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Flashcards in 10) EKG Deck (109):
1

EKG

Graphic representation of the electrical impulses of the heart to ID arrhythmias

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What is the path of electrical conduction through the heart?

SA node-->AV node-->Bundle of HIS-->L & R Bundle Branches-->Purkinje Fibers

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What do P waves represent?

Atrial depolarization

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How should a normal P wave look?

Nice & rounded

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What follows a P wave?

Atrial contraction

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What does the PR interval represent?

Slowing of conduction through the AV node

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What does the QRS complex represent?

Ventricular depolarization followed by ventricular contraction

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What does the ST segment represent?

Initiation of ventricular depolarization

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How should the ST segment look?

Straight line

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On a normal EKG, how should the RR interval be?

Regular

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Why is a basic understanding of single-lead EKG's necessary?

It can help a PT determine the safety of certain interventions in pt's w/abn's

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What is a single-lead EKG used for?

To detect rate & rhythm abn's

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Can a single-lead EKG detect ischemia?

No

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Where are single-lead EKG's most commonly done?

*ICU *Step-downs *CPPT rehab

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What us a twelve-lead EKG used for?

To determine ischemia or infarction

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When is a 12-lead EKG ordered?

When there's a change in pt condition or suspected ischemia

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V1 & V2

Septum

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V3 & V4

Anterior Left Ventricle

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V5 & V6

Lateral Left Ventricle

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On an EKG, what is indicated by heightened R waves & deeper S waves?

Ventricular Hypertrophy

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How can ventricular hypertrophy be ID'ed on an EKG?

Look for heightened R waves & deeper S waves

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True or False:Ventricular hypertrophy can be seen in both healthy & sick pt's.

True

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W/what cardiac dysfxns can ventricular hypertrophy be present?

LV dysfxn & CHF

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On an EKG, what indicates myocardial ischemia?

ST depression or T wave inversion w/angina

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What is ST depression or T wave inversion indicative of?

Myocardial ischemia

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On an EKG, what indicates an MI?

ST elevation

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What is ST elevation indicative of?

MI

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Is ST elevation a medical emergency?

Yes

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What length of time is 1 small box equal to?

.04sec

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What length of time is 1 big box equal to?

.20 seconds

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What length of time is each tick mark equal to?

3 seconds

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What is one method of calculating HR?

Count # of QRS complexes in 6sec & multiply by 10

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What is the square counting method good for?

Regular rhythms

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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

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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?

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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

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What are T-wave changes indicative of?

Hyperkalemia

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What do U waves represent?

Purkinje repolarization

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Are U waves normal to see?

Yes but they can also be indicative of hypokalemia, hypercalcemia, & MI

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What are Q waves indicative of?

Absence of electrical activity so sign of previous MI

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What is a widened QT interval indicative of?

Impending ventricular arrhythmia

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What is a widened QT interval commonly misdx'ed as?

Seizures

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Dysrhythmia/Arrhythmia

Any rhythm other than NSR

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Sinus arrhythmia

SA node is intact & working

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Junctional arrhythmia

Premature impulses that arise from the AV node or junctional tissue

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What is the most dangerous location for arrhythmia & why?

Ventricle bc it can alter cardiac output

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Tachyarrythmia

HR >100bpm

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Bradyarrhythmia

HR <60bpm

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Ectopy

Electrical activity outside of the normal pathways

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Sinus Tachycardia

HR >100bpm

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What causes sinus tachycardia

*Stimulants *Stress *Fever *Hemmorrhage

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What is the tx for sinus tachycardia?

Eliminate the cause &amp; beta-blockers

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Sinus Bradycardia

HR <60bpm

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What causes sinus bradycardia?

*Beta-blockers *Incr vagal stimulation *Being a highly trained athlete

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Sx's of sinus bradycardia

*Syncope *Dizziness *Angina *Diaphoresis

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Tx for sinus bradycardia

Do nothing unless pt is symptomatic *Atropine or pacemaker

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Sinus Arrhythmia

Inconsistent RR intervals

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What can cause sinus arrhythmia?

Normal respiration

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True or False: Normal respiration can cause sinus arrhythmia.

True

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What population is sinus arrhythmia common in?

Young/elderly at rest

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What is sinus arrhythmia associated w/?

*Morphine or digoxin toxicity *Infection *Fever

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Atrial Flutter

No true P waves, but rather flutter waves so there will be multiple P waves before every QRS

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What can cause atrial flutter?

