Dysrhythmia Interpretation & EKG Interpretation Flashcards
(180 cards)
1
Q
Right coronary artery supplies what parts of the heart
A
inferior wall and left ventricle
2
Q
the Sa node is supplied by what in 50-60% of people
A
RCA
3
Q
in 85-90% of hearts, the RCA supplies the
A
AV node
4
Q
two main branches of the left coronary artery
A
left descending artery
left circumflex
5
Q
occlusion of the LAD can result in
A
pump failure
intraventricular conduction delays
septal wall
ventricular rupture
6
Q
polorization is resting or stimulated
A
resting
7
Q
during polarization what is inside the cell
A
negative
8
Q
depolorization is
A
sitmulated
9
Q
what is inside the cell during depolorization
A
positive
10
Q
steps to the condition system
A
sinus node
av node
bundle of His
purkinje fivers
11
Q
absolute refractory period
A
onset of QRS
12
Q
relative refractory peroid
A
downslope of the T wave
13
Q
supernormal peroud
A
end of T wave
14
Q
EKG records
A
electrical voltages generated by depolarization of heart muscle
15
Q
what are somethings an EKG can tell us
A
orirtentaion
condution
electrical effects
mass
presence of ischemia, injury, and infarction
16
Q
high potassium is what wave
A
increase T wave
17
Q
post MI is what wave
A
persistant Q wave and ST depression
18
Q
current MI
A
ST evelation
19
Q
difference between bedside telemetry and 12 lead ECG
A
bedside has 1-2 views and is continuous
12 lead is 12 views and 10 seconds
20
Q
where do telemetry stickers go
A
right side white on top and green below
left side black on top and red below
brown in the middle
cloud over grass
white on right
smoke over fire
21
Q
what is the most common lead to look at for 12 lead
A
lead 2
22
Q
what leads make up the standard limb leads
A
I II III
23
Q
what triangle do I, II, III make up
A
Einthoven triangle
24
Q
horizontal axis on EKG
A
time
25
vertical axis on EKG
voltage/amplitiude
26
one block= time and size
0.04
1mm
27
P wave is
atrial depolorization
28
QRS is
ventricular depolarization
and atrial repoloarization
29
T wave is
ventricular depolarization
30
how do we measure PR interval
baseline before P and baseline before Q
31
Normal PR interval
0.12-0.20
32
what does PR interval representt
length it take the impulse to travel from atria to ventricules
33
QRS measures
spread of electrical impulse through ventricles
34
normal QRS
0.04-0.12
35
ST segment represents
early part of repoloraiztion of the right and left ventricles
36
what is the point where the QRS complex and ST segment meet
J point
37
what are the characteristics of a ST segment
flat and isoelectric
38
ST elevation defintion
segment is deviated above baseline of PR segment
39
ST Depression defintion
if the segment deviates below baseline of the PR segment
40
elevated ST means
MI
41
depressed ST means
post MI
42
T wave represents
ventricular repolorization
43
hyperkalemia might do what to the T wave
peak it
44
QT interval represents
total ventricular activity
45
how to measure QT
beginning of Q to end of T
46
what can prolong QT
meds
47
how to measure T wave
start to end of T wave
48
why might measuring the QT be important
for pro arrhythmic drugs
49
if the OT interval is less than half the _________ it is probably normal
RR interval
50
which lead do we look at the most common
lead II
51
long ST segments are typical of
hypocalcemia
52
U wave might be evident in
hypokalemia
53
how to find the rate
could the number of R waves in a 6 second strip and multiply by 10
54
how many ticks is 6 seconds
3 ticks or 2 inervals
55
R wave measures what rate
ventricular
56
P wave measures what rate
atrial
57
how do we determine regularity
R to R interval
58
each interval of the tic is worth how many seconds
3
59
criteria for normal sinus rhythm
rate is 60-100
regular rhythm
all intervals are within normal limits
P for every QRS
P wave look the same
60
criteria for normal sinus rhythm
- rate
60-100
61
criteria for normal sinus rhythm
- regularity
yes
62
criteria for normal sinus rhythm
- intervals
within normal limits
63
criteria for normal sinus rhythm
- P wave
looks the same is there is one for every QRS
64
Sinus Bradycardia criteria
rate is less than 60
rhythm us regular
intervals are within normal limits
P for every QRS
P look the same
65
Sinus Bradycardia criteria
- rate
less than 60
66
Sinus Bradycardia criteria
- regularity
yes
67
Sinus Bradycardia criteria
- intervals
normal limits
68
Sinus Bradycardia criteria
- P wave
P for every QRS
all look the same
69
Sinus Bradycardia be caused by
beta blockers
digitalis
calcium channel blockers
hypoxemia
70
Sinus Bradycardia may be normal in
athletes or while sleeping
71
