ECG Flashcards by Amanda S.

Pacemaker cells possess

AUTOMATICITY (the ability to initiate an impulse)

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Bundle Branches & Purkinje Fibers: - bmp (slowest ones)

20-40 bpm

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pulseless electrical activity (vents don’t have pulses, of course)

looks like a normal EKG but ventricles don’t contract so there’s no cardiac output or BP

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with AV blocks, is something wrong with the SA nodes?

there’s nothing wrong with SA nodes (because they come before AV)

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supraventricular tachycardia - rate (the suprer hero goes 100 mph)

above ventricles but something else is causing rapid firings - rates higher than 100 bmp

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SA nodes

Sinoatrial node (SA) is the pacemaker that:
Sets the rate (60-100)
Generates nerve impulses to contract both atria
P wave on ECG

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Atrioventricular (AV)

SA to AV bundle transmission

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Atrioventricular bundle is a - which segment on the ECG? (Ava purrs)

bundle of nerve fibers in the septum that:
Carries impulses doen the septum to the RBB
PR segment on the ECG
Allows atrial contraction

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ask yourself this with every ECG (in this order) (RRP RPR QRS ST T - rip ripper)

Is the rhythm regular?
what is the rate?
are there P waves? Are they consistent? (atrial)
are there R waves? (ventricular)
waht is the P-R interval?
are the QRS complexes normal shape and duration?
is the S-T segment isoelectric? (waves go down not up - icicles go down)
Do the T waves have normal configuration? (can detect eschemia and K+ problems) don’t need to figure out rate***

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P wave

P wave: Atrial depolarization

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QRS Complex

QRS Complex: Ventricular depolarization (atrial repolarization is hidden)

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T wave

T wave: Ventricular repolarization

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measurements in seconds - PR interval: (Prrr cats age is 12 - 20)

PR interval: .12 - .2 sec

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ECG paper - each square is how many seconds?

Standard paper speed= 25mm/sec
mm= .04 sec (60 sec/1500=.04 sec)
5mm= .2 sec (.04 x 5) = .2 sec (60 sec/ .2 = 300/min

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heart rate determination - how to count on ecg (heart rate needs some R and R for 300 days)

Count the number of large boxes between R-R interval and divide into 300
Example: 300/4=75 bpm

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rhthym can be normal, but doesn’t mean that

the pt is perfusing

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Arrhythmias are no big deal UNTIL they affect…

cardiac output

VT
Vfib
Heart Blocks
Multiple PVC’s (premature ventricular contractions)
Atrial fibrillation/flutter
Junctional rhythms

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how to diagnose arrthymias

ECG
3 lead, 5 lead, 12 lead, Transcutaneous paddles
EPS
Echocardiography
Tilt table testing
Genetic testing
Labs
CXR (chest x-ray)
Coronary angiography

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premature atrial contraction

rhythm - irregular - it comes early and prob faster.

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AFib - rate and rhythm - Gab is bigger than 150

Rhythm: Irregular
Rate: >150 (depends on AV conduction)
AV node is the bouncer at a bar and lets a few in at a time.

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AFib causes (gab door)

CAD, HTN, mitral or tricuspid valve disease, PE

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Afib treatments (gab gets the RAT treatment)

1 GOAL is to Control rate

Rhythm conversion
Prevent thrombus formation
Surgical ablation

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AFib - assessments (assess gab bc she’s an SOB and she passes out when she beats on her chest pain)

Assess patient for SOB, decreased energy, fatigue, “feeling beats”, chest pain, light headedness, syncope, decreased ability to exert

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atrial flutter rhythm (butterflies can have regular or irregular shapes)

rhythm: Regular or regularly irregular

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atrial flutter Causes (butterfly causes are the PIT ishmail)

PE, thyrotoxicosis (too much thyroid hormone), ischemic heart disease

atrial flutter treatment (same as aFib)

Control rate Rhythm conversion Prevent thrombus formation Surgical ablation successful in 80-90% cases

premature ventricular contraction - what about perfusion?

not good perfusion.

premature ventricular contraction - causes (jimmy was always irritated)

electrolyte imbalances, irritability of the heart, stress response. more than 6 is bad.

isolectric - what is it and when does it happen? (Jimmy Icicles)

wave goes down not up - happens with PVC

ventricular tachycardia - how does the ECG look? (Tachy Tombstones)

rapid rate, can't decipher P waves.