*Rheumatic heart disease *Mitral valve disease *Hypoxemia

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Tx for atrial flutter

*Meds (digoxin, verapamil, &amp; beta blockers) *Cardioversion

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Does atrial flutter effect ventricular rate?

Usually not

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Atrial Fibrillation

No true P wave leaving a flat/wavy baseline between QRS complexes &amp; SA node is no longer doing its job so AV node takes over

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Describe the RR interval seen w/A-fib

Regularly irregular

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What causes A-fib?

*Age *Ischemia/Infarction *Stress *CHF *Renal failure

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Why is A-fib a problem?

Bc it can decr CO by 15-30%

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What is A-fib very dangerous &amp; why?

Tachycardia bc it can cause stagnant blood-->Excess coagulation-->Clot

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Until what point can a pt w/a-fib exercise until?

Ventricular rate >120bpm at rest

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Tx for a-fib?

Blood thinners, anticoags, &amp; ablation

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Heart Block

Occurs when cardiac electrical impulse is delayed/blocked w/in the AV node, bundle of HIS. or purkinje system

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1° Heart Block

Delay caused by conduction at the AV node or bundle of HIS so PR interval becomes longer by .2 sec

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2° (Mobitz 1/Wenckebach) Heart Block

Progressive elongation of PR interval followed by a dropped (missing) QRS complex

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What part of the heart has a problem during 2° (Mobitz 1) heart block?

AV node

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Tx for 2° (Mobitz 1) heart block

Nothing unless pt is symptomatic

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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

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What part of the heart has a problem during 2° (Mobitz 2) heart block?

Bundle of HIS or Purkinje Fibers

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What can 2° (Mobitz 2) heart block progress to?

Complete heart block or cardiac arrest

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Tx for 2° (Mobitz 2) heart block

Pacemaker

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3° (Complete) Heart Block

SA node generates impulse, but its not conducted to the ventricles

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What will 3° heart block look like on an EKG?

*Complete lack of relationship between P waves &amp; QRS complexes *Escape rhythms-->2 independent rhythms on EKG *Regular P waves &amp; QRS complex, but variable PR interval

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What can cause 3° heart block?

Ischemia or MI

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Sx of 3° heart block

*Severe bradycardia *Hypotension *Hemodynamic instability

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Tx for 3° heart block

*Electrical pacing by dual chamber artificial pacemaker

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Premature Ventricular Contractions

Ectopic focus generating an impulse from somewhere in the ventricles

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Regarding PVC's, when should you be concerned?

When a pt has 3 PVC's in a row or 6 in a minute

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What can PVC lead to?

V-tach

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What can cause PVC's?

*Stress *Caffeine *Nicotine Sensitivity *Electrolyte imbalance *Ischemia *Myocardial Irritation *Cardiac disease

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Sx's of PVC's

*Feeling of skipped beat *Anxiety *SOB *Dizziness

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Tx for PVC's

*Tx underlying cause *Meds *Supplemental O2 for pt's w/lung disease

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In pt's lung disease, what can PVC indicate?

Hypoxemia

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Ventricular Tachycardia

3+ PVC's in a row w/HR >120bpm

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Why does V-tach occur?

Rapid firing from a single ventricular focus

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How can you ID v-tach on an EKG?

No P waves &amp; will look like a bunch of PVC's in a row

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Non-sustained V-tach

Self-termination in <30sec

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Sustained V-tach

V-tach lasts >30sec

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Causes of V-tach

*Ischemia *Acute infarction *CAD *Heart disease *Med rxn to digoxin or qunidine *Athletes w/electrolyte imbalance

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Sx's of V-tach

*Weak thready pulse *Dizziness *Syncope *Disorientation

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Tx for V-tach

*Immediate pharmacologic intervention *Cardioversion *Defibrillation

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Torsade de Pointes

Unique configuration of V-tach; Twisting of the points around the isoelectric line

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What is Torsade de Pointes associated w/?

Prolonged QT interval

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Tx for Torsade de Pointes

Cardioversion

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V-Fib

Erratic quivering of ventricular musculature-->Multiple ectopic foci firing simultaneously, so there's no CO

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On an EKG, what does a vertical spike indicate?

Pacemaker activity (V-fib)

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How does a pacemaker fxn during V-fib &amp; 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

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What is V-fib almost always associated w/?

Cardiac Arrest

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Tx for V-fib

*Always de-fib V-fib *CPR *O2