if a patient has Sinus Bradycardia we should assess
BP and symptoms
72
hypoxemia causes
Sinus Bradycardia
73
sinus tachycardia criteria
rate is above 100
regular rhythm
intervals are within normal limits
P wave for every QRS
P wave look the same
74
sinus tachycardia criteria
- rate
above 100
75
sinus tachycardia criteria
- regularity
yes
76
sinus tachycardia criteria
- intervals
normal limits
77
sinus tachycardia criteria
- P wave
for every QRS and looks the same
78
sinus tachycardia can be caused by
fever
stress
caffeine
pain
exercise
shock
hypoxemia
increased symaptehic tone
hypovolemia
79
how do we treat sinus tachycardia
treat the underlying cause
80
criteria for sinus arrhythmia/dysrhythmia
- rate between 60-100
- rhythm is irregular
- all intervals are within normal limits
- P for every QRS
- P look the same
81
sinus arrhythmia/dysrhythmia critera
- rate
60-100
82
sinus arrhythmia/dysrhythmia critera
- regularity
no, irregular
83
sinus arrhythmia/dysrhythmia criteria
- intervals
normal
84
sinus arrhythmia/dysrhythmia
- P wave
for every QRS and all look the same
85
in sinus arrhythmia/dysrhythmia, the SA node can increase or decrease with
respirations
86
who might sinus arrhythmia or dysrhythmia be more common in
children and athletes
87
premature atrial contraction criteria
any rate
rhythm is irrgeular because of the early beat
intervals are normal limits
P for every QRS
P look the same EXCEPT the P in front of the PAC will be different
88
premature atrial contraction criteria
- rate
any rate
89
premature atrial contraction criteria
- regularity
it is irregular because of the early beat but the underlying rhythm may be regular
90
premature atrial contraction criteria
- interval
normal
91
premature atrial contraction criteria
- P wave for every QRS
yes
92
premature atrial contraction criteria
- P wave look the same
no the P in the PAC will be different
93
SVT/PVST criteria
rate 150-250
regular
QRS intervals can be within normal limits
Can be a P wave but it is most likely hidden in T wave
94
difference between SVT and PSVT
paroxysmal starts and stops abruptly
sustained is continous
95
SVT/PVST criteria
- rate
150-150
96
SVT/PVST criteria
- regularity
regular
97
SVT/PVST criteria
- intervals
QRS is normal
* most of the time there is no P wave so we cannot determine PR
98
SVT/PVST criteria
- P wave
there can be one but more like it is hidden in the T wave
99
atrial flutter criteria
atrial rate is 250-350
* ventricular can vary
regular or regularly irregular
no PR interval/QRS may be normal
NO P WAVES, called flutter waves
100
how might atrial flutter look
jagged saw tooth edges or picked fence
101
what is the problem with atrial flutter
loss of atrial kick and ventricular condition is too fast or too slow to allow good filling of the ventricles
102
atrial flutter criteria
- atrial rate
250-350
103
atrial flutter criteria
- ventricular rate
can vary
104
atrial flutter criteria
- regularity
regular or regularly irregular
105
atrial flutter criteria
- intervals
QRS may be normal
NO PR
106
atrial flutter criteria
- P waves
NO P WAVES
* called flutter waves
107
atrial fib criteria
rhythm is IRREGULARLY IRREGULAR
no PR interval, QRS may be normal
108
atrial fib criteria
- P waves
no regular P waves, then meaning no PR interval
109
atrial fib criteria
- rhythm
irregularly irregular
110
atrial fib criteria
- QRS interval
may be normal
111
atrial fib criteria
- flutter waves compared to QRS
more flutter waves
112
atrial fib at risk for
mural thrombi
cardiac output: due to loss of arterial kick
113
junctional rhythm criteria
rate can depend on type, anywhere between 40 and above 100
regular
P wave can be in three different places
- inverted before or after the QRS
- buried in the QRS
- normal after the QRS
114
junctional rhythm criteria
- rate
vary
115
junctional rhythm criteria
- regularity
yes
116
junctional rhythm criteria
- p wave places
inverted before or after the QRS
normal after the QRS
buried in the QRS
117
junctional rhythm criteria
- if a P wave occurs before a QRS what will the PR interval be
0.12 or less
118
premature junctional contractions criteria
rate can vary
irregular
P wave is present in the normal beats but follows criteria for junctional rhythm
119
premature ventricular contractions criteria
rate varies
irregular
No P wave in the PVC
120
PVC classification
- apperence of the contraction
unifocal: look the same
multifocal: look different
121
PVC classification
- numbers
couplet: 2 in a row
triplet: 3 in a row
bigeminy: every other
trigeminy: every third
122
in a PVC, anything more than what would be considered V tach
3
123
why might PVC happen
acid base imbalances
