ECG

Question 1

Sa node fires and stimulates atrial contraction

normal duration - 0.06-0.12

Answer 1

P wave

Question 2

Beginning of P wave to beginning of QRS complex
time taken for impulse to spread from SA node to purkinje fibers
immediately preceding ventricular contraction
normal duration - 0.12 - 0.20

Answer 2

PR Interval

Question 3

Beginning to end of QRS complex
represent depolarization(contraction) of both ventricles (systole)
normal duration - < 0.12 (3 small squares)

Answer 3

QRS Complex(interval)

Question 4

Measured from S wave to beginning of T wave
represents time between ventricular depolarization and depolarization (diastole)
normal duration - 0.12

Answer 4

ST segment

Question 5

time for ventricular repolarization (resting phase)

normal interval - 0.16

Answer 5

T wave

Question 6

from beginning of QRS complex to end of T wave
represents time taken for entire depolarization and depolarization of ventricles
Normal duration - 0.34-0.43

Answer 6

QT interval

Question 7

rhythm that initiates in SA node at rate of 60-100 times per min.
follow normal conduction pattern of cardiac cycle.

Answer 7

Normal Sinus rhythm

Question 8

secondary pacemaker at the rate of 40-60 times per min. delay allows for atrial contraction and filling of ventricles. Not considered lethal.

Answer 8

Atrial dysrhythmia - Originates at AV node

Question 9

secondary pacemaker at the rate of 20-40 times per minute.

Answer 9

Ventricular Rhythm - Originates at His-Purkinje system. - carry electrical impulse directly to ventricles

Question 10

1 rule of ECG

Answer 10

Check the patient. How are they tolerating rhythm, S/S, Lethal dysrhythmia?

Question 11

reversal of charges at the cell membrane when the cells are stimulated that allow sodium to flow into the cell making the inside of the cell positive.

Answer 11

depolarization

Question 12

restoration of the polarized state at a cell membrane making the inside of the cell negative

Answer 12

repolarization

Question 13

Ability to initiate an impulse spontaneously and continuously

Answer 13

automaticity

Question 14

ability to be electrically stimulated

Answer 14

excitability

Question 15

Ability to transmit an impulse along a membrane in an orderly manner

Answer 15

conductivity

Question 16

Ability to respond mechanically to an impulse

Answer 16

contractility

Question 17

One complete contraction and relaxation cycle of the heart.

Answer 17

cardiac cycle

Question 18

Pulse < 60. PR interval normal, QRS for Each P wave

Answer 18

Sinus Bradycardia

Question 19

Pulse 100-200. PR interval normal. QRS for each P wave

Answer 19

Sinus Tachycardia

Question 20

Information obtainable from ECG

Answer 20

HR, Rhythm/regularity, Impulse conduction intervals, abnormal conduction pathways

Question 21

a printed record of electrical activity that defines the graphic representation of the electrical activity of the heart

Answer 21

the ECG (Electrocardiogram)

Question 22

5 steps to ECG strip interpretation

Answer 22

1. HR
2. Heart Rhythm
3. P-wave
4. PRI
5. QRS Complex

Question 23

Step 1 - HR

Answer 23

Six second strip count R wave multiple by 10.

Question 24

Step 2 - Heart Rhythm

Answer 24

Regular or Irregular?
Established pattern between QRS complexes?
Measure ventricular rhythm between r-r
Measure atria rhythm between p-p

Question 25

Step 3 - P-wave

Answer 25

Are they present? Do they occur regularly? Is there a P for each QRS? Do they all look similar?

Question 26

Step 4 - PR Interval

Answer 26

Normal - 0.12-0.20 (3-5 small boxes) Are they < or >? Are they consistent?