VFib rate and rhythm (Velma is chaotic with no rate)

Rhythm Chaotic Rate - None, non discernable can defibrillate the pt.

VFib causes - how does the ECG look? (Velma’s ecg is gone)

No P, P-R interval, atrial rate or QRS duration

VFib treatment

CPR, precordial thump (strike person's sternum), defibrillation (do it fast), medications - epinephrine, ABC, check pulses, call code right away

Vfib nursing implications

Nursing Implications Assess patient NO palpable pulses ABC Call code/ask for AED (automated external defibrillator)

biphasic defibrillator

delivers shock going in both directions - sandwich the paddles between the heart. goes through posterior and anterior then back the other way. uses less electricity and causes less damage to the pt.

QRS interval in seconds (can't stand QVC for 12 seconds)

QRS interval: < .12 sec

QT interval in seconds (QTs are 36 - 44)

QT interval: .36 - .44 sec

heart rate - how to count rapid HR? (rapidly die in 1500 bc)

Rapid heart rate, count number of small boxes between R and R and divide into 1500 Example: 1500/19 = 79 bpm

premature atrial contraction - what's missing on ECG?

there's a P wave missing. what is causing it?

premature ATRIAL contraction - causes (everyone has atrials)

Caffeine, meds, anxiety, sleep deprivation

afib triggers (Gab is triggered by caffeine and alcohol when she's exhaustion and hormones)

Emotional triggers, exhaustion, caffeine, sleep deprivation, hormonal, alcohol, surgery or medical procedures

afib causes (gab plant)

pericarditis, hypoxia, hyperthyroidism, CM (cardiomyopapthy)

afib nursing interventions - bridges (gab needs hep to bridge the war)

Anticoagulant therapy Bridges (Bridging anticoagulation refers to giving a short-acting blood thinner, usually low-molecular-weight heparin given by subcutaneous injection for 10 to 12 days around the time of the surgery/procedure, when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range)

atrial flutters - causes (Quinn butterfly after surgery)

hypoxia, quinidine toxicity, post cardiac surgery

vFib causes (MY velma is MIC junk)

Ischemic heart disease, cardiomyopathy, myocarditis

vfib - ST? (Velma on Brugunda Street)

ST elevation (end of ventricular depolarization and beginning of ventricular repolarization) with BBB (bundle branch block) in V1-V3 = Brugada Syndrome

vFib

vFib = < 40 - check this when you watch the video again

atrial flutter - rate (butterflies can be 75 years old, or 300)

Rate: 75-150 (depends on A-V conduction) Atrial rate 200-300 Ventricular rate varies depending on A-V ratio maybe like 3-4 P waves followed by 1 QRS

second-degree heart block, Mobitz Type 1 treatment (2nd degree atop the pine)

bolus of atropine (pine tree high)

first-degree atrioventricular (AV) block - ECG (prolonged purring gets you the 1st degree)

Delayed conduction, producing a prolonged PR interval

early warning sign of acute coronary syndrome (ACS) and heart failure (HF)

fatigue

fall in blood pressure sensed by...

baroreceptors

junction rhythms do what?

take over when the whole conduction system doesn't work

EPS (electrophysiology studies) (ESP is irritating)

we irritate the heart to try to figure out what the pt has, identify cells that are not firing correctly