hyper/hypokalemia
post MI
124
PVC how do the QRS look
wide
125
why do PVC not have a P wave
stimulus originates in the ventricle
126
V tach criteria
101-250 rate
pulse or pulsless
usually regular
normally P waves are absent
127
v tach rate
101-250
128
will a patient always be unstable with v tach
no they can be stable
129
what is the first thing we do for v tach
check for a pulse
130
if a patient is in v tach with a pulse what do we do
meds
valsalva manöver
synchronized cardioversion
131
what do we do if a patient is in v tach with no pulse
defibrillator and CPR
132
difference between synchronized cardio and defibrillator
synchronized cardio looks where the R wave is
133
the most common cause of sustained monomorphic V Tach in American adults is
coronary artery disease with prior myocardia infarction
134
causes of V tach
overdose
dig tox
heart disease
mitral valve prolapse
trauma
acid base imbalance
electrolyte imbalance
135
treatment of v tach depends on
pulse and symptoms
136
for V tach what is our treatment
underlying cause
137
torsades is caused by
long QT (commonly caused by meds)
hypokalemia
subarachnoid bleed
138
v fib criteria
rate cannot be determined
irregular, no pattern
no distinguishable waves
NO PULSE
139
will V fib have a pulse
NO
140
treatment of V fib
CPR and defibrillator
141
problem in V fib
ventricular myocardium quivers and there is no effective myocardial contraction and no pulse
142
two types of V fib
fine and course
143
indioventricular rhythm criteria
20-40
regular
No P wave
long QRS
T wave opposite direction
144
what happens during indioventricular rhythm
SA node and Av junction fail to initiate electrical impulse
* explains why pulse is low
145
indioventricular rhythm caused by
MI
dig tox
metabolic imbalances
146
indioventricular rhythm vs accelerated idioventricualr rhythm
accelerated is 40-100
147
asystole pulse
none
148
what is the issue for the AV blocks
delay or interruption of the electrical links between atrium and ventricle
149
who might first degree be normal in
athelets
150
first degree can also happen because of
ischemia/injury
medication therapy
hyperkalemia
151
first degree AV block criteria
rate: normal
regular
P wave normal
PR EXCEEDS 0.20
152
what is the difference between sinus and first degree heart block
PR is longer than 0.20
153
second degree wnkebach criteria
rate: atrial is greater than ventricular
rhythm irregular
PR interval: lengthens with each cycle until P wave appears without QRS
154
saying for wenkebach
longer longer longer drop
one baseball bat hits the ball further further gone
155
second degree type one indicates
atria are being depolarized normally but not every impulse is being conducted to the ventricles
156
second degree heart block type 2
rate: atrial faster than ventricle
rhythm is regular or irregular
PR interval is fixed and constant
random dropped QRS
157
only difference between 2nd degree type 1 and 2
type 1 the PR interval is not fixed
type 2 the PR interval is fixed
both have dropped QRS
158
what rhythm has a higher tendency to progress to complete heart blood
2nd degree type 2
159
complete or 3rd degree heart block criteria
atria and ventricles beat independently of each other
not a QRS for every P wave
PR interval varies without pattern, not fixed
160
what will we always do for complete heart blood
pace them
161
if there is a rhythm but no pulse what is it
pulsesless electrical activity
162
pulsesless electrical activity is a what type of situation, not a specific dysrhythmia
clinical
163
why might PEA occur (H and T)
Hypovolemia
hypoxia
acidosis
kalmia
hypothermia
hypoglycemia
toxins
tamponade
tension pneumo
thrombosis
trauma
164
In v tach, when the QRS complexes are the same shape and amplitude this is called
monomorhpic VT
165
In complete heart block how can we determine the impulse to the ventricles
narrow: junctional
wide: ventricular
166
treatment of pulses electrical activity
whatever the problem is
167
SVT is rapid for what time peroid
whole strip
168
purkinjie fiber rate
20-40BPM
169
bundle of His/av node intrinsic rate
40-60
170
SA node intrinsic rate
60-100
171
what artery is called the widow maker
LCA
172
SVT rate
150
173
treatment for SVT or PVST
adenosine
174
difference between PSVT and SVT
PSVT starts and stops suddenly
SVT is susatiend and needs intervention
175
2 rhythms where you might have to shock
V fib and V tach (pulsless)
176
treatment of unstable VT
cardioversion
177
treatment for bradycardia
atropine
178
med treatment for torsades
mag
179
idioventricular are slow or fast
slow
180
how to differentiate between bundle branch block and indioventricukar
BBB has p waves