Question 27

Step 5 - QRS Complex

Answer 27

Are they narrow (< 0.12)? Are they wide (>0.12)? Are they similar across strip

Question 28

Steps for emergency management

Answer 28

``` 1- ensure ABCs 2 - Administer O2 via nasal canula or non-rebreather mask 3 - Obtain baseline vitals 4 - Obtain ECG 5 - Initiate continuous ECG monitoring 6 - Identify underlying rate and rhythm 7 - Identify dysrhythmia 8 - Establish IV access ```

Question 29

S/S Sinus Bradycardia

Answer 29

pale,cool skin, hypotension, weakness, angina, dizziness, syncope, confusion, SOB

Question 30

TX Sinus Bradycardia

Answer 30

Administer atropine, possible pacemaker therapy, Hold drugs or reduce dosage if they are the cause.

Question 31

S/S Sinus Tachycardia

Answer 31

Dizziness, dyspnea, hypotension due to decreased cardiac output. Increased myocardial O2 consumption associaed with increased HR. Angina or increased MI

Question 32

TX Sinus Tachycardia

Answer 32

treat underlying cause. (pain, hypovolemia) also IV beta blockers may reduce HR and O2 consumption.

Question 33

Premature atrial contraction (PAC)

Answer 33

Atrial contraction originating from somewhere other than SA Node. created a distorted P wave.

Question 34

PAC clinical causes

Answer 34

may result from emotional stress, physical fatigue, caffeine, tobacco, alcohol. Also hypoxia, electrolyte imbalance, COPD, hyperthyroidism, heart disease.

Question 35

Atrial Flutter

Answer 35

atrial tachydysrhythmia identified by recurring regular sawtooth shaped flutter waves that originate mostly from rt atrium.

Question 36

Atrial Fibrillation

Answer 36

total disorganization of atrial electro activity. Most common clinically significant dysrhythmia. Pwaves are replaced by chaotic fibrillatory wave (350-600 per min). results in decreased CO because of ineffective atrial contraction. Cause for 20% of strokes.

Question 37

SA or AV node fails to initiate impulse. Ventricle pace heart

Answer 37

ventricular rhythms

Question 38

Premature QRS complex that is wide and distorted in shape. Associated with stimulants (caffeine, alcohol, nicotine,epinephrine)

Answer 38

Premature Ventricular Contraction (PVC)

Question 39

Three or more consecutive PVCs. May or may not have pulse. Associated with MI, CAD, electrolyte imbalance, cardiomyopathy, mitral valve prolapse. Also can be seen with no cardiac disease.

Answer 39

Ventricular Tachycardia

Question 40

MI, mitral valve prolapse, HF, CAD

Answer 40

Disease states associated with PVCs

Question 41

TX PVC

Answer 41

relates to cause. (O2, electrolyte replacement), Drugs - Beta adrenergic blockers ( procainamide, lidocaine)

Question 42

ventricles fire with no order or rhythm. No pulse. Lethal rhythm. ventricles quiver with no effective contraction. Start CPR and defib immediately.

Answer 42

Ventricular fibrillation

Question 43

Most common lethal rhythm with electrolyte imbalance (usually magnesium). Has prolonged QT intervals.

Answer 43

torsades de pointes

Question 44

No ventricular activity. patient is unresponsive, pulseless, apneic. Patient usually has end stage cardiac disease.

Answer 44

Asystole

Question 45

electrical activity on ECK but patient has no pulse. Most common causes hypovolemia, hypoxia, metabolic acidosis, hyper/hypokalemia, hypothermia, drug overdose, MI. TX is CPR and drug therapy (epinephrine)

Answer 45

Pulseless Electrical Activity(PEA)

Question 46

Block of electrical impulse. PR interval is very important.

Answer 46

heart block

Question 47

Normal HR and rhythm, normal P wave. Prolonged PRI. normal QRS. patient is asymptomatic.

Answer 47

1st degree heart block

Question 48

Gradual lengthening of PRI. occurs because of prolonged AV conduction time until atrial impulse is non-conducted and QRS is missing

Answer 48

2nd degree heart block (Mobitz type I or wenckebach)

Question 49

P wave non-conducted without lengthening PRI. heartbeats get dropped. will need pacemaker

Answer 49

2nd degree heart block (Mobitz type II )

Question 50

No impulses from atria are conducted to ventricles. No communication between atria and ventricles. They work independently.

Answer 50

3rd degree heart block ( complete)

Question 51

common causes of Dysrhythmias

Answer 51

accessory pathways, cardiomyopathy, conduction defects, heart failure, myocardial cell degeneration, MI, valve disease

Question 52

Other causes of Dysrhythmias

Answer 52

acid-base imbalance, alcohol, caffeine, tobacco, drug effects, electric shock, hypoxia, poisoning, near drowning

Question 53

S/S of dysrhythmias

Answer 53

Change BP, Dec O2 sat, chest/neck/shoulder/back/jaw/arm pain, dizziness, syncope, dyspnea, diaphoresis, pallor, N&V, anxiety restlessness, DEC LOC/confusion, feeling impending doom, numbness/tingling arms, weakness, fatigue, cold clammy skin, palpitations

Question 54

Dysrhythmias treatments

Answer 54

Med review, Synchronized cardioversion, Ablation therapy, pacemakers, defibrillation

Question 55

check pt, sychronized cardioversion, digitalis, diltiazem, heparin/coumadin, ablation

Answer 55

Atrial flutter tx

Question 56

check pt, check leads, risk of clots, digitalis, amiodarone, procainamide, syn cardio, ablation

Answer 56

Atrial fibrillation tx

Question 57

Ask patient to bear down/cough hard

Answer 57

valsalva maneuver - (for SVT)

Question 58

Care of pt with AICD

Answer 58

dressing- sutures in place, oozing from site, infection, keep left arm down below shoulder, ID card

Question 59

Pacemakers

Answer 59

Implantable, temporary, atrial or ventricular, set of low and high HR

Question 60

Blurred vision, green/yellow halos, bradycardia, anorexia, monitor electrolytes

Answer 60

Digoxin toxicity