrhythmia common in?
Young/elderly at rest
61
What is sinus arrhythmia associated w/?
\*Morphine or digoxin toxicity \*Infection \*Fever
62
Atrial Flutter
No true P waves, but rather flutter waves so there will be multiple P waves before every QRS
63
What can cause atrial flutter?
\*Rheumatic heart disease \*Mitral valve disease \*Hypoxemia
64
Tx for atrial flutter
\*Meds (digoxin, verapamil, & beta blockers) \*Cardioversion
65
Does atrial flutter effect ventricular rate?
Usually not
66
Atrial Fibrillation
No true P wave leaving a flat/wavy baseline between QRS complexes & SA node is no longer doing its job so AV node takes over
67
Describe the RR interval seen w/A-fib
Regularly irregular
68
What causes A-fib?
\*Age \*Ischemia/Infarction \*Stress \*CHF \*Renal failure
69
Why is A-fib a problem?
Bc it can decr CO by 15-30%
70
What is A-fib very dangerous & why?
Tachycardia bc it can cause stagnant blood--\>Excess coagulation--\>Clot
71
Until what point can a pt w/a-fib exercise until?
Ventricular rate \>120bpm at rest
72
Tx for a-fib?
Blood thinners, anticoags, & ablation
73
Heart Block
Occurs when cardiac electrical impulse is delayed/blocked w/in the AV node, bundle of HIS. or purkinje system
74
1° Heart Block
Delay caused by conduction at the AV node or bundle of HIS so PR interval becomes longer by .2 sec
75
2° (Mobitz 1/Wenckebach) Heart Block
Progressive elongation of PR interval followed by a dropped (missing) QRS complex
76
What part of the heart has a problem during 2° (Mobitz 1) heart block?
AV node
77
Tx for 2° (Mobitz 1) heart block
Nothing unless pt is symptomatic
78
2° (Mobitz 2) Heart Block
Normal PR interval but beats are dropped--\>Intermittent non-conducted P waves so there's 2 P waves for every 1 QRS
79
What part of the heart has a problem during 2° (Mobitz 2) heart block?
Bundle of HIS or Purkinje Fibers
80
What can 2° (Mobitz 2) heart block progress to?
Complete heart block or cardiac arrest
81
Tx for 2° (Mobitz 2) heart block
Pacemaker
82
3° (Complete) Heart Block
SA node generates impulse, but its not conducted to the ventricles
83
What will 3° heart block look like on an EKG?
\*Complete lack of relationship between P waves & QRS complexes \*Escape rhythms--\>2 independent rhythms on EKG \*Regular P waves & QRS complex, but variable PR interval
84
What can cause 3° heart block?
Ischemia or MI
85
Sx of 3° heart block
\*Severe bradycardia \*Hypotension \*Hemodynamic instability
86
Tx for 3° heart block
\*Electrical pacing by dual chamber artificial pacemaker
87
Premature Ventricular Contractions
Ectopic focus generating an impulse from somewhere in the ventricles
88
Regarding PVC's, when should you be concerned?
When a pt has 3 PVC's in a row or 6 in a minute
89
What can PVC lead to?
V-tach
90
What can cause PVC's?
\*Stress \*Caffeine \*Nicotine Sensitivity \*Electrolyte imbalance \*Ischemia \*Myocardial Irritation \*Cardiac disease
91
Sx's of PVC's
\*Feeling of skipped beat \*Anxiety \*SOB \*Dizziness
92
Tx for PVC's
\*Tx underlying cause \*Meds \*Supplemental O2 for pt's w/lung disease
93
In pt's lung disease, what can PVC indicate?
Hypoxemia
94
Ventricular Tachycardia
3+ PVC's in a row w/HR \>120bpm
95
Why does V-tach occur?
Rapid firing from a single ventricular focus
96
How can you ID v-tach on an EKG?
No P waves & will look like a bunch of PVC's in a row
97
Non-sustained V-tach
Self-termination in \<30sec
98
Sustained V-tach
V-tach lasts \>30sec
99
Causes of V-tach
\*Ischemia \*Acute infarction \*CAD \*Heart disease \*Med rxn to digoxin or qunidine \*Athletes w/electrolyte imbalance
100
Sx's of V-tach
\*Weak thready pulse \*Dizziness \*Syncope \*Disorientation
101
Tx for V-tach
\*Immediate pharmacologic intervention \*Cardioversion \*Defibrillation
102
Torsade de Pointes
Unique configuration of V-tach; Twisting of the points around the isoelectric line
103
What is Torsade de Pointes associated w/?
Prolonged QT interval
104
Tx for Torsade de Pointes
Cardioversion
105
V-Fib
Erratic quivering of ventricular musculature--\>Multiple ectopic foci firing simultaneously, so there's no CO
106
On an EKG, what does a vertical spike indicate?
Pacemaker activity (V-fib)
107
How does a pacemaker fxn during V-fib & what will it look like on an EKG?
1) It emits a pulse when a native P wave or QRS complex isn't sense w/in a certain amount of time 2)Atrial pacer spikes are seen right before the P wave 3)Ventricular pacing is seen right before the QRS complex
108
What is V-fib almost always associated w/?
Cardiac Arrest
109
Tx for V-fib
\*Always de-fib V-fib \*CPR \*O2