12 lead is for___, and not for___

for diagnostics, not continous monitoring

3 lead - pics of the heart or not? (3 is basic phone)

no pics of the heart

Coronary angiography measures what? (angie is pressuring me, grrrr)

measures pressure in heart

what happens with afib? (a million gabs think they're the boss)

a whole bunch of cells become pacemakers and override SA node. if we can't convert the rate, ppl need to be on anticoagulants bc the blood is sloshing around and causes clots

with afib, where do you feel the beats?

in neck or temple region usually (palpitations)

vfib pattern on ecg

random squiggly line

ventricular tachycardia pattern on ecg (T for tachy, T for tombstone)

V Tac = Tombstone patterns

ventricular tachycardia causes (Be Tachy without the sheriff)

low K and low mag

ventricular tachycardia treatment - but WHEN?

EARLY defib

vfib treatment

CPR before anything

when to shock with vfib? (if you can C, count a pulse, C cardiovert)

no pulse = dfib with pulse = cardiovert

Afib on ecg (fib s floPPing)

no P wave, so fib floPPing

Afib causes (don't memorize this one)

valve disease, HF, pulm. HTN, COPD, and after heart surgery.

afib treatment (just cardio and 2 meds)

cardioversion (after TTE to rule out clots) digoxin for long term - but check ATP before giving (apical pulse, toxicity, potassium less than 3.5) anticoagulants - warafin (vitamin K antidote, monitor INR)

atrial flutter on ecg (butterfly with teeth)

saw tooth (looks like little teeth) - causes and treament same as afib

SVT on ecg (supraventricular tachycardia) (super fast = super ventricular)

close and fast

SVT causes (super hero front door)

stimulants, exercise, hyopxia, heart disease

treatment for SVT (super hero just needs vegas and Alden and do cardio version)

vagal maneuver, ice on neck, adenosine (HR may stop, this is good and normal) cardioversion

hold digoxin before what procedure? ( digoxin can’t do cardio)

cardioversion

torsades de pointes on ecg (torsades tornados)

tornado of points

torsades de pointes causes (without the sheriff there are tornados)

low magnesium

magnesium mellows out the

heart waves, without HR is crazy.

aystole (assist fully)

flat line. DO NOT defibrillate - can't shock bc there is no electricity

wide or bizarre QRS =

v tach

chaotic or unorganized ecg

fibrillation

chaotic with no P waves =

afib

bizarre = (bizarre is tacky)

tachycardia

bizarre = (bizarre is tacky)

tachycardiara

rhthym with premature ventricular contraction? (Jimmy's rhythm was mostly normal, but sometimes abnormal)

rhythm should be normal w/ some abnormal moments.

What are the known causes of sinus tachycardia?

hypovolemia

ventricular bigeminy cardiac rhythm

The rhythm has a normal beat, then a premature beat pattern

removal of an arterial or venous catheter - how to reverse vasoval response?

The vasovagal response is reversed by promptly elevating the lower extremities above the level of the heart, infusing a bolus of IV fluid, and administering IV atropine to treat the bradycardia.

ECG impulse travels where?

travels through the atrial muscles, causing them to contract

ECG - how to calculate ventricular rate?

count the QRS complexes and multiply by 6, which would be 15 x 6 = 90 bpm

right leg lead is

neutral

horizontal axis on ECG measures..

The horizontal axis measures time.

The vertical axis on ECG measures (vertical voltage)

amplitude or voltage

how to calculate atrial rate on EKG? (atria needs some R and R)

count the P waves in 30 large squares and multiply by 10, which would be 4 x 10 = 40 bpm

how to calculate ventricular rate on EKG?

count the QRS complexes in 30 large squares and multiply by 4, which would be 4 x 10 = 40 bpm

sinus arrhtyhmia

R and R is greater than .12

Lymphangitis is (just inflammation)

inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites.

Lymphadenitis (the dentist is enlarged)

enlargement in one or more lymph nodes, usually due to infection

Lymphedema

swelling due to build-up of lymph fluid in the